Colorectal cancer screening measure updated

Due to the importance of screening Medicare patients for colorectal cancer, we want to make sure you’re aware of updates to the Healthcare Effectiveness Data and Information Set measure for colorectal cancer screening, as well as screening coverage.

According to Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, “There are more than 20 million adults in this country who haven’t had any recommended screening for colorectal cancer and who may therefore get cancer and die from a preventable tragedy.”

The HEDIS^® Colorectal Cancer Screening 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.

The following preventive screenings meet HEDIS specifications. They’re also fully covered without cost sharing when provided by an in-network health care provider.

• New: FIT DNA (e.g., multi-target stool DNA, Cologuard^®) test every three years for patients who show no signs or symptoms of colorectal disease and are at average risk for developing it.
• Screening fecal occult blood test every year
  

  Note: Performing FIT (FOBT or iFOBT) in an office setting or on a sample collected during digital rectal exam doesn’t meet HEDIS and the American Cancer Society’s requirements as a screening.

• Screening flexible sigmoidoscopy every five years
• Screening colonoscopy every 10 years:
• Patients at high risk for colorectal cancer are covered once every 24 months.
• Patients who aren’t high risk are covered once every 120 months or 48 months after a previous flexible sigmoidoscopy for patients who aren’t at high risk.
• HEDIS specifications count a colonoscopy for 10 years.
• A screening colonoscopy turns into a diagnostic colonoscopy with cost sharing if a patient has an abnormality such as a polyp.

While CT colonography meets HEDIS screening requirements, Medicare doesn’t reimburse for it as of April 1, 2017.

Go to Medicare.gov for more information.

Once you screen your patient for colorectal cancer, you must either:

• Submit a claim for one of the appropriate screenings, or
• Provide documentation in the medical record of one of the following:
• Put the date and name of the test performed in the medical history section of the chart
• Indicate the type of screening performed, date and result.

Helpful tips
Here are helpful tips for improving HEDIS scores:

• Begin colorectal screening at age 50. For high-risk patients, begin screenings sooner.
• Encourage stool tests in patients who are resistant to receiving a colonoscopy.
• Document test results in chart.
• Develop a callback system to ensure patients complete testing because only completed tests count.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance, or NCQA.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.