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Clinical Quality Language – A new feature for Quality Measures

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Insurance denials are a growing cause of concern for hospitals and care providers. Denial write-offs and subsequent administrative costs involved in reworking them, pile up to destabilize the financial operations of a care provider. Your effort to reduce the frequency of insurance denials should comprise of a comprehensive evaluation of the common reasons that cause them and technological solutions that can help eliminate them.


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Clinical Quality Language – A new feature for Quality Measures

  1. 1. Clinical Quality Language A new feature for quality measure Healthcare Consultant Keerthi Chavva is a subject matter expert at Nalashaa with hands-on experience with different clinical and billing workflows. She is proficient with analyzing and embedding different regulations within regular workflows and identifying solutions that help providers with better A/R outcomes. She is passionate about creating generalized solutions that indicate providers from multiple perspectives w.r.t different regulatory programs.
  2. 2. What is Clinical Quality Language (CQL)? Why is CQL Important in the Healthcare Market? How is CQL Different from CQM? Benefits of CQL Future of CQL in the Healthcare Market Advantages of CQL based CQM over Existing Implementation of CQM Technical Approach to Achieve CQL Implementation 3 3 4 4 5 5 6 Contents
  3. 3. All rights reserved � 2019 6 The major endeavor in this whole exercise is the development of the CQL Engine. While this can be implemented in different ways , we recommend the FHIR route. The CQL Engine understands CQL grammar through lexical analysis and parsing components in order to identify the respective population criteria based on the measure. This in turn is split into different FHIR queries to pull information from respective EHR systems, parse and compute participating patients based on the criteria. The retrieved data is then converted into CAT 1 files. These files are further consolidated and stratified to generate a CAT3 file necessary for provider submissions in March. Now the same solution can be extended to meet CDS requirements by using them to provide alerts to providers. This enables them to perform better in quality reporting. The diagram below denotes the workings of the CQL engine. Technical Approach to Achieving CQL Implementation
  4. 4. We listen, we understand and we deliver. WehavebeenaroundforawhilenowandhavebeenmakingourmarkintheHealthcare industry. We have been steadily moving into various areas of US Healthcare, starting off from Meaningful Use Stage 2. With time we have traversed the journey from the clinical space to financial aspects of healthcare. Kind words from our clients and their continued belief in our capabilities to deliver have kept us steadfast on the path of growth. CQL is precise enough for machines to interpret and separates out the logical expression of quality measures and CDS criteria from the domain model. This improves the pace of specifying, implementing and testing new quality measures by up to 90%. Nalashaa offers technology and services to help payers, providers and technology vendors adopt the benefits of CQL. Contact Us 510 Thornall Street, Suite 210, Edison, NJ-08837, USA 732-602-2560 X 200 www.nalashaahealth.com About Us Get in Touch Speak With the Experts

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