Advantage MD. Members age 18 years and older

The percentage of acute and non-acute discharges, on or between January 1 and December 1 of the Measurement Year, for members 18 years of age and older. Medication Reconciliation Inpatient Notification is one of the four rates reported for the TRC Measure. Requires documentation of medication reconciliation documented on the date of the discharge through 30 days after the discharge (31 days total).

Provider Specialty: Prescribing Practitioner, Clinical Pharmacist, Registered Nurse.

Best Practice and Measure Tips

• Member must be discharged to home on or by December 1st of the MY to remain in the measure for the episode.
• Members may be in the measure more than once in the measurement year based on below criteria:
  • An episode ends if the member remains discharged to home for 31 days. Any admission after this would create a new Admission episode.
  • An episode continues when the first discharge is followed by a readmission or direct transfer to an acute or non-acute inpatient care setting on the date of discharge through 30 days after discharge (31 days total).
  • Admit date = Date of the first admission
  • Discharge date = The date of the discharge where there are no readmissions or direct transfers within the 31 days total.
  • Example: Inpatient acute care admit 9/3/MY to 9/10/MY with a transfer to SNF on 9/10/MY and discharged to home 9/20/MY. Admit date = 9/3/MY and discharge = 9/20/MY.
• Documentation in outpatient medical record:
  • Must include evidence of medication reconciliation with most recent list and the date when it was performed.
  • The medical record must be accessible to the PCP or ongoing care provider to be eligible for use in reporting.
  • Only documentation in the outpatient chart meets the intent of the measure, but an outpatient visit is not required.

Any of the following meets criteria:

• Current medications list with a notation the provider reconciled the current and discharge medications.
• The current medications with a notation that references the discharge medications (e.g., no changes in medications since discharge, same medications at discharge, discontinue all discharge medications).
• Documentation of the current medications with evidence that the member was seen for post-discharge hospital follow-up with evidence of medication reconciliation or review.
• Evidence that the member was seen for post-discharge hospital follow-up requires documentation that indicates the provider was aware of the member’s hospitalization or discharge.
• Documentation in the discharge summary that the discharge medications were reconciled with the most recent medication list in the outpatient medical record.
• There must be evidence that the discharge summary was filed in the outpatient chart on the date of discharge through 30 days after discharge (31 total days).
• Notation that no medications were prescribed or ordered upon discharge.
• The medication list may include medication names only or may include medication names, dosages and frequency.

Measure Exclusions

Required Exclusion: Hospice

Measure Codes

• Medication Reconciliation
• Medication Reconciliation Encounter:
  • CPT: 99483, 99495, 99496
• Medication Reconciliation Intervention:
  • CPT II:1111F