Quality Stars Program

Abbreviations

100

KED 

Kidney Health Evaluation

200

Breast Cancer Screening

BCS-E

300

Transitions of Care

TRC

400

COB

Concurrent Use of Opioids & Benzodiazepines 

500

Use of Multiple Anticholinergic Medications in Older Adults

Poly-ACH

Exclusions

100

T/F 

Exclusions fall into 2 categories: Required Exclusions and Optional Exclusions 

FALSE

MY24 Removed the Optional Exclusions categories- All member exclusions are required

200

Name 2 Exclusions for Breast Cancer Screening

Bilateral mastectomy, Unilateral mastectomy with bilateral modifier, Mastectomy of both left and right side (may be on different dates of service)

Hospice or palliative care, Death during measurement year, For members 66 and older – enrolled in I-SNP, living in a long-term care facility and/or meet both frailty and advanced illness criteria

300

Do exclusions impact the numerator or the denominator in Quality scores?

Denominator

400

Name 2 Exclusions for OMW

• BMD (DEXA Scan) test that was performed within 24 months prior to the fracture,  

• Osteoporosis therapy within 12 months before the fracture,  

• Prescription to treat or prevent osteoporosis within 12 months before the fracture,  

• Patients in hospice,  

• Patients 67-85 years old living long-term in an institutional setting,  

• Patients 67-80 years old with frailty and advanced illness, or  

• Patients 81 years old or older with frailty only   

500

Define Frailty & Advanced Illness exclusion criteria

TWO instances of Frailty AND TWO instances of Advanced Illness

Know Where To Go

100

Name 2 "where to go" resources when data mining for labs (KED, A1c)

Labcorp
Quest
CPL
HIE
ChartFast
Datavant

200

Name "where to go" when uploading supplemental data

P3 Provider

300

Name "where to go" when uploading supplemental data & the gap is NOT OPEN in P3 Provider

Share Drive Folder: "Gap Closing Documentation & Exclusions"

400

Name "where to go" to find updated GIC files

RQC and National Quality Teams Channel Shared Drive - GIC Files

500

Name "where to go" to find the Learning Lab schedule

RQC and National Quality Teams Channel Shared Drive > Quality Team Meetings> Ice Breaker & SME Assignments 2026

Compliance Time Frames

100

Name 2 compliant timelines for COL-E & the type of test 

FOBT- 1yr

FIT (Cologuard)- 3yrs

Sigmoidoscopy- 5yrs

Colonoscopy- 10yrs

200

Breast Cancer Screening

27 months
For MY 2026 - 10/01/2024 through 12/31/2026

300

Eye Exam for Persons with Diabetes

1 Year for a Positive Retinal or Dilated Eye Exam (2026)

2 Years for a Negative Retinal or Dilated Eye Exam (2025)

400

Transitions of Care

30 Days plus the date of discharge = 31 days

500

Follow Up for Persons with Multiple Chronic Conditions

7 Days plus the date of discharge = 8 days

Diabetes

100

Name the FIVE measures that can apply to people with diabetes 

Part C: GSD, EED, KED

Part D: SUPD, MA-D

200

A member has the following labs in their EMR record- are they compliant for MY26?

1.15.26: A1c 8.2%, 4.22.26: A1c 7.9%

6.26.26: A1c 8.5%, 11.15.26: A1c 9.2%

Non-Compliant A1c reading 9.2%

300

Name the 2 labs needed to close the KED measure

uACR & eGFR

400

What can you upload to close SUPD? 

NOTHING - Part D measures are claims based.

Exclusions can be uploaded if found

500

A member has their A1c taken in February and is recorded at 8.2%. In September, the member is on your GIC file again- explain why.

A 2nd A1c was taken after February & is out of range (non-compliant) & the member back on the GIC list.

Or its a DSAP error ;)