A1c - clinical vs. claims question CMS122v14

XMLWordPrintable

    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Theresa Loomis
    • 504-559-7808
    • Ochsner Health
    • Hide
      Thank you for your inquiry regarding CMS122v14 (2026 Performance Period). The eCQMs are designed to use clinical data from structured fields in the EHR, as opposed to billing/claims data. This measure requires documentation of an HbA1c or GMI lab test, identified by the "HbA1c Laboratory Test" (2.16.840.1.113883.3.464.1003.198.12.1013) value set or the "Glucose Management Indicator" LOINC code (97506-0), along with the test result and date. You will need documentation of the criteria mentioned above in the structured fields of the EHR for measure evaluation. Please review the measure specification for further details about measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS122-v14.0.000-QDM.html.
       
      If you need assistance reading an eCQM, please refer to the resources available at eCQI Resource Center, such as "Guide for Reading eCQMs" or "Implementation Checklist eCQM Annual Update": https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs. For inquiries about CMS quality program reporting requirements or other quality measure collection types (e.g., MIPS CQM), please contact the QPP Helpdesk at QPP@cms.hhs.gov.
      Show
      Thank you for your inquiry regarding CMS122v14 (2026 Performance Period). The eCQMs are designed to use clinical data from structured fields in the EHR, as opposed to billing/claims data. This measure requires documentation of an HbA1c or GMI lab test, identified by the "HbA1c Laboratory Test" (2.16.840.1.113883.3.464.1003.198.12.1013) value set or the "Glucose Management Indicator" LOINC code (97506-0), along with the test result and date. You will need documentation of the criteria mentioned above in the structured fields of the EHR for measure evaluation. Please review the measure specification for further details about measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS122-v14.0.000-QDM.html .   If you need assistance reading an eCQM, please refer to the resources available at eCQI Resource Center, such as "Guide for Reading eCQMs" or "Implementation Checklist eCQM Annual Update": https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs . For inquiries about CMS quality program reporting requirements or other quality measure collection types (e.g., MIPS CQM), please contact the QPP Helpdesk at QPP@cms.hhs.gov .
    • CMS0122v14
    • CMS0122v13
    • CMS0122v12
    • A1c reporting - knowledge and understanding; accuracy

      We have a question regarding the eCQM A1c measure and clinical vs. claims data. If a patient has evidence of a compliant clinical result and only claims data for a later A1c result, which data trumps? Is the patient still compliant for the measure using the earlier result since clinical data is satisfying? Or would the patient be non-compliant for the measure until clinical data is supplied for the later result since the measure requires the most recent value of the measurement year? 

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Theresa Loomis (Inactive)
            Votes:
            0 Vote for this issue
            Watchers:
            2 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: