URSA-CORE-913: Office Visit Services Not Matched to Office Visit

Measure Description

Among medical billing or claims service line items with a place of service or HCPCS code indicating a clinician office visit, the percentage of those documents that are not associated with a clinician office visit encounter.

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 service line items with a place of service code indicating an office setting (POS = 11) or a HCPCS code for outpatient evaluation and management.

Numerator Description

Denominator observations not matched to a clinician office visit encounter

Published Fields

• Data Model Keys

  • Document ID
  • Patient ID
  • 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)

• Provider Fields

  • Billing Provider NPI
  • Billing Provider Description

• 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
  • CMS Type of Bill Description

• Numerator Fields

  • Clinician Office Visit Encounter ID

• Measure Fields

  • Denominator
  • Numerator