Tag: #HEDIS

Posted in HEDIS Measures, Training, Updates

HEDIS Measure: Colorectal Cancer Screening (COL)

Posted on by KR2Medical Billing

This HEDIS® measure evaluates the percentage of patients age 50 to 75 who had appropriate screening for colorectal cancer.

In order for PCPs to get credit for this Measure they need to document the following:

Document (date and result) one or more of these screenings:

  • Colonoscopy during measurement year or nine years prior
  • Fecal occult blood test (FOBT) during measurement year
  • CT colonography during measurement year or four years prior
  • Fecal immunochemical test (FIT)-DNA test during measurement year or two years prior
  • Flexible sigmoidoscopy during measurement year or four years prior

There following are exclusions for this measure:

  • Diagnosis of colorectal cancer
  • Total colectomy
  • Members who receive palliative 

Quest Test available:

There is an option for your patient to get a FIT kits through Quest Diagnostics.®* This option is only available for PARTICIPATING providers.

Quest will ship InSure® ONE™ FIT kits directly to your practice. There are 2 ways to order:

  • Online, use the Quest Quanum® Lab Services Manager. Create an account at https://bit.ly/3qLxNPh.
  • Via phone, call 1-866-MY-QUEST and state supplies for assistance.

Quest will ship the kits to your practice at no cost, based on usage and test completion.

Posted in HEDIS Measures, Training, Updates

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

Posted on by KR2Medical Billing

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)
Posted in HEDIS Measures, Training, Updates

BCBS Empire NY Medicaid: Summary of changes for HEDIS Measures from NCQA (2020/2021)

Posted on by KR2Medical Billing

Source: Empire Health Plus Plan (NY Managed Medicaid Plan)

Revised measures:

  • The former Well-Child Visits in the First 15 Months of Life (W15) measure was revised to Well‑Child Visits in the First 30 Months of Life (W30). It includes two indicators:
    • Well-child visits in the first 15 months — children who turned 15 months during the measurement year with six or more well-child visits
  • Well-child visits for ages 15 to 30 months — children who turn 30 months during the measurement year with two or more well-child visits
  • The former Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) and Adolescent Well-Care Visits (AWC) measures have been combined into Child and Adolescent Well-Care Visits (WCV):
    • The percentage of members 3 to 21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year

Key measure changes:

  • Controlling High Blood Pressure (CBP and CDC-CBP)
    Telephone visits, e-visits and virtual check-ins are now acceptable settings for blood pressure (BP) readings. Digital BP readings reported by the member are considered numerator compliant.
  • Telehealth updates
    NCQA has updated telehealth guidance in 40 HEDIS® measures for HEDIS measurement years 2020 and 2021. The purpose of these changes is to:
    • Support increased use of telehealth caused by the pandemic.
    • Align with guidance from Centers for Medicare & Medicaid Services and other stakeholders.