Thank you for your questions regarding CMS506v7, Safe Use of Opioids - Concurrent Prescribing. Inpatient hospitalizations with discharge medications of a new or continuing opioid or a new or continuing benzodiazepine prescription should be included in the initial population. Inpatient hospitalizations with discharge medications of two or more new or continuing opioids or new or continuing opioid and benzodiazepine resulting in concurrent therapy at discharge should be included in the numerator. Please see below for responses to your questions: A) If a patient was in Observation, then admitted as in inpatient:   1) Are these patients included in the numerator? To qualify for the numerator, the patient would need to have two or more opioids or an opioid and benzodiazepine at discharge from the inpatient encounter.   2) Are these patients included in the denominator? To qualify for the denominator, the patient would need to have one or more opioids and/or benzodiazepine at discharge from the inpatient encounter. B) If a patient was in Observation, then discharged directly to home:    3) Are these patients included in the numerator? This patient would not be included in the numerator because the measure requires an inpatient hospitalization.   4) Are these patients included in the denominator? This patient would not be included in the denominator because the measure requires an inpatient hospitalization. C) when a patient is in Acute Care at a Critical Access Hospital, Upon discharge from Acute into a Skilled Swing bed at the same Critical Access Hospital:   1) are these patients included in the numerator? These patients would not be in the numerator. Patients who are admitted to an inpatient encounter and subsequently transferred to a skilled nursing level of service within the same facility (swing beds) should not be included in the measure. eCQMs are not able to differentiate patients based upon level of service. Please work with your EHR vendor to remove these patients from the measure for purposes of reporting.   2) are these patients included in the denominator? These patients would not be in the denominator. Please see above for an explanation regarding swing beds. D) When a patient is in a Skilled Swing Bed at a Critical Access Hospital, upon discharge to home:   1) are these patients included in the numerator? These patients are not the numerator. Please see above for an explanation regarding swing beds.   2) are these patients included in the denominator? These patients would not be in the denominator. Please see above for an explanation regarding swing beds. E) For patients that are currently receiving hospice benefits and are then admitted for any diagnosis and discharged - are these patients included in the numerator / denominator?   Patients who are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the hospitalization or in an emergency department encounter or observation stay immediately prior to hospitalization are excluded from the measure.