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. 0031 Breast Cancer Screening CMS125 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. 0031 Breast Cancer Screening CMS125 4 4 What’s New with MU 2014 Breast Cancer Screening What’s New with MU 2014 Breast Cancer Screening LOINC New LOINC codes related to mammogram were added. This increases the range of mammogram DI services so that more coded services will meet the requirements for the numerator LOINC New LOINC codes related to mammogram were added. This increases the range of mammogram DI services so that more coded services will meet the requirements for the numerator SNOMED- CT A range of codes related to BC screening were removed. This can potentially reduce your performance results if codes were historically used for the DI procedure Bilateral and Unilateral Mastectomy procedures were also removed however a larger range of Unilateral Mastectomy codes were added in the 2014 version. This will increase the performance rate Additional codes related to Face to Face Intervention making the denominator population larger SNOMED- CT A range of codes related to BC screening were removed. This can potentially reduce your performance results if codes were historically used for the DI procedure Bilateral and Unilateral Mastectomy procedures were also removed however a larger range of Unilateral Mastectomy codes were added in the 2014 version. This will increase the performance rate Additional codes related to Face to Face Intervention making the denominator population larger ICD 9 and 10 Codes Diagnosis Specific ICD 10 and 9 codes were removed (see excel) since these encounter types will no longer meet the denominator, potentially reducing the overall population for the performance measure ICD 9 and 10 Codes Diagnosis Specific ICD 10 and 9 codes were removed (see excel) since these encounter types will no longer meet the denominator, potentially reducing the overall population for the performance measure CPT Codes & HCPCS A range of CPT codes were removed (see excel) since the encounter types will no longer be included in the denominator ***** HCPCS Codes related to annual wellness visits were added. Potentially increasing the patients included in the denominator HCPCS codes related to Mammogram performance were added which could improve performance rates for the measure CPT Codes & HCPCS A range of CPT codes were removed (see excel) since the encounter types will no longer be included in the denominator ***** HCPCS Codes related to annual wellness visits were added. Potentially increasing the patients included in the denominator HCPCS codes related to Mammogram performance were added which could improve performance rates for the measure Population Criteria Reduced look back period for DI screening performed (went from 2 years to 12 months in the 2014 measure specification) Potential decrease in performance rate since the look back time has shortened by 12 months Population Criteria Reduced look back period for DI screening performed (went from 2 years to 12 months in the 2014 measure specification) Potential decrease in performance rate since the look back time has shortened by 12 months MU 2014 Measure Update Change Summary

5. 0031 Breast Cancer Screening CMS125 5 5 Breast Cancer Screening MU 2014 Women with one or more mammograms during the measurement period or the year prior to the measurement period Numerator Women 41-69 years of age with a visit during the measurement period Denominator

6. 0031 Breast Cancer Screening CMS125 6 6 Measure Short Definition Breast Cancer Screening MU 2011 The percentage of women 40–69 years of age who had a mammogram to screen for breast cancer MU 2014 Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer Numerator - Women with one or more mammograms during the measurement period or the year prior to the measurement period Denominator - Women 41-69 years of age with a visit during the measurement period

7. 0031 Breast Cancer Screening CMS125 7 7 Explanation and Impact of Changes Population Criteria 2011 Numerator = AND: “Diagnostic study performed: breast cancer screening” <= 2 years before or simultaneously to “measurement end date”; 2014 AND: "Diagnostic Study, Result: Mammogram (result)" <= 12 month(s) ends before or during "Measurement Period" Breast Cancer Screening (Measure)

8. 0031 Breast Cancer Screening CMS125 8 8 Explanation and Impact of Changes CPT Codes Removed (Encounter) 99211, 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245, 99347-99350 99384, 99394, 99401, 99402, 99403, 99404, 99411, 99412, 99420, 99429, 99455, 99456 CPT Codes Added- NONE CPT CODES  A range of CPT codes were removed since these encounter types will no longer be included in the denominator  There were no additional CPT codes added in the 2014 measure specifications that weren't already part of the 2011 measure specifications  A range of CPT codes were removed since these encounter types will no longer be included in the denominator  There were no additional CPT codes added in the 2014 measure specifications that weren't already part of the 2011 measure specifications

9. 0031 Breast Cancer Screening CMS125 9 9 Explanation and Impact of Changes  HCPCS Codes related to annual wellness visits were added. Potentially increasing the patients included in the denominator  HCPCS codes related to Mammogram performance were added resulting in better performance rates for the measure  HCPCS Codes related to annual wellness visits were added. Potentially increasing the patients included in the denominator  HCPCS codes related to Mammogram performance were added resulting in better performance rates for the measure Health Care Common Procedure Codes (HCPCS) HCPCS Codes Added (Annual Wellness Visit) G0438, G0439 (Mammogram) G0202, G0204, G0206

10. 0031 Breast Cancer Screening CMS125 10 Explanation and Impact of Changes ICD 10/ ICD 9 CODES ICD-10-CM Removed Z12.31 ICD-9-CM Removed (Encounter outpatient) V70.0, V70.3, V70.5, V70.6, V70.8, V70.9  ICD 10 and 9 codes (see below) were removed since these encounter types will no longer meet the denominator, potentially reducing the overall population for the performance measure

11. 0031 Breast Cancer Screening CMS125 11 Explanation and Impact of Changes SNOMED- CT Codes Removed (Breast Cancer Screening) 12389009, 241055006, 241056007, 241057003, 241058008, 241189009, 241539009, 24623002, 258172002, 35482003, 418074003, 418378007, 43204002, 439324009, 71651007 (Bilateral Mastectomy) 172046003, 172049005 237370008, 367502008, 395165008, 59860000 (Unilateral Mastectomy) 41104003 Systematized Nomenclature of Medicine Codes (SNOMED-CT)  SNOMED- CT a range of codes related to BC screening were removed. This can potentially reduce your performance results if codes were historically used to document for the DI procedure  a few Bilateral and Unilateral Mastectomy procedures were also removed however a larger range of Unilateral Mastectomy codes were added in the 2014 version. This will potentially increase the performance rate  Additional codes related to Face to Face Intervention were added potentially expanding the denominator  SNOMED- CT a range of codes related to BC screening were removed. This can potentially reduce your performance results if codes were historically used to document for the DI procedure  a few Bilateral and Unilateral Mastectomy procedures were also removed however a larger range of Unilateral Mastectomy codes were added in the 2014 version. This will potentially increase the performance rate  Additional codes related to Face to Face Intervention were added potentially expanding the denominator SNOMED-CT Codes Added (Face to Face Intervention) 12843005, 18170008, 185349003,185463005, 185465003, 19681004, 207195004, 270427003, 270430005, 308335008, 390906007, 406547006, 439708006, 4525004, 87790002, 90526000 (Unilateral Mastectomy) 22964006, 317230007, 446109005, 446420001, 447135002, 447421006, 59620004, 72269009, 73359007, 8115005, 88764002

12. 0031 Breast Cancer Screening CMS125 12 Explanation and Impact of Changes  New LOINC codes related to mammogram were added This increases the range of mammogram DI services so that more coded services will meet the requirements for the numerator LOINC CODES LOINC Codes added (Mammogram) 24604-1- 69259-0 (see detailed excel)