Posted in BCBS (Various States), NY Providers, Training, Updates

HEDIS Measure: Update Colorectal Cancer Screening for 2022

Are you a primary care physician and is reporting HEDIS measures? Then this following blog post is for you.


In this blog post we will discuss the changes/updates that NCQA just released for HEDIS Colorectal Cancer Screening Measure.

Measure Description: Measures the percentage of members 45 to 75 years of age who had appropriate screening for rectal cancer. The Medicaid product was added to the administrative data collection method for this measure and the age range was changed to 45 to 75 years of age.

In order to meet this measure your patients need to fall in ANY of the following criteria:

  • Fecal occult blood test during the measurement year
  • Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year
  • Colonoscopy during the measurement year or the nine years prior to the measurement year
  • CT colonography during the measurement year or the four years prior to the measurement year
  • Stool DNA (sDNA) with FIT test during the measurement year or the two years prior to the measurement year

If you would like to report this measure via Electronic Clinical Data Reporting system you will need to select: Colorectal Cancer Screening (COL-E).


Reminder: please make sure to document all of needed information in the patient medical records.


#HEDIS #Cancer #primarycare #physicians #NCQA


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Posted in HEDIS Measures, Training, Updates

HEDIS Measure: Comprehensive Diabetes Care

In this blog post we will explore the Comprehensive Diabetes Care HEDIS measure. .

What is New for 2020?

New measure Kidney Health Evaluation for Patient with Diabetes measure was added in 2020. This is a new measure. It evaluates the percent of members that are between 18 and 85 years of age that have diabetes and who received a kidney health evaluation, including estimated glomerular filtration gate test (eGFR) and a urine albumin-creating ration.

What is Comprehensive Diabetes Care Measure?

Measure that evaluates percentage of adult members between ages of 18 and 75 years of age (looks at both type 1 and type 2 diabetes) and who had each of the following:

  1. HbA1c testing
  2. HbA1c poor control (>9%)
  3. HbA1c control of (<8%)
  4. Retinal Eye Exam performed
  5. Blood Pressure Control (<140/90 mm/Hg)\

Documentation:

Record your efforts: document results of, all of the above mentioned test, in the patient’s medical record.


How to meet this measure?

  • Provide reminders to patients for upcoming appointments and screenings.
  • Draw labs in your office if available or refer patients to a local lab for screenings.
  • Refer patients to participating eye professionals for annual retinal eye exams.
  • Follow up on lab test, eye exams and specialist referrals and document in your chart.
  • Telephone visits, e-visits and virtual check-ins are acceptable settings for blood pressure readings and should be recorded in the chart.
  • Include Category II reporting codes on claims to reduce the burden of HEDIS medical record review.
  • Educate patients on topics (for example, home monitoring of blood sugar and blood pressure, taking medications as prescribed, and other healthy lifestyle education like diet, exercise, and smoking cessation).

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Posted in HEDIS Measures, Training, Updates

HEDIS Measure: Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)

HEDIS is always a hot topic of discussion. In this blog post we will discuss the HEDIS measure WCC or Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents.

Background/Research Data:

The research analyzed doctor visits pre-pandemic then during the pandemic period and the increases were dramatic. Overall obesity increased from 13.7% to 15.4%. Increases observed ranged from 1% in children aged 13 to 17 years to 2.6% for those aged 5 to 9 years.


The purpose of this HEDIS Measure:

This HEDIS measure looks at the percentage of patients between the 3-17 years of age, who had an outpatient visit with a PCP or OB/GYN and have documented evidence for all the following during the measurement year:

  • Body mass index (BMI) percentile (percentage, not value)
  • Counseling for nutrition
  • Counseling for physical activity

This HEDIS Measure (WCC) requires the following documentation:

  • When counseling for nutrition, document current nutritional behavior, such as meal patterns, eating and diet habits, and weight counseling.
  • When counseling for physical activity, document current physical activity behavior, such as exercise routine, participation in sports activities, bike riding and play groups.
  • Handouts about nutrition and physical activity also count toward meeting this HEDIS measure when documented in the member’s health record.

Telehealth, virtual check-in, and telephone visits all meet the criteria for nutrition and physical activity counseling. Counseling does not need to take place only during a well-visit, WCC can also be completed during sick visits. Documenting guidance in your patient’s records is key.



Proper Coding and Billing:

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