Reframe tone to move away from implication that physician relies on payer systems as the primary "source of truth."

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    • Type: Change Request
    • Resolution: Persuasive
    • Priority: Highest
    • US Da Vinci DEQM (FHIR)
    • 2.1.0 [deprecated]
    • Clinical Quality Information
    • Example Use Cases
    • 3.4.4.3
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      Original: The provider noticed Gaps Patient01 was indicated as having an open gap for Colorectal Cancer Screening. The provider ordered an colonscopy and the patient was able to get it done in the next few days.

      Since the payer system did not have this new data, the provider then used the DEQM Data Exchange profile(s) to submit additional data to the payer. Please see Colorectal Cancer Screening (COL) Use Case for details on how to complete the DEQM Data Exchange.

       

      Change:

      The provider noticed Gaps Patient01 was indicated as having an open gap for Colorectal Cancer Screening. The provider ordered an colonoscopy and the patient was able to get it done in the next few days.  Typically a claim by the colonoscopy performer will close the gap.  However, the provider may elect to send the submit report data to close the gap. Please see Colorectal Cancer Screening (COL) Use Case for details on how to complete the DEQM Data Exchange.

       

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      Original: The provider noticed Gaps Patient01 was indicated as having an open gap for Colorectal Cancer Screening. The provider ordered an colonscopy and the patient was able to get it done in the next few days. Since the payer system did not have this new data, the provider then used the DEQM Data Exchange profile(s) to submit additional data to the payer. Please see Colorectal Cancer Screening (COL) Use Case for details on how to complete the DEQM Data Exchange.   Change: The provider noticed Gaps Patient01 was indicated as having an open gap for Colorectal Cancer Screening. The provider ordered an colonoscopy and the patient was able to get it done in the next few days.  Typically a claim by the colonoscopy performer will close the gap.  However, the provider may elect to send the submit report data to close the gap. Please see Colorectal Cancer Screening (COL) Use Case for details on how to complete the DEQM Data Exchange.  
    • Peter Muir/Molly Malavey: 20-0-0
    • Clarification
    • Non-substantive

      Wouldn't the claim take care of this? This sounds like extra work for the practice. The tone is that the physician relies on the payer as the “source of truth” for a patient’s treatment history. Payers can provide helpful info – for example, flag if a patient had recent imaging through another provider – but the practice’s EHR runs its own reports to ID care gaps. It seems unlikely that the practice will spend this much time pinging the payer to let it know a gap has been addressed (and double-checking, too!) unless the payer won’t/didn’t receive a claim for the service for some reason.

      Existing Wording:

      Since the payer system did not have this new data, the provider then used the DEQM Data Exchange profile(s) to submit additional data to the payer. Please see Colorectal Cancer Screening (COL) Use Case for details on how to complete the DEQM Data Exchange.

            Assignee:
            Linda Michaelsen
            Reporter:
            molly.malavey@ama-assn.org
            Watchers:
            1 Start watching this issue

              Created:
              Updated:
              Resolved: