Good morning,
We have been testing QRDA-I file submission for 2024 and are running into some questions about logic intent as it relates to insurances.  We have been in discussions with our EHR vendor about this, as we are using their logic to pull the data and submit the QRDA-I files.  
The issue we are encountering is that some patients may have Medicare FFS or Medicare Advantage as an insurer overall, but it might not be the insurance that the admission is being billed to.  For example, we are seeing several patients that are Veterans and have VA insurance.  The VA insurance is listed as primary and self pay is listed as secondary on their admission.  But, when a visit is not being billed to the VA, they also have a Medicare FFS or Medicare Advantage plan available.  Since the patient has Medicare FFS or MEdicare Advantage on file as other available coverage, their records are being pulled into our QRDA-I files, even though those insurances did not apply to that particular visit/hospitalization.
Is the intent of the measure to pull data for all patients that have Medicare FFS or Medicare Advantage listed as a type of coverage they have ever had, or just the coverage for the visit being evaluated for readmissions?
In thinking about CMS intends to use the files that we send them, we wouldn't expect them to have a claim for these VA visits, thus they wouldn't have a claim to link these to.  Should we be including them anyway?
Our EHR vendor is saying they pull any insurance listed on a patient in the patient accounting system, regardless of whether or not it applies to the visit/admission.
Please help us understand if what they are telling us is correct.