eCQM: Closing the Referral Loop: Receipt of Specialist Report (CMS 50v5)

eCQM:

Closing the Referral Loop: Receipt of Specialist Report

CMS ID:

CMS 50v5

NQF Number:

N/A

NQS Domain:

Communication and Care Coordination

Measure Type:

Process

MIPS High Priority Measure:

Yes

Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)
  • Comprehensive Primary Care Plus (CPC+)

Description:

Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred.

  • Numerator: Number of patients with a referral, for which the referring provider received a report from the provider to whom the patient was referred.

  • Denominator: Number of patients, regardless of age, who were referred by one provider to another provider, and who had an eligible visit (a signed chart note with one of the following encounter types: Office Visit, Nurse Visit, Nursing Home Visit, or Home Visit) during the measurement period.

    • Denominator Exclusions: None

    • Denominator Exceptions: None

Performance Benchmark for MIPS: 71.88%
For further benchmarks and details on how this measure will be scored within the Quality performance category of MIPS, please click here.

Practice Fusion Suggested Workflow
Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR.

  1. When sending a referral for a patient, make sure that the referral is sent via Direct Message if the recipient is not a Practice Fusion provider, through the Practice Fusion network if the recipient is a verified Practice Fusion provider, or via the "Send by Fax" option available in the referral window. Referrals sent from within your Practice Fusion account using these methods will be available for review within the patient's Timeline.

  2. Coordinate, as appropriate, with the provider whom the referral was sent to ensure that they received it and to ensure that they send a follow-up consultant report after the patient is seen.

  3. After receiving the appropriate follow-up consultation report from the provider to whom the patient was referred, select the Complete check-box in the "Follow Up" column shown in Graphic 1 next to each completed referral (accessible from the Timeline by selecting “Referrals” from the drop down menu filter) to meet the measure criteria. Please note that you must check the specified checkbox in order to receive numerator credit for this measure. Checking the Receipt Confirmed checkbox will not result in numerator credit for this measure.

Graphic 1. Referral Follow-Up Checkbox

Additional Measure Information

  • This 2016 measure version has been updated from the previous 2015 version specifications, incorporating the following change:

    • Guidance added to account for the numerator actions intentionally not having an end parameter. If the consultant report is communicated after the referral but falls outside of the measurement period, that satisfies the numerator criteria as long as the communication occurs before the submission of measure results is required.

    • Updated the numerator timing from “during measurement period” to “starts after start of ‘Occurrence A of Intervention, Performed: Referral.’” This update further connects the referral and the communication of the consultant report by requiring the correct workflow sequencing and allows additional time for closing the referral loop in instances of referrals nearing the end of the measurement period.

  • The provider to whom the patient was referred should be the same provider that sends the report. If there are multiple referrals for a patient during the measurement period, the first referral sent will be used for numerator calculation.

  • The consultant report that will fulfill the referral loop should be completed after the referral. Eligible clinicians reporting on this measure should note that all data for the performance year is to be submitted by the deadline established by CMS, so clinicians who see patients towards the end of the reporting period (i.e. December), should record the consultant report as soon as possible using the workflow listed in order for those patients to be counted in the measure numerator.

More Information

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