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  2. CQM-5262

CMS 50 Closing Referral loop - Guidance / CQL conflict

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      ​​Thank you for the inquiry on CMS50v10, Closing the Referral Loop: Receipt of Specialist Report. For performance year 2023 (version 11), the time period when the first referral can occur is limited to January through October of the measurement period, to allow some time for the referring clinician to collect the consult report by the end of the measurement period (which runs from January to December). The numerator captures referrals completed by the end of the measurement period, and not beyond December 31.

      Thank you

      Question: Are you going to add to the CQL for 2023 that to count in the numerator that the referral is completed by Dec 31 of reporting year? If so, since some referrals take 3 months to even get in, will you write in Guidance and CQL either an exclusion for referrals that are not able to get an appointment until after the Dec 31 time frame?
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      ​​Thank you for the inquiry on CMS50v10, Closing the Referral Loop: Receipt of Specialist Report. For performance year 2023 (version 11), the time period when the first referral can occur is limited to January through October of the measurement period, to allow some time for the referring clinician to collect the consult report by the end of the measurement period (which runs from January to December). The numerator captures referrals completed by the end of the measurement period, and not beyond December 31. Thank you Question: Are you going to add to the CQL for 2023 that to count in the numerator that the referral is completed by Dec 31 of reporting year? If so, since some referrals take 3 months to even get in, will you write in Guidance and CQL either an exclusion for referrals that are not able to get an appointment until after the Dec 31 time frame?
    • EP
    • Closing the Referral Loop: Receipt of Specialist Report
    • Clarify when to stop counting Consult reports that come in after the end of the performance year.

       Guidance for measure "...all data for the reporting year is to be submitted by the deadline established by CMS. ... that providers to whom they referred their patients share their consult reports asap in order for those patients to be counted in the measure numerator during the measurement period."

      DOES THIS STATEMENT MEAN THAT THE PROVIDER CAN COUNT CONSULT REPORTS THAT COME IN AFTER THE END OF THE PERFORMANCE YEAR ie. Dec 31, since final submission may not occur until for Example March 30 of the next performance year.

      It seems that Numerator CQL "Referring Provider Receives Consultant Report to Close Referral Loop" does not include an end time for the consult reports to come in, but includes everything else in the definition. 

      Numerator

           "Referring Provider Receives Consultant Report to Close Referral Loop"

      What is the requirement for programmers to follow the Guidance section, when it is not written into the CQL?

      I saw the Issue created where I believe it was going to be written in that referrals made only through October of the measure year would be included. I didn't see it in the 2022 CQL. When will this start?

      Thank you

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        3. CQLIT-312 NumerFAIL-PASS RefEye2 done after 2nd, link to 2nd,1afterMP.png
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            edave Mathematica EC eCQM Team
            crich89 cynthia richesin (Inactive)
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