URSA-CORE-921: Institutional Claims with Suspected Duplicate

Measure Description

Among institutional claim service line items, the percentage for which another record exists with identical patient, service start date, line number, and HCPCS code plus the first HCPCS modifier code or CMS revenue center code; the idea is that these duplicates will appear if the claims data have not been properly reconciled to final action.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Event
• Component Class: Normal-Form
• Denominator Case Field: Claim Service Line Item ID
• Target Direction: Down

Denominator Description

Institutional claim service line items.

Numerator Description

Denominator observations with at least one other institutional claim service line item with the same patient, service start date, service line number, and HCPCS code plus the first HCPCS modifier code or CMS revenue center code.