We have downloaded 2018 Cypress files along with the expected results for the purpose of internal testing. In doing so, we notice several instances of the same patient having multiple QRDA files, and when viewing expected results we are seeing that name only once. We have attached an example of this for reference, along with a snapshot of the expected results.

When viewing the contents of each of the files attached, we notice that the only way these files could produce the expected result is if the contents of both files are combined.
The files attached were generated for CMS111v6 (ED-2). 2_Alicia_Perkins.xml contains only a reference to an Emergency Department Visit, but no subsequent Inpatient Encounter. 3_Alicia_Perkins.xml contains on a reference to an Inpatient Encounter and an Encounter Order, but no Emergency Department Visit. Since the IPP definition for this measure requires the presence of an ER Visit, and Encounter Order and an Inpatient Encounter, neither file by itself would qualify the patient for the CMS111v5 (ED-2) Initial Patient Population or Measure Population. However, the expected result shows that this patient is included in the Initial patient population and measure population.

It is our understanding that a QRDA file when constructed for a patient and a given measure is designed to hold all relevant information for that patient for the time period specified in the QRDA’s reporting parameter section. As such, our system does not combine a second QRDA for the same patient, but overrides the existing information with the latest version of the QRDA for that patient.

Can you confirm for us that for instances where we have downloaded Cypress test files and expected results, and duplicate files exist for a patient, that the expected results are reflective of the collective contents of all files for that patient?