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  2. CQM-5905

CMS 69 and Qualifying encounter for Den Exception outcome

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      ​​Thank you for your inquiry regarding CMS69v10: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. You are correct that the qualifying encounter logic does not include "most recent." To clarify, to satisfy the numerator requirements the most recent documented BMI must occur during or within 12 months prior to the qualifying encounter. If a BMI is outside of normal parameters, the follow-up plan/intervention must be documented on the same day or within the 12 months after the high/low BMI.

      With regard to exceptions, the exception criteria must be met on the date of a qualifying encounter. However, you are correct that it does not need to be the most recent qualifying encounter. In the example provided, there was a qualifying encounter at which a medical reason was documented and therefore this patient meets the denominator exception criteria. We apologize for any confusion caused by the previous response.
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      ​​Thank you for your inquiry regarding CMS69v10: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. You are correct that the qualifying encounter logic does not include "most recent." To clarify, to satisfy the numerator requirements the most recent documented BMI must occur during or within 12 months prior to the qualifying encounter. If a BMI is outside of normal parameters, the follow-up plan/intervention must be documented on the same day or within the 12 months after the high/low BMI. With regard to exceptions, the exception criteria must be met on the date of a qualifying encounter. However, you are correct that it does not need to be the most recent qualifying encounter. In the example provided, there was a qualifying encounter at which a medical reason was documented and therefore this patient meets the denominator exception criteria. We apologize for any confusion caused by the previous response.
    • CMS0069v10

      I would like to request additional guidance regarding the recent solution provided to CQM-5886 Need clarification related to the most recent Qualifying BMI encounter - Office of the National Coordinator for Health Information Technology (healthit.gov). The solution states 'If there are multiple qualifying encounters, the most recent qualifying encounter is used to meet measure intent.' Can you please clarify how is that statement represented in the measure CQL logic? 

      'Most Recent Documented BMI' or 'Last(["Physical Exam, Performed": "Body mass index (BMI) [Ratio]" are only included in the logics related to the numerator definitions

      • High BMI and Follow up Provided
      • High BMI and Order for Follow up
      • Low BMI and Follow up Provided
      • Low BMI and Order for Follow up
      • Most Recent Documented BMI
      • Normal BMI

      'Most Recent' or 'Last'  are not mentioned in the CQL definitions for:

      • Qualifying Encounter 
      • Medical Reason for Not Documenting a Follow up Plan for Low or High BMI
      • Medical Reason or Patient Reason for Not Performing BMI Exam

       

      We have performed additional testing using Bonnie and Cypress tools, and the outcome for the scenario described in the CQM-5886 was Den Exception. Attached some screen-prints from Bonnie and Cypress + sample file with the following scenario tested in Cypress:

      Qualifying encounters dates:

      • 2022 07 11 080000
      • 2022 09 13 080000

      BMI documentation: 30 kg/m2 on  2022 09 13 080000

      Medication order negation date: 2022 07 11 080000

      Outcome: Denominator Exception

      We understand what seems to be the intent of the measure, but based on our testing using the tools provided in the eCQI site and how we are interpreting the CQL logic, intent does not seem to align with the logic.

      Your prompt response and guidance will be greatly appreciated. 

      Thanks!

        1. CMS69_DenException.zip
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        2. cms69.docx
          215 kB

            edave Mathematica EC eCQM Team
            isbelia Isbelia Briceno
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