HIV Diagnosis for Denominator for CMS314v2: HIV Viral Suppression

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Megan Carlucci
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      Thank you for your questions related to CMS314v2. To answer your first two questions, the measure specification captures any HIV diagnoses that start before the start of the measurement period or within the first 90 days of the measurement period. The CQL logic looks back in the medical record to determine if a patient has ever had a diagnosis. The measure does not require an additional diagnosis or documentation to be considered active, and there currently is not a provision in the logic for patients whose diagnosis was abated. Regarding the third question, there is no provision in the measure logic for erroneous diagnoses; the CQL is unable to tell if a diagnosis is incorrect. Please work with your EHR vendor on removing incorrect codes and maintain documentation on any code changes in case of CMS audit.
      Show
      Thank you for your questions related to CMS314v2. To answer your first two questions, the measure specification captures any HIV diagnoses that start before the start of the measurement period or within the first 90 days of the measurement period. The CQL logic looks back in the medical record to determine if a patient has ever had a diagnosis. The measure does not require an additional diagnosis or documentation to be considered active, and there currently is not a provision in the logic for patients whose diagnosis was abated. Regarding the third question, there is no provision in the measure logic for erroneous diagnoses; the CQL is unable to tell if a diagnosis is incorrect. Please work with your EHR vendor on removing incorrect codes and maintain documentation on any code changes in case of CMS audit.
    • CMS0314v2

      Patients have a qualifying diagnosis on a visit prior to 2025; however, after review it has been determined that the patient does not actually have HIV. These patients are appearing in the denominator but do not require testing.

      • Is there a lookback as to what would be considered an "active" diagnosis? Some of these are coming from a few years back but do not have a related diagnosis on any encounters in the last few years.

      • Is there any other logic that can be applied to determine an "active" diagnosis? Perhaps looking to see if the diagnosis still appears on the patient's problem list?

      • For recently misdiagnosed patients, is there anything that can be done to exclude the patients or should they be manually removed from the report at the end of the year? If manual removal of these patients is allowed, is there anything needed to designate such on the report?

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Megan Carlucci
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