[CQM-6789] Initial Population eCQM CMS506v6 Created: 02/25/24  Updated: 01/09/25  Resolved: 03/11/24

Status: Closed
Project: eCQM Issue Tracker
Component/s: None

Type: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals Priority: Moderate
Reporter: Michelle Conner Assignee: Mathematica EH eCQM Team
Resolution: Answered Votes: 0
Labels: None

Contact Name: Michelle Conner
Contact Email: michelle.conner@integrishealth.org
Solution: Thank you for your question regarding CMS506v6. Evaluating data for this measure is retrospective so regardless of what the patient statuses were throughout the stay, the measure evaluates the final documentation. If that final documentation indicates an observation encounter, that data is not evaluated against the measure criteria. Inpatient encounters are defined by the value set Encounter Inpatient (OID 2.16.840.1.113883.3.666.5.307) which includes codes for Emergency hospital admission (procedure), Hospital admission (procedure), and Hospital admission, elective (procedure).
Solution Posted On:
2024 Reporting Period EH/CAH eCQMs:
CMS0506v6
Impact: Initial population including patients with a final billing status of Observation (outpatient) status
Last Commented Date:

 Description   

Regarding the Safe Use of Opioids measure for 2024 discharges, could you please clarify the definition of "inpatient encounter"?  If a patient is admitted to inpatient status (and has a Patient Placement admission order of Inpatient), but this order is updated to Observation status, and the case has a final billing status of Observation status, which is considered an outpatient encounter, would this patient be considered as meeting the definition for the Initial Population for this measure?

 Comments   
Comment by Mathematica EH eCQM Team [ 01/09/25 ]

Thank you for your question about eligible hospital eCQM reporting requirements. We recommend you submit your question about EH eCQM reporting to the QualityNet Question and Answer Tool (https://cmsqualitysupport.servicenowservices.com/qnet_qa).

 

To submit a question go to the question entry page at https://cmsqualitysupport.servicenowservices.com/qnet_qa?id=ask_a_question

  • Enter the required information designated by a red asterisk “*”
  • Under the Question Details section
  • Program: select “IQR – Inpatient Quality Reporting”
  • Topic: select “eCQM”
  • Subject: enter a short description of your question
  • Please describe your question: enter your complete question
Comment by Michelle Conner [ 01/09/25 ]

If the QRDA file/report for CMS 506 includes a patient with a final billing status of observation, will CMS remove/delete this patient case from the data?

Comment by Michelle Conner [ 01/06/25 ]

If the QRDA file/report includes a patient with a final billing status of observation, will CMS remove/delete this patient case from the data?

Comment by Joelencia Leflore [ 03/22/24 ]

Thank you for your follow up question. Cases with a final billing of observation status should be excluded from this report (and not show up at all on the case list report for this eCQM). Only cases with a final billing status of inpatient status should be included. 

Comment by Joelencia Leflore [ 03/15/24 ]

Thank you for the follow-up question. We will review your ticket and provide a response as soon as possible.

Comment by Michelle Conner [ 03/13/24 ]

Please clarify the following. Your response indicates that "if that final documentation indicates an observation encounter, that data is not evaluated against the measure criteria".  In the report from our electronic medical record for this eCQM, I am seeing "observation" status cases.  Should these cases be included in the eCQM report from our EMR, or should cases with a final billing of observation status be excluded from this report (and not show up at all on the case list report for this eCQM)?

Comment by Joelencia Leflore [ 03/11/24 ]

We apologize for the delay in providing a response for your question. We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your continued patience.

Comment by Joelencia Leflore [ 03/04/24 ]

We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your patience.

Comment by Joelencia Leflore [ 02/26/24 ]

Thank you for submitting your question. We will review your ticket and provide a response as soon as possible.

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