On July 2, 2020, the Centers for Medicare and Medicaid Services (CMS) released guidance documents on the allowance of telehealth encounters for the Eligible Professional and Eligible Clinician electronic clinical quality measures (eCQMs) used in CMS quality reporting programs for the 2020 and 2021 performance periods. The guidance applies to eCQMs used in the:

  • Quality Payment Program: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs)
  • APM: Comprehensive Primary Care Plus (CPC+)
  • APM: Primary Care First (PCF)
  • Medicaid Promoting Interoperability Program for Eligible Professionals

The guidance documents list the telehealth-eligible eCQMs for their respective performance periods. Interestingly, there are 42 telehealth-eligible eCQMs for the 2020 performance period, but only 39 for the 2021 performance period. (The 2020 performance period guidance is available here. The 2021 performance period guidance is available here.) CMS states that when an encounter can be identified with a telehealth-eligible code, it may be included in an eCQM regardless of whether the encounter was provided in person or via telehealth, unless otherwise indicated by CMS in the guidance or in the eCWM definition statements. In both guidance documents, CMS notes that there may be instances in which the quality action cannot be completed during the telehealth encounter, and that “it is the eligible professionals’ and eligible clinicians’ responsibility to make sure they can meet all other aspects of the quality action within the measure specification, including other quality actions that cannot be completed by telehealth.”

This post was co-authored by Michael Lisitano, legal intern at Robinson+Cole. Michael is not yet admitted to practice law.