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  1. CYPRESS Issue Tracker
  2. CYPRESS-1286

CMS 69 denominator exception issue?

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    • Icon: Bug/Issue Bug/Issue
    • Resolution: Answered
    • Icon: Moderate Moderate
    • Implementation Problem

      We believe there is a bug on CMS69v5.

      It states our patient "Bonnie Stokes" should be a denominator exception.

      However, she had an action that satisfies the numerator (a referral and an above normal follow-up.

      Therefore she shouldn't be considered a denominator exception?

      Here is my understanding on denom exceptions (copied from another ticket)

      BLOCKER! URGENT!

      ​"Denominator exceptions are utilized when there are populations for which the numerator action may be appropriate, but there might be valid reasons for not performing the said action. In the scenario outlined for Patient A, when calculating the measure, the patient would first meet the Initial Population (IP)/Denominator (D) requirements. The numerator is then assessed, and, if the numerator action was not performed, one would look to see if there were applicable exceptions and, if so, whether or not the patient had a valid denominator exception. It would be at that point, if the patient had a valid denominator exception, where the patient would then be removed from the denominator count, and reported in the exception rate. In the scenario for Patient B, a patient cannot meet both the numerator and the denominator exception. As described above, if a patient meets the IP/D criteria, the numerator would then be assessed. Since Patient B successfully met the numerator, that patient would be counted in both the denominator and the numerator calculations. Because the numerator was met, there would be no need to look for a documented denominator exception, and calculation for that patient would end."

            dczulada David Czulada
            dstrubler Diana Strubler (Inactive)
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