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["Patient Characteristic, Payer": "Payer"]

Performance/Reporting Period
2023
Value Set Description from VSAC
Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC
Inclusion Criteria: All codes in the code system
Exclusion Criteria: none

Constrained to codes in the Patient Characteristic, Payer: Payer value set (2.16.840.1.114222.4.11.3591)

QDM Datatype and Definition

"Patient Characteristic, Payer"

Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set.

Timing:

The relevantPeriod addresses:

  • startTime – the first day of insurance coverage with the referenced payer.
  • stopTime – the last day of insurance coverage with the referenced payer.
eCQMs using this data element:
CMS104v11 - Discharged on Antithrombotic Therapy
CMS105v11 - Discharged on Statin Medication
CMS108v11 - Venous Thromboembolism Prophylaxis
CMS111v11 - Median Admit Decision Time to ED Departure Time for Admitted Patients
CMS117v11 - Childhood Immunization Status
CMS122v11 - Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS124v11 - Cervical Cancer Screening
CMS125v11 - Breast Cancer Screening
CMS127v11 - Pneumococcal Vaccination Status for Older Adults
CMS128v11 - Anti-depressant Medication Management
CMS129v12 - Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
CMS130v11 - Colorectal Cancer Screening
CMS131v11 - Diabetes: Eye Exam
CMS133v11 - Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery
CMS135v11 - Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
CMS136v12 - Follow-Up Care for Children Prescribed ADHD Medication (ADD)
CMS137v11 - Initiation and Engagement of Substance Use Disorder Treatment
CMS138v11 - Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS139v11 - Falls: Screening for Future Fall Risk
CMS142v11 - Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
CMS143v11 - Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
CMS144v11 - Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
CMS145v11 - Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than or equal to 40%)
CMS146v11 - Appropriate Testing for Pharyngitis
CMS147v12 - Preventive Care and Screening: Influenza Immunization
CMS149v11 - Dementia: Cognitive Assessment
CMS153v11 - Chlamydia Screening in Women
CMS154v11 - Appropriate Treatment for Upper Respiratory Infection (URI)
CMS155v11 - Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
CMS156v11 - Use of High-Risk Medications in Older Adults
CMS157v11 - Oncology: Medical and Radiation - Pain Intensity Quantified
CMS159v11 - Depression Remission at Twelve Months
CMS161v11 - Adult Major Depressive Disorder (MDD): Suicide Risk Assessment
CMS165v11 - Controlling High Blood Pressure
CMS177v11 - Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment
CMS190v11 - Intensive Care Unit Venous Thromboembolism Prophylaxis
CMS22v11 - Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
CMS249v5 - Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture
CMS2v12 - Preventive Care and Screening: Screening for Depression and Follow-Up Plan
CMS347v6 - Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
CMS349v5 - HIV Screening
CMS506v5 - Safe Use of Opioids - Concurrent Prescribing
CMS50v11 - Closing the Referral Loop: Receipt of Specialist Report
CMS529v3 - Core Clinical Data Elements for the Hybrid Hospital-Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data
CMS56v11 - Functional Status Assessment for Total Hip Replacement
CMS645v6 - Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy
CMS646v3 - Intravesical Bacillus-Calmette-Guerin for non-muscle invasive bladder cancer
CMS68v12 - Documentation of Current Medications in the Medical Record
CMS69v11 - Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
CMS71v12 - Anticoagulation Therapy for Atrial Fibrillation/Flutter
CMS72v11 - Antithrombotic Therapy By End of Hospital Day 2
CMS74v12 - Primary Caries Prevention Intervention as Offered by Dentists
CMS75v11 - Children Who Have Dental Decay or Cavities
CMS771v4 - Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic Hyperplasia
CMS816v2 - Hospital Harm - Severe Hypoglycemia
CMS844v3 - Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM)
CMS871v2 - Hospital Harm - Severe Hyperglycemia
CMS90v12 - Functional Status Assessments for Heart Failure
CMS951v1 - Kidney Health Evaluation
CMS996v3 - Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)
CMS9v11 - Exclusive Breast Milk Feeding
Last Updated: Jul 15, 2022