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  2. CQM-7127

CMS50 - Referrals not to specific clinicians but to specific clinic

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
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    • Leslie Busbee
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      Thank you for your inquiry about CMS50v12 Closing the Referral Loop: Receipt of Specialist Report.

      The referral does not need to be to a specific clinician to fulfill the referral criteria that creates the initial population/ denominator. However, to meet the numerator requirement for consultant report and pass the measure, the communication received must be associated with the initial referral. For example, if a referral was made to radiology, then a second referral was made to gastroenterology, only a radiology consultant report received can close the referral loop. We hope this helps.
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      Thank you for your inquiry about CMS50v12 Closing the Referral Loop: Receipt of Specialist Report. The referral does not need to be to a specific clinician to fulfill the referral criteria that creates the initial population/ denominator. However, to meet the numerator requirement for consultant report and pass the measure, the communication received must be associated with the initial referral. For example, if a referral was made to radiology, then a second referral was made to gastroenterology, only a radiology consultant report received can close the referral loop. We hope this helps.
    • CMS0050v12
    • Not measure related

      Our clinicians may refer patients to a specialty (ex. Primary Care specific clinician refers a patient to a GI clinic) but not specify a clinician or specific clinic. Communication from the specialty clinic may come back to the referring clinician but given that the initial referral was not to a specific clinician, the communication may not be associated to the initial referral to show that the referral loop is closed.

      The question is: Does the initial referral need to be to a specific clinician to fulfill the measure in this scenario?

            edave Mathematica EC eCQM Team
            busbeela Leslie Busbee
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