​Thank you for your question. This measure has three populations, each representing a 4-month period within the measurement period. These 4-month periods would not negate each other. The Guidance states that, if a patient has both a qualifying diagnosis and encounter in more than one of the 4-month periods within the measurement year, the patient must be included in each applicable 4-month period. For example, a patient has a qualifying diagnosis and encounter in the first 4-months of the measurement period and in the third 4-month period of the measurement period. They would be included in the denominator for the first and third 4-month periods. Depending on if that patient was appropriately assessed would determine if they would be included in the numerator at all, or once, or twice. We hope this addresses your concern.

Apparently guidance was issued stating that the 3 stratification for this rule were to be processed as "AND" conditions. Meaning success would be that a patient passes Stratification 1 AND Stratification 2 AND Stratification 3. Doing this means that no patient can be successful as the stratification negate each other. Is it possible that the stratification were meant to be interpreted as OR conditions? So success would then be that a patient passes Stratification 1 OR Stratification 2 OR Stratification 3.