Quality Measures
Annual Wellness VIsit
Quality Assurance Specialty Roles
Satisfying Quality Measures

How long does the Breast Cancer Screening measures stay closed?

27 months (Oct 1, 2019-Dec 31, 2021)


What is required for a Medicare Wellness visit?

Education and counseling about preventative services and recording of height, weight, blood pressure.


How does the QA let the office know what measures are needed by the Insurance Carrier?

Add a note to upcoming appt stating what measures are needed according to the insurance company open care gap report?


Why is it important to document Allergies in the chart for Quality?

The patient can sometimes be excluded if they have an allergy to a statin medication, Ace/Arb medication or flu vaccine.


What will satisfy a colorectal cancer screening?

Colonsocopy during measurement year or 9 years prior.

CT Colonoscopy during measurement year or 4 years prior.

Flexible Sigmoidoscopy during measurment year or 4 years prior.

Cologuard (FIT-DNA) during measurement year or 2 years prior.

Fecal occult blood test (FOBT) during measurement year.


What will close the DM Nephrology measure?

Urine Micro-albumin or Urinalysis


Do you have to wait a full 366 days to do an Annual Wellness visit?

You can do the AWV on the first day of the 12th month. (Medicare only, all other plans are from Jan 1- Dec 31)


How does the QA specialist know what is needed by the Carrier?

Carrier open care gap reports


Why should I not document treatment/refusals in the Quality tab?

The quality tab does not carry over to the encounter like the surgical history does, therefore, it cannot be submitted to the carrier.


What will satisfy a fall risk screening?

Documentation in chart of a fall risk assessment for the measurement year. (Steadi fall risk)


How long does a Cologuard keep the measure closed?

What is 3 years.  Measurement year and 2 years prior.


These 3 screenings are recommended to close Quality Measures at the AWV.

PHQ-9, Steadi fall risk, and katz ADL screenings


How does the QA specialist submit Mammograms and Colorectal Screenings?

Depending on the carrier, they would submit the data via the carrier's portal or fax the data to the carrier.


Why is it important to document refusals of any treatment/procedure?

If the patient refuses any procedures/vaccines etc.. We will still fail the measure but we will not send a note to the provider asking for that procedure/vaccine.


How do I satisfy a HgbA1c measure?

Most recent (in the measurement year) HgbA1c less than 9.


What are we looking for to hold a Diabetic Eye Exam for 2 years?

What is negative retinopathy in both eyes


How do you document Mammogram and Colorectal Cancer Screening tests in Surgical History?

Name of procedure, date of procedure, and result of procedure.  (Mammogram- 7-22-21- Normal per patient)


How does the QA specialist submit Blood pressures, HgbA1cs, BMI, and Microalbumin results to the carrier?

Submits a penny claim to the carrier, the claim is only for a penny and it does not go to the patient.


Why do we document in the Mammogram/Colorectal screening in the surgical history area?

The surgical history is the only section that is brought forward to every encounter (after it is documented)


How do I satisfy the controlling blood pressure measure?

Document blood pressure in vitals section, if less that 140/90, measure will close.  If blood pressure is >140/90, take a second blood pressure and document in the vitals section.


What if the blood pressure is 140/90 or higher?

Take a second blood pressure and document it.


How do I request an eye exam that was done but is not in the chart?

In orders and results, hit plus sign and type in Missing Diabetic Eye Exam, add diagnosis, click on external records, then receiver and enter eye care facility/provider.


What is the most important role of a QA specialist?

Working with the provider/staff to ensure that patients are geting the best care possible.


How do you close a Colonoscopy in the chart if your patient tells you she  had it done this summer in New York, there were no polyps, repeat in 10 years?

Document in the surgical history section as follows: Colonoscopy-June 31, 2021-No polyps- repeat in 10 years


How do I satisfy a diabetic eye exam measure?

Must have the hard copy of the Diabetic Eye Exam in chart and it must state positive or negative retinopathy to submit to carrier.

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