Measure 130: Documentation and Verification of Current Medications in the Medical Record (SOAP 1.0)

Prescription medication use is common among adults of all ages, particularly older adults and adults with chronic conditions. On average, 81% of adults in the U.S. are taking at least one medication (prescription or nonprescription, vitamin/mineral, herbal/natural supplement); 29% are taking five or more. While these agents may provide some relief, they also may influence physical, mental, and emotional performance. We particularly worry about the impact on activity tolerance, clarity of thought and understanding, self-sufficiency, and motivation.

Note:

Quality measures must be documented in both WebPT and Keet. The data in Keet is collated and sent to CMS during the MIPS submission period, and the data in the WebPT EMR supports what is sent to CMS.
Previously, Members reporting for MIPS with WebPT selected which measures they wanted to collect data for during the setup process. This step has been eliminated. You can now select which MIPS measures to collect data for on a visit by visit basis.

Who can report this measure?

PTs, OTs, and SLPs are all eligible to report on this measure

Patient Qualifications

Patient age (18 or older)
Visit type (All)

When do I report on this measure?

Initial Evaluation, Re-Evaluation, OR Discharge Summary

Measure Requirements

Document all known medications on Subjective tab.

For each medication, include:

The medications’ name (e.g., Ibuprofen, Zetia, Vitamin D, St. John’s Wort, etc.)
Dosage (e.g., 25 mg)
Frequency (e.g., 2x daily)
Route of administration (e.g., oral, injection, sublingual, etc.)

Measure Specification

For more information on Measure 130, please see the Measure Specification Guide.

Measure Reporting in WebPT

On the Subjective tab, use the checkbox to add each type of medication and include the necessary information to satisfy measure requirements. If the patient has multiple medications for each category, you can include these in the comment box and reference this in your documentation.

When finished documenting, validate the selection in Keet.

What if the patient is not on medication?

If the patient is not taking any medications, please check the Not currently taking any medications checkbox Then, select the Performance Met selection (Current Medications Documented) on the MIPS tab.

What if I want to scan the patient's prescriptions into the patient's chart?

After scanning the prescription list into eDoc on the patient's chart, please enter " See eDoc" in the comment box. Then check the Written provider documentation was obtained confirming that current medications with dosages were verified with the patient or authorized representative checkbox. Click here to learn more about scanning eDocs.

Keet: Reporting Selections

In Keet, you’ll need to add this activity to the patient’s Care Plan.

Note: The data in Keet is collated and sent to CMS. The data in the WebPT EMR supports what is submitted to CMS in the event of an audit.

Use the MIPS Badge on the patient chart or the MIPS tab in the note to open Keet.
Log in to Keet.

Note: After logging in to Keet, keep the tab open to remain logged in to Keet to streamline this step while documenting on future appointments. Keet may log users out after three hours of inactivity.
In Keet, navigate to the patient’s Episode of Care that corresponds with the case in the WebPT EMR.
Click Add Activity.
Click Measure 130: Documentation and Verification of Current Medications in the Medical Record to add to the patient’s Care Plan.
In the Care Plan, click the ellipses (...) icon in the Action column.
Click Complete.
Select the option that best describes your supporting documentation.
Click Submit.