[CHM-362] CCDE files without a MBI number How will CMS link CCDE files to the claims data for encounters covered by Medicare Advantage plans where a MBI number is not included in the CCDE file? Created: 02/28/25 Updated: 03/05/25 |
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| Status: | Done |
| Project: | CMS Hybrid Measures |
| Component/s: | None |
| Affects Version/s: | None |
| Fix Version/s: | None |
| Type: | Logic/Intent/Data Elements | Priority: | Moderate |
| Reporter: | Robert Trout | Assignee: | CHM Admin User |
| Resolution: | Unresolved | Votes: | 0 |
| Labels: | None | ||
| Remaining Estimate: | Not Specified | ||
| Time Spent: | Not Specified | ||
| Original Estimate: | Not Specified | ||
| Impact: | With the addition of encounters paid for by Medicare Advantage plans to the hybrid measures, providing the data required to link the CCDE files to claims data is essential to reach the data completeness requirements. |
| Contact Name: | Robert Trout |
| Contact Email: | robert.trout@commonspirit.org |
| Contact Phone: | 281 785-0282 |
| Institution/Name: | St Luke's Health |
| Guidance required: | Instruction on data requirements to ensure capture of CCDE files for encounters ensured by MA plans. |
| Solution: | Instruction on data requirement to ensure capture of CCDE files for encounters ensured by MA plans. |
| Comment Posted On: |
| Description |
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The ecqi.healthit.gov website page for the 2024 hybrid measures states that for each hospitalization please also submit linking variables which include the Medicare Beneficiary Identifier (MBI) https://ecqi.healthit.gov/ecqm/eh/2024/cms0529v4?qt-tabs_measure=measure-information For each encounter please also submit the following Linking Variables: |
| Comments |
| Comment by CHM Admin User [ 03/04/25 ] |
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Thank you for your question and continued interest in the hybrid measures. If a case is missing MBI, CMS will be unable to match it to a claim and the case’s CCDE would be considered missing. This is because MBI is a required variable to match, along with CCN, Admission Date, and Discharge Date. In accordance with the QRDA I file structure and HQR system, if MBI is missing (that is, the field is empty), the QRDA file will be rejected by the system. If MBI is unknown, hospitals can populate the MBI field with a null value, such as 'UNK', so that the QRDA will be accepted by the HQR system. However, CMS would not be able to match the case’s CCDE to claims data for measure calculation. In the calendar year 2025 Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) Payment System final rule, CMS extended voluntary reporting for the hybrid measures for the Hospital Inpatient Quality Reporting (IQR) Program fiscal year 2027 performance period of July 1, 2024 – June 30, 2025 (data submission deadline October 1, 2025). CMS guides hospitals that choose to participate in this period of voluntary reporting to submit data for their Medicare FFS and Medicare Advantage patients per the measure specifications. CMS Hybrid Measures Team |