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May 2018
Here’s what you need to know about colorectal cancer screening
Colorectal cancer screening, a HEDIS® measure, examines the percentage of adults ages 50 to 75 who get the appropriate screening for colorectal cancer. It excludes patients with a history of colorectal cancer or a total colectomy as well as those in hospice.
Important reminders:
- Begin colorectal screening at age 50 and monitor screening in accordance with screening guidelines. For high-risk patients, begin screenings sooner.
- Perform patient outreach to ensure they complete testing.
- Once the patient is screened for colorectal cancer, submit a claim and document the name of the test, date performed and results in the patient’s medical record.
How to ensure you’re meeting HEDIS specifications (closing the gap):
These preventive screenings meet HEDIS specifications for an appropriate screening for colorectal cancer:
Procedure |
HEDIS specifications |
Notes |
Screening colonoscopy |
Every 10 years |
|
Screening flexible sigmoidoscopy |
Every five years |
|
Screening CT colonography |
Every five years |
While it meets HEDIS screening requirements, Medicare doesn’t reimburse for it as of April 1, 2017 |
FIT DNA (e.g., Cologuard®) |
Every three years |
Visit https://www.cologuardtest.com/hcp/ordering-cologuard/how-to-order-the-test to order the test by fax or online |
Fecal occult blood test (e.g., FIT, iFIT, guaiac) |
Every year |
Performing fecal occult testing on a sample collected from a rectal exam doesn’t meet screening criteria by the American Cancer Society or HEDIS. |
HEDIS®, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance. |
