Exclusions
If there is a possible exclusion for the patient,what do you do?
1. Go to the task in question and “revert” it back to “provider decision” (the first step).
2. Once there, select “provider noted exclusion” from the drop-down menu
3. Put as much detail as possible in the “details” section so your market manager, or other leader, can to go into the task and understand what is happening without the need to contact you.
What details should every document include before being uploaded?
1. Patient's name
2. Patient's DOB
3. Results
4. Date of results or encounter
5. Provider Signature and date
What is the timeframe for BP?
The most recent BP.
What 3 exclusions are the same for all gaps?
Hospice, Palliative care and expired in facility
What two tests are required to close out a KED gap?
Both an uACR urine test and eGFR blood test are required on same or different dates of service:
1. At least 1 urine albumin-creatinine ratio (uACR) test identified by one of the following:
A quantitative urine albumin test and a urine creatinine test 4 or less days apart
OR
A uACR test AND at least 1 estimated glomerular filtration rate (eGFR)
What is the timeframe for a BCS (Breast cancer screening)?
To be completed every 2 years and 3 months. (If a mammogram occurred after October 1, 2023, test completion is valid through 12/31/2025)
What medication therapies are recognized as exclusions for closing Osteoporosis gaps?
Recognized osteoporosis therapies include:
1. Bisphosphonates (alendronate, alendronate-cholecalciferol, ibandronate)
2. Other agents (denosumab, abaloparatide)
What can you do if you have multiple BP's taken during a visit but none of them are compliant on their own?
Mix and match- If you have a Systolic (top #) that is noncompliant and a previous Diastolic that is compliant you can use that.
When does a Med Recon need to be completed by?
Within 30 days of discharge.
What is a common exclusion for Med Adherence (MAH, MAC, MAD)?
ESRD
How many days do you have to upload a discharge summary?
2 days.
What is the timeframe for Osteoporosis?
To be completed within 6 months of the date of the fracture
What are the exclusions for Statin Therapy for SPC (cardiovascular disease)?
Hospice, ESRD, dialysis, diagnosis of pregnancy in vitro fertilization, cirrhosis, myalgia, myositis, myopathy, rhabdomyolysis, patients who receive palliative service or expire during the measurement year.
If a Med Rec populates after a TOC visit, how can you close the measure?
Go to your provider and sign OR
If a visit note is used the following must be true:
-Needs to be a mention in the note of the hospital visit
-An up to date medication list needs to be in the note or a note about reconciliation
-Needs to be within 30 days
-Upload the visit note
What is the timeframe for a CCS (Colorectal Cancer Screening)?
To be completed lesser of the previous
screening’s timeframe-
Colonoscopy – current year or completed 9 years prior (2016-2025)
Flexible Sigmoidoscopy – current year or completed 4 years prior (2021-2025)
Stool-DNA (Cologuard) and FIT-DNA Test –
current year or completed 2 years prior (2023-2025)