["Participation": "Medicare payer"]

Performance/Reporting Period

2022

Value Set Description from VSAC

Clinical Focus: The purpose of this value set is to identify concepts for Medicare Fee-For-Service payer types.
Data Element Scope: This value set may use a model element related to Patient Characteristic.
Inclusion Criteria: Includes concepts that identify a patient with Medicare Fee-For-Service as a payer source.
Exclusion Criteria: Excludes concepts that represent non-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.

QDM Attributes

participationPeriod

The time from:

enrollmentStartdate - The time the patient enrolled in the program.

to

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.