RiskAdjustmentCodingGapMeasureReport

Risk Adjustment Coding Gap MeasureReport

activeDa Vinci Risk Adjustment2.1.0resource25 key elements

This profile is based on the MeasureReport to represent a risk adjustment coding gap report. Payer runs risk adjustment engine and uses this profile to represent the risk adjustment Condition Category (CC) coding gaps and their detailed information for a patient.

Metadata

hl7.org/fhir

Canonical URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport
ID: ra-measurereport
Type
Base Definition
Derivation: constraint

Mandatory and Must-Support Elements

Elements with cardinality > 0 or marked as Must Support (S)

Path	Card.	Type	Flags	Description
:measurereport-category	1..1	Extension	S1+
extension.value[x].coding	1..1		1+
extension.value[x].coding.code	1..1		1+
:clinicalDataCollectionDeadline	0..1	Extension	S
status			S
type		code	S	The type code is fixed to 'individual' for a risk adjustment coding gap report
measure		canonical	S	This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject	1..1	Reference	S1+
date	1..1		S1+	When the report was generated
reporter	1..1	Reference	S1+	Organization that generated the MeasureReport
period	1..1	Period	S1+	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
period.start	1..1		S1+
period.end	1..1		S1+
group	0..*		S	A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
group.id	1..1		S1+
:ccType	1..1	Extension	S1+
:dxCode	0..*	Extension	S	diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition.
:evidenceStatus	0..1	Extension	S
:evidenceStatusDate	0..1	Extension	S
:hierarchicalStatus	0..1	Extension	S
:confidenceScale	0..1	Extension	S
:ccRemark	0..*	Extension	S	Remark added to a Condition Category
group.code	0..1	CodeableConcept	S	Condition Category (CC) code for a Risk Adjustment Model
evaluatedResource			S	An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
:groupReference	0..*	Extension	S	This id references the `MeasureReport.group.id`, which allows linking a supporting resource to a specific Condition Categories coding gap.