Form
|
Notes
on Updates
|
Hospital
Inpatient Quality Reporting Notice of Participation
|
No
updates/changes to previously submitted form. Form still in use.
|
Hospital
Inpatient Quality Reporting (IQR) Program Data Accuracy and
Completeness Acknowledgement (DACA)
|
Form
resubmitted to update applicable program year.
|
Hospital
Compare Request for Withholding Data from Public Reporting Form
|
Form
resubmitted to include the names of all applicable quality
reporting and pay-for-performance programs, with updates to
submission information (which includes
providing
the submission deadline for claims-based measures), and to
add/remove measures for the upcoming preview period and Hospital
Compare release.
|
Centers
for Medicare & Medicaid Services (CMS) Inpatient Prospective
Payment System (IPPS) Quality Reporting Programs Measure Exception
Form for PC, ED, and HAI Data Submission
|
No
updates/changes to previously submitted form. Form still in use.
|
CMS
Quality Reporting Program APU Reconsideration Request Form
|
Form
resubmitted to add a signature line for the designated provider
personnel’s signature.
|
Hospital
Inpatient Quality Reporting (IQR) Program Validation Educational
Review Form
|
Form
newly included with this PRA package.
|
Hospital
Value-Based Purchasing (VBP) Program Review and Corrections
Request Form
|
No
updates/changes to previously submitted form. Form still in use.
|
Hospital
Value-Based Purchasing (VBP) Program Appeal Request Form
|
No
updates/changes to previously submitted form. Form still in use.
|
Hospital
Value-Based Purchasing (VBP) Program Independent CMS Review
Request Form
|
No
updates/changes to previously submitted form. Form still in use.
|
Centers
for Medicare & Medicaid Services (CMS) Quality Reporting
Program Extraordinary Circumstances Exceptions (ECE) Request Form
|
Form
being resubmitted to align terminology with other quality
reporting and pay-for-performance programs that have policies to
provide exceptions from program requirements to facilities that
have experienced extraordinary circumstances.
|
CMS
Hospital IQR Program Validation Review for Reconsideration Request
Form
|
No
updates/changes to previously submitted form. Form still in use.
|
Validation
Templates for CLABSI, CAUTI, MRSA, and CDI measures
|
Templates
resubmitted to reflect the annual changes in fiscal year and
beginning reporting quarter, as well as new CDC pathogen lists,
with each new selection of hospitals for validation.
|