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How do I read the CMS Individual Specification Manual?

Use the following outline to determine how to read the specifications.

Denominator Data

Eligible Instances: The number of instances (patients, visits, episodes, etc.) that meet all eligibility criteria for a specific measure of interest, as explained in the 2015 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Claims and Registry Reporting of Individual Measures (2015 PQRS Measure Spec Manual).

Example of a measure denominator description, from the 2015 PQRS Measure Spec Manual:

  • Measure #12 (NQF 0086): Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

Numerator Data

The numerator must detail the clinical quality action expected that satisfies the condition(s) and is the focus of the measurement for each patient, procedure or event established by the denominator. The numerator options are “MET” and “NOT MET” for all measures with some measures having the additional option of “EXCLUDED”. Under “Numerator” in the 2015 PQRS Measure Spec Manual, the options will be separated by “OR”. The order will be MET, NOT MET if there is no EXCLUDED option. The order will be MET, EXCLUDED, NOT MET if there is an EXCLUDED option.

Performance Met: The number of eligible instances that meet the “MET” criteria. The “MET” criteria is listed first under “Numerator” in the 2015 PQRS Measure Spec Manual.

Performance Exclusion: The number of eligible instances that meet the “EXCLUDED” criteria. The “EXCLUDED” criteria is listed between the “MET” and “NOT MET” criteria under “Numerator” in the 2015 PQRS Measure Spec Manual. *This does not apply to every measure.

Performance Not Met: The number of eligible instances that meet the “NOT MET” criteria. The “NOT MET” criteria is listed last under “Numerator” in the 2015 PQRS Measure Spec Manual.

Posted in: PQRS