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  1. eCQM Issue Tracker
  2. CQM-6119

Measure Specifications eCQM - CMS-50 & CMS-22 for inpatient encounters.

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
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      Thank you for your inquiry on CMS50v11 Closing the Referral Loop: Receipt of Specialist Report. The measure does not specify that referrals must be to outpatient specialists only. The “Referral” value set (2.16.840.1.113883.3.464.1003.101.12.1046) specifies outbound referral requests while the value sets that define the return reports are “Consultant Report” (2.16.840.1.113883.3.464.1003.121.12.1006). We recommend reviewing the codes listed in the “Referral” value set (https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1046/expansion/Latest) to determine if any of the codes would capture a referral to a relevant inpatient clinician and reviewing the “Consultant Report” value set (https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.121.12.1006/expansion/Latest) to determine whether any of the codes apply to a relevant inpatient clinician to whom the patient was referred.

      For CMS22 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented, qualifying encounters are specified by the “Encounter to screen for blood pressure” value set (2.16.840.1.113883.3.600.1920). Patient visits at an inpatient facility include inpatient visits with the same date for the admission and discharge (CPT code 99236) or evaluation and management services provided during an emergency department visit (SNOMED code 4525004 and CPT codes 99281-99285).

      We are not aware of any list of MIPS eCQMs focused on inpatients under the care of eligible clinicians who bill to Medicare Part B claims, though eligible clinician eCQMs are generally directed toward outpatient/ambulatory care.
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      Thank you for your inquiry on CMS50v11 Closing the Referral Loop: Receipt of Specialist Report. The measure does not specify that referrals must be to outpatient specialists only. The “Referral” value set (2.16.840.1.113883.3.464.1003.101.12.1046) specifies outbound referral requests while the value sets that define the return reports are “Consultant Report” (2.16.840.1.113883.3.464.1003.121.12.1006). We recommend reviewing the codes listed in the “Referral” value set ( https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1046/expansion/Latest ) to determine if any of the codes would capture a referral to a relevant inpatient clinician and reviewing the “Consultant Report” value set ( https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.121.12.1006/expansion/Latest ) to determine whether any of the codes apply to a relevant inpatient clinician to whom the patient was referred. For CMS22 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented, qualifying encounters are specified by the “Encounter to screen for blood pressure” value set (2.16.840.1.113883.3.600.1920). Patient visits at an inpatient facility include inpatient visits with the same date for the admission and discharge (CPT code 99236) or evaluation and management services provided during an emergency department visit (SNOMED code 4525004 and CPT codes 99281-99285). We are not aware of any list of MIPS eCQMs focused on inpatients under the care of eligible clinicians who bill to Medicare Part B claims, though eligible clinician eCQMs are generally directed toward outpatient/ambulatory care.
    • CMS0050v11
    • Medium. Answering this question will help our new Hospitalist MIPS TIN decide if CMS-50 and/or CMS-22 will apply to their care of inpatients.

      First, I cannot tell by looking at the expression logic for CMS-50 if closing the referral loop is satisfied for an inpatient encounter when the Attending Provider orders a referral or consult that is completed/signed during the inpatient encounter. Does this measure only consider outpatient referrals to specialists?

      Second, and along the same note, does CMS-22 (Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented) only consider blood pressures taken during outpatient encounters and inpatient observation patients? The expression logic for this measure under "Encounter, Performed" does not seem to include hospital inpatient encounters. Is this correct?

      Lastly, has anyone complied a short list of MIPS eCQMs that tend to work well for inpatients under the care of eligible clinicians who bill M-Part-B?

      Thanks!

            edave Mathematica EC eCQM Team
            NCurrah Nathan Jay Currah (Inactive)
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