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URSA-HCC-003: Patients with Office Visit in Calendar YTD

  • Published on Nov 4, 2026
  • 15 minute(s) read
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Measure Description

Among patients with a calculated CMS-HCC RAF score, the percentage with one or more clinician office visits in the current calendar year-to-date.

Metadata

  • Measure Identifier: URSA-HCC-003
  • Measure Type: Rate Measure
  • Temporal Structure: Entity
  • Component Class: Normal-Form
  • Case Field: Patient ID
  • Observation Fields: Patient ID, Snapshot Date [, snapshot_date]
  • Target Direction: Up

Denominator Description

Patients with a calculated CMS-HCC RAF score as of the snapshot date.

Numerator Description

Qualifying denominator patients with one or more clinician office visits in between the start of the calendar year containing the snapshot date and the snapshot date, exclusive.

Published Fields

  • Data Model Keys

    • Patient ID -- The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.) (See also [URSA-CORE] Patient)
    • Primary Payor ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Primary Payor. (See also [URSA-CORE] Primary Payor)
    • Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment.
    • Primary Plan Attributee Provider ID

  • Patient Fields

    • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
    • Patient Age Category Tier 1 -- Non-overlapping ranges of the patient age in years into three categories; [01] Pediatrics < 19, [02] Adults 19 - 64, and [03] Older Adults >= 65. Coarser grain to the Patient Age Category Tier 2. (See also [URSA-CORE] Patient Age Category Tier 2)
    • Patient Age Category Tier 2 -- Non-overlapping ranges of the patient age in years representing finer grain categories than the Patient Age Category Tier 1. This field incorporates findings from publications on defining meaningful age groups in the context of disease. These ranges closely, but not exactly, align with standard age ranges such as those defined by the Medical Subject Headings (MeSH). See results of K-Means simple clustering method at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825015/ (See also [URSA-CORE] Patient Age Category Tier 1)
    • Patient First Name
    • Patient Last Name
    • Patient Date of Birth -- The patient's date of birth. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the date of birth found on that particular type of record in the source data.
    • Patient State Abbreviation
    • Patient ZIP Code 5-Digit

  • Date Fields

    • Period Start Date -- The date identifying the start of a period of time. Period Start Date values are inclusive; e.g., a period with Period Start Date = January 1 would begin be considered to begin at 00:00 on January 1.
    • Period End Date -- The date identifying the end of an period of time. Period End Date values are exclusive; e.g., a period with Period End Date = January 1 would begin be considered to end at precisely 00:00 on January 1 (meaning that the period did not include any time on January 1).
    • Current Continuous Primary Payor Membership Episode Start Date -- The start date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Primary Payor Membership Episode)
    • Current Continuous Primary Payor Membership Episode End Date -- The end date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Primary Payor Membership Episode, [URSA-CORE] Period End Date)
    • Current Continuous Medical Claim Data Coverage Episode Start Date -- The start date of the Continuous Medical Claim Data Coverage Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Medical Claim Data Coverage Episode)
    • Current Continuous Medical Claim Data Coverage Episode End Date -- The end date of the Continuous Medical Claim Data Coverage Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Medical Claim Data Coverage Episode, [URSA-CORE] Period 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)
    • Snapshot Date -- The date, evaluated at 00:00:00 AM, giving the moment the state of the world will be set to for the purposes of an analysis. The snapshot date does not represent the freshness of the data, or the date in real time at which an analysis was executed.

  • Insurance Fields

    • CMS RAF Type Code -- The standard 1- or 2-character CMS Part C Risk Adjustment Factor Type Code; e.g., E = New Enrollee, I = Institutional, D = Dialysis (ESRD), CF = Community Full Dual, CP = Community Partial Dual, CN = Community Non-Dual, etc.
    • Primary Payor Description
    • Primary Plan Description
    • Primary Plan CMS Contract Number
    • Primary Plan CMS PBP Number
    • Primary Plan Financial Class Description

  • Numerator Fields

    • Numerator Encounter ID
    • Numerator Encounter Date

  • Metadata Fields

    • Random Integer 1 to 1000

  • Measure Fields

    • Denominator
    • Numerator

  • Program Fields

    • Is Medicare Advantage Risk Contract Member
    • Is MSSP Member
    • Is ACO REACH Member
    • Is LEAD Member
    • Is MSSP Enrollment Type ESRD
    • Is MSSP Enrollment Type Disabled
    • Is MSSP Enrollment Type Aged Dual
    • Is MSSP Enrollment Type Aged Non-Dual
    • MSSP ACO Agreement Year Start Date
    • MSSP Renormalization Factor

  • Module Fields

    • Is CMS-HCC ESRD Status
    • CMS-HCC Eligibility Code -- The coded value used by the CMS-HCC model to characterize the patient's community vs. long-term institutional residential status, full dual vs. partial dual vs. non-dual status, and aged vs. disabled Medicare eligibility status. Values are as follows: CFA = Community Full Benefit Dual Aged; CFD = Community Full Benefit Dual Disabled; CNA = Community Non-Dual Aged; CND = Community Non-Dual Disabled; CPA: Community Partial Benefit Dual Aged; CPD = Community Partial Benefit Dual Disabled; INS = Long Term Institutional; NE = New Enrollee; SNPNE = SNP NE. Derived, when possible, from the CMS RAF Type Code (obtained either from an MMR record or a membership record). Because the model requires this code as an input, patients are assumed to be CNA if their true status is not known. (See also [URSA-HCC] CMS RAF Type Code)
    • CMS-HCC Eligibility Code Description -- The natural language description of the CMS-HCC Eligibility Code. (See also [URSA-HCC] CMS-HCC Eligibility Code)
    • CMS-HCC Patient Age -- For a given reference date or month, the patient age, expressed as an integer, evaluated as of February 1 of the calendar year containing the reference date or month; this is the method used to establish a patient's age for calculation of HCC/RAF score results.
    • CMS-HCC Age Category -- A categorical value describing the patient's age with respect to the age ranges used to group patients for the CMS-HCC RAF score calculation; uses the CMS-HCC Patient Age value. (See also [URSA-HCC] CMS-HCC Patient Age)
    • CMS-HCC Patient Sex Code -- Takes the value of "M" for male patients and "F" for female patients, which are the values expected by the CMS-HCC RAF score model. Because the model requires patient sex as an input, patients are assumed to be female if their sex is not known.
    • Is CMS-HCC Medicaid Patient -- The binary value used by the CMS-HCC model to identify Medicaid patients. Derived, when possible, from the CMS RAF Type Code (obtained either from an MMR record or a membership record). (See also [URSA-HCC] CMS RAF Type Code)
    • Is CMS-HCC Full Dual Medicaid Patient
    • Is CMS-HCC Partial Dual Medicaid Patient
    • CMS-HCC Original Reason for Entitlement Code -- The CMS Original Reason for Entitlement Code (OREC) for the patient used by the CMS-HCC model. Takes the same values as the standard CMS Original Reason for Entitlement Code field. This value is obtained from the MMR if available there, then from the membership record. Because the model requires this code as an input, patients are assumed to be OREC = Aged if their true status is not known. (See also [URSA-CORE] CMS Original Reason for Entitlement Code)
    • CMS-HCC Original Reason for Entitlement Code Description -- The natural language description of the CMS-HCC Original Reason for Entitlement Code. (See also [URSA-HCC] CMS-HCC Original Reason for Entitlement Code)
    • Is CMS-HCC LTI Status
    • Is CMS-HCC New Enrollee Status
    • Is CMS-HCC ESRD Dialysis Patient
    • Is CMS-HCC ESRD Post-Transplant Patient
    • CMS-HCC Months Since Kidney Transplant
    • Standard Final Action CMS-HCC RAF Score -- The normalized CMS-HCC RAF score calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Final Action CMS-HCC Scenario)
    • Standard Final Action CMS-HCC Raw RAF Score -- The raw (non-normalized) CMS-HCC RAF score calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Final Action CMS-HCC Scenario)
    • Standard Final Action CMS-HCC Demographic Component RAF Score -- The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Final Action CMS-HCC Scenario)
    • Standard Final Action CMS-HCC Disease Component RAF Score -- The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Final Action CMS-HCC Scenario)
    • Standard Final Action CMS-HCC v28 RAF Score -- The normalized CMS-HCC RAF score, calculated under the Standard Final Action scenario, using the CMS-HCC model v28. (See also [URSA-HCC] Standard Final Action CMS-HCC Scenario)
    • Standard Final Action CMS-HCC v28 Raw RAF Score
    • MSSP Renormalized Standard Final Action CMS-HCC RAF Score
    • Standard Final Action CMS-HCC v28 All Outputs Summary -- A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Standard Final Action scenario. (See also [URSA-HCC] CMS-HCC Model Outputs, [URSA-HCC] Standard Final Action CMS-HCC Scenario)
    • Standard Final Action CMS-HCC ESRD v24 All Outputs Summary
    • Within-Year-Updated CMS-HCC RAF Score -- The normalized CMS-HCC RAF score calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Within-Year-Updated CMS-HCC Scenario)
    • Within-Year-Updated CMS-HCC Raw RAF Score -- The raw (non-normalized) CMS-HCC RAF score calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Within-Year-Updated CMS-HCC Scenario)
    • Within-Year-Updated CMS-HCC Demographic Component RAF Score -- The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Within-Year-Updated CMS-HCC Scenario)
    • Within-Year-Updated CMS-HCC Disease Component RAF Score -- The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Within-Year-Updated CMS-HCC Scenario)
    • Within-Year-Updated CMS-HCC v28 RAF Score -- The normalized CMS-HCC RAF score, calculated under the Within-Year-Updated scenario, using the CMS-HCC model v28. (See also [URSA-HCC] Within-Year-Updated CMS-HCC Scenario)
    • Within-Year-Updated CMS-HCC v28 Raw RAF Score
    • MSSP Renormalized Within-Year-Update CMS-HCC RAF Score
    • Within-Year-Updated CMS-HCC v28 All Outputs Summary -- A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Within-Year-Updated scenario. (See also [URSA-HCC] CMS-HCC Model Outputs, [URSA-HCC] Within-Year-Updated CMS-HCC Scenario)
    • Within-Year-Updated CMS-HCC ESRD v24 All Outputs Summary
    • Within-Year-Updated Count CMS-HCC v28 HCCs
    • Historical-Diagnoses CMS-HCC RAF Score -- The normalized CMS-HCC RAF score calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Historical-Diagnoses CMS-HCC Scenario)
    • Historical-Diagnoses vs. Standard Final Action CMS-HCC RAF Score Gap -- The difference between the CMS-HCC RAF score calculated under the Historical-Diagnoses scenario and the Standard Final Action scenario; represents a theoretical increase to RAF score if all qualifying historical diagnoses had been redocumented in the reference calendar year. (See also [URSA-HCC] Historical-Diagnoses CMS-HCC Scenario, [URSA-HCC] Standard Final Action CMS-HCC Scenario)
    • Historical-Diagnoses vs. Within-Year-Updated CMS-HCC RAF Score Gap -- The difference between the CMS-HCC RAF score calculated under the Historical-Diagnoses scenario and the Within-Year-Updated scenario; represents a theoretical increase to RAF score if all qualifying historical diagnoses had been redocumented in the reference calendar year. (See also [URSA-HCC] Historical-Diagnoses CMS-HCC Scenario, [URSA-HCC] Within-Year-Updated CMS-HCC Scenario)
    • Historical-Diagnoses CMS-HCC Raw RAF Score -- The raw (non-normalized) CMS-HCC RAF score calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Historical-Diagnoses CMS-HCC Scenario)
    • Historical-Diagnoses CMS-HCC Demographic Component RAF Score -- The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Historical-Diagnoses CMS-HCC Scenario)
    • Historical-Diagnoses CMS-HCC Disease Component RAF Score -- The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Historical-Diagnoses CMS-HCC Scenario)
    • Historical-Diagnoses CMS-HCC v28 RAF Score -- The normalized CMS-HCC RAF score, calculated under the Historical-Diagnoses scenario, using the CMS-HCC model v28. (See also [URSA-HCC] Historical-Diagnoses CMS-HCC Scenario)
    • Historical-Diagnoses CMS-HCC v28 Raw RAF Score
    • MSSP Renormalized Historical-Diagnoses CMS-HCC RAF Score
    • Historical-Diagnoses CMS-HCC v28 All Outputs Summary -- A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario. (See also [URSA-HCC] CMS-HCC Model Outputs, [URSA-HCC] Historical-Diagnoses CMS-HCC Scenario)
    • Historical-Diagnoses CMS-HCC ESRD v24 All Outputs Summary
    • Historical-Diagnoses Count CMS-HCC v28 HCCs
    • Count Historical-Diagnoses CMS-HCC v28 Outputs Missing from Within-Year-Updated Outputs -- A count of all distinct outputs produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is the count of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year. (See also [URSA-HCC] CMS-HCC Model Outputs, [URSA-HCC] Historical-Diagnoses CMS-HCC Scenario, [URSA-HCC] Within-Year-Updated CMS-HCC Scenario)
    • Historical-Diagnoses CMS-HCC v28 Outputs Missing from Within-Year-Updated Outputs Summary -- A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Historical-Diagnoses scenario that are not produced by the same model run under the Within-Year-Updated scenario. In effect, this is the list of model outputs (HCCs, primarily) that are, as of the reference date, "missing" from the patient's RAF score because some diagnoses have not been documented at that point in the reference year. (See also [URSA-HCC] CMS-HCC Model Outputs, [URSA-HCC] Historical-Diagnoses CMS-HCC Scenario, [URSA-HCC] Within-Year-Updated CMS-HCC Scenario)
    • Standard Initial Run CMS-HCC RAF Score -- The normalized CMS-HCC RAF score calculated under the Standard Initial Run scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Initial Run CMS-HCC Scenario)
    • Standard Initial Run CMS-HCC Raw RAF Score -- The raw (non-normalized) CMS-HCC RAF score calculated under the Standard Initial Run scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Initial Run CMS-HCC Scenario)
    • Standard Initial Run CMS-HCC Demographic Component RAF Score -- The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Initial Run scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Initial Run CMS-HCC Scenario)
    • Standard Initial Run CMS-HCC Disease Component RAF Score -- The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Initial Run scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Initial Run CMS-HCC Scenario)
    • Standard Initial Run CMS-HCC v28 RAF Score -- The normalized CMS-HCC RAF score, calculated under the Standard Initial Run scenario, using the CMS-HCC model v28. (See also [URSA-HCC] Standard Initial Run CMS-HCC Scenario)
    • Standard Initial Run CMS-HCC v28 Raw RAF Score
    • Standard Initial Run CMS-HCC v28 All Outputs Summary -- A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Standard Initial Run scenario. (See also [URSA-HCC] CMS-HCC Model Outputs, [URSA-HCC] Standard Initial Run CMS-HCC Scenario)
    • Standard Midyear Run CMS-HCC RAF Score -- The normalized CMS-HCC RAF score calculated under the Standard Midyear Run scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Midyear Run CMS-HCC Scenario)
    • Standard Midyear Run CMS-HCC Raw RAF Score -- The raw (non-normalized) CMS-HCC RAF score calculated under the Standard Midyear Run scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Midyear Run CMS-HCC Scenario)
    • Standard Midyear Run CMS-HCC Demographic Component RAF Score -- The demographic component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Midyear Run scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Midyear Run CMS-HCC Scenario)
    • Standard Midyear Run CMS-HCC Disease Component RAF Score -- The disease component contribution to the normalized CMS-HCC RAF score, calculated under the Standard Midyear Run scenario, blending different versions of the model (v24 vs. v28) as appropriate. (See also [URSA-HCC] Standard Midyear Run CMS-HCC Scenario)
    • Standard Midyear Run CMS-HCC v28 RAF Score -- The normalized CMS-HCC RAF score, calculated under the Standard Midyear Run scenario, using the CMS-HCC model v28. (See also [URSA-HCC] Standard Midyear Run CMS-HCC Scenario)
    • Standard Midyear Run CMS-HCC v28 Raw RAF Score
    • Standard Midyear Run CMS-HCC v28 All Outputs Summary -- A semicolon-delimited list of the CMS-HCC model outputs, including both the code and natural language description for each, produced by the CMS-HCC v28 model run under the Standard Midyear Run scenario. (See also [URSA-HCC] CMS-HCC Model Outputs, [URSA-HCC] Standard Midyear Run CMS-HCC Scenario)
    • Standard Final Run CMS-HCC RAF Score
    • Standard Final Run CMS-HCC Raw RAF Score
    • Standard Final Run CMS-HCC Demographic Component RAF Score
    • Standard Final Run CMS-HCC Disease Component RAF Score
    • Standard Final Run CMS-HCC v28 RAF Score
    • Standard Final Run CMS-HCC v28 Raw RAF Score
    • Standard Final Run CMS-HCC v28 All Outputs Summary
    • Is Patient With CMS-HCC Calculations Using MAO-004 Diagnoses -- Indicates the CMS-HCC model used at least one MAO-004 diagnosis record to calculate this patient's HCC/RAF score in at least one time period.
    • Is Patient With CMS-HCC Calculations Using Claim Diagnoses -- Indicates the CMS-HCC model used at least one qualifying claim diagnosis record to calculate this patient's HCC/RAF score in at least one time period.