["Participation": "Medicare payer"]

Performance/Reporting Period

2021

Value Set Description from VSAC

Clinical Focus: This value set contains codes for Medicare payer types.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype Participant. The intent of this data element is to identify patients with Medicare Fee-For-Service as a payer source.
Inclusion Criteria: Includes only codes that identify Medicare Fee-For-Service as a payer source.
Exclusion Criteria: Excludes codes which do not represent Medicare Fee-For-Service as a payer source.

Constrained to codes in the Participation: Medicare payer value set (2.16.840.1.113762.1.4.1104.10)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

"Participation"

Data elements that meet criteria using this datatype should document the type of plan or program in which the patient is expected to be enrolled. The program is identified as the Issuer (e.g., Aetna, Blue Cross Blue Shield Association, Cigna). The code attribute indicates the coverage type indicating the program in which the subject of record participates (e.g., health insurance plan policy, disease specific policy, health maintenance organization policy)

Timing:

participationPeriod addresses:

enrollmentStartdate - The time the patient enrolled in the program.
enrollmentEnddate - The time the patient’s enrollment in the program ends.

eCQMs using this data element:

CMS529v1 - Core Clinical Data Elements for the Hybrid Hospital-Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data

QDM Attributes

participationPeriod

The time from:

enrollmentStartdate - The time the patient enrolled in the program.

enrollmentEndDate - The time the patient's enrollement in the program ends.

Note: participationPeriod references the QDM datatype "Participation", representing a patient's coverage by a program such as an insurance or medical plan or a payment agreement. The participationPeriod is not to be confused with the QDM participant attribute used with the "Encounter, Performed" QDM datatype.