Total Discharges (based on claims)

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    • Type: Other
    • Resolution: Unresolved
    • Priority: Moderate
    • None
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      HSR Report show we fell below the 95% threshold to submit all linking variables on 95% or more of discharges.
      Total discharges (based on claims) was 4839 (row 6).
      Total discharges for which CCDE were successfully submitted [a] was 3939 (row 7).
      Total discharges with successfully linked claims and CCDE information [b][c][d] was 3816 (row 8).

      4839 minus 3939 equals 900 (which is about 81.4% data completeness and we need to at 95%. We calculate this as 18.6% of discharges with a claim might have been missing from our submission files).

      3939 minus 3816 equals 120 (which is about 3.1% of patients without linking variables)

      18.6% plus 3.1% equals 21.7%. Which is closer or matches the 1023 files (21.1%) of total discharges that failed linkage of claims and CCDE information (row 9)


      Mandatory Reporting Data Submission Requirements datils at the bottom of the table on this tab says
      "Requirement Met (Yes/No)" is NO for Submitted linking variables on 95 percent or more of discharges [f]
      "Number of Total Discharges with Complete Data" is 3816

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      HSR Report show we fell below the 95% threshold to submit all linking variables on 95% or more of discharges. Total discharges (based on claims) was 4839 (row 6). Total discharges for which CCDE were successfully submitted [a] was 3939 (row 7). Total discharges with successfully linked claims and CCDE information [b][c][d] was 3816 (row 8). 4839 minus 3939 equals 900 (which is about 81.4% data completeness and we need to at 95%. We calculate this as 18.6% of discharges with a claim might have been missing from our submission files). 3939 minus 3816 equals 120 (which is about 3.1% of patients without linking variables) 18.6% plus 3.1% equals 21.7%. Which is closer or matches the 1023 files (21.1%) of total discharges that failed linkage of claims and CCDE information (row 9) Mandatory Reporting Data Submission Requirements datils at the bottom of the table on this tab says "Requirement Met (Yes/No)" is NO for Submitted linking variables on 95 percent or more of discharges [f] "Number of Total Discharges with Complete Data" is 3816
    • Kourtney Kouns
    • 940-232-2036
    • United Regional Health Care
    • would like to know how row 6 total number of discharges based on claims is actually calculated and we have a list of these patients in our report.

      We received our HSR reports from our July 1st 2021 - June 30th 2022 voluntary data submission on 6/28/2024 and are actively reviewing our results internally with our quality department and with our EHR vendor. 

      We would like to know how CMS calculates the number that displays in row 6 "Total discharges (based on claims)" in the table on tab "Table III: Summary of Your Hospital's Submission of CCDE Information for the Hybrid HWM Measure". 

      The description in the PDF guide says "Number of inpatient stays for Medicare FFS patients 65 and older, discharged from your hospital, during the discharge period, based on the claims records.". However, it does not tell us how you are calculating this number. 

      For example, one report show 4839 discharges in this row. Then, we have 3939 as the total number of discharge for which CCDE were successfully submitted [a]. That is 900 discharges that CMS has a claim for that we must not have submitted a QRDA I file for. All patients that with no matching CCDE have an exclusion in column Q on the 5th tab o the workbook "Table IV H-HWM Discharges". So, we are confused as to how CMS came up with such a higher number of 4839. Any help you can provide is greatly appreciated. 

      Thank you

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            Assignee:
            Samantha Mancuso (Inactive)
            Reporter:
            Kourtney Kouns (Inactive)
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              Created:
              Updated: