June 2016
HEDIS 2017 Medicare Stars
Quick Cue Sheet
We want to help you improve your quality ratings. Listed below for your reference are some key
indicators for several of the Healthcare Effectiveness Data and Information Set (HEDIS ®)
measures.
ABA - Adult BMI Assessment
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18-74 yrs. through 12/31/16 (Born 1942-1998)
January 1, 2015 – December 31, 2016
Assessment w/weight & BMI same visit
18-21 yrs. percentile growth chart = weight/height or weight & BMI
Exclusion: Pregnancy
CBP – Controlling High Blood Pressure
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18-85 yrs. through 12/31/16 (Born 1931-1998)
January 1, 2016 – December 31, 2016
< 140/90
60-85 yrs. < 150/90 w/out diagnosis of DM
Diagnosis prior to June 30, 2016
New diagnosis HBP & BP reading same visit not acceptable
Last BP of the year (The most recent BP reading – as long as it occurred after diagnosis)
Exclusions: Pregnancy, ESRD, Kidney Transplant, Non-Acute Inpatient Admission
BCS – Breast Cancer Screening
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52-74 yrs. through 12/31/16 (Born 1942-1964)
October 1, 2014 – December 31, 2016
1 or more mammograms
Exclusions: Bilateral Mastectomy, Unilateral Mastectomy w/bilateral modifier, Two
unilateral Mastectomies, 14 days or greater apart, History of Bilateral Mastectomy
Blue Cross and Blue Shield Inc. is a Licensee of the Blue Cross and Blue Shield Association.
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HEDIS 2017 Medicare Stars
Cue Sheet (continued)
OMW – Osteoporosis Management in Women Who Had a Fracture (ADMIN)
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67-85 yrs. Female through 12/31/2016 (Born 1931-1949)
Fracture July 1, 2015 – June 30, 2016
Within 6 months of fracture BMD -OR- prescription therapy
BMD/Dexa Scan July 1, 2013 – December 31, 2016
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Exclusions: BMD w/in 24 months prior to IESD*, Osteoporosis Therapy or Prescribed
Medication w/in 12 months prior to IESD*
*IESD (Index Episode Start Date) the earliest date of service for any encounter during the Intake
Period with a diagnosis of fracture.
Table OMW-C: Osteoporosis Therapies
Description Prescription
Biphosphonates  Alendronate
 Alendronatecholecalciferol
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Other agents
 Ibandronate
Calcitonin
 Denosumab
 Risedronate
 Zoledronic acid
 Raloxifene
 Teriparatide
Complete NCQA medication lists available at:
http://www.ncqa.org/HEDISQualityMeasurement/HEDISMeasures/HEDIS2016/HEDIS2016NDCLicense/HED
IS2016FinalNDCLists.aspx
COL – Colorectal Cancer Screening
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51-75 yrs. through 12/31/2016 (Born 1941-1965)
Fecal Occult Blood Test (FOBT) x3 -OR- FIT Test January 1, 2016 – December 31, 2016
Flexible Sigmoidoscopy January 1, 2012 – December 31, 2016
Colonoscopy January 1, 2007 – December 31, 2016
Exclusions: Colorectal Cancer, Total Colectomy
CDC – Comprehensive Diabetes Care
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18-75 yrs. through 12/31/2016 (Born 1941-1998)
HbA1c January 1, 2016 – December 31, 2016
Eye Exam (Dilated or Retinal) January 1, 2015 – December 31, 2016
BP (most recent) < 140/90 January 1, 2016 – December 31, 2016
Blue Cross and Blue Shield Inc. is a Licensee of the Blue Cross and Blue Shield Association.
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HEDIS 2017 Medicare Stars
Cue Sheet (continued)
 Nephropathy Attention by one of the following from January 1, 2016 – December 31, 2016
o
o
A urine test for albumin or protein
A visit with the nephrologist
o Evidence of prescription for ACE inhibitors/ARBs
o Medical attention for any of the following: diabetic nephropathy, chronic
kidney disease, ESRD, kidney transplant, chronic renal failure, renal
insufficiency, proteinuria, albuminuria, renal dysfunction, acute renal failure,
dialysis, hemodialysis or peritoneal dialysis
 Exclusions: Gestational Diabetes, Steroid-Induced Diabetes
Description
Angiotensin
converting
enzyme inhibitors
Angiotensin II
inhibitors
Antihypertensive
combinations
 Benazepril
 Captopril
 Azilsartan
 Candesartan
Table CDC-L: ACE Inhibitors/ARBs
Prescription
 Enalapril
 Lisinopril
 Perindopril
 Fosinopril
 Moexipril
 Quinapril
 Eprosartan
 Irbesartan
 Aliskiren-valsartan
 Amlodipine-benazepril
 Amlodipine-
hydrochlorothiazidevalsartan
 Amlodipinehydrochlorothiazideolmesartan
 Amlodipine-olmesartan
 Amlodipine-telmisartan
 Amlodipine-valsartan
 Losartan
 Olmesartan
 Telmisartan
 Valsartan
 Azilsartan-chlorthalidone
 Benazepril-
hydrochlorothiazide
 Candesartan-
 Ramipril
 Trandolapril
hydrochlorothiazide
 Captopril-hydrochlorothiazide
 Enalapril-hydrochlorothiazide
 Eprosartanhydrochlorothiazide
 Fosinopril-hydrochlorothiazide
 Hydrochlorothiazideirbesartan
 Hydrochlorothiazide-lisinopril
 Hydrochlorothiazide-losartan
 Hydrochlorothiazide-moexipril
 Hydrochlorothiazide-
olmesartan
 Hydrochlorothiazide-quinapril
 Hydrochlorothiazide-
telmisartan
 Hydrochlorothiazide-valsartan
 Trandolapril-verapamil
Complete NCQA medication lists available at:
http://www.ncqa.org/HEDISQualityMeasurement/HEDISMeasures/HEDIS2016/HEDIS2016NDCLicense/HED
IS2016FinalNDCLists.aspx
Blue Cross and Blue Shield Inc. is a Licensee of the Blue Cross and Blue Shield Association.
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900-1782-0616