Scribd Logo
Upload

Welcome to Scribd!

  • ACE MIPS Attestation 22FEB2018

    Uploaded by

    jmauldin
    7 views1 page
    This document is an attestation from Central Utah Informatics, LLC to the Centers for Medicare & Medicaid Services regarding improvement activities for Anesthesiology Consultants Exchange, PC. It lists one improvement activity with an ID of IA_BE_6 and a high weighting. It also confirms that the listed improvement activity was implemented for at least 90 consecutive days and was intended to improve clinical practice. The attestation is signed by Johnathan M. Mauldin, MD as the Chairman of Compliance Committee for Anesthesiology Consultants Exchange, PC.

    Original Description:

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is an attestation from Central Utah Informatics, LLC to the Centers for Medicare & Medicaid Services regarding improvement activities for Anesthesiology Consultants Exchange, PC. It lists one improvement activity with an ID of IA_BE_6 and a high weighting. It also confirms that the listed improvement activity was implemented for at least 90 consecutive days and was intended to improve clinical practice. The attestation is signed by Johnathan M. Mauldin, MD as the Chairman of Compliance Committee for Anesthesiology Consultants Exchange, PC.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    7 views1 page

    ACE MIPS Attestation 22FEB2018

    Uploaded by

    jmauldin
    This document is an attestation from Central Utah Informatics, LLC to the Centers for Medicare & Medicaid Services regarding improvement activities for Anesthesiology Consultants Exchange, PC. It lists one improvement activity with an ID of IA_BE_6 and a high weighting. It also confirms that the listed improvement activity was implemented for at least 90 consecutive days and was intended to improve clinical practice. The attestation is signed by Johnathan M. Mauldin, MD as the Chairman of Compliance Committee for Anesthesiology Consultants Exchange, PC.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    DocuSign Envelope ID: 2262ED70-1F88-4057-87A3-D2CF0EE61CA2

    Central Utah Informatics, LLC


    1055 North 500 West
    Provo, UT 84604
    Tel: 801.812.5555
    www.Centralutahinformatics.com

    Improvement Activities - Anesthesia


    To: Centers for Medicare & Medicaid Services
    From: Central Utah Informatics, LLC
    Re: Attestation - Quality Payment Program (please complete information below)
    Improvement Activity/Activities
    Activity #1
    IA_BE_6
    Activity ID: ____________________________________________________________________________
    High
    Activity Weighting: ___________________________________________________________________
    Activity #2
    Activity ID: _____________________________________________________________________________
    Activity Weighting: ____________________________________________________________________
    Activity #3
    Activity ID: _____________________________________________________________________________
    Activity Weighting: ____________________________________________________________________
    Activity #4
    Activity ID: _____________________________________________________________________________
    Activity Weighting: ____________________________________________________________________
    Activity #5 (Other)
    Activity ID: _____________________________________________________________________________
    High
    Activity Weighting: ____________________________________________________________________
    621445498
    TIN: ______________________________________________________________________
    1184670218
    NPI: ______________________________________________________________________

    Anesthesiology Consultants Exchange, PC


    On Behalf of (Provider/Group) ________________________________________________, I attest that, Yes:
    A. The above improvement activity(ies) were implemented and participation in such
    activities were to improve clinical practice.
    AND
    B. The above improvement activity(ies) were performed for a minimum of 90
    consecutive days.

    Signature: ______________________________________________________________
    Johnathan M. Mauldin, MD
    Name (please print): _________________________________________________
    Chairman of Compliance Committee
    Title: ____________________________________________________________________
    22 February 2018
    Date: ________________________________________________________________

    You might also like