Merit-based Incentive Payment System Value Pathways (MVP) Documentation & Coding Tips:

ONC Direct Review Attestation Requirement Added to the MIPS Value Pathways (MVPs)

Lolita M. Jones, MSHS, RHIA, CCS, CRC
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Lolita M. Jones, MSHS, RHIA, CCS, CRC

In the calendar year (CY) 2023 Medicare Physician Fee Schedule (PFS) Final Rule, the Centers for Medicare and Medicaid Services (CMS) added the Office of the National Coordinator for Health Information Technology (ONC) Direct Review Attestation Requirement that was inadvertently omitted from the Promoting Interoperability performance category, for the following seven Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) that were finalized in the CY 2022 PFS Final Rule.

  • The Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP focuses on important assessors of the care emergency clinicians provide to patients with undifferentiated high-risk conditions. By focusing on these specific measures and activities, emergency clinicians can reduce clinical variability, improve the quality of emergency care and potentially lower costs.
  • The Advancing Care for Heart Disease MVP focuses on the clinical theme of providing fundamental treatment and management of costly clinical conditions that contribute to, or may result from, heart disease.
  • The Advancing Rheumatology Patient Care MVP focuses on the clinical theme of providing fundamental treatment and management of rheumatological conditions.
  • The Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes MVP focuses on the clinical theme of providing fundamental prevention and treatment of those patients at risk for or that have had a stroke.
  • The Improving Care for Lower Extremity Joint Repair MVP focuses on the clinical theme of providing fundamental treatment and management of patients with osteoarthritis and lower extremity surgical repair, such as fracture and total joint replacement, to ensure appropriate care and reduce costs.
  • The Optimizing Chronic Disease Management MVP focuses on the clinical theme of providing fundamental treatment and management of chronic disease such as diabetes, coronary artery disease, chronic obstructive disease, and major adult depression.
  • The Patient Safety and Support of Positive Experiences with Anesthesia MVP focuses on increasing quality of anesthesia care, improving postoperative outcomes, promoting patient safety, and enhancing satisfaction for patients receiving anesthesia. The measures are used for a variety of surgical procedures that anesthesiologists deliver care for, and are broadly applicable to anesthesiologists practicing within ambulatory, outpatient, and inpatient hospital settings.

An ONC Direct Review Attestation is the mechanism for a Certified Health Information Technology (IT) Developer to indicate to the Secretary of Health and Human Services (HHS), their compliance, noncompliance, or inapplicability with the following Conditions and Maintenance of Certification requirements:

• Information Blocking

• Assurances

• Communications

• Application Programming Interfaces (APIs)

• Real World Testing.

Attestations hold Certified Health IT Developers accountable on an ongoing basis and encourage continued compliance with the Conditions and Maintenance of Certification requirements.  Certified Health IT Developers submit their attestations of compliance for past actions under the Certification Program within a designated 30-day window every 6 months (i.e., semiannually).  During the submission period, a Certified Health IT Developer, or its authorized representative, will complete and submit their attestations to ONC-Authorized Certification Bodies (ONC-ACBs) for review using the Certified Health IT Product List (CHPL) page.

Noncompliance Attestation Scenario and Use Case Example – Nondisclosure of a Known Issue:  This scenario is for illustrative purposes only. The information presented here is intended to provide stakeholders with an example only and may not be universally applicable to every Certified Health IT Developer or their individual circumstances, nor is it intended to be.  This scenario assumes that any Certified Health IT Modules were active at some point during a specified attestation period, unless otherwise noted.

You are a Certified Health IT Developer with an active Certified Health Module certified to at least one of the API criteria adopted in § 170.315(g)(7) through (10) requiring you to publish complete business and technical documentation via a publicly accessible hyperlink to meet the API condition at 45 Code of Federal Regulations (CFR) 170.404(a)(2)(i). You became aware the hyperlink was broken and did not fix it, making the documentation no longer publicly accessible. You also did not disclose the issue to your ONC-Authorized Certification Body (ONC-ACB).  You should attest “Noncompliant” to the APIs Condition and Maintenance of Certification. Certified Health IT Developers must select “Noncompliant” for a Condition and Maintenance of Certification requirement if they were not compliant with the requirement at any point during the specified attestation period, regardless of whether it was a disclosed instance of non-compliance in the Certification Program. This is true even if the broken hyperlink that resulted in the noncompliance has already been fixed by the time of your attestation.  You may submit additional information as needed either during the ONC-ACB completeness review or during ONC’s Direct Review process, should ONC choose to initiate Direct Review.

ONC obtains information on the performance of Certified Health IT and compliance to Certification Program requirements from numerous sources including, but not limited to, ONC-ACB quarterly surveillance reports, questions submitted and issues raised by ONC-ACBs and ONC-Authorized Testing Laboratories (ONC-ATLs), issues submitted directly to ONC from users, and referrals from other government agencies. ONC continuously analyzes information from these sources to identify cases that may warrant the initiation of a Direct Review. ONC may coordinate and share information with other agencies and may engage other persons and entities, as appropriate, to effectively respond to suspected problems with Certified Health IT.

For more information download the 2023 QPP Final Rule MVP Table.pdf,, and/or contact