Thank you for your question regarding CMS135v13. In order for a patient to meet the Initial Patient Population (IPP), they must have at least two qualifying outpatient encounters and at least one heart failure outpatient encounter during the measurement period. In order to ensure care is established, a minimum of two encounters is required for any patient to be included in the measure. However, the actual number of encounters required to meet the IPP is unique to each patient and dependent upon the timing of heart failure diagnosis as it relates to the encounter(s). The encounters to not have to be distinct (the same encounter can count as both a qualifying encounter and a heart failure encounter), but it is important to review the encounter codes in the value set to ensure encounters meet the criteria for each encounter type. A few scenarios are included below, detailing how different patients with heart failure meet the IPP with various encounter types. Scenario 1: Patient with existing Heart Failure diagnosis • Encounter 1 → Office Visit [Heart Failure Outpatient Encounter] • Encounter 2 → Outpatient Consultation [Heart Failure Outpatient Encounter] Patient meets IPP on second encounter Scenario 2: Patient with existing Heart Failure diagnosis • Encounter 1 → Patient Provider Interaction [Qualifying Outpatient Encounter] • Encounter 2 → Patient Provider Interaction [Qualifying Outpatient Encounter] • Encounter 3 → Outpatient Consultation [Heart Failure Outpatient Encounter] Patient meets IPP on third encounter. Note that Patient Provider Interaction is not a valid Heart Failure Outpatient Encounter, so the patient must have an encounter that meets this criterion before meeting the IPP Scenario 3: Patient without an existing Heart Failure diagnosis • Encounter 1 → Office Visit [Qualifying Outpatient Encounter] • Encounter 2 → Outpatient Consultation [Qualifying Outpatient Encounter] • Encounter 3 → Outpatient Consultation + Patient diagnosed with Heart Failure on day of encounter [Heart Failure Outpatient Encounter] Patient meets IPP on third encounter Scenario 4: Patient without an existing Heart Failure diagnosis • Encounter 1 → Office Visit [Qualifying Outpatient Encounter] • Encounter 2 → Outpatient Consultation Patient diagnosed with Heart Failure on day of encounter [Heart Failure Outpatient Encounter] Patient meets IPP on second encounter Scenario 5: Patient without an existing Heart Failure diagnosis • Encounter 1 → Office Visit [Qualifying Outpatient Encounter] • Encounter 2 → Outpatient Consultation [Qualifying Outpatient Encounter] • Encounter 3: Nursing Facility Visit [Qualifying Outpatient Encounter] • Encounter 4: Nursing Facility Visit [Qualifying Outpatient Encounter] • Encounter 5: Home Healthcare Services [Qualifying Outpatient Encounter] • Encounter 5: Office Visit [Qualifying Outpatient Encounter] • Encounter 6: Outpatient Consultation [Qualifying Outpatient Encounter] • Encounter 7: Outpatient Consultation Patient diagnosed with Heart Failure on day of encounter [Heart Failure Outpatient Encounter] Patient meets IPP on seventh encounter