Quality Measures and Procedures for Hospital Reporting of Quality Data

Hospital Reporting Initiative--Hospital Quality Measures (CMS-10210)

OMB: 0938-1022

IC ID: 204350

Documents and Forms

Document Name Document Type
Form CMS-10210 Quality Measures and Procedures for Hospital Reporting of Quality Data Form and Instruction
CMS-10210 Data Accuracy and Completeness Form IPPS_DataAccuracyCompletenessAcknowledgement_FY 2020 (Apr 2018)(508).pdf Form and Instruction
CMS-10210 Hospital VPB Review and Corrections Form HVBP_Review_and_Corrections_Request_Form_Final_April2018.(508)ff.pdf Form and Instruction
CMS-10210 Extraordinary Circumstances Form CMS Quality Program Extraordinary Circumstances Exception Request Form (Apr 2018).FF.(508).pdf Form and Instruction
CMS-10210 Hospital Compare Request Form for Withholding/Footnoting Hospital Compare Withholding_Footnoting_Request_Form (4.17.2018).ff.(508).pdf Form and Instruction
CMS-10210 IQR Measure Exception Form IPPS_MeasureExceptionForm_CY 2019 Data Collection (July 2018) ff(508)c.pdf Form and Instruction
CMS-10210 IQR Notice of Participation Form IQR NOP and Public Reporting NOP Text (Apr 2018).(508).pdf Form and Instruction
CMS-10210 IQR Reconsideration Request Form QR_Form_APU Reconsideration Request (Apr 2018)FF.(508).pdf Form and Instruction
CMS-10210 CAUTI Validation Template FY2021_CAUTI_Validation Template_April 2018.FINAL(508).xlsx Form and Instruction
CMS-10210 CDI Validation Template FY2021_CDI_Validation Template_April 2018.FINAL(508).xlsx Form and Instruction
CMS-10210 CLABSI Validation Template 1Q18-2Q18 FY2021_CLABSI_Validation Template_April 2018.FINAL(508).xlsx Form and Instruction
CMS-10210 MRSA Validation Template FY2021_MRSA_Validation Template_April 2018.FINAL(508).xlsx Form and Instruction
CMS-10210 Validation Review for Reconsideration Request IQR Validation Review Request Form (Apr 2018) ff.(508).pdf Form and Instruction
CMS-10210 VBP Appeal Request Form HVBP Appeal Request Form Final April2018.(508)ff.pdf Form and Instruction
CMS-10210 HVBP CMS Independent Review Form HVBP CMS Independent Review Form_April2018_Final.(508)ff.pdf Form and Instruction
CMS-10210 Validation Educational Review Form Quality Reporting Validation Educational Review Form (Apr 2018)ff(508).pdf Form and Instruction
FY 2019 IPPS Final Rule - Index of HIQR Information Collection Forms (7-25-2018).docx Index of changes to forms IC Document