CMS50v13 Referring Provider making multiple specialty referrals for patient on same day

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • John Buen
    • 3479311615
    • NYC H+H
    • Hide
      Thank you for inquiring about the Closing the Referral Loop: Receipt of Specialist Report eCQM. The measure is not prescriptive about which specialties are reported, only that a consultant report is received for the first referral. You would not parse the specialties but list them all ordinally from first to most recent and then use the earliest time stamp.

      Question 1:
      All specialties are included. Use the nutritionist referral to assess measure compliance; therefore, without receiving a consultant report, this would fail to meet numerator criteria.

      Question 2:
      The other referrals are not considered for the measure. The measure’s Guidance section indicates the following:
      "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."
      Show
      Thank you for inquiring about the Closing the Referral Loop: Receipt of Specialist Report eCQM. The measure is not prescriptive about which specialties are reported, only that a consultant report is received for the first referral. You would not parse the specialties but list them all ordinally from first to most recent and then use the earliest time stamp. Question 1: All specialties are included. Use the nutritionist referral to assess measure compliance; therefore, without receiving a consultant report, this would fail to meet numerator criteria. Question 2: The other referrals are not considered for the measure. The measure’s Guidance section indicates the following: "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."
    • CMS0050v13
    • CMS0050v12
    • Impacting our denominator for this metric and which referrals we are tracking for loop closed/open.

      This might be a silly question, but it's got us stuck here. I've read other questions similar to this, regarding multiple referrals made for a patient with identical time stamp.
      My follow-up question is explicitly about multiple specialty referrals being created at the time of the patient encounter: do we still focus on the time stamp creation of the first specialty referral created by the provider? Or do we look at each specific specialty referral and look at the earliest time stamp?

      Example: 

      Patient 1 comes in during the measurement period. The Provider is creating four referrals for Patient 1 during that same encounter. The Provider creates referrals to Nutrition, Social work, Ophthalmology, and Cardiology during this patient encounter. 

      Provider sends 4 referrals for the same patient:
      Referral 1/1/2025 12:00:00 Orderid: ABC  Specialty: Nutrition
      Referral 1/1/2025 12:01:00 Orderid: DEF   Specialty: Social work
      Referral 1/1/2025 12:02:00 Orderid: GHI   Specialty: Ophthalmology
      Referral 1/1/2025 12:01:30 Orderid: XYZ   Specialty: Cardiology

      Consult Report 2/1/2025 12:00:00 - with related to: orderid XYZ Specialty: Cardiology

      Given: All time stamps are different. 

      Questions:
      1) Which of the referrals are in consideration for the measure?
      Please correct me if I am going down the wrong path: Based on what i understand, "Referral 1/1/2025 12:00:00 Orderid: ABC  Specialty: Nutrition" is the referral that should be counted in the measure because it has the earliest time stamp. 

      "Referral 1/1/2025 12:00:00 Orderid: ABC  Specialty: Nutrition" received no consult report. Therefore, the referral loop for this patient remains open. 

      2) What happens to other other referrals that were ordered on that same day for the patient? Are they also part of the measure? Or is it because "Referral 1/1/2025 12:00:00 Orderid: ABC  Specialty: Nutrition" was the earliest, it is considered 1st, and then that is the only referral considered for the measure?

       

            Assignee:
            AIR EC eCQM Team
            Reporter:
            John-Conrad
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              Created:
              Updated:
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