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  1. eCQM Issue Tracker
  2. CQM-2844

CMS 2v7, 22v6,69v6 and 50v6: referral values sets are not aligned for inclusion in CMS50

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
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      The Referral value set in CMS50 intends to include concepts that explicitly capture referral by one provider to another type of provider, and not a specific program or service. Therefore, there may be intentional differences to the concepts included. PCPI will review the contents of the referral value sets used in measures CMS2, CMS22, and CMS69 in the next cycle of annual updates to determine if there are additional concepts which can be added that would meet the intent of the Referral data element included in CMS50.
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      The Referral value set in CMS50 intends to include concepts that explicitly capture referral by one provider to another type of provider, and not a specific program or service. Therefore, there may be intentional differences to the concepts included. PCPI will review the contents of the referral value sets used in measures CMS2, CMS22, and CMS69 in the next cycle of annual updates to determine if there are additional concepts which can be added that would meet the intent of the Referral data element included in CMS50.
    • CMS2v7/NQF0418, CMS69v6/NQF0421, CMS50v6/NQFna, CMS22v6/NQFna
    • If codes in value sets for the referral codes don’t align, CMS50 may miss some referrals that should be included.

      Measures CMS 2v7, 22v6 and 69v6 and 50v6 use SNOMEDCT value sets for referrals. CMS 50v6 (Closing the Referral Loop) is evaluating patients with a referral. The codes in the value sets used in CMS 2,33 and 69 are not wholly contained in the CMS50 referral value set. Some referrals may not be included in measure 50. The codes in the value sets from 2, 22 and 69 should be included in the referral value set used in 50.

            edave Mathematica EC eCQM Team
            annecoultas Anne Coultas (Inactive)
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