CMS-10210 Hospital Inpatient Quality Reporting Program Denominator

Hospital Inpatient Quality Reporting Program
Denominator Declaration
Please Note: A data collection tool available within the Hospital Quality Reporting system via the Hospital
Quality Reporting Secure Portal allows hospitals to complete and submit their denominator declaration
data. This document is a representation of the text contained in the denominator declaration data form
and is for reference purposes only.

Denominator Declaration

Discharge Quarter

If your total cases are 5 or less for your reporting quarter please
use the drop down below to identify Zero Denominator Declaration or
Case Threshold Exemptions.
[*] Select if there was no denominator patient population for the
certified measure for the selected date range.
[**] Enter 0-5 for quarter selection. Leave blank if eCQM is to be
submitted.
Successful QRDA production submissions that meet the program
requirements for the selected reporting quarter will override
corresponding denominator declaration entries and are displayed
on the Program Credit Report and Export.
Measure
STK-2

Zero Denominator Declaration*/Case Threshold Exemption**
Discharge on Antithrombotic Therapy

STK-3

Anticoagulation Therapy for Atrial Fibrillation/Flutter

STK-5

Antithrombotic Therapy by End of Hospital Day 2

VTE-1

Venous Thromboembolism Prophylaxis

VTE-2

Intensive Care Unit Venous Thromboembolism
Prophylaxis
Safe Use of Opioids – Concurrent Prescribing

Safe Use of
Opioids
ePC-02

Cesarean Birth

ePC-07

Severe Obstetrics Complications

HH-01

Hospital Harm – Severe Hypoglycemia Measure

HH-02

Hospital Harm – Severe Hyperglycemia Measure

HH-ORAE

Hospital Harm – Opioid-Related Adverse Event

GMCS

Global Malnutrition Composite Score
I’m ready to submit

Hospital Inpatient Quality Reporting Program
Denominator Declaration
PRA Disclosure Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection
of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 09381022 (Expires XX/XX/XXXX). The time required to complete this information collection is estimated to average xx minutes per
response, including the time to review instructions, search existing data resources, gather the data needed, and complete and
review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for
improving this form, please write to CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05,
Baltimore, MD 21244-1850. ****CMS Disclosure**** Please do not send applications, claims, payments, medical records or
any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any
correspondence not pertaining to the information collection burden approved under the associated OMB control number
listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to
submit your documents, please contact the Inpatient Value, Incentives, and Quality Reporting Outreach and Education
Support Contractor at (844) 472-4477.