Posted in HEDIS Measures, Training, Updates

New and Retired Medicaid HEDIS measures (NCQA 2020/2021)

Source: Empire BCBS NY

New HEDIS Medicaid Measures:

  1. Kidney Health Evaluation for Patients With Diabetes (KED) — The percentage of members 18 to 85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a uACR identified by both a quantitative urine albumin test and a urine creatinine test with service days four or less days apart during the measurement year

2. Cardiac Rehabilitation (CRE) — The percentage of members 18 years and older who attended cardiac rehabilitation following a qualifying cardiac event, including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, heart and heart/lung transplantation, or heart valve repair/replacement; four rates are reported:

  • Initiation — The percentage of members who attended two or more sessions of cardiac rehabilitation within 30 days after a qualifying event
  • Engagement 1 — The percentage of members who attended 12 or more sessions of cardiac rehabilitation within 90 days after a qualifying event
  • Engagement 2 — The percentage of members who attended 24 or more sessions of cardiac rehabilitation within 180 days after a qualifying event
  • Achievement — The percentage of members who attended 36 or more sessions of cardiac rehabilitation within 180 days after a qualifying event

Retired Medicaid measures:

  • Comprehensive Diabetes Care (CDC) retired sub-measures —
    • Medical Attention for Nephropathy (retired for Commercial and Medicaid)
    • HbA1c control (< 7.0%) for a selected population
  • Adult BMI Assessment (ABA)
  • Medication Management for People With Asthma (MMA)
  • Children’s and Adolescents’ Access to Primary Care Practitioners (CAP)

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s