• Measure 374: Closing the Referral Loop: Receipt of Specialist Report


    Updated January 2019.

    Reporting Options: 

      • IRIS Registry Manual Data Entry: groups and individuals
      • IRIS Registry for EHR: groups and individuals
      • EHR through your vendor (if offered): groups and individuals

    eMeasure Identifier: CMS50v7

    Measure Type: Process- High Priority

    NQS Domain: Communication and Care Coordination

    Meaningful Measure Area: Transfer of Health Information and Interoperability

    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

    Instructions: This is an outbound measure, meaning the provider who referred the patient submits this measure, not the provider who received the referral.

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

    This measure is to be reported on the number of patients with a referral, for which the referring provider received a report from the provider to whom the patient was referred.

    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, use the first referral.

    Definition: 

    Referral: A request from one physician or other eligible provider to another practitioner for evaluation, treatment, or co-management of a patient’s condition. This term encompasses referral and consultation as defined by Centers for Medicare and Medicaid Services.

    To Which Patients Does the Measure Apply?

    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

    There are two criteria for inclusion of a patient into the denominator.

    1. Patient characteristics: Description located in “Instructions” (see above).
    2. Procedure codes (CPT and HCPCS): Codes located in “CPT Codes” and “HCPCS Codes.”

    CPT Codes

    Patient encounter during the performance period (CPT or HCPCS): 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*

    WITHOUT Telehealth Modifier: GQ, GT, 95, POS 02

    AND

    Patient was referred to another provider or specialist during the performance period: G9968

    How To Report the Measure

    IRIS Registry Manual Reporting

    Category II Codes

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

    • Performance Met: Provider who referred the patient to another provider received a report from the provider to whom the patient was referred (G9969)
    • Performance Not Met: Provider who referred the patient to another provider did not receive a report from the provider to whom the patient was referred (G9970)

     

    IRIS Registry EHR Reporting

    These are the required elements to be documented at least once a year to meet the measure performance requirements.

    • For patient referred outside of the practice, receipt of the report from the provider 

    How CMS Scores Your Performance

    • If you successfully report a measure for less than 60 percent of your patients, you will earn points based on your practice size:
      • Small practices (≤ 15 clinicians) will receive 3 points,
      • Larger practices (> 15 clinicians) will receive 1 point.
    • If you successfully report a measure for at least 60 percent of your patients, but do not report at least 20 cases, you will receive 3 points.
    • If you report this measure for at least 60 percent of applicable patients and on at least 20 patients during a reporting period, you will earn points based on the decile that corresponds to your performance rate. Not all measures offer points for every decile.

    Benchmarks

    Decile/Points EHR (Including EHR–IRIS integration) IRIS Registry web portal (no EHR)
    3 7.63 – 14.97 6.77 - 8.50
    4 14.98 – 26.32 8.51 - 37.83
    5 26.33 – 36.73 37.84 - 62.85
    6 36.74 – 48.14 62.86 - 82.42
    7 48.15 – 60.24 82.43 - 88.88
    8 60.25 – 74.43 88.89 - 92.73
    9 74.44 – 90.74 92.74 - 99.01
    10 >=90.75 >= 99.02