I have a question regarding the reporting of CQMs. Our EHR vendor is telling me that if a patient meets the criteria to be included in the denominator for a specific measure for one of our providers, based on the fact that there is a face-to-face encounter during the reporting period, that patient is then included in the denominator for any of our providers who signed any kind of order for the patient, even if there was no face-to-face encounter as defined by the specific CPT codes for an outpatient office visit.

For instance, Patient John Smith, who has an active diagnosis of hypertension, has an outpatient office visit (99214) with Dr. Jones on April 5th, thereby qualifying him for inclusion in the denominator for NQF 0018. Patient John Smith comes in on July 15th for an injection of a medication. That visit does not include any face-to-face encounter with any provider, as defined by a CPT code for an outpatient office visit, but the encounter is signed by Dr. Adams, who was the physician present in the clinic at the time of the injection. Our EHR vendor is telling me that Patient John Smith should be counted toward the denominator for this measure for Dr. Adams as well as for Dr. Jones.

In my reading of the measures, and the specifics that determine whether a patient meets the numerator and denominator for each measure, it appears to me that a patient would only qualify for the denominator for the provider with whom they had a face-to-face encounter during the reporting period. Could someone please confirm my understanding of this reporting logic, or show me where to find additional resources to better understand?