CMS 50v11: Closing the Referral Loop: Receipt of Specialist Report

Measure: Percentage of patients with referrals, regardless of age, for which the referring clinician receives a report from the clinician 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 had an encounter during the measurement period and were referred by one clinician to another clinician on or before October 31
Numerator Number of patients with a referral on or before October 31, for which the referring clinician received a report from the clinician 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 eligible encounter during the Measurement Period finalized by EC

    AND

  • Have at least one referral created on or before October 31 during the Measurement Period

CPT: 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99395, 99396, 99397, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394

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:
    1. Date Requested (chart level only)
    2. Requested By
      1. Requested By must be EC
    3. Refer To
      1. Refer To must be another provider
    4. Reason for Referral/Notes
    5. ICD Code or CPT/HCPCS
  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 type information in the 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/ec/2023/cms050v11

 

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