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_Data Accuracy Completeness Acknowledgement (April 2019) (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 ECE Request Form (April 2019)(508).pdf Form and Instruction
CMS-10210 Hospital Compare Request Form for Withholding/Footnoting Hospital Compare Withholding Footnoting Request Form (April 2019)(508).pdf Form and Instruction
CMS-10210 IQR Measure Exception Form IPPS Measure Exception Form CY2020 Data (April 2019)(508).pdf Form and Instruction
CMS-10210 IQR Notice of Participation Form IQR NOP and PR NOP Text (April 2019)(508).pdf Form and Instruction
CMS-10210 IQR Reconsideration Request Form Quality Reporting Reconsideration Request Form (April 2019)(508).pdf Form and Instruction
CMS-10210 CAUTI Validation Template FY2022_CAUTI_Validation Template_April 2019 (508).xlsx Form and Instruction
CMS-10210 CDI Validation Template FY2022_CDI_Validation Template_April 2019 (508).xlsx Form and Instruction
CMS-10210 CLABSI Validation Template 1Q18-2Q18 FY2022_CLABSI_Validation Template_April 2019 (508).xlsx Form and Instruction
CMS-10210 MRSA Validation Template FY2022_MRSA_Validation Template_April 2019 (508).xlsx Form and Instruction
CMS-10210 Validation Review for Reconsideration Request IQR Validation Reconsideration Request Form (April 2019)(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
Summary of HIQR Information Collection Forms - FY2020 IPPS Final Rule - HIQR PRA Package (July 2019).docx Summary of Updates on HIQR Collection Forms IC Document