Star Ratings is a quality measurement tool the Centers for Medicare & Medicaid Services (CMS) uses to rate the quality of medical care and services provided by Medicare Advantage health plans. In the 2018 Star Ratings, Health Alliance and Health Alliance Northwest earned 4 out of 5 stars for our Illinois and Washington HMO and POS plans. We have a goal of 5 stars, and we need your help to make this a reality!
Here is one area of focus for 2018–2019:
There are four measures related to people with diabetes:
- Yearly eye exam
- Yearly kidney function test
- Yearly A1C lab test showing average blood sugar is controlled
- One statin fill per year
Documentation in the patient’s electronic medical record and accurate coding are key to ensuring all patients receive the diabetes care they need.
If a patient is not able to take a statin, this must be documented and coded annually to exclude them from the diabetes measures listed above.
- Having in vitro fertilization procedure
- Current prescription for clomiphene
- End-stage renal disease
Below is a list of suggested codes for these excluded conditions. This is for your reference but is not an all-inclusive list.
|G72.2||Myopathy due to other toxic agent|
|K74.60||Cirrhosis of the liver, unspecified|
|N18.6||End-Stage Renal Disease|
|T46.6X5A||Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter|
|T46.6X5D||Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, subsequent encounter|
|T46.6X5S||Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, sequela|
|Z31.83||Encounter for Assisted Reproductive Fertility Procedure Cycle|
Every year, Medicare evaluates plans based on a 5-star rating system.