Clinical Summaries Clarification

Doctor using laptop

The ICS previously placed several formal inquiries to CMS regarding clarification for Clinical Summaries (Measure 13, Stage 1). We made the inquiries because the language in many of their publications was ambiguous and left providers uncertain. However, CMS recently released a statement with greater clarification:

“For the EHR Incentive Programs, an office visit includes separate, billable encounters that result from evaluation and management services provided to the patient. While CMS does not specify a range of E&M billing codes to which this exclusion applies, we define office visits as:

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  1. Concurrent care or transfer of care visits 
  2. Consultant visits*, or 
  3. Prolonged Physician Service without Direct (Face-To-Face) Patient Contact (telehealth).

*A consultant visit occurs when a provider is asked to render an expert opinion/service for a specific condition or problem by a referring provider. If you do not have any visits that fit into the three categories above, you may claim the exclusion for this objective.”

This clarification is welcome news to providers who are beginning and who continue to work towards meaningful use of certified software. The language above indicates that NOT every visit is an “office visit.” Unlike the language contained in previous CMS releases indicated (see “Providing Patients in Ambulatory Care Settings with a Clinical Summary of the Office Visit” – November 2012 – HealthIT.gov), now only the office visits as indicated in those three areas will require a Clinical Summary. Here is a link to the full release (see page 2).

The ICS will be offering a series of webinars in late 2013 which will cover the overall incentive program, Stage 1 measures and requirements, Stage 2 measures and requirements (begins in 2014 for providers who attested in 2012 and before), the new 2014 certified software standards and criteria, and more. Please watch future publications for more information.

About Author

Marc Abla, CAE

Marc Abla began working at the Illinois Chiropractic Society in 2002 and became the Executive Director in 2008. He brings his extensive financial, administrative and association experience to the ICS. He is a Certified Association Executive and a graduate of the Certified Leadership Series through the Illinois Society of Association Executives. Additionally, he is a member of the Illinois Society of Association Executives, the American Society of Association Executives, Association Forum, Congress of Chiropractic State Associations, and the American Chiropractic Association.


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