Other scenarios not listed may include: needed care happened but was not documented, maybe because patient received care elsewhere or paid out of pocket; maybe needed care was documented in a way the payer didn’t account for or did not receive – e.g. billed as part of a service bundle; documented in EHR but not in claims; also, how to account for situations where the measure would not apply?

Existing Wording:

Gaps in care may be caused by several potential reasons. . .