Vendor counting referrals to self in CMS50 - closing referral loop.

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: High
    • Component/s: None
    • None
    • Deborah Young
    • Signature Medical Group of KC PA
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      Thank you for your inquiry regarding CMS0050v14 (Closing the Referral Loop: Receipt of Specialist Report). The measure is designed to capture qualifying encounters in which a referral was ordered. As outlined in the definition section of the measure header, a referral is defined as, “a request from one clinician to another clinician for evaluation, treatment, or co management of a patient’s condition.”
       
      A surgical order placed by Dr. X for a procedure that Dr. X will also perform does not meet this definition, as it is not a referral to another clinician. Please let us know if you have any further questions.
      Show
      Thank you for your inquiry regarding CMS0050v14 (Closing the Referral Loop: Receipt of Specialist Report). The measure is designed to capture qualifying encounters in which a referral was ordered. As outlined in the definition section of the measure header, a referral is defined as, “a request from one clinician to another clinician for evaluation, treatment, or co management of a patient’s condition.”   A surgical order placed by Dr. X for a procedure that Dr. X will also perform does not meet this definition, as it is not a referral to another clinician. Please let us know if you have any further questions.
    • CMS0050v14
    • CMS0050v13
    • Our surgeons have an inaccurate denominator (and numerator) because eClinicalWorks is counting orders entered for surgery as a referral back to the ordering surgeon.

      We report as individuals and our EMR vendor, eClinicalWorks, includes surgery orders in the denominator of Closing the Referral Loop.  For example, Dr. X will see Jane Doe and recommend surgery.  The surgery order to do her right total knee replacement at Outpatient Surgery Center Z by Dr. X is counting in our denominator.  Most of the time the surgeries are performed and we can close the loop based on the operative note, but I don't believe this is the intent of the measure.  I'm afraid if I report and we get audited that this would count against us.  I opened a ticket with the QPP Help Desk and they said I had to post the issue here to see if I could still use this data.  I need to report for 2025 ASAP.

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Debbie Young
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