Measure Report Category: Risk Adjustment

Clinical Data Collection Deadline Extension: 2022-03-31

status: Complete

type: Individual

measure: Risk Adjustment Model Version 5 - CMS Prescribing Drug Hierarchical Category Condition (CMS-RxHCC)

subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

date: 2021-10-18

reporter: Organization ABC Payer

period: 2021-01-01 --> 2021-09-30

group

id

group-001

Condition Category Type Extension: Historic Condition Category Gap

Evidence Status Extension: Closed Condition Category Gap

Evidence Status Date Extension: 2021-04-01

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 227: Pulmonary Fibrosis and Other Chronic Lung Disorders

group

id

group-002

Condition Category Type Extension: Historic Condition Category Gap

Evidence Status Extension: Open Condition Category Gap

Evidence Status Date Extension: 2020-07-01

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 131: Bipolar Disorders

group

id

group-003

Condition Category Type Extension: Suspected Condition Category Gap

Evidence Status Extension: Closed Condition Category Gap

Evidence Status Date Extension: 2021-02-15

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 30: Diabetes with Chronic Complications

group

id

group-004

Condition Category Type Extension: Suspected Condition Category Gap

Evidence Status Date Extension: 2021-04-01

Evidence Status Extension: Closed Condition Category Gap

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 43: Morbid Obesity

group

id

group-005

Condition Category Type Extension: Suspected Condition Category Gap

Evidence Status Extension: Pending Condition Category Gap

Evidence Status Date Extension: 2021-09-29

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 31: Diabetes without Complications

group

id

group-006

Condition Category Type Extension: Net-New Condition Category

Evidence Status Extension: Pending Condition Category Gap

Evidence Status Date Extension: 2021-09-29

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma

evaluatedResource:

• Condition Allergic bronchopulmonary aspergillosis
• Condition Bipolar disorder, current episode mixed, mild
• Condition Diabetes mellitus due to underlying condition with other diabetic kidney complication
• Condition Body mass index [BMI] 45.0-49.9, adult
• Condition Long term (current) use of insulin
• Condition Chronic obstructive pulmonary disease with (acute) exacerbation
• Condition Allergic bronchopulmonary aspergillosis
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-03-27 --> 2021-03-27
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2017-02-03 --> 2017-02-03
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-01-31 --> 2021-01-31
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-09-26 --> 2021-09-26
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2018-07-21 --> 2018-07-21