CMS 50 questions re: Referring Dr and Referrals refused

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Minor
    • Component/s: None
    • None
    • Judi Dorsey
    • Medent EHR
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      Response to question 1: Yes. The referring provider needs to the EP reporting the measure.
      Response to question 2: The denominator requirements of CMS50 include a visit during the measurement period, and a referral during the measurement period. Only instances where a referral is made (performed) by an EP will be included in the denominator. This measure does not in any way require or encourage that an EP order a referral for a consult. If a patient refuses or declines the referral, the provider would not document the order for a referral in the record, and that patient would not be included in the denominator, rather than being counted as an exclusion to the measure.
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      Response to question 1: Yes. The referring provider needs to the EP reporting the measure. Response to question 2: The denominator requirements of CMS50 include a visit during the measurement period, and a referral during the measurement period. Only instances where a referral is made (performed) by an EP will be included in the denominator. This measure does not in any way require or encourage that an EP order a referral for a consult. If a patient refuses or declines the referral, the provider would not document the order for a referral in the record, and that patient would not be included in the denominator, rather than being counted as an exclusion to the measure.
    • CMS50v4/NQFna

      I have two questions relating to CMS 50 - Closing The Referral Loop.

      1. The Numerator description states "Number of patients with a referral, for which the referring provider received a report from the provider to whom the patient was referred". Does the "referring provider" in this statement have to be the EP reporting the measure? Or can it be another EP in the same practice?

      2. If a patient refuses a referral to another provider, will that patient still be included in the EPs denominator count or should they be excluded?

      Any assistance you can provide with regard to these questions is greatly appreciated.

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Judi Dorsey (Inactive)
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