Uploaded image for project: 'eCQM Issue Tracker'
  1. eCQM Issue Tracker
  2. CQM-7417

CMS50 "First Referrral" and "Provider attribution" clarification

XMLWordPrintable

    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Icon: Moderate Moderate
    • None
    • None
    • Hide
      Thank you for reaching out with your question related to CMS50. While this is a patient-based measure, each clinician will need to ensure the referral loop is closed on the first referral for each patient. This is particularly relevant when considering data reporting to CMS for MIPS. For example, if each clinician is reporting data to CMS as an individual, the measure will be reported based on individual performance for the clinicians who choose the measure. If the facility is reporting as a group, the aggregated measure performance of all clinicians billing under your TIN will be reported. In the case of group reporting, the measure will be attributed to every qualifying clinician billing under the TIN. For more information on measure attribution and calculation as it relates to reporting, please refer to Individual or Group Participation.

      To answer your specific questions:
      • Question 1: The patient will meet the IPP requirements for Providers A and B since both providers had a qualifying encounter with the patient and both sent a referral.
      • Question 2: The first referral for Provider A is the referral related to the January 1, 2024 encounter; the first referral for Provider B is the referral related to the February 1, 2024 encounter.
      Show
      Thank you for reaching out with your question related to CMS50. While this is a patient-based measure, each clinician will need to ensure the referral loop is closed on the first referral for each patient. This is particularly relevant when considering data reporting to CMS for MIPS. For example, if each clinician is reporting data to CMS as an individual, the measure will be reported based on individual performance for the clinicians who choose the measure. If the facility is reporting as a group, the aggregated measure performance of all clinicians billing under your TIN will be reported. In the case of group reporting, the measure will be attributed to every qualifying clinician billing under the TIN. For more information on measure attribution and calculation as it relates to reporting, please refer to Individual or Group Participation. To answer your specific questions: • Question 1: The patient will meet the IPP requirements for Providers A and B since both providers had a qualifying encounter with the patient and both sent a referral. • Question 2: The first referral for Provider A is the referral related to the January 1, 2024 encounter; the first referral for Provider B is the referral related to the February 1, 2024 encounter.
    • CMS0050v13
    • CMS0050v12
    • CMS50

      The measure guidance states
       
      "The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure.
       
      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."
       
      Scenario: 
          In a shared Electronic Medical Record (EMR) system, a patient has the following interactions with healthcare providers:
       
          Provider A: Has a qualifying encounter with the patient on January 1, 2024, and the doctor sends an outgoing referral.
          Provider B: Has a qualifying encounter with the patient on February 1, 2024, and the doctor sends an outgoing referral.
          Provider C: Has a qualifying encounter with the patient on March 1, 2024, but the doctor does not send any referral.
       
      Given that this is patient based measure and above interactions, please clarify the following:
       
      Initial Patient Population (IPP) Eligibility and First Referral Determination:
       
          Question 1: Will the patient meet the IPP requirements for all three providers (Provider A, Provider B, and Provider C), or only specific ones, and if so, which specific ones?
       
          Question 2: Which referral will be considered "the first referral" for the purposes of determining IPP eligibility for each of the three Providers in the scenario above? 

            AIR EC eCQM Team AIR EC eCQM Team
            saileshdixit Sailesh
            Votes:
            0 Vote for this issue
            Watchers:
            4 Start watching this issue

              Created:
              Updated:
              Resolved: