Risk Adjustment Coding Gap MeasureReport - Da Vinci Risk Adjustment Implementation Guide v2.0.0

Da Vinci Risk Adjustment Implementation Guide
2.0.0 - STU2 United States of America flag

Da Vinci Risk Adjustment Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ra/ and changes regularly. See the Directory of published versions

Resource Profile: Risk Adjustment Coding Gap MeasureReport

Official URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport		Version: 2.0.0
Standards status: Trial-use	Maturity Level: 2	Computable Name: RiskAdjustmentCodingGapMeasureReport
Other Identifiers: OID:2.16.840.1.113883.4.642.40.29.42.12
Copyright/Legal: Used by permission of HL7 International - Clinical Quality Information Work Group, all rights reserved Creative Commons License

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.

Mandatory Data Elements and Terminology

The following data-elements must always be present (Mandatory) or must be supported (Must Support). The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each MeasureReport must have:

A measurereporot-category extension with a fixed code “ra”
A MeasureReport.status element
A MeasureReport.type element with a fixed code “individual”
A MeasureReport.measure element references a Risk Adjustment Model Measure
A MeasureReport.subject element references a US Core Patient profile
A MeasureReport.period element for the clinical evaluation period for which the risk adjustment coding gap report was generated.
If MeasureReport.group is present, each MeasureReport.group must have a MeasureReport.group.ccType element

Each MeasureReport should have ([Must Support]):

Zero to many MeasureReport.group element
Each MeasureReport.group should have a MeasureReport.group.code element
Each MeasureReport.group should have a MeasureReport.group.evidenceStatus element
Each MeasureReport.group should have a MeasureReport.group.evidenceStatusDate element
Each MeasureReport.group should have a MeasureReport.group.hierarchicalStatus element
Each MeasureReport.group should have zeor too many MeasureReport.group.dxCode element
Each MeasureReport.group should have zero to many MeasureReport.evalautedResource element

Each MeasureReport may have ([Must Support]):

Each MeasureReport.group may have zero to one MeasureReport.group.confidenceScale element
Each MeasureReport.group may have zero to many MeasureReport.group.ccRemark element

Additional Profile specific implementation guidance:

evaluatedResource SHALL reference resources using USCore profiles where applicable

The Clinical Data Collection Deadline element, clinicalDataCollectionDeadline, was added as an extension to MeasureReport. We are seeking comment from implementers if they intend to use this element when communicating risk adjustment coding gap reports from payers to providers.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from MeasureReport

Name	Flags	Card.	Type	Description & Constraints
MeasureReport		0..*	MeasureReport	This is a risk adjustment coding gap report.
Slices for extension				Content/Rules for all slices
measurereport-category	S	1..1	(Complex)	What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
value[x]
coding		1..1	Coding	Code defined by a terminology system
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ra
clinicalDataCollectionDeadline	S	0..1	date	This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
status	S	1..1	code	complete \| pending \| error
type	S	1..1	code	The type code is fixed to 'individual' for a risk adjustment coding gap report Fixed Value: individual
measure	S	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject	S	1..1	Reference(US Core Patient Profile)	What individual(s) the report is for
date	S	1..1	dateTime	When the report was generated
reporter	S	1..1	Reference(US Core Organization Profile)	Organization that generated the MeasureReport
period	SC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
start	S	1..1	dateTime	Starting time with inclusive boundary
end	S	1..1	dateTime	End time with inclusive boundary, if not ongoing
group	S	0..*	BackboneElement	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.
id	S	1..1	string	Unique id for inter-element referencing
Slices for extension				Content/Rules for all slices
ccType	S	1..1	CodeableConcept	Condition Category type: historic\|suspected\|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Risk Adjustment Condition Category Type ValueSet (extensible)
dxCode	S	0..*	CodeableConcept	diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: US Core Condition Code (preferred)
evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap\|closed-gap\|invalid-gap\|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible)
evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
hierarchicalStatus	S	0..1	CodeableConcept	How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded\|applied-not-superseded\|not-applied\|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible)
ccRemark	S	0..*	(Complex)	Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark
code	S	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
stratifier
code		0..1	CodeableConcept	What stratifier of the group
evaluatedResource	S	0..*	Reference(Resource)	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.
Slices for extension				Content/Rules for all slices
groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
MeasureReport.group.code	example	SampleCMSHCC `http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc` from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9

Name	Flags	Card.	Type	Description & Constraints
MeasureReport	C	0..*	MeasureReport	This is a risk adjustment coding gap report. dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
measurereport-category	S	1..1	(Complex)	What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/measurereport-category"
value[x]		1..1	CodeableConcept	Value of extension Binding: MeasureReportCategory (extensible) ele-1: All FHIR elements must have a @value or children
coding	Σ	1..1	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
code	Σ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children Fixed Value: ra
clinicalDataCollectionDeadline	S	0..1	date	This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!SΣ	1..1	code	complete \| pending \| error Binding: MeasureReportStatus (required): The status of the measure report. ele-1: All FHIR elements must have a @value or children
type	SΣC	1..1	code	The type code is fixed to 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. ele-1: All FHIR elements must have a @value or children Fixed Value: individual
measure	SΣ	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28. ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(US Core Patient Profile)	What individual(s) the report is for ele-1: All FHIR elements must have a @value or children
date	SΣ	1..1	dateTime	When the report was generated ele-1: All FHIR elements must have a @value or children
reporter	SΣ	1..1	Reference(US Core Organization Profile)	Organization that generated the MeasureReport ele-1: All FHIR elements must have a @value or children
period	SΣC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ele-1: All FHIR elements must have a @value or children ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
start	SΣC	1..1	dateTime	Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children
end	SΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children
improvementNotation	?!Σ	0..1	CodeableConcept	increase \| decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue. ele-1: All FHIR elements must have a @value or children
group	SC	0..*	BackboneElement	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. ele-1: All FHIR elements must have a @value or children
id	S	1..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
ccType	S	1..1	CodeableConcept	Condition Category type: historic\|suspected\|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Risk Adjustment Condition Category Type ValueSet (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
dxCode	S	0..*	CodeableConcept	diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: US Core Condition Code (preferred) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap\|closed-gap\|invalid-gap\|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
hierarchicalStatus	S	0..1	CodeableConcept	How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded\|applied-not-superseded\|not-applied\|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
ccRemark	SC	0..*	(Complex)	Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both ra-2: A remark shall include an author, an authorOrganization, or an authorSoftware
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
code	SΣ	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example) ele-1: All FHIR elements must have a @value or children
evaluatedResource	S	0..*	Reference(Resource)	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. ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MeasureReport.extension:measurereport-category.value[x]	extensible	MeasureReportCategory `http://hl7.org/fhir/ValueSet/measurereport-category`
MeasureReport.status	required	MeasureReportStatus `http://hl7.org/fhir/ValueSet/measure-report-status\|4.0.1` from the FHIR Standard
MeasureReport.type	required	Fixed Value: individual `http://hl7.org/fhir/ValueSet/measure-report-type\|4.0.1` from the FHIR Standard
MeasureReport.improvementNotation	required	MeasureImprovementNotation `http://hl7.org/fhir/ValueSet/measure-improvement-notation\|4.0.1` from the FHIR Standard
MeasureReport.group.code	example	SampleCMSHCC `http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc` from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MeasureReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MeasureReport	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MeasureReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mrp-1	error	MeasureReport	Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not()
mrp-2	error	MeasureReport	Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9
ra-2	error	MeasureReport.group.extension:ccRemark	A remark shall include an author, an authorOrganization, or an authorSoftware : extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()

Description & Constraints

MeasureReport

C

0..*

MeasureReport

This is a risk adjustment coding gap report.
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components

id

Σ

0..1

id

Logical id of this artifact

Terminology Bindings

Path Conformance ValueSet / Code URI

MeasureReport.language

preferred

CommonLanguages

http://hl7.org/fhir/ValueSet/languages

from the FHIR Standard

Additional Bindings

Purpose

AllLanguages

Max Binding

MeasureReport.extension:measurereport-category.value[x]

extensible

MeasureReportCategory

http://hl7.org/fhir/ValueSet/measurereport-category

MeasureReport.status

required

MeasureReportStatus

http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1

from the FHIR Standard

MeasureReport.type

required

Fixed Value: individual

http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1

from the FHIR Standard

MeasureReport.improvementNotation

required

MeasureImprovementNotation

http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1

from the FHIR Standard

MeasureReport.group.code

example

SampleCMSHCC

http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc

from this IG

MeasureReport.group.population.code

extensible

MeasurePopulationType

http://hl7.org/fhir/ValueSet/measure-population

from the FHIR Standard

MeasureReport.group.stratifier.stratum.population.code

extensible

MeasurePopulationType

http://hl7.org/fhir/ValueSet/measure-population

from the FHIR Standard

MeasureReport.evaluatedResource.type

extensible

ResourceType

http://hl7.org/fhir/ValueSet/resource-types

from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MeasureReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MeasureReport	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MeasureReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mrp-1	error	MeasureReport	Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not()
mrp-2	error	MeasureReport	Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9
ra-2	error	MeasureReport.group.extension:ccRemark	A remark shall include an author, an authorOrganization, or an authorSoftware : extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()

This structure is derived from MeasureReport

Summary

Mandatory: 9 elements(2 nested mandatory elements)
Must-Support: 23 elements
Fixed: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Maturity: 2

Differential View

This structure is derived from MeasureReport

Name	Flags	Card.	Type	Description & Constraints
MeasureReport		0..*	MeasureReport	This is a risk adjustment coding gap report.
Slices for extension				Content/Rules for all slices
measurereport-category	S	1..1	(Complex)	What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
value[x]
coding		1..1	Coding	Code defined by a terminology system
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ra
clinicalDataCollectionDeadline	S	0..1	date	This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
status	S	1..1	code	complete \| pending \| error
type	S	1..1	code	The type code is fixed to 'individual' for a risk adjustment coding gap report Fixed Value: individual
measure	S	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject	S	1..1	Reference(US Core Patient Profile)	What individual(s) the report is for
date	S	1..1	dateTime	When the report was generated
reporter	S	1..1	Reference(US Core Organization Profile)	Organization that generated the MeasureReport
period	SC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
start	S	1..1	dateTime	Starting time with inclusive boundary
end	S	1..1	dateTime	End time with inclusive boundary, if not ongoing
group	S	0..*	BackboneElement	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.
id	S	1..1	string	Unique id for inter-element referencing
Slices for extension				Content/Rules for all slices
ccType	S	1..1	CodeableConcept	Condition Category type: historic\|suspected\|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Risk Adjustment Condition Category Type ValueSet (extensible)
dxCode	S	0..*	CodeableConcept	diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: US Core Condition Code (preferred)
evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap\|closed-gap\|invalid-gap\|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible)
evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
hierarchicalStatus	S	0..1	CodeableConcept	How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded\|applied-not-superseded\|not-applied\|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible)
confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible)
ccRemark	S	0..*	(Complex)	Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark
code	S	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example)
stratifier
code		0..1	CodeableConcept	What stratifier of the group
evaluatedResource	S	0..*	Reference(Resource)	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.
Slices for extension				Content/Rules for all slices
groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
MeasureReport.group.code	example	SampleCMSHCC `http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc` from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
MeasureReport	C	0..*	MeasureReport	This is a risk adjustment coding gap report. dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
measurereport-category	S	1..1	(Complex)	What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/measurereport-category"
value[x]		1..1	CodeableConcept	Value of extension Binding: MeasureReportCategory (extensible) ele-1: All FHIR elements must have a @value or children
coding	Σ	1..1	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
code	Σ	1..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children Fixed Value: ra
clinicalDataCollectionDeadline	S	0..1	date	This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!SΣ	1..1	code	complete \| pending \| error Binding: MeasureReportStatus (required): The status of the measure report. ele-1: All FHIR elements must have a @value or children
type	SΣC	1..1	code	The type code is fixed to 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. ele-1: All FHIR elements must have a @value or children Fixed Value: individual
measure	SΣ	1..1	canonical(Risk Adjustment Model Measure)	This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28. ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(US Core Patient Profile)	What individual(s) the report is for ele-1: All FHIR elements must have a @value or children
date	SΣ	1..1	dateTime	When the report was generated ele-1: All FHIR elements must have a @value or children
reporter	SΣ	1..1	Reference(US Core Organization Profile)	Organization that generated the MeasureReport ele-1: All FHIR elements must have a @value or children
period	SΣC	1..1	Period	Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ele-1: All FHIR elements must have a @value or children ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
start	SΣC	1..1	dateTime	Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children
end	SΣC	1..1	dateTime	End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children
improvementNotation	?!Σ	0..1	CodeableConcept	increase \| decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue. ele-1: All FHIR elements must have a @value or children
group	SC	0..*	BackboneElement	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. ele-1: All FHIR elements must have a @value or children
id	S	1..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
ccType	S	1..1	CodeableConcept	Condition Category type: historic\|suspected\|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Risk Adjustment Condition Category Type ValueSet (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
dxCode	S	0..*	CodeableConcept	diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: US Core Condition Code (preferred) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
evidenceStatus	S	0..1	CodeableConcept	This is evidence status of a Condition Category (CC) coding gap: open-gap\|closed-gap\|invalid-gap\|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
evidenceStatusDate	S	0..1	date	When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
hierarchicalStatus	S	0..1	CodeableConcept	How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded\|applied-not-superseded\|not-applied\|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
confidenceScale	S	0..1	CodeableConcept	Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
ccRemark	SC	0..*	(Complex)	Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both ra-2: A remark shall include an author, an authorOrganization, or an authorSoftware
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
code	SΣ	0..1	CodeableConcept	Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example) ele-1: All FHIR elements must have a @value or children
evaluatedResource	S	0..*	Reference(Resource)	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. ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
groupReference	S	0..*	string	This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MeasureReport.extension:measurereport-category.value[x]	extensible	MeasureReportCategory `http://hl7.org/fhir/ValueSet/measurereport-category`
MeasureReport.status	required	MeasureReportStatus `http://hl7.org/fhir/ValueSet/measure-report-status\|4.0.1` from the FHIR Standard
MeasureReport.type	required	Fixed Value: individual `http://hl7.org/fhir/ValueSet/measure-report-type\|4.0.1` from the FHIR Standard
MeasureReport.improvementNotation	required	MeasureImprovementNotation `http://hl7.org/fhir/ValueSet/measure-improvement-notation\|4.0.1` from the FHIR Standard
MeasureReport.group.code	example	SampleCMSHCC `http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc` from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MeasureReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MeasureReport	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MeasureReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mrp-1	error	MeasureReport	Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not()
mrp-2	error	MeasureReport	Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9
ra-2	error	MeasureReport.group.extension:ccRemark	A remark shall include an author, an authorOrganization, or an authorSoftware : extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()

Snapshot View

Description & Constraints

MeasureReport

C

0..*

MeasureReport

This is a risk adjustment coding gap report.
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components

id

Σ

0..1

id

Logical id of this artifact

Terminology Bindings

Path Conformance ValueSet / Code URI

MeasureReport.language

preferred

CommonLanguages

http://hl7.org/fhir/ValueSet/languages

from the FHIR Standard

Additional Bindings

Purpose

AllLanguages

Max Binding

MeasureReport.extension:measurereport-category.value[x]

extensible

MeasureReportCategory

http://hl7.org/fhir/ValueSet/measurereport-category

MeasureReport.status

required

MeasureReportStatus

http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1

from the FHIR Standard

MeasureReport.type

required

Fixed Value: individual

http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1

from the FHIR Standard

MeasureReport.improvementNotation

required

MeasureImprovementNotation

http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1

from the FHIR Standard

MeasureReport.group.code

example

SampleCMSHCC

http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc

from this IG

MeasureReport.group.population.code

extensible

MeasurePopulationType

http://hl7.org/fhir/ValueSet/measure-population

from the FHIR Standard

MeasureReport.group.stratifier.stratum.population.code

extensible

MeasurePopulationType

http://hl7.org/fhir/ValueSet/measure-population

from the FHIR Standard

MeasureReport.evaluatedResource.type

extensible

ResourceType

http://hl7.org/fhir/ValueSet/resource-types

from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MeasureReport	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MeasureReport	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MeasureReport	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MeasureReport	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mrp-1	error	MeasureReport	Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not()
mrp-2	error	MeasureReport	Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1	error	MeasureReport.period	Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9
ra-2	error	MeasureReport.group.extension:ccRemark	A remark shall include an author, an authorOrganization, or an authorSoftware : extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()