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  2. CQM-5423

Closing Referral Loops: Referrals to PT in same practice

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    • James Person
    • 985-264-5651
    • Optum
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      ​
      Thank you for your clarification request regarding CMS50v10, Closing the Referral Loop: Receipt of Specialist Report.

      Question 1: Is a referral from a provider to a physical therapist in their practice considered a referral for the MIPS Closing Referral Loops quality measure? A referral from a provider to a physiotherapist is covered by the measure. A list of the SNOMEDCT codes included in the “Referral” value set for the measure can be found on the Value Set Authority Center website: https://vsac.nlm.nih.gov/valueset/expansions?pr=ecqm&rel=eCQM%20Update%202022-05-05&q=CMS50v11

      Question 2: Can you confirm that the measure does not consider if the provider works in the same practice or not? The measure logic is only identifying an encounter with a referral from one clinician to another clinician. The measure logic does not consider if the referral is internal or external to the practice of the referring clinician (see below).

      Initial Population
      "Has Encounter during Measurement Period"
        and "First Referral during First 10 Months of Measurement Period" is not null
      Denominator
      "Initial Population"
      Numerator
      "Referring Clinician Receives Consultant Report to Close Referral Loop"
      Show
      ​ Thank you for your clarification request regarding CMS50v10, Closing the Referral Loop: Receipt of Specialist Report. Question 1: Is a referral from a provider to a physical therapist in their practice considered a referral for the MIPS Closing Referral Loops quality measure? A referral from a provider to a physiotherapist is covered by the measure. A list of the SNOMEDCT codes included in the “Referral” value set for the measure can be found on the Value Set Authority Center website: https://vsac.nlm.nih.gov/valueset/expansions?pr=ecqm&rel=eCQM%20Update%202022-05-05&q=CMS50v11 Question 2: Can you confirm that the measure does not consider if the provider works in the same practice or not? The measure logic is only identifying an encounter with a referral from one clinician to another clinician. The measure logic does not consider if the referral is internal or external to the practice of the referring clinician (see below). Initial Population "Has Encounter during Measurement Period"   and "First Referral during First 10 Months of Measurement Period" is not null Denominator "Initial Population" Numerator "Referring Clinician Receives Consultant Report to Close Referral Loop"
    • CMS0050v10
    • Can a provider referring a patient to a physical therapist in the same practice be considered a referral for MIPS quality and HIE process measures?

      Is a referral from a provider to a physical therapist in their practice considered a referral for the MIPS Closing Referral Loops quality measure? 

      Can you confirm that the measure does not consider if the provider works in the same practice or not....the distinction that CMS has allowed in the measure is to include or exclude internal referrals (on the same EHR) so long as the provider chooses consistently across their reporting period.  In Cerner, this is accomplished by an EHR-level setting, so we cannot make the decision by provider.

            edave Mathematica EC eCQM Team
            James.person James Person (Inactive)
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