Data Validation - Overview
The Centers for Medicare & Medicaid Services (CMS) assesses the accuracy of chart-abstracted data submitted to the Hospital Outpatient Quality Reporting (OQR) Program through the validation process. CMS verifies on a quarterly basis that hospital-abstracted data submitted to the Clinical Warehouse can be reproduced by a trained abstractor using a standardized process. Critical Access Hospitals and other hospitals not subject to Hospital OQR Program requirements are exempt from the validation process.
CMS performs a random and targeted selection of Outpatient Prospective Payment Systems (OPPS) hospitals on an annual basis. The random and targeted selection for Calendar Year (CY) 2020 occurred in September of 2018. The selection includes up to 500 hospitals including: 450 randomly selected hospitals and up to 50 targeted hospitals. It is possible for a hospital to be selected in consecutive years. The quarters included in CY 2020 validation are first quarter 2018 through fourth quarter 2018.
CMS will validate up to 12 cases for clinical process of care measures per quarter, per hospital. Cases are randomly selected from data submitted to the clinical warehouse by the hospital. Below is a list of the measures available to be validated in each quarter of CY 2020. For a full description of the measures, please see the Outpatient Quality Reporting Measures page.
- 1Q18 – OP-1, OP-2, OP-3, OP-4, OP-5, OP-18, OP-20, OP-21, OP-23
- 2Q18 – OP-2, OP-3, OP-5, OP-18, OP-23
- 3Q18 – OP-2, OP-3, OP-5, OP-18, OP-23
- 4Q18 – OP-2, OP-3, OP-5, OP-18, OP-23
Medical Record Request
Each quarter, the Clinical Data Abstraction Center (CDAC) will send hospitals a written request to “Medical Records Director,” using FedEx, to submit a patient medical record for each case that CMS selected for validation. Outpatient hospitals have 45 days from the original request date to submit requested records to the CDAC. Hospitals will be sent a written notice if the CDAC has not received the records 30 days after the request was issued (which is approximately 15 days before the due date). Hospitals have the option to submit the requested medical records in paper format, on removable media, or via the QualityNet Secure Portal Secure File Transfer application. Records not received by the specified due date are not eligible for abstraction and will be scored a “zero”. For more information regarding medical records requested by the CDAC, refer to CDAC Information.
A hospital’s list of cases selected for validation each quarter, including all available patient identifiers, can be accessed via the QualityNet Secure Portal by a registered user. Please note that this report can take several business days after original request date to become available. To access the report:
- Log in to the QualityNet Secure Portal.
- Select My Reports, followed by Run Reports.
- Select the Run Reports tab.
- Under Report Program, select OQR.
- Under Report Category, select Hospital Reporting – Data Validation Reports.
- Under Report Name, select Hospital Data Validation – Case Selection Report.
It typically takes approximately four months after each quarter’s submission deadline for hospitals to see their validation results for the quarter. Hospital staff with the Reports role will receive email notification when their Validation Case Detail and Validation Summary reports become available to run. The reports provide the validation results of abstraction determined by the CDAC on each selected case.
Within 30 days of validation results being posted on the My Reports section of the QualityNet Secure Portal, if a hospital has a question or needs further clarification on a particular outcome, the hospital may request an educational review. For more information regarding the educational review process, refer to Educational Reviews.
At the end of each calendar year, annual payment update (APU) results are expected to be released in the fall (for calendar year 2020, this is anticipated to be October 2019). CMS computes a confidence interval around the combined scores of all quarters involved in the CY. If the upper bound of this confidence interval is 75 percent or higher, the hospital will pass the Hospital OQR Program validation requirement; if the confidence interval is below 75 percent, the hospital will fail the Hospital OQR Program validation requirement.
If a hospital does not meet the overall validation requirement, the hospital will not receive full APU. For additional information regarding APU reduction, refer to the APU Determinations page of QualityNet. Hospitals that fail validation will also automatically be selected for validation in the next calendar year.
Refer to Data Validation Resources for more information regarding the validation process.