Clarification for CMS0108v13 Episode of Care Evaluation

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Redirected
    • Priority: Moderate
    • Component/s: None
    • None
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      Hello and thank you for your inquiry. Unfortunately, this ticket is out of scope for the eCQM Issue Tracker. Your question has been redirected to the QualityNet Service Desk, and the following ticket has been opened for you:

      [CS2670302]

      You will be contacted by their team and assigned a customer service representative who will work to resolve your inquiry. We are closing this ticket now. Please let us know if you have any additional questions about eCQM logic or specifications.
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      Hello and thank you for your inquiry. Unfortunately, this ticket is out of scope for the eCQM Issue Tracker. Your question has been redirected to the QualityNet Service Desk, and the following ticket has been opened for you: [CS2670302] You will be contacted by their team and assigned a customer service representative who will work to resolve your inquiry. We are closing this ticket now. Please let us know if you have any additional questions about eCQM logic or specifications.
    • CMS0108v14
    • CMS0108v13

      Hello,

      We are requesting clarification regarding how a specific scenario is expected to be evaluated under CMS0108v13 and other eCQM inpatient/hospital measures.

      Please note that the dates and details below are for illustrative purposes only and do not reflect any real patient information. This example is to demonstrate the scenario in question.

      Example Scenario:

      ED Arrival: December 1, 2024 at 9:00 AM – December 2, 2024 at 8:30 AM

      Observation Start: December 2, 2024 at 9:00 AM – April 2, 2025 at 11:00 AM

      Inpatient Encounter: April 2, 2025 at 11:15 AM – April 6, 2025 at 3:00 PM

      In this scenario, the ED, Observation, and Inpatient encounters occur sequentially, with less than an hour between levels of care, and clinically represent a single episode of care.

      However, during submission, CMS does not evaluate any qualifying data documented during the Observation encounter because the Observation length of stay exceeds 120 days. As a result, CMS only evaluates data associated with the Inpatient encounter.

      We are seeking clarification on the following:

      Is it the intent of CMS0108v13 to exclude all Observation encounter data when the Observation length of stay exceeds 120 days, even when the encounters are continuous and represent a single episode of care?

      What is the rationale for limiting evaluation in this way?

      We believe this is bad workflow but wondering how our code should handle this. We appreciate your guidance!

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Talisa Williams
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              Created:
              Updated:
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