We need to document that we ask ACO beneficiaries if they have had a Pneumonia Vaccine this often.
What is Annually?
100
There are three tests that meet this 5 Star measure for members between the ages of 50-75. One can be done yearly, the second every 5 years, the third every 10 years.
What is Colorectal Cancer Screening?
100
ICD-10 is mandatory beginning this date.
What is October 1, 2015?
100
Children between 2-18 years of age with a sole diagnosis of Pharyngitis who are dispensed an antibiotic must also have this done for quality reporting.
What is Group A Strep test?
100
Each diagnosis needs these two elements documented.
What is Status and Plan?
200
If a beneficiary's BMI is outside the normal parameters, this needs to be documented.
DAILY DOUBLE!!!
Name a medical reason exclusion for this measure.
What is a Follow Up plan?
DAILY DOUBLE:
Palliative Care
Pregnancy
Urgent or Emergent medical situation
200
Members with one of these three diagnoses exclude them from the Comprehensive Diabetes Care 5 Star measure. Name two of the three exclusion diagnoses.
What are:
PCOS
Gestational Diabetes
Steroid-induced (Secondary) Diabetes
200
In 2016, we will being reporting female adolescents receiving all three doses of the HPV vaccine by this birthday.
What is the 13th birthday?
200
Children between 3 months and 18 years with a diagnosis of URI should not be dispensed an antibiotic for the CWP measure. This excludes them from the measure.
What is a secondary diagnosis?
200
Name two types of Hypertension that risk adjust.
What are:
Pulmonary Hypertension
Portal Hypertension
Hypertensive Renal Disease with Stage 5 CKD
300
This is the only exclusion for the annual ADL and Future Fall Risk measure for beneficiaries 65+.
What is Non Ambulatory?
300
This diagnosis in the MY or year prior excludes a member from the BMI 5 Star measure.
What is Pregnancy?
300
In 2016, we must begin reporting the number of well-child visits within the first 15 months of life. This is the number of well-child visits required for measure compliance.
What is 6 or more?
300
Sexually active women in this age range need an annual Chlamydia test.
What is 16-24 years old?
300
Patient has a longstanding history of GFR hover around 39, what should we look for?
What is Hyperparathyroidism?
400
A positive Clinical Depression screening needs this documented by this day.
What is a follow up plan ON THE DATE of the positive screen?
400
The Adequately Controlled BP 5 Star measure excludes members between the ages of 18-85 that have one of the exclusion events in the MY. Name two of the three exclusion events.
What are:
ESRD
Pregnancy
Admission to a non-acute inpatient setting
400
Task completion must be within 7 days to be eligible for this in the future.
What is the RAF Benchmark Incentive?
400
These two HEDIS measures require at least one Serum Creatinine therapeutic monitoring and one Serum Potassium each year.
DAILY DOUBLE!!!
This is the third Members on Persistent Medication measure.
What is annual monitoring for members on:
ACE or ARB
Diuretics
DAILY DOUBLE!!!
What is Digoxin?
400
CKD Stage 5D means this.
What is Stage 5 CKD on Dialysis?
500
Identified tobacco users need to receive this to meet the ACO Tobacco Cessation measure.
What is cessation counseling and/or pharmacologic therapy?
500
These are three preventive measure screening tests ordered automatically by the HCC/Quality Measures team and Nursing teams on behalf of the PCP.
What are:
Mammograms
Fit Kits (FOBT)
Diabetic Labs
500
A SW exam must be repeated the following year by this time.
DAILY DOUBLE!!!
True or False: If a SW is done on October 8th, the patient can't have their next SW done until October 8th the following year.
What is December 31st?
DAILY DOUBLE!!!
What is False.
500
For the LBP measure, members age 18-50 with a primary diagnosis of Low Back Pain should not have an imaging study (X-ray, MRI, CT) within this timeframe of the diagnosis.
What is 28 days?
500
These are our 2015 RAF goals for the following lines of business:
Sr. HMO
CMC
Exchange