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EC eCQMs - Eligible Clinicians
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Resolution: Answered
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Minor
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None
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Elissa Chandler
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2677255354
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NextGen Healthcare Information Systems
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measure criteria - Initial population and DENOMINATOR question - see below
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CMS166v1/NQF0052
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Critical to measures team development!!
CMS 166:
Initial Patient Population:
Question 1#: Is the measure looking for the very ‘FIRST’ OCCURRENCE A Diagnosis, Active: Low Back Pain to occur during the measurement period? Or are we looking for the ‘FIRST’ Diagnosis, Diagnosis, Active: Low Back Pain that occur during the first 337 days of the measurement period on a qualifying encounter for Office Visit , Emergency Department Visit, or Face-to-Face Interaction during the measurement period?
As per the spec ‘OCCURRENCE A of Diagnosis, Active: Low Back Pain’ MUST also meet the criterion below. Thus, if a patient has more than one diagnosis documented for Low Back Pain see example below, which would be considered ‘FIRST’ ‘OCCURRENCE A Low Back Pain? (see example below)
The example below, which is considered the FIRST: "Occurrence A of Diagnosis, Active: Low Back Pain?
Would Encounter on 1/3/13 be considered the ‘FIRST’ OCCURRENCE A of Diagnosis, Active: Low Back Pain even thought this occurrence fails to be documented on a qualifying encounter?
OR Would encounter#2 on 12/3/13 be considered ‘FIRST’ OCCURRENCE A of Diagnosis, Active: Low Back Pain as this was on a qualifying encounter? Please clarify
• Encounter#1: 1/3/13: Documentation of Low Back Pain Diagnosis
• Encounter#2: 12/3/13: Documentation of Low Back Pain Diagnosis AND 99201 documented for qualifying office visit encounter
Thank you