Measure Specifications eCQM CMS 50

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Kimberly Watson
    • 8137749800
    • DAS Health
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      Thank you for your feedback on the Closing the Referral Loop: Receipt of Specialist Report eCQM.
       The measure’s Guidance section explicitly states, “The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure.” However, the current logic cannot assign attribution to the provider. The measure determines whether the numerator requirements have been met based on information in the patient’s EHR. For patient-based measures, while a specific clinician may perform an action (or fail to) for a given patient, and thereby meet (or fail to meet) the numerator requirements, any clinician who has a qualifying encounter with that same patient, uses the same EHR, and reports on that measure can also receive credit (either favorable or unfavorable). In your situation, both Providers A and B can report favorable performance for this patient once the consultation report is received.
      Show
      Thank you for your feedback on the Closing the Referral Loop: Receipt of Specialist Report eCQM.  The measure’s Guidance section explicitly states, “The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure.” However, the current logic cannot assign attribution to the provider. The measure determines whether the numerator requirements have been met based on information in the patient’s EHR. For patient-based measures, while a specific clinician may perform an action (or fail to) for a given patient, and thereby meet (or fail to meet) the numerator requirements, any clinician who has a qualifying encounter with that same patient, uses the same EHR, and reports on that measure can also receive credit (either favorable or unfavorable). In your situation, both Providers A and B can report favorable performance for this patient once the consultation report is received.
    • CMS0050v13
    • Score earned because of the referral assignment is lower than anticipated.

      In reviewing the 2025 specifications for CMS 50 Closing the Referral loop, I was wondering if a practice has documented a referral for a physician (provider A) with a multi-provider practice, and that patient is seen by a different physician (provider B) within that same physician group; is the referring provider still able to obtain credit for this instance, once the consultation report has been completed? We are coming across a discrepancy in our EHR and want to understand if credit is still warranted. The eCQI only provides the following: Referral: A request from one clinician to another clinician for evaluation, treatment, or co-management of a patient's condition. This term encompasses referral and consultation as defined by Centers for Medicare & Medicaid Services. Report: A written document prepared by the eligible clinician (and staff) to whom the patient was referred and that accounts for his or her findings, provides summary of care information about findings, diagnostics, assessments and/or plans of care, and is provided to the referring eligible clinician. The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure. Any additional clarification you could provide would be greatly appreciated,

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Kimberly Watson
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              Created:
              Updated:
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