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  1. eCQM Issue Tracker
  2. CQM-6590

Hospital Harm- HH-01/HH-02 Billing- IP vs OBS status

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Answered
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    • Cari Jones
    • 4054738842
    • INTEGRIS Healthcare
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      Thank you for your inquiry specific to CMS816v3 Hospital Harm – Severe Hypoglycemia. An inpatient stay is indeed one of the requirements to meet this measure’s initial population (IP)/denominator. Direct admissions to inpatient meet the IP, and inpatient stays that start in the emergency department (ED) and/or observation (when the time between the end of those encounters and the start of the inpatient encounter are within an hour or less of each other) also meet the IP. For example, if a patient came to the ED and was admitted to inpatient, then this encounter qualifies for the IP with the encounter starting in the ED. Please see these examples to further clarify:

      -ED encounter on 11/19 starts at 0200 and ends at 0730. Inpatient admission starts on 11/19 at 0900. In this scenario, there is a qualifying IP encounter which begins with the inpatient admission on 11/19 at 0900.
      -Observation encounter on 11/19 starts at 0200 and ends at 0830. Inpatient admission starts on 11/19 at 0900. In this scenario, there is a qualifying IP encounter which begins with the observation encounter on 11/19 at 0200.

      We are unable to provide specific guidance related to the mapping of codes. We recommend you consult with your EHR vendor and clinical partners. If mapping is conducted, you should maintain documentation in case of a CMS audit.
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      Thank you for your inquiry specific to CMS816v3 Hospital Harm – Severe Hypoglycemia. An inpatient stay is indeed one of the requirements to meet this measure’s initial population (IP)/denominator. Direct admissions to inpatient meet the IP, and inpatient stays that start in the emergency department (ED) and/or observation (when the time between the end of those encounters and the start of the inpatient encounter are within an hour or less of each other) also meet the IP. For example, if a patient came to the ED and was admitted to inpatient, then this encounter qualifies for the IP with the encounter starting in the ED. Please see these examples to further clarify: -ED encounter on 11/19 starts at 0200 and ends at 0730. Inpatient admission starts on 11/19 at 0900. In this scenario, there is a qualifying IP encounter which begins with the inpatient admission on 11/19 at 0900. -Observation encounter on 11/19 starts at 0200 and ends at 0830. Inpatient admission starts on 11/19 at 0900. In this scenario, there is a qualifying IP encounter which begins with the observation encounter on 11/19 at 0200. We are unable to provide specific guidance related to the mapping of codes. We recommend you consult with your EHR vendor and clinical partners. If mapping is conducted, you should maintain documentation in case of a CMS audit.
    • CMS0816v3
    • Determines which patients should be falling into the measure (Initial Population/Denominator). Ability to correctly map which patients should be included in the report (IP vs OBS)

      At our facility, a number of patients have been pulled into the patient population (Initial Population/Denominator) for HH-01/02 that are registered in the record as "Observation" patients.  Reviewing the billing for these patients, you can see that at some point in their hospital stay they were registered as Inpatients, but billing determined the patient did not meet IP criteria and changed the pt status to "OBS" and the patients were billed as OBS. 

      Are these types of encounters to be pulled into the Initial Population/Denominator?  Is there some requirement of how the pt is billed to determine whether or not they should be included as "inpatient?"  OR as long as they were inpatient at some point in their stay they meet the criteria for inpatient criteria? 

            JLeflore Joelencia Leflore
            shorca Cari Ann Jones
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