CMS826 clarification of initial population

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Lori Davidson
    • 6077636214
    • United Health Services, Inc
    • Hide
      Hello and thank you for the inquiry.

      Based on our review of your scenario, we recommend that you work with your revenue cycle and IT teams to confirm that these cases are being appropriately handled.

      When a patient’s class is restatused from inpatient to observation, if the case is determined to be an accurate revision of the inpatient status, it should be excluded or filtered out in QRDA I submissions. For the purposes of reporting inpatient eCQMs, only true inpatient admissions should be included.

      We hope this helps, please let us know if you have any follow up questions.
      Show
      Hello and thank you for the inquiry. Based on our review of your scenario, we recommend that you work with your revenue cycle and IT teams to confirm that these cases are being appropriately handled. When a patient’s class is restatused from inpatient to observation, if the case is determined to be an accurate revision of the inpatient status, it should be excluded or filtered out in QRDA I submissions. For the purposes of reporting inpatient eCQMs, only true inpatient admissions should be included. We hope this helps, please let us know if you have any follow up questions.
    • CMS0826v3
    • CMS0826v2
    • Erroneously identifying "inpatient admission" encounters for initial population.

      We need some help clarifying how to identify an "inpatient hospitalization" encounter for initial population reporting on eCQMS as we are in disagreement with how our EHR EPIC is defining it.  

      Example:  Patient X arrives via ED and provider enters an "Inpatient admission" order and sends the patient to a floor unit.  Three hours later the patient is reevaluated and it is determined the patient does not qualify as an inpatient admission and is reclassified as an observation stay.  Patient is discharged two days later with final coded/billed patient class/encounter type of "observation"

      For this example EPIC is saying that the patient must be included in the initial population for inpatient eCQMs like CMS826 because they were in the ADT patient class of "inpatient" at any time and for any duration during their encounter.  We are interpreting this as not a qualifying encounter because the patient class for the encounter itself (ending patient class and what was coded/billed as) is observation status/encounter type.

      Currently, the "encounter inpatient" snowmed codes from 2.16.840.1.113883.3.666.5.307 will trigger in EPIC EHR as existing and qualifying the encounter for inpatient hospitalization eCQM reporting if an ADT inpatient admission class ever existed for any duration of time during the encounter even if the coding/billing encounter type is observation (as seen in the patient example given).  Should the initial population "inpatient hospitalization" be determined as ever in inpatient class status or ever admitted into an inpatient unit (note that all our units are inpatient units but hold both inpatient and observation status patients at the same time) as EPIC states is the determination or should the initial population be based on the encounters final determination of patient class as "inpatient" via the final patient class of the encounter which is coded/billing patient class/encounter type.  

       

      Thanks

      Lori Davidson, RN BSN

      Nursing Analytics & Informatics Liaison, Quality & Patient Safety

      United Health Services, Inc.

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            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Lori Davidson
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