A patient has a colonoscopy across town. Weeks later the gastroenterologist’s report comes in by fax. Someone files it in the chart, correctly, and moves on.
As far as MIPS is concerned, that colonoscopy may never have happened.
The same goes for an A1c from a lab you don’t usually use, which arrives as a faxed page rather than a structured result. The care happened. The patient did what they were asked. The evidence is sitting in your chart. And the measure stays open, because a scanned page isn’t something a quality report can read.
Reading what comes in
Every document that comes in goes through our document intelligence service, which reads the page and identifies what it is. A colonoscopy report. An A1c result. A diabetic eye exam.
From there, the matching is automatic. The document is matched to the patient, then matched to the measure it could close. Your staff don’t have to remember that this patient had an open colorectal screening when the fax arrives. The match is waiting for them.
A person always reviews it before it counts. Software suggests and a staff member confirms, because a person’s name should be behind a statement that a measure was met. The review takes seconds instead of a search through the chart, and the system still catches what your staff missed the first time.
Marking it met is only half the job
We learned this one the hard way, and it’s the most useful thing in this post.
At one practice, staff were doing exactly what we asked. They worked the gap list, found the reports in the chart, and marked the measures met. By early October 2026 they had made 404 of those marks.
Not one had produced a quality code on a claim.
The work was real, but it stopped at our own system. The claim is the only place CMS sees it, and nothing was carrying the mark that far. So we built the missing link: at the patient’s next coded visit, a measure staff marked as met this year goes onto the claim, as long as that visit is eligible and it hasn’t already been reported. It is flagged for the biller with who marked it and what they wrote.
Those quality codes are separate lines on the claim. They aren’t revenue. Where the billing system won’t accept a zero-dollar line, they carry a one-cent charge, purely so the code can travel with the claim.
You can’t go back and fix an old claim
CMS is explicit that a claim can’t be resubmitted just to add a missing quality code, because it will be rejected as a duplicate. The code has to travel on the claim for an eligible encounter, for the same patient and the same date of service. That’s why the mark has to be ready before the patient’s next visit, and why it’s worth getting those visits booked before the year ends.
A mark isn’t always enough
Not every measure can be closed by a checkbox, and pretending otherwise is how a practice ends up with a report it can’t defend. So the rules follow the measure:
- A1c: The right code depends on the result, so we need the value itself. A mark with no number doesn’t get billed.
- Diabetic eye exam: It’s billed only when the record says there was no retinopathy.
- Depression screening: The screen has to fall on the date of the visit or in the 14 days before it. A score from an earlier visit belongs on that visit’s claim and can’t be carried forward.
Anything that doesn’t meet its rule stays off the claim, and the biller gets a note explaining why.
Why this matters more than it looks
Your staff are already doing a lot of this work. They’re chasing reports, filing results, and asking patients about their last screening. Much of it simply never gets counted.
Before you ask a tired team to do more, make sure the work they already do reaches the place where it’s measured.
This is part of a series. Start with why you can’t close a gap you don’t know is open, or read on about getting your providers out of the clicks.