CMS 50v6: Closing the Referral Loop: Receipt of Specialist Report
| Measure: 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 | ||
| Measure Type | High Priority Measure | Scoring |
| Process | Yes | A higher percentage indicates better quality |
| Denominator | Number of patients, regardless of age, who were referred by one provider to another provider, and who had a visit during the measurement period |
| 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 Exceptions | None |
| Denominator Exclusions | Not Applicable |
DenominatorPatients who meet the following criteria will be included in the denominator:
Have at least one encounter during the Measurement Period finalized by EC/EP
AND
- Have at least one referral created during the Measurement Period
Encounter Codes Eligible for DenominatorCPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 92002, 92004, 92012, 92014, 99231, 99232, 99233, 99234, 99235, 99236, 99241, 99242, 99243, 99244, 99245, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99221, 99222, 99223, 99251, 99252, 99253, 99254, 99255, 99024, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337
HCPCS: G0402, G0438, G0439
Patient ReferralTo document a referral from the patient chart or patient encounter:
- From the Referrals tab in the chart or the Orders/Referrals tab in the encounter, click Add
- Populate the following sections: Date Requested (chart level only), Requested By, Refer To, Reason for Referral/Notes, and ICD Code or CPT/HCPCS
- Requested By must be EC/EP
- Click Add
NumeratorA patient will be counted in the numerator when the referral results are documented in the referral.
- Referral results must be documented at the chart level
- Documentation of results must occur after the referral has been created
- If a patient has multiple referrals during the Measurement Period, the first referral will be counted toward the numerator
Documenting Referral ResultsTo document referral results:
- From the Referrals tab, select the referral and click Update
- From the Authorization Status/Results tab, populate Date Results Received and add information to Results field
- Date Patient Seen, Date Results Given to Patient, and Attachments can be populated but are optional
- Click Save
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