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If the answer to any of these raises concerns, a fresh vial may be warranted

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Inserting the needle smoothly at the appropriate angle (90 degrees for IM, 45-90 degrees for SC depending on subcutaneous tissue thickness)

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Additionally, we estimate that updated data and assumption will result in a total change of 487 submissions (384 Medicare Part B claims measure submissions + 134 MIPS CQM/QCDR measure submissions + 237 eCQM submissions), an annual burden change of 4,081.08 hours (3,624.96 hr for Medicare Part B claims measure submissions + 799.98 hr for MIPS CQM/QCDR measure submissions + 1,256.10 hr for eCQM submissions) at a cost of$489,314.70 ($430,993.76 for Medicare Part B claims measure submissions + $98,114.37 for MIPS CQM/QCDR measure submissions +$156,435.31 for eCQM submissions)