URSA-CORE-911: ED Visit Services Without ED Visit

Measure Description

Among medical billing or claims service line items with a place of service code, HCPCS code, or revenue center code indicating an emergency department setting, the percentage of those documents that are not associated with an emergency department encounter. A positive result suggests missing data needed to identify an emergency department visit on that date.

Metadata

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

Denominator Description

Institutional and professional claims or billing service line items with a place of service code indicating an emergency department setting (POS = 23), a HCPCS code indicating emergency department evaluation and management, or a revenue center code indicating emergency department setting care.

Numerator Description

Denominator observations not matched to a corresponding emergency department visit encounter

Published Fields

• Data Model Keys

  • Document ID
  • Patient ID
  • Service Line Number
  • Billing Provider ID
  • Payor ID
  • Source ID

• Date Fields

  • Document Effective Date
  • Parent Document Effective Start Date
  • Parent Document Effective End Date
  • Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
  • Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)

• Clinical Services Fields

  • HCPCS Code
  • HCPCS Description
  • CMS Revenue Center Code
  • CMS Revenue Center Description
  • CMS Place of Service Code
  • CMS Place of Service Description

• Billing and Claims Fields

  • Document Type Category
  • CMS Type of Bill Code

• Financial Fields

  • Document Allowed Amount
  • Document Plan Paid Amount

• Numerator Fields

  • ED Visit Encounter ID

• Metadata Fields

  • Document Type Description

• Measure Fields

  • Denominator
  • Numerator