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

Performance/Reporting Period
2024
Value Set Description from VSAC
Clinical Focus: Categories of types of health care payer 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 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:
CMS1028v2 - Severe Obstetric Complications
CMS104v12 - Discharged on Antithrombotic Therapy
CMS108v12 - Venous Thromboembolism Prophylaxis
CMS117v12 - Childhood Immunization Status
CMS1188v1 - Sexually Transmitted Infection (STI) Testing for People with HIV
CMS122v12 - Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS124v12 - Cervical Cancer Screening
CMS125v12 - Breast Cancer Screening
CMS128v12 - Anti-depressant Medication Management
CMS129v13 - Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
CMS130v12 - Colorectal Cancer Screening
CMS131v12 - Diabetes: Eye Exam
CMS133v12 - Cataracts: 20 over 40 or Better Visual Acuity within 90 Days Following Cataract Surgery
CMS135v12 - 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)
CMS136v13 - Follow-Up Care for Children Prescribed ADHD Medication (ADD)
CMS137v12 - Initiation and Engagement of Substance Use Disorder Treatment
CMS138v12 - Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS139v12 - Falls: Screening for Future Fall Risk
CMS142v12 - Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
CMS143v12 - Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
CMS144v12 - Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
CMS145v12 - Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF) less than or equal to 40%
CMS146v12 - Appropriate Testing for Pharyngitis
CMS149v12 - Dementia: Cognitive Assessment
CMS153v12 - Chlamydia Screening in Women
CMS154v12 - Appropriate Treatment for Upper Respiratory Infection (URI)
CMS155v12 - Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
CMS156v12 - Use of High-Risk Medications in Older Adults
CMS157v12 - Oncology: Medical and Radiation - Pain Intensity Quantified
CMS159v12 - Depression Remission at Twelve Months
CMS165v12 - Controlling High Blood Pressure
CMS177v12 - Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment
CMS190v12 - Intensive Care Unit Venous Thromboembolism Prophylaxis
CMS22v12 - Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
CMS249v6 - Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture
CMS2v13 - Preventive Care and Screening: Screening for Depression and Follow-Up Plan
CMS314v1 - HIV Viral Suppression
CMS334v5 - Cesarean Birth
CMS347v7 - Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
CMS349v6 - HIV Screening
CMS506v6 - Safe Use of Opioids - Concurrent Prescribing
CMS50v12 - Closing the Referral Loop: Receipt of Specialist Report
CMS529v4 - Core Clinical Data Elements for the Hybrid Hospital-Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data
CMS56v12 - Functional Status Assessment for Total Hip Replacement
CMS645v7 - Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy
CMS646v4 - Intravesical Bacillus-Calmette-Guerin for non-muscle invasive bladder cancer
CMS68v13 - Documentation of Current Medications in the Medical Record
CMS69v12 - Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
CMS71v13 - Anticoagulation Therapy for Atrial Fibrillation or Flutter
CMS72v12 - Antithrombotic Therapy By End of Hospital Day 2
CMS74v13 - Primary Caries Prevention Intervention as Offered by Dentists
CMS75v12 - Children Who Have Dental Decay or Cavities
CMS771v5 - Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic Hyperplasia
CMS816v3 - Hospital Harm - Severe Hypoglycemia
CMS819v2 - Hospital Harm - Opioid-Related Adverse Events
CMS844v4 - Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM)
CMS871v3 - Hospital Harm - Severe Hyperglycemia
CMS90v13 - Functional Status Assessments for Heart Failure
CMS951v2 - Kidney Health Evaluation
CMS986v2 - Global Malnutrition Composite Score
CMS996v4 - Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)
Last Updated: Jun 29, 2023

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