CMS off-cycle update affects claims-based measures

Ken BellClient News, Skilled NursingLeave a Comment


On Monday, Nov. 26, CMS alerted providers via their CASPER Five-Star Report that CMS had performed an off-cycle update to the claims-based scores in November. This update affects the outcomes of three claims-based measures:

  • Re-Hospitalized After SNF Admission
  • Outpatient ER Visit
  • Discharged to Community

According to CMS:

“…It is not typical for the claims-based QMs to be updated off cycle, so a given facility may see an unexpected change in the QM star rating and potentially a change in the overall star rating based on this update. Going forward, CMS plans to update the claims-based QMs quarterly (in January, April, July, and October) to correspond with the MDS-based QM updates.”

How this affects SimpleAnalyzer™ users

For SimpleAnalyzer™ users, results for the three affected claims-based measures (Re-Hospitalized After SNF Admission, Outpatient ER Visit, and Discharged to Community) and your overall Total QM points in SimpleAnalyzer™ could change as well.

We’re currently in the process of updating SimpleAnalyzer™ with the modified scores from CMS. This update will be finalized over the coming weekend (Dec. 1-2). By Monday, Dec. 3, you should see the updated calculations for these three measures.

Thank you for your patience as we catch up with these latest changes from CMS. If you have any questions, please contact our Support Team.

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