INSTRUCTIONS FOR COMPLETING THE NACOR QUALITY REPORTING CMS CONSENT FORM

1. Indicate whether your practice is a new NACOR customer (did not participate last year) or a renewal (participated last year).
2. If your practice is an existing NACOR customer, please provide your AQI Practice ID. Contact AQI if you do not know your Practice ID.
3. Indicate whether this is a new order, replacing an existing order, or adding providers to an existing order.
4. Select your reporting option.
5. Select if your practice has any providers who will ‘Opt-In’ for reporting.
6. Enter provider quantities according to provider type and ASA member status. Please be as accurate as possible.
7. Enter contact, practice and billing information.
8. Click "Submit" at the bottom of the form. You will receive an email confirmation shortly thereafter.

Payment Policies and Procedure Agreements: In order for your practice to participate in NACOR's Quality Concierge, a NACOR Participation Agreement is required. If your practice did not previously participate in NACOR, please contact Gerard Tarafa at g.tarafa@asahq.org for details.

Login Information for New Participating Groups: will be emailed to the practice champion (designated in the NACOR Participation Agreement) once the Agreements are fully executed.

Additional Information for Group vs. Individual Reporting: Group Reporting: All Eligible Clinicians (ECs) in your group billing must be included in the data submitted to NACOR. Individual Reporting: CMS requires every Eligible Clinician (EC) submit a consent form for individual reporting practices. Each EC for which you intend to submit quality data must sign a consent form for 2024. CMS requires this consent be collected annually. Your practice is to keep a copy of the consents in your files for a period of seven years, in case of CMS audit. You will receive a copy of the consent form with your signed agreements or you can locate it on the AQI website. Regardless of which reporting option is selected, each practice participating in MIPS reporting for 2024 must complete the registration below.

Opt-In Option: is only available to practices which do not meet all three of the 2024 MIPS eligibility criteria (bill more than $90,000 for Part B covered services, see more than 200 Part B patients and provide 200 or more covered professional services to Part B patients). Please check your clinician's 2024 MIPS Eligibility to see if your practice meets the criteria to opt in. If your practice is not MIPS eligible but meets one or two of the MIPS criteria and would like to submit 2024 MIPS data for a potential payment adjustment, please select the Opt-In box.

If you choose to Opt-In, email askaqi@asahq.org to provide the NPIs for those clinicians who will be included.

Questions?: Email askaqi@asahq.org