Hints for HEDIS® (and more) P
BCBSRI is committed to making it easier for your practice to be successful in all areas of quality improvement. Together, we can achieve our shared goal of improving health outcomes by identifying and addressing open care gaps.
Hints for HEDIS (and more) is a reference tool developed to explore various quality topics, including:
- Definitions, specifications, and exclusions of the many quality measures;
- Billing codes used to report gap closure;
- Collection and reporting methodologies; and
- Tips and best practices to maximize gap closure.
We know that quality screenings are down due to the COVID-19 pandemic. Many elective procedures were cancelled to decrease exposing patients to the virus. Now, as restrictions begin to be lifted, we want our members to have the best options for preventing cancer and managing their chronic diseases. Here are some recommendations for addressing quality gaps in care over the next few months.
Breast cancer screening
Imaging centers are open with new hours to safely distance patients with additional accommodations per COVID‐19 safety guidelines. Facilities are sending texts to patients 90 minutes in advance for registration and check‐in, and patients are then asked to wait in their car until called in to an exam room. Other offices are staggering appointments to provide social distancing in waiting rooms.
Colorectal cancer screening
Endoscopy centers are open but some are not at full capacity. Appointments are being rescheduled but there remains quite a backlog. Centers are offering stool testing alternatives [FOBt, FIT, FIT‐DNA (Cologuard)] if a member declines a colonoscopy.
Controlling high blood pressure
Submit the appropriate CPT® Cat II code(s) associated with a patient’s blood pressure obtained from the latest in-office visit.
Hemoglobin A1c control
Point‐of‐care A1c readings can be performed in the office or at a preferred lab. Review your diabetic panel to ensure orders are scheduled for your patients.
Diabetic eye exam
Eye care centers are reopening at select locations. Review the eye exam status of your diabetic patients, and reach out to those overdue. Submit a claim for negative retinopathy from the prior year with the CPT Cat II code 3072F based on last year’s exam of no diabetic retinopathy.
Diabetes nephropathy screening
Review your diabetic patient panel for an annual urine microalbumin screening. Lab orders can be conducted at major testing centers that remain open. Urine samples can be collected during an office visit and sent to the lab to reduce exposure for patients.
These guidelines will be updated regularly as we learn more and as new information becomes available.
Our Quality Concierge Team (QCT) is also available to answer questions, provide updates, assist in the interpretation of monthly gap-in-care reports, and provide overall HEDIS support to you and your practice. Reach our QCT nurses at QualityHEDIS@bcbsri.org or (401) 459-1005.