CMS529v1 - Identification of Inpatient Encounters

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    • Type: Value Sets
    • Resolution: Unresolved
    • Priority: Blocker
    • None
    • Aditi Wage
    • Because this issue involves measure intent, we request the CHM team review the response and confirm accuracy.

      One of the criteria in Initial Population states:
      end of Payer.participationPeriod != start of InpatientEncounter.relevantPeriod

      Consider scenarios below:

      Scenario 1-
      Patient ABC aged 66 years is documented with:
      Inpatient encounter code - 183452005
      IP admit - 1/1/2021 04:45:00
      IP discharge - 12/25/2021 04:30:00
      Medicare payer code – 1
      Start Date Payer participation - 1/1/2021 04:45:00
      End Date Payer participation - 1/1/2021 04:45:00
      Length of Stay for Inpatient - 359 days

      Scenario 2-
      Patient XYZ aged 66 years is documented with:
      Inpatient encounter code - 183452005
      IP admit - 1/1/2021 04:45:00
      IP discharge - 12/25/2021 04:30:00
      Medicare payer code – 1
      Start Date Payer participation - 1/1/2021 04:45:00
      End Date Payer participation - 1/5/2021 04:45:00
      Length of Stay- 359 days

      Query:
      1. Which of the above 2 patients will qualify for the Initial Population?

            Assignee:
            Unassigned
            Reporter:
            Aditi Waje (Inactive)
            Aditi Waje (Inactive)
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              Created:
              Updated: