SOP Codes are mandatory but desired implementation of SOP codes is not clear

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    • Type: Implementation Guidance
    • Resolution: Answered
    • Priority: Minor
    • Component/s: None
    • None
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      Some of the questions have been addressed in the CMS QRDA IG for EP and HQR programs, the IG can be downloaded from the CMS eCQM Library website under the QRDA Resources.
      1. For QRDA-I, it allows multiple payer information to be sent. The CMS QRDA IG has this statement "when a patient has multiple payers, only count the primary payer (usually this is the first payer listed)", and it applies to QRDA-III only.
      2. For QRDA-I, missing sex will be submitted as unknown.
      3. For QRDA-I, missing race and ethnicity could be either submitted as unknown or patient has declined to specify, please refer to the CMS QRDA IG for details.
      4. Birth time is required for QRDA-I as many eCQMs requires age in their measure logics.

      Regarding the missing payer information, for QRDA-I, the SOP value set contains a code "9999 Unavailable/Unknown".
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      Some of the questions have been addressed in the CMS QRDA IG for EP and HQR programs, the IG can be downloaded from the CMS eCQM Library website under the QRDA Resources. 1. For QRDA-I, it allows multiple payer information to be sent. The CMS QRDA IG has this statement "when a patient has multiple payers, only count the primary payer (usually this is the first payer listed)", and it applies to QRDA-III only. 2. For QRDA-I, missing sex will be submitted as unknown. 3. For QRDA-I, missing race and ethnicity could be either submitted as unknown or patient has declined to specify, please refer to the CMS QRDA IG for details. 4. Birth time is required for QRDA-I as many eCQMs requires age in their measure logics. Regarding the missing payer information, for QRDA-I, the SOP value set contains a code "9999 Unavailable/Unknown".

      1.SOP codes use a new code system and are not currently being collected by the vast majority of providers.
      a.Is there any help, implementation guidance or other methods of easing the burden for providers to begin using this new code?
      b.Is it reused anywhere else?
      c.Is there a crosswalk to existing collected payment information?
      2.What is the desired logic in case of a patient missing a SOP code?
      3.What is the desired logic in case of a patient with multiple SOP codes?
      4.Both the above apply to the logic of how to
      a.add up the numbers of patients with missing and extra SOP codes
      b.select patient as Medicare patients when filtering for Medicare patients if they have multiple or missing SOP codes
      5.What is the desired logic in case of other missing or incomplete patient information such as:
      a.missing sex, age, (missing or multiple) race, ethnicity
      b.corrected/updated/otherwise changed sex, age, race, ethnicity, etc. that happens within the reporting period

            Assignee:
            Yan Heras
            Reporter:
            Harika Prabhakar (Inactive)
            Votes:
            1 Vote for this issue
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              Created:
              Updated:
              Resolved: