Thank you for your questions. There are two separate issues here. #1-In HQMF R2, the actionNegationInd is/should be used when you're talking about "Medication, administered, Not Done". It should not be used for NOT: Encounter, performed or NOT Medication, administered. In other words, the difference is that the actionNegationInd is signifying an act was not performed, while the "NOT:" is excluding an act that was performed. #2 The discrepancy in the template IDs has been submitted to the Measure Authoring Team as an issue. We believe it is probably a typographical error. Some further clarification: In HQMF R2.1, actionNegationInd is used to indicate the evidence of absence. In other words, the EHR must have a recorded statement that the certain action did not occur (or was not observed). This pertains to the negation rationale (a.k.a. "not done") in QDM. A statement that something did not occur (evidence of absence) is not the same as the lack of any statements that it did occur. The NOT construct in QDM is used to indicate that there should not be any record of that action occurring (or being observed). It indicates lack of positive evidence that something happened. In HQMF R2.1, "AND NOT" is represented by the allFalse grouper. The MAT implementation of HQMF R1, however, followed different rules and used actionNegationInd differently. It used actionNegationInd for "not done" (evidence of absence) and "NOT" (lack of positive evidence). If actionNegationInd was on a data criteria element, then it indicated "not done". If it was on a precondition, then it indicated "NOT". In addition, actionNegationInd was used to flag denominator exclusions. Please note that the MAT has moved to HQMF R2.1 now, so future measure bundles will adhere to the rules described for HQMF R2.1 above (not the rules described for the legacy HQMF R1).

I am having some trouble understanding actionNegationInd. For example in CMS 100v3: In the Exceptions actionNegationInd seems to mean something not done.     "Medication, Administered not done" But elsewhere in the same measure actionNegationInd seems to indicate not something done.     NOT: "Encounter, Performed"      Is it this the correct interpretation? How does one distinguish the two? Is it simply the presence of a reason value set that causes to be something not done instead of a not something done? Further complicating the matter, the measure uses different templates for the same concept: In the Exceptions:     Medication, Administered not done uses template 2.16.840.1.113883.3.560.1.14 But in the Data Criteria:     Medication, Administered not done uses template 2.16.840.1.113883.3.560.1.114 Is there a specific reason for this?