Quality ID #374: Closing the Referral Loop: Receipt of Specialist Report

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    • Type: Other
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Tina Ivis
    • 516-582-0003
    • Catholic Health
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      Thank you for your question on CMS50v13: Closing the Referral Loop: Receipt of Specialist Report.

      Q1. If a single clinician places multiple referrals for a single patient to the same provider, only the first referral can meet or fail to meet the numerator and the measure does not look at subsequent referrals. “First referral” signifies the first referral each eligible clinician makes for a single patient. This is explained in the Guidance section of the measure that states “only the first referral made between January 1 – October 31 of the measurement period will be considered for this measure to allow adequate time for the referring clinician to collect the consult report by the end of the measurement period. If there are multiple referrals for a patient during the measurement period, use the first referral.”

      Q2. If there are multiple referrals placed to the same clinician and the first one is canceled, this referral will still be used as the first referral that can meet or fail to meet the numerator.

      Q3. "First referral” signifies the first referral each eligible clinician makes for a single patient. If a single clinician creates multiple referrals for a single patient to two different clinicians, only the first referral will meet or fail to meet the numerator.
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      Thank you for your question on CMS50v13: Closing the Referral Loop: Receipt of Specialist Report. Q1. If a single clinician places multiple referrals for a single patient to the same provider, only the first referral can meet or fail to meet the numerator and the measure does not look at subsequent referrals. “First referral” signifies the first referral each eligible clinician makes for a single patient. This is explained in the Guidance section of the measure that states “only the first referral made between January 1 – October 31 of the measurement period will be considered for this measure to allow adequate time for the referring clinician to collect the consult report by the end of the measurement period. If there are multiple referrals for a patient during the measurement period, use the first referral.” Q2. If there are multiple referrals placed to the same clinician and the first one is canceled, this referral will still be used as the first referral that can meet or fail to meet the numerator. Q3. "First referral” signifies the first referral each eligible clinician makes for a single patient. If a single clinician creates multiple referrals for a single patient to two different clinicians, only the first referral will meet or fail to meet the numerator.
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    • I summited this question to QPP.CMS.GOV who advised me to send the request here.

      For eCQM for Quality ID#374 / CMS eCQM ID: CMS50v12: Closing the Referral Loop: Receipt of Specialist Report

       

      The denominator note reads:

      • DENOMINATOR NOTE: If there are multiple referrals for a patient during the measurement period, use the first referral.

       

      Questions:

      1. If there are multiple referrals placed to the same provider and the loop is closed on the referral placed second, does the patient satisfy the measure?

       

      1. If there are multiple referrals placed to the same provider and the "first" one is cancelled, should that referral be remove and therefore no longer count as the "first" referral?  

       

      1. If referrals are created for two different providers, is each referral independent of one another for closing the loop? Or, is satisfying the measure based on whichever referral was  made "first".

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Tina Ivis (Inactive)
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