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We refer readers to CY 2019 PFS final rule (83 FR59747 through 59749) for our discussion of previously finalized policies related to the use of the term submission mechanism. Under the existing process for the quality and improvement performance categories, if we receive multiple submissions for an individual clinician, group, subgroup, or virtual group from submitters from separate organizations (for example, registry, practice administrator, or EHR vendor), we score each submission and assign the highest of the scores for the performance category

some of which have been shown to be effective [31]

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