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  2. CQM-6755

Quality ID 374 Clarification

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    • Resolution: Answered
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    • Audrey A Lenox
    • 302-346-2447
    • CNMRI, PA
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      Thank you for your inquiry regarding CMS50v12: Closing the Referral Loop: Receipt of Specialist Report. The measure assesses whether a clinician who made a referral to another clinician, received a consultant report closing the referral communication loop. Diagnostic testing, such as an MRI, ordered during an exam is not considered a referral in CMS50v12. A list of qualifying referrals can be found in the following value set listed in the measure:
      • "Intervention, Order: Referral" using "Referral (2.16.840.1.113883.3.464.1003.101.12.1046)"
      • "Intervention, Performed: Referral" using "Referral (2.16.840.1.113883.3.464.1003.101.12.1046)"
      These value sets are found on The National Library of Medicine's Value Set Authority Center (VSAC), https://vsac.nlm.nih.gov/. The VSAC provides downloadable access to all official versions of value sets content contained in the eCQM specifications. The value sets are lists of unique coded identifiers with names (called descriptors) for groupings of clinical and administrative concepts selected from standard vocabularies.
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      Thank you for your inquiry regarding CMS50v12: Closing the Referral Loop: Receipt of Specialist Report. The measure assesses whether a clinician who made a referral to another clinician, received a consultant report closing the referral communication loop. Diagnostic testing, such as an MRI, ordered during an exam is not considered a referral in CMS50v12. A list of qualifying referrals can be found in the following value set listed in the measure: • "Intervention, Order: Referral" using "Referral (2.16.840.1.113883.3.464.1003.101.12.1046)" • "Intervention, Performed: Referral" using "Referral (2.16.840.1.113883.3.464.1003.101.12.1046)" These value sets are found on The National Library of Medicine's Value Set Authority Center (VSAC), https://vsac.nlm.nih.gov/ . The VSAC provides downloadable access to all official versions of value sets content contained in the eCQM specifications. The value sets are lists of unique coded identifiers with names (called descriptors) for groupings of clinical and administrative concepts selected from standard vocabularies.
    • CMS0050v12
    • Confusion

      I am working with our EHR vendor for data pick up related to Quality ID 374, closing the referral loop for one of our providers. They are picking up MRI's ordered by our physician as a "referral" under Quality ID 374. It's my understanding that a referral is between clinicians, ie, a specialist and a PCP or specialist to specialist like another physician or therapist. Referral: A request from one physician or other eligible provider to another practitioner for evaluation, treatment, or co-management of a patient's condition. This term encompasses referral and consultation as defined by Centers for Medicare and Medicaid Services. Can you provide more clarity on whether diagnostic testing ordered during an exam is considered a referral under Quality ID 374?

            edave Mathematica EC eCQM Team
            ALENOX1 Audrey Lenox
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