Thank you for your question about CMS506v3 Safe Use of Opioids – Concurrent Prescribing. A palliative care encounter that occurs within 3 months could only be considered for exclusion if the care overlapped with the inpatient stay, i.e. if the ongoing care ended, started, or lasted through the inpatient stay. If the palliative care was not given at any point in the inpatient stay but is intended after the inpatient stay, then to meet exclusion criteria the client can either order palliative care (see logic below) or discharge to hospice care. The measure does exclude orders for palliative care from the denominator. Please let us know if you have additional questions. Denominator Exclusions /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/ "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter   where exists ( ["Diagnosis": "All Primary and Secondary Cancer"] Cancer       where Cancer.prevalencePeriod overlaps InpatientEncounter.relevantPeriod   )     or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter         where exists InpatientEncounter.diagnoses Diagnosis           where Diagnosis.code in "All Primary and Secondary Cancer"     )     or exists ( ["Intervention, Order": "Palliative or Hospice Care"] PalliativeOrHospiceCareOrder         where PalliativeOrHospiceCareOrder.authorDatetime during InpatientEncounter.relevantPeriod     )     or exists ( ["Intervention, Performed": "Palliative or Hospice Care"] PalliativeOrHospiceCarePerformed         where Global."NormalizeInterval" ( PalliativeOrHospiceCarePerformed.relevantDatetime, PalliativeOrHospiceCarePerformed.relevantPeriod ) overlaps InpatientEncounter.relevantPeriod     )     or exists ( "Inpatient Encounter with Age Greater than or Equal to 18" InpatientEncounter         where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility"           or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission"           or InpatientEncounter.dischargeDisposition in "Patient Expired"     )​  ​