Determine a Patient's MIPS Eligibility (the MIPS Qualification and Pre-Visit Patient Forms)

All patients need to be evaluated for MIPS eligibility based on their condition. Keet provides two versions of MIPS Qualification forms to determine a patient's eligibility: the MIPS Qualification Clinic Form and the Pre-Visit Patient Form. One of the MIPS Qualification forms should be completed for all patients who complete an initial evaluation in 2019.

Keet provides two versions of MIPS Qualification form

  • MIPS Qualification Clinic Form that is visible and completed by clinic staff

  • Pre-Visit Patient Form is visible and completed by the patient


What is the difference between the MIPS Qualification Clinic Form and the Pre-Visit Patient Form?

The MIPS Qualification Clinic Form and Pre-Visit Patient Form include the same questions but are intended to be completed by different users (clinic staff or the patient). The questions included on these two forms are required for MIPS submission. While the forms ask for identical information, they are worded differently based on the audience (the clinic staff or the patient). 

Because of the importance of the information being collected, a MIPS requirement, two forms were created to help your clinic ensure the information is gathered. 


Important! - Only one of the two forms needs to be completed. 

Either the MIPS Qualification Clinic Form OR or the Pre-Visit Patient Form should be completed for any patient who attends an initial evaluation appointment. 


Which of the two MIPS Qualification forms should be completed? 

Pre-Visit Patient Form is the patient-facing form to be completed by the patient. With the appropriate automated workflows activated, the Pre-Visit from is added to the patient's account and the patient is notified by email to complete the form prior to their intial evaluation. Once the patient completes the Pre-Visit Form, the patient is sent the corresponding patient reported outcome form automatically if they are eligible for a PRO measure. 

MIPS Qualification-Clinic Form is only visible to the clinic and can only be completed by clinic staff on behalf of the patient. If the Pre-Visit Form was not completed by the patient prior to their initial evaluation, the clinic staff must complete the MIPS Qualification Form and assign the appropriate patient reported outcome survey to the patient if they are eligible for a PRO measure. The clinic staff should then delete the Pre-Visit From from the patient's account.