Thank you for your inquiry about CMS130v11. Applicable screenings to meet the numerator criteria may include; Fecal Occult Blood Test, Fecal Immunochemical Test, Flexible Sigmoidoscopy, CT Colonography, or a colonoscopy. The applicable screenings mentioned above may count towards the numerator when performed within the measurement period and/or within the time frame indicated.
A result is not required for the flexible sigmoidoscopy, colonoscopy, or CT colonography. A "non-null" result is required for screening options such as FOBT and FIT-DNA laboratory tests. An insufficient sample may count towards numerator since a non-null result can be interpreted as a result that is present in the electronic record in which any entry is acceptable; no specific value or code is required. Equivalent services can be mapped to the measure's value sets. If mapping is done, you should maintain documentation in case of a CMS audit.
Solution Posted On:
2023 Performance Period EC eCQMs:
CMS0130v11
Impact:
We would like clarification on what is required for the numerator for this measure because the specifications state that the patient had one or more screenings in the measurement period and/or that the screening was performed. We feel that would indicate that there is a result for the screening, but our vendor doesn't agree. When we get an interfaced result into our system from Exact Sciences for a Cologuard test for example that says there was an insufficient specimen, it is indicating in our system that the patient had this test performed, but the test was not performed because there was insufficient specimen to do so.
Description
This is impacting the numerator of the Colorectal Cancer Screening measure for us because the insufficient specimens are being counted as meeting the numerator. From what I am being told our system is set up to count these specimens because they are coming back into the system as a test that was performed instead of a test with a result. We need to clarify with you whether a result is expected or not to meet the numerator.
CMS130v10.zip