Submission Checklist · BPCI Advanced PRO-PM · 2026
PRO-PM CMS Reporting Checklist for Orthopedic Programs
Step-by-step submission checklist for hospitals and orthopedic practices collecting HOOS Jr. / KOOS Jr. data under BPCI Advanced. Almost no comparable resource exists publicly - this is your competitive advantage.
Completed: 0 / 14 items
Baseline Collection Setup
Pre-op workflow
Confirm CMS-specified instruments are loaded in your collection system: HOOS Jr. (hip replacement), KOOS Jr. (knee replacement). Modified or translated versions are not accepted. Critical
Set baseline collection window: PRO-PM baseline must be collected within 90 days prior to the anchor procedure. Build a hard stop in your scheduling workflow to trigger the survey at the pre-op appointment. Critical
Configure multi-channel delivery - Offer the survey via patient portal, SMS link, and paper fallback for patients without digital access. Response rates drop 30–40% without a paper option for patients 70+.
Map patient identifiers (MRN, Medicare ID, date of procedure) to each baseline survey at time of collection - this is required for linking baseline to follow-up at submission. Do not skip this step. Critical
Follow-Up Collection (270–365 Days Post-Discharge)
Outreach
Build a 3-touch follow-up outreach sequence: First outreach at 270 days, second at 300 days for non-responders, third at 340 days via phone for patients still unreached. Critical
Track response rate weekly by surgeon - Low response rates from a specific surgeon's panel typically indicate a workflow gap at the post-op visit level, not a technology failure.
Confirm response rate threshold: CMS requires a minimum response rate for the measure to be scored. Below the threshold, your PRO-PM data is collected but unscored - effectively invisible for quality reporting. Important
Document exclusions correctly - Patients who died, moved to hospice, or had a revision surgery within the episode window require specific documentation for CMS exclusion - do not simply drop from the denominator without documentation.
Data Validation Before Submission
QA
Run a patient matching validation - Confirm every baseline survey has a linked follow-up attempt. Unmatched baselines waste collection effort and don't contribute to your denominator. Critical
Check instrument version consistency - Ensure all collected surveys used the same CMS-approved version of HOOS Jr. / KOOS Jr. Version mismatches invalidate the longitudinal change score calculation.
Validate date ranges - Confirm baseline dates fall within 90 days pre-procedure and follow-up dates fall within the 270–365 day window post-discharge. Date errors are the #1 cause of CMS submission rejection. Critical
Submit validation run 30+ days before deadline - Build buffer for CMS to return error reports and allow time for resubmission. Do not submit on the deadline date.
Program Improvement Loop
Continuous improvement
Review PRO-PM results by surgeon quarterly - Surgeon-level outcome scores identify where care pathway standardization or PT protocol improvements will have the most impact. Important
Feed PRO-PM data back into your bundled payment episode management - Patients with low functional improvement at 9 months are at higher risk of readmission and revision - use this as an early signal for care coordination outreach.