• MDinteractive is an approved CMS Qualified Registry for
    2020 and 2021.

  • Did you miss our Primary Care First Webinar on reporting the Advance Care Planning measure?
    Click here to watch it now!

  • CMS Publishes 2021 Final Rule. What will it mean for your practice?
    Check out our highlights blog here.

Care transition standard operational improvements

Activity ID

IA_CC_11

Activity Weighting

Medium

Subcategory Name

Care Coordination

Activity Description

Establish standard operations to manage transitions of care that could include one or more of the following:

  • Establish formalized lines of communication with local settings in which empaneled patients receive care to ensure documented flow of information and seamless transitions in care; and/or
  • Partner with community or hospital-based transitional care services.

Validation

Functionality of information flow during transitions of care to ensure seamless transitions

Suggested Documentation

1) Communication Lines with Local Settings - Documentation of formal lines of communication to manage transitions of care with local settings (e.g. community or hospital-based transitional care services) in which empaneled patients receive care to ensure documented flow of information and seamless transitions; or
2) Partnership with Community or Hospital-Based Transitional Care Services - Documentation showing partnership with community or hospital-based transitional care services

Register with MDinteractive