Patients are attributed to hospitalists though the patients do not have a qualifying encounter with the hospitalists

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • 4152976156
    • Commonspirit Health
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      Thank you for your inquiry regarding CMS125v13 (2025 Performance Period). The eCQMs are designed to use clinical data from structured fields in the EHR, as opposed to billing/claims data. The logic is specified such that if the providers are sharing an EHR or if data is being shared through Health Information Exchange, all providers that have access to the data would receive credit. Please note that the denominator encounter logic/codes are not provider specific. As specified in the measure logic, visits that would qualify for the Initial Population are those encoded with any codes listed in the value sets from the "Qualifying Encounters" definition. To fulfill the criteria for this measure, ensure documentation aligns with the measure requirements and is recorded within the EHR. Patient inclusion/exclusion would be determined as per this specification.

      If you have questions about understanding measure requirements, you may refer to the "Guide for Reading eCQMs" for additional guidance. If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs. For additional guidance regarding MIPS eligibility and participation options, you may submit questions to the QPP Service Center.
      Show
      Thank you for your inquiry regarding CMS125v13 (2025 Performance Period). The eCQMs are designed to use clinical data from structured fields in the EHR, as opposed to billing/claims data. The logic is specified such that if the providers are sharing an EHR or if data is being shared through Health Information Exchange, all providers that have access to the data would receive credit. Please note that the denominator encounter logic/codes are not provider specific. As specified in the measure logic, visits that would qualify for the Initial Population are those encoded with any codes listed in the value sets from the "Qualifying Encounters" definition. To fulfill the criteria for this measure, ensure documentation aligns with the measure requirements and is recorded within the EHR. Patient inclusion/exclusion would be determined as per this specification. If you have questions about understanding measure requirements, you may refer to the "Guide for Reading eCQMs" for additional guidance. If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs . For additional guidance regarding MIPS eligibility and participation options, you may submit questions to the QPP Service Center.
    • CMS0125v13
    • Inpatient data is not included in the QRDAs. Patients attributed to hospitalists - and who have no PCP or other participating provider affiliation in our system - will have no data that can be reported.

      We have a number of patients in our ACOs that are attributed to hospitalists. We are checking PECOS now to ensure the hospitalists have been correctly identified as inpatient providers and will correct this if they have not been accurately identified as inpatient providers.

      None of the attributed patients had a qualifying encounter with the hospitalist or any other provider within our system. None of the inpatient data is included in our QRDAs. Our questions:

      1) Would patients be attributed to a hospitalist because they had a qualifying encounter elsewhere?

      2) Is it possible to exclude these patients because they have no qualifying encounter or data that we can submit to CMS?

       

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Susan Merrill
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              Created:
              Updated:
              Resolved:
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