Blue Cross | Blue Shield | Blue Care Network of Michigan The Record

Stethoscope with RX papers

Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article

September 2019

New advanced illness and frailty exclusions for certain HEDIS® star measures

The National Committee for Quality Assurance now allows providers to exclude patients from select Medicare Star Rating System measures that are also HEDIS® measures** due to advanced illness and frailty. NCQA acknowledges that some measured services won’t benefit patients who are in declining health.

You can now submit claims with advanced illness and frailty codes to exclude patients who meet the criteria from these measures. Using the appropriate codes also reduces the number of medical record requests you may receive for HEDIS data collection purposes.

For a description of the criteria and a list of HEDIS-approved billing codes, view the 2019 HEDIS® Advanced Illness and Frailty Exclusions Guide.

**HEDIS®, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance, or NCQA.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.