Quality Stars Program

Abbreviations

100

Eye Exam for Persons with Diabetes

EED

200

Breast Cancer Screening

BCS-E

300

Transitions of Care

TRC

400

Follow Up for Persons with Multiple Chronic Conditions

FMC

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

Name all of the exclusions for Transitions of Care

Hospice Care
Death during MY
Any inpatient discharge that occurs after December 1st of the MY

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

How many CMS measures qualify for exclusion with ESRD in MY 2026 and what are the measures?

4
CBP
SPC
SPD/SUPD
KED

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 insurance letters of representation when requesting medical records.

RQC and National Quality Teams Channel Shared Drive > Resources > Provider Info > Letters of Rep for Record Request

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

Misc.

100

You will be abstracting retrospective data beginning in 2026. What year is considered the measurement year? (MY)

2025

200

If a member refuses to have a test done and the provider documents the refusal, does this close the care gap?
a. True
b. False

False

300

Name the 3 measures that are triple weighted for MY 2026

CBP
GSD
PCR

400

Part 1: Name all of the measures that will continue to re-open throughout the MY even after submitting initial documentation.

Part 2: Name the measures that you can have more than one GAP open at a time.

Part 1: CBP, GSD
Part 2: FMC, TRC

500

Name the acceptable 4 types of documentation for TRC-PED and who can complete the documentation.

A billed In-Person Outpatient, Home Visit, Telephone, or Telehealth Visit completed by an MD, PA, NP, or RN