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  1. eCQM Issue Tracker
  2. CQM-7509

CMS1028 (ePC-07)

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Answered
    • Icon: Moderate Moderate
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    • Michelle Amy Morrison
    • 7817562192
    • BILH Winchester Hospital
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      Thank you for your inquiry regarding CMS1028v2/PC-07 (Severe Obstetric Complications). The intent of the measure is to report a single delivery encounter only. If the two encounters in the scenario provided were merged, the resulting encounter should count toward the numerator, only once. It may be beneficial to have the EMR vendor verify that the report meets measure intent.
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      Thank you for your inquiry regarding CMS1028v2/PC-07 (Severe Obstetric Complications). The intent of the measure is to report a single delivery encounter only. If the two encounters in the scenario provided were merged, the resulting encounter should count toward the numerator, only once. It may be beneficial to have the EMR vendor verify that the report meets measure intent.
    • CMS1028v3
    • CMS1028v2
    • Encounter is hitting the measure numerator twice

      We found an OB case that is counting twice in the numerator for ePC-07 OB complications. The patient came in for their delivery encounter (had a blood transfusion), so is correctly included in the numerator. The patient was readmitted within a day of their delivery discharge. According to billing rules, the two encounters get merged into one. However, according to Epic, the eCQM technical specifications don't reference anything about merged encounters. Epic is counting this patient in the measure twice, even though we know it is only possible for a patient to deliver one time during this timeframe.

      How should hospitals handle 2 encounters that become merged into one per billing rules? All the coding information would be the exact same and only one claim would be submitted yet it's hitting the eCQM twice. According to Epic their specifications are behaving as expected but it doesn't make sense for hospitals to be penalized twice for one complication.

      Thank you.

            aweber Mathematica EH eCQM Team
            mdiciaccio Michelle Morrison (Inactive)
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