Thank you for your inquiry. The definition of a qualifying visit will vary by measure and may be defined by but not limited to the type of visit, the timing of the visit, or the purpose of the visit. In regard to CMS22v6: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented, the measure requires at least one eligible encounter during the measurement period. A qualifying visit or eligible encounter is outlined in the value set provided in the measure, "Encounter, Performed: BP Screening Encounter Codes" using "BP Screening Encounter Codes Grouping Value Set (2.16.840.1.113883.3.600.1920)". Patient refusals from a previous reporting year of BP screening would not qualify as a denominator exception as a patient with an eligible encounter during the reporting period must have documentation during the eligible encounter of the refusal. In order to meet denominator exception intent, patient refusal for BP screening must be documented during the eligible encounter AND during the reporting period. “Occurrence A of Encounter…” is used to refer to the same encounter, which was eligible for inclusion in the denominator. In addition, to meet denominator exception intent, patient refusal for a follow-up intervention must be documented within 24 hours of the start of the eligible encounter AND during the reporting period. For CMS 138, to be in the Initial Population, the patient must be >= 18 years old at the start of the Measurement Period and have at least one encounter that is listed in the “Preventive Visit During Measurement Period” definition OR at least two encounters that are listed in the “"Office Based Visit During Measurement Period” definition. Population 2 also has a separate requirement, in order to meet the denominator criteria. The exceptions are listed and evaluated as follows: · "Medical Reason for Not Screening for Tobacco Use,” the medical reason for not screening for tobacco use must be evaluated and recorded 24 months or less before the end of the "Measurement Period. · "Limited Life Expectancy Diagnosis," the "Limited Life Expectancy Diagnosis” must be active through the end of the “Measurement Period” for the exception to be valid, which is why the “overlaps after” timing operator is used. · "Medical Reason for Not Counseling Tobacco User,” the medical reason for not counseling the tobacco user must be evaluated and recorded either at the same date time as the positive tobacco screening for a patient or after the documented date time of the positive screen, AND must be before the end of the Measurement Period. · "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy,” the medical reason for not ordering tobacco cessation pharmacotherapy must be evaluated and recorded either at the same date time as the positive tobacco screening for a patient or after the documented date time of the positive screen, AND must be before the end of the Measurement Period. For CMS 167, to be in the Initial Population, the patient must be >= 18 years old at the start of the Measurement Period and have an encounter listed in the “Diabetic Retinopathy Encounter” definition, which includes a list of encounters as found in the “Face to Face Encounters” definition and a diagnosis of Diabetic Retinopathy during the Measurement Period. The exceptions for this measure are listed and evaluated as follows: · “Macular Exam Not Performed for Medical or Patient Reason," for this measure, the medical or patient reason for not performing the macular exam must be evaluated and recorded during the same “Diabetic Retinopathy Encounter” used to satisfy the Initial Population criterion. For CMS 142, to be in the Initial Population, the patient must be >= 18 years old at the start of the Measurement Period and have an encounter listed in the “Diabetic Retinopathy Encounter” definition, which includes a list of encounters as found in the “Face to Face Encounters” definition and a diagnosis of Diabetic Retinopathy during the Measurement Period. The exceptions for this measure are listed and evaluated as follows: · "Retinopathy Level of Severity Not Communicated for Medical or Patient Reason,” the medical or patient reason for not communicating the level of severity of retinopathy findings must be evaluated and recorded during the same “Diabetic Retinopathy Encounter” used to satisfy the Initial Population criterion. · "Macular Edema Absent Not Communicated for Medical or Patient Reason,” the medical or patient reason for not communicating that the macular edema findings are absent must be evaluated and recorded during the same “Diabetic Retinopathy Encounter” used to satisfy the Initial Population criterion. · "Macular Edema Present Not Communicated for Medical or Patient Reason." Similarly, the medical or patient reason for not communicating that the macular edema findings are present must be evaluated and recorded during the same “Diabetic Retinopathy Encounter” used to satisfy the Initial Population criterion. For CMS 149, to be in the Initial Population, the patient must have at least two encounters as listed in the “Qualifying Encounters” definition and at least one “Dementia Encounter” which as listed in the definition, includes a “Face to Face Encounters” and a diagnosis of Dementia. The exceptions for this measure are listed and evaluated as follows: · "Patient Reason for Not Performing Assessment of Cognition Using Standardized Tools,” The patient reason for not performing the assessment of cognition using standardized tools must be evaluated and recorded during the same “Dementia Encounter” used to satisfy the Initial Population criterion. · "Patient Reason for Not Performing Cognitive Assessment Using Alternate Methods." The patient reason for not performing the assessment of cognition using alternate methods must be evaluated and recorded during the same “Dementia Encounter” used to satisfy the Initial Population criterion. For CMS 143, to be in the Initial Population, the patient must be >= 18 years old at the start of the Measurement Period, and have an encounter listed in the “Primary Open Angle Glaucoma Encounter” definition, which includes a list of encounters as found in the “Face to Face Encounters” definition, and a diagnosis of Primary Open-Angle Glaucoma during the Measurement Period. The exceptions for this measure are listed and evaluated as follows: · "Cup to Disc Ratio Not Performed for Medical Reason," the medical reason for not performing the cup to disc ratio must be evaluated and documented during the same “Primary Open Angle Glaucoma Encounter” used to satisfy the Initial Population criterion. · “Optic Disc Exam Not Performed for Medical Reason,” the medical reason for not performing the optic disc exam must be evaluated and recorded during the same “Primary Open Angle Glaucoma Encounter” used to satisfy the Initial Population criterion. For CMS 147, to be in the Initial Population, the patient must be >= 6 months old at the start of the Measurement Period, have an encounter as listed in the “Initial Qualifying Encounter During Measurement Period" definition, OR be receiving hemodialysis during the measurement period; the list of applicable encounters are included in the Hemodialysis During Measurement Period" definition. OR a patient can also be receiving peritoneal dialysis, the list of applicable encounters are found in the "Peritoneal Dialysis During Measurement Period" definition to be included in the Initial Population. For the purposes of this measure, the “Influenza Season” is defined as August 1-March 31. The list of exceptions are listed and evaluated as follows: · "Medical Patient or System Reason for Not Performing Influenza Vaccination," the medical system, or patient reason for not performing the influenza vaccination must be evaluated and recorded the “Influenza Season including August and September of the Previous Year.” · "Medical Patient or System Reason for Not Administering Influenza Vaccine," the medical system, or patient reason for not administering the influenza vaccine must take be evaluated and recorded during the “Influenza Season including August and September of the Previous Year.” · "Diagnosis of Allergy to Egg," the egg allergy diagnosis must be active through the entire current Influenza season, which is why the “overlaps after” timing operator is used. · "Egg Substance Allergy," the egg allergy substance diagnosis must be active through the entire current Influenza season, which is why the “overlaps after” timing operator is used. · "Diagnosis of Allergy to Influenza Vaccine," the allergy diagnosis for the influenza vaccine must be active through the entire current Influenza season, which is why the “overlaps after” timing operator is used. · "Diagnosis of Intolerance to Influenza Vaccine," the diagnosis of intolerance to the influenza vaccine must be active through the entire current Influenza season, which is why the “overlaps after” timing operator is used. · "Intolerance of Influenza Vaccination Procedure," the diagnosis of intolerance for the influenza vaccine procedure must be active through the entire current Influenza season, which is why the “overlaps after” timing operator is used. · "Allergy or Intolerance to Influenza Vaccine," the diagnosis of intolerance for the influenza vaccine procedure must be active through the entire current Influenza season, which is why the “overlaps after” timing operator is used.

For 2018 Reporting year, we are trying to determine whether the Reasons not done in the Exception can be met by any reason not done from the beginning of time OR if the intent of the measure is to capture Reasons Not Done that were new to the specific Measurement Period.