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  1. eCQM Issue Tracker
  2. CQM-7107

Closing the Referral Loop - CMS_50: Not receiving required documentation back from referring physicians/clinics and patients not going to the appointment.

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Icon: Moderate Moderate
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    • Darryann Johnson
    • 9706162486
    • Capital Digestive Care
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      Thank you for your inquiry into 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 back, closing the referral communication loop.

      1. At this time the measure can only be met if a consultant report is received from the clinician to whom the patient was referred as this is the intent of the measure.

      2. Thank you for bringing the issue of no shows to our attention. We will continue to investigate cases where patients do not attend appointments and may consider a measure update in a future update cycle.
      Show
      Thank you for your inquiry into 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 back, closing the referral communication loop. 1. At this time the measure can only be met if a consultant report is received from the clinician to whom the patient was referred as this is the intent of the measure. 2. Thank you for bringing the issue of no shows to our attention. We will continue to investigate cases where patients do not attend appointments and may consider a measure update in a future update cycle.
    • CMS0050v12
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      This is a major issue for a couple reasons -
      1. Referring providers are not being responsive, even after requesting the documentation multiple times.
      2. Patients are not following through with the requested referral and seeing the referring provider.
      Without receiving documentation from the referring provider or patients not going to see the provider, we are unable to close the loop. This is ultimately affecting our score because those referral loops are staying open.
      Show
      This is a major issue for a couple reasons - 1. Referring providers are not being responsive, even after requesting the documentation multiple times. 2. Patients are not following through with the requested referral and seeing the referring provider. Without receiving documentation from the referring provider or patients not going to see the provider, we are unable to close the loop. This is ultimately affecting our score because those referral loops are staying open.

      All the loops we are unable to close due to referring providers not sending documentation or patients not going to see the referring provider, it is leaving all those referrals as "Performance Not Met." All those open referrals are going against our score and hurting our performance, which is completely out of our hands. 

      A way to close the loop without documentation for instances where contact has been made to the referring provider and they have not sent the requested documentation AND for patients that do not follow through with the requested referral. 

            edave Mathematica EC eCQM Team
            darryann Darryann Johnson (Inactive)
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