HEDIS_and_Star_Ratings (1)

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HEDIS and Star Ratings © 2013 Medical Audit Resource Services, Inc. All Rights Reserved 1 Star ratings are comprised of a particular set of HEDIS measures, surveys (HOS and CAHPS), and Part D measures Star ratings for Medicare Advantage Plans are on a scale from 1-5, with a star rating of 5 being the highest attainable rating indicating excellent performance. Medicare Advantage Plans with a 5 Star Rating are able to enroll beneficiaries year round

Wingdings 2:

BMI 2 18-74 years of age as of 12/31 of the current year BMI documentation must be present in current year or prior year on an outpatient visit V codes (V85.0-V85.5) must be submitted For patients younger than 19, documentation of BMI percentile documented as a value (ex. 85 th percentile) or plotted on an age growth chart also meets criteria Exclusions for this measure: Pregnancy during the current year or the year prior Review medical records for height, weight, and BMI as specified above © 2013 Medical Audit Resource Services, Inc. All Rights Reserved

Wingdings:

Breast Cancer Screening 3 Female Ages 52 to 74 as of 12/31 of the current year Mammogram must be performed anytime on or between October 1, two years prior to the current year to 12/31 of the current year (ex. 10/1/11-12/31/13) Captured by insurance claims with CPT/HCPCS/ICD-9 Mammogram codes Exclusions include patients with a history of a bilateral mastectomy or 2 unilateral mastectomies Review medical record for Mammogram report on females starting at age 50 to 74 as specified above © 2013 Medical Audit Resource Services, Inc. All Rights Reserved

Calibri:

Glaucoma Screening 4 Ages 67 and older as of 12/31 of the measurement year Must have an eye exam for glaucoma performed by an optometrist or ophthalmologist in the current year or the year prior Exclusions to this measure include those patients with a prior diagnosis of Glaucoma or Glaucoma suspect (365.0 X -365.9 , 377.14) Review medical record for eye exam reports on any patient 65 and older without a diagnosis of Glaucoma or Glaucoma suspect Captured by the health plan by CPT or HCPCS codes submitted by the optometrist or ophthalmologist © 2013 Medical Audit Resource Services, Inc. All Rights Reserved

Civic:

Care Of Older Adult-Pain Assessment 5 Pain assessment in the current year and the date it was performed must be documented in the medical record Documentation must include that the patient was assessed for pain (positive or negative findings) OR result of an assessment using a standardized pain assessment tool (Numeric Scale rating-verbal or written, Brief pain inventory, Chronic pain grade, Promis Pain Intensity Scale, FLACC Scale, etc.) Submit a 1125F if pain is present and 1126F if pain is not present © 2013 Medical Audit Resource Services, Inc. All Rights Reserved

HEDIS and Star Ratings:

Plan All Cause Readmission 6 Patients 18 years and older who were readmitted for any diagnosis within 30 days of an acute inpatient stay. A lower rate indicates better performance PCPs and hospitalists must be aware of readmissions and have measures in place to prevent readmissions. Practices should receive information from both the hospitals and the MA plans on admits, discharges, and ER admits © 2013 Medical Audit Resource Services, Inc. All Rights Reserved

BMI:

MARSI Contact Information 8 For more information please contact: Bob Palumbo, Chief Executive Officer, MARSI   407-679-6794   bpalumbo@himexperts.com © 2013 Medical Audit Resource Services, Inc. All Rights Reserved