1. Azara Proprietary & Confidential Overview June 2014 Improving Patient Outcomes through Data

2. Azara Proprietary & Confidential 2 2 CONFIDENTIAL This file contains information that is confidential to Azara Healthcare, LLC Do not view, copy, distribute, or disclose without prior consent. CONFIDENTIAL This file contains information that is confidential to Azara Healthcare, LLC Do not view, copy, distribute, or disclose without prior consent.

3. 0034 Colorectal Cancer Screening CMS130 3 3 Measure Update Measure Title & Steward # Measure Short Description Measure Detailed Description Measure Comparison MU 2011 vs MU 2014 What did the old measure include What changes are applied to the new measure What are current considerations due to measure update Azara CQM’s

4. 0034 Colorectal Cancer Screening CMS130 4 4 Updates to MU 2014 Colorectal Cancer Screening Updates to MU 2014 Colorectal Cancer Screening SNOMED- CT T he SNOMED code changes follows the same removal and addition patterns as previous codes. Specific CRC, Flex sig, FOBT Dx and procedures were removed and updated Colonoscopy, Total Colectomy and Face to Face encounters were added to accommodate the 2014 measure specifications SNOMED- CT T he SNOMED code changes follows the same removal and addition patterns as previous codes. Specific CRC, Flex sig, FOBT Dx and procedures were removed and updated Colonoscopy, Total Colectomy and Face to Face encounters were added to accommodate the 2014 measure specifications Population Criteria The 2011 population queried for patients >= 50 and = 50 year(s) and < 75 Criteria for CRC screening type and look back timing also changed Population Criteria The 2011 population queried for patients >= 50 and = 50 year(s) and < 75 Criteria for CRC screening type and look back timing also changed MU 2014 Measure Update Change Summary ICD 9 and 10 Codes Diagnosis Some ICD-9 codes for Colonoscopy, Colorectal Cancer, Flex sig, FOBT and Total Colectomy were removed from the 2014 measure specification from both the exclusion and numerator criteria ‘s In addition V codes for Encounter outpatient were also removed from the 2014 measure specification ICD-10 codes for CRC were removed as indicators for patients that would fall into the denominator exclusion group ICD 9 and 10 Codes Diagnosis Some ICD-9 codes for Colonoscopy, Colorectal Cancer, Flex sig, FOBT and Total Colectomy were removed from the 2014 measure specification from both the exclusion and numerator criteria ‘s In addition V codes for Encounter outpatient were also removed from the 2014 measure specification ICD-10 codes for CRC were removed as indicators for patients that would fall into the denominator exclusion group LOINC Additions to LOINC codes for FOBT test were made LOINC Additions to LOINC codes for FOBT test were made CPT Codes & HCPCS Additional CPT codes were added for patients that have a Home Health Care encounter. This may expand the initial population if the practice renders significant home care visits. Several outpatient encounter codes were deleted from the 2014 measure specification. Some HCPCS codes for Colorectal cancer have been removed e.g., G0214 as indicators for patients to be excluded from the population Some FOBT codes were also removed e.g. G0328 as indicators for patients that meet the numerator criteria Codes for Annual Wellness visit were added to identify established patients to fall into the initial population CPT Codes & HCPCS Additional CPT codes were added for patients that have a Home Health Care encounter. This may expand the initial population if the practice renders significant home care visits. Several outpatient encounter codes were deleted from the 2014 measure specification. Some HCPCS codes for Colorectal cancer have been removed e.g., G0214 as indicators for patients to be excluded from the population Some FOBT codes were also removed e.g. G0328 as indicators for patients that meet the numerator criteria Codes for Annual Wellness visit were added to identify established patients to fall into the initial population

5. 0034 Colorectal Cancer Screening CMS130 5 5 Colorectal Cancer Screening MU 2014 Patients with one or more screenings for colorectal cancer Numerator Patients 51-75 years of age with a visit during the measurement period Denominator The percentage of adults 50–75 years of age who had appropriate screening for colorectal cancer.

6. 0034 Colorectal Cancer Screening CMS130 6 6 Measure Short Definition Colorectal Cancer Screening Measure MU 2011 The percentage of adults 50–75 years of age who had appropriate screening for colorectal cancer. MU 2014 Patients 50-75 years of age with a visit during the measurement period Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria below: - Fecal occult blood test (FOBT) during the measurement period - Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period - Colonoscopy during the measurement period or the nine years prior to the measurement period,

7. 0034 Colorectal Cancer Screening CMS130 7 7 Explanation and Impact of Changes Population Criteria  The 2011 population queried for patients >= 50 and = 50 year(s) and < 75  Criteria for meeting the CRC screening also changed the timings as follows:  2011 FOBT 2yrs 2014 FOBT 1yr/Measure Period  2011 Flexsig w/in 5 yrs 2014 Flexsig performed within 4 years  2011 Colonoscopy w/in 10 yrs 2014 Colonoscopy w/in 9 yrs  The 2011 population queried for patients >= 50 and = 50 year(s) and < 75  Criteria for meeting the CRC screening also changed the timings as follows:  2011 FOBT 2yrs 2014 FOBT 1yr/Measure Period  2011 Flexsig w/in 5 yrs 2014 Flexsig performed within 4 years  2011 Colonoscopy w/in 10 yrs 2014 Colonoscopy w/in 9 yrs See excel for details on Population Criteria Colorectal Cancer Screening Measure

8. 0034 Colorectal Cancer Screening CMS130 8 8 Explanation and Impact of Changes CPT Codes Removed (from 2011) - Encounter Outpatient 99211 99217 99218 99219 99220 99241 99242 99243 99244 99245 99348 99349 * 99394 99401 99402 99403 99404 99411 99412 99420 99429 99455 99456 - FOBT- 82270 82274 CPT Codes Added (to 2014) - Home Healthcare 99348 99349 * 99348 99349 (removed from Encounter Outpatient but added for Home Care services CPT Codes Added- NONE CPT CODES  Additional CPT codes were added for patients that have a Home Health Care encounter. This may expand the initial population if the practice renders significant home care visits.  Several outpatient encounter codes were deleted from the 2014 measure specification. Practices should review their CPT code usage to assess if deleted codes are currently active.  Additional CPT codes were added for patients that have a Home Health Care encounter. This may expand the initial population if the practice renders significant home care visits.  Several outpatient encounter codes were deleted from the 2014 measure specification. Practices should review their CPT code usage to assess if deleted codes are currently active. Colorectal Cancer Screening Measure

9. 0034 Colorectal Cancer Screening CMS130 9 9 Explanation and Impact of Changes  Some HCPCS codes for Colorectal cancer have been removed e.g., G0214 as indicators for patients to be excluded from the population  Some FOBT codes were also removed e.g. G0328 as indicators for patients that meet the numerator criteria  Codes for Annual Wellness visit were added to identify established patients to fall into the initial population  All of these changes further validates eligible patients that meet the initial population, denominator exclusion and numerator criteria  Some HCPCS codes for Colorectal cancer have been removed e.g., G0214 as indicators for patients to be excluded from the population  Some FOBT codes were also removed e.g. G0328 as indicators for patients that meet the numerator criteria  Codes for Annual Wellness visit were added to identify established patients to fall into the initial population  All of these changes further validates eligible patients that meet the initial population, denominator exclusion and numerator criteria Health Care Common Procedure Codes (HCPCS) HCPCS Codes Removed (from 2011) -Colorectal cancer- G0213, G0214, G0215, G0231 -FOBT G0328, G0394 HCPCS Codes Added (to 2014) -Annual Wellness Visit G0438 G0439 Colorectal Cancer Screening Measure

10. 0034 Colorectal Cancer Screening CMS130 10 Explanation and Impact of Changes  Some Dx codes for Colonoscopy, Colorectal Cancer, Flex sig, FOBT and Total Colectomy were removed from the 2014 measure specification from both the exclusion and numerator criteria's  In addition V codes for Encounter outpatient were also removed from the 2014 measure specification  Some Dx codes for Colonoscopy, Colorectal Cancer, Flex sig, FOBT and Total Colectomy were removed from the 2014 measure specification from both the exclusion and numerator criteria's  In addition V codes for Encounter outpatient were also removed from the 2014 measure specification ICD-9 Codes ICD-9 Codes Removed from 2011 -Colonoscopy 45.22 45.23 45.25 45.42 45.43 -Colorectal cancer V10.05 -Encounter outpatient V70.0 V70.3 V70.5 V70.6 V70.8 V70.9 -Flexible Sigmoidoscopy 45.24 -FOBT V76.51 -Total colectomy 45.8 45.81 45.82 45.83 ICD-9 Codes Added 2014 -None Colorectal Cancer Screening Measure

11. 0034 Colorectal Cancer Screening CMS130 11 Explanation and Impact of Changes  Dx codes for CRC were removed as indicators for patients that would fall into the denominator exclusion group ICD-10 Codes ICD-10 Codes Removed from 2011 -Colorectal Cancer C18 C18.0 C21 D12 D12.0 D12.1 D12.2 D12.3 D12.4 D12.5 D12.6 D12.7 D12.8 D12.9 D50 D50.0 K50.1 K50.111 K50.112 K50.8 K50.80 K50.81 K50.811 K50.812 K50.813 K50.814 K50.818 K50.819 K51 K51.5 K51.8 K51.9 K52 K52.1 K52.2 K52.8 K55 K55.0 K55.1 K55.8 K57.30 K57.33 K59 K59.01 K59.02 K59.09 K62.0 K62.1 K62.5 R19.5 Z12.12 Z12.13 Z15 Z83.71 Z85.03 Z85.04 Z86.010 ICD-10 Codes Added 2014 - NONE Colorectal Cancer Screening Measure

12. 0034 Colorectal Cancer Screening CMS130 12 Explanation and Impact of Changes The SNOMED code changes follows the same removal and addition patterns as previous codes. Specific CRC, Flex sig, FOBT Dx and procedures were removed and updated Colonoscopy, Total Colectomy and Face to Face encounters were added to accommodate the 2014 measure specifications Systematized Nomenclature of Medicine Codes (SNOMED-CT) SNOMED-CT Codes Removed from 2011 -Colorectal cancer 126838000 428283002 429047008 -Flexible Sigmoidoscopy 174222002 21423008 235153008 265409002 32414000 396225009 -FOBT 252156002 441579003 441626002 442067009 442516004 442554004 442563002 442722005 61788003 -Total colectomy 23968004 265393006 SNOMED-CT Codes Added 2014 -Colonoscopy 12350003 174158000 174184006 235150006 235151005 25732003 303587008 310634005 34264006 367535003 418714002 427459009 443998000 444783004 446521004 446745002 447021001 73761001 8180007 -Face-to-Face Interaction 12843005 18170008 185349003 185463005 185465003 19681004 207195004 270427003 270430005 308335008 390906007 406547006 439708006 4525004 87790002 90526000 -Total Colectomy 303401008, 31130001, 36192008, 44751009 Colorectal Cancer Screening Measure

13. 0034 Colorectal Cancer Screening CMS130 13 Explanation and Impact of Changes  Additions to LOINC codes for FOBT test were made  This is a common unbilled service therefore clinics should review protocols for using proper LOINC code options associated to ordering a Fecal Occult, Occult Blood Guaiac etc.  Additions to LOINC codes for FOBT test were made  This is a common unbilled service therefore clinics should review protocols for using proper LOINC code options associated to ordering a Fecal Occult, Occult Blood Guaiac etc. LOINC CODES Colorectal Cancer Screening Measure LOINC Codes Removed from 2011 None LOINC Codes Added 2014 FOBT- 56490-6, 56491-4, 57905-2, 58453-2