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

Patients 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

CPT: 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

To document a referral from the patient chart or patient encounter:

  1. From the Referrals tab in the chart or the Orders/Referrals tab in the encounter, click Add
  2. Populate the following sections: Date Requested (chart level only), Requested By, Refer To, Reason for Referral/Notes, and ICD Code or CPT/HCPCS
    1. Requested By must be EC/EP
  3. Click Add

A 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

To document referral results:

  1. From the Referrals tab, select the referral and click Update
  2. From the Authorization Status/Results tab, populate Date Results Received and add information to Results field
    1. Date Patient Seen, Date Results Given to Patient, and Attachments can be populated but are optional
  3. Click Save

https://ecqi.healthit.gov/ecqm/ep/2018/cms050v6

 

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