In this section, you’ll find:
• Ways to improve Star ratings
• HEDIS measures completed at telehealth visits
• Cigna Healthcare telehealth resources
• Cigna Healthcare in-home vendor resources
Utilizing telehealth and vendors to close HEDIS gaps may also improve a patient’s perception of Getting Needed Care, and Getting Appointments and Care Quickly, both of which are CAHPS measures. Click here for details around HEDIS measures that can be affected by telehealth and vendor options.
Click here for CAHPS measures.
Cigna Healthcare supports you and our Medicare Advantage patients by providing up-to-date HEDIS data and resources to help close gaps, improve patient care, and positively impact overall Star quality ratings.
HEDIS measures that can be completed during telehealth visits (HEDIS measure-level information begins here:
Controlling High Blood Pressure – Patient-reported blood pressure readings taken with a digital device may be documented in the medical record and used as a basis for advice and prescriptive treatment. Click here for a list of CPT II codes to document systolic and diastolic blood pressure readings
Transitions of Care (including Medication Reconciliation) – This gap can be closed by completing the following:
− Notification of admission to the PCP on day of or two days after admission (three total days).
− Receipt of discharge information by the PCP on the day of or two days after discharge (three total days).
− Patient engagement within 30 days post-discharge (can be by telephone, telehealth, or eVisit).
− Medication Medication reconciliation on day of discharge through 30 days after discharge (31 total days) (the patient does not have to be present). CPT II 1111F can be used to identify a medication reconciliation post discharge.
Care of Older Adults:
− Functional Status Assessment – Documentation of at least 5 ADLs, 4 IADLs, or completion of a standardized functional status assessment tool anytime in the current year. CPT II 1170F can be used to identify a completed Functional Status Assessment.
− Medication Review – Medication list present in the medical record along with evidence of medication review conducted by a pharmacist or prescribing practitioner any time in the current year. CPT II 1159F and 1160F can be used together to identify medication list and a completed medication review. The patient does not have to be present or involved in the medication review process.
− Pain Assessment – Documentation that patient was assessed for pain anytime in the current year. CPT II 1125F or 1126F can be used to identify a completed Pain Assessment.
Osteoporosis Management – Eligible patients are prescribed an osteoporosis medication, if appropriate for the patient.
Statin Therapy for Patients with Cardiovascular Disease – Eligible patients are prescribed a moderate- or high-intensity statin medication, if appropriate for the patient.
HEDIS measures that cannot be completed during telehealth visits:
Breast Cancer Screening – Mammogram must occur every two years. Appropriate coding for bilateral or two unilateral mastectomies excludes patients from this HEDIS measure. CPT II 3014F, 3341F, 3342F can be used to identify a mammogram. Click here for more information about these codes.
Eye Exam for Patients with Diabetes – Retinal eye exam completed anytime in the current year; or retinal eye exam with evidence of negative retinopathy completed in the prior year. Any provider can submit one of the following CPT II codes indicating eye exam and retinopathy status: 2022F, 2023F, 2024F, 2025F, 2026F, 2033F.
Glycemic Status Assessment for Patients with Diabetes– Lab test for HbA1c must occur any time during current year. Providing diabetes education to patients who have A1c values > 9% could help with diabetes management. Click here for a list of CPT II codes to document A1c results.
Colorectal Cancer Screening – Evidence of one of the following screenings: colonoscopy in the past 10 years; Flex Sig /CT in the past five Years; Cologuard (FitDNA) in the past three years; or FOBT in the current year. CPT II 3017F can be used to identify a colorectal cancer screening was documented and reviewed.
– Patients may be eligible for mail-in FitDNA or FOBT.
While these measures cannot be completed during a telehealth visit, you can document if a patient has had one in the past. For A1C control, patient-reported A1Cs can be used as long as the date and value are known, and it is documented in the medical record. However, a range is not acceptable.
Telehealth can help your patients with Cigna Healthcare Medicare Advantage coverage conveniently access care at any time and may be a viable option to close Star gaps.
About MDLIVE
We offer telehealth for urgent, non-emergency, care management, behavioral health, and dermatology. Customers can speak with an MDLive® provider by telephone, computer, or tablet. Virtual care providers can diagnose, treat, and prescribe medication for conditions that include, but are not limited to:
Access to MDLIVE
Eligible customers have access to the telehealth benefit with MDLIVE providers—after-hours, nights, weekends, and holidays. To access this benefit, customers need to complete the MDLIVE registration process, and provide a brief medical history.
Cigna Healthcare Arizona Medicare Advantage customers: Visit MDLive.com/CignaMedicareAZ, or call 866.301.8658
All other Cigna Healthcare Medicare Advantage customers: Visit MDLive.com/CignaMedicare, or call 866.918.7836
Telehealth resources for providers in your office
Many providers are encouraging their patients to utilize telehealth services when needed to avoid certain health issues from escalating.
You can stay up to date on the latest telehealth billing guidelines, including diagnosis and CPT codes, by visiting MedicareProviders.Cigna.com > Billing Guidelines and FAQ.
Visit telehealth.hhs.gov/providers for additional telehealth resources, including:
Getting started with telehealth
Best practice guides
Preparing patients for telehealth
Policy changes during COVID-19
Your Cigna Healthcare Medicare Advantage patients who are unable to come to your office for an in-person visit or have not been able to engage with you for care, can be referred to one of our vendors that conduct preventive health screenings and help close gaps in care. The completion of both measures, preventive screenings and closing gaps in care, can improve Star ratings, and help you get a more comprehensive and accurate picture of your patient’s health.
In-office gap closure events from our vendors
Our vendors also offer in-office events to close Eye Exam for Patients with Diabetes (EED) gaps and perform other needed preventive health screenings, such as hemoglobin A1c (HbA1c) or fecal immunochemical test (FIT).
If you are interested in referring patients to an in-home vendor or arranging an in-office event, please work with your Provider Performance Enablement or Stars Market Operations representative. All referrals and distribution to our third-party vendors is handled internally so we can track their activity and monitor the status of outreach.
Vendor prioritization and referrals
Our internal Stars and Risk Adjustment (SRA) teams monitor the completion of preventive health screenings by providers, vendors, and through claim submissions to ensure that our customers receive quality service in a timely manner. We leverage different vendor services at different points throughout the year and streamline the referral process so customers receive the necessary screenings within a single encounter. For example:
If a patient needs a yearly health checkup, we will refer them to a contracted vendor that will also close gaps in care at the same time.
If a patient does not need a yearly health checkup, but has open gaps in care for EED or Osteoporosis Management in Women Who Had a Fracture (OMW) measures, we will refer them to a gaps in care vendor to close these and other open gaps.
If a patient does not need a yearly health checkup or have EED or OMW gaps to close, our vendor, Let’s Get Checked, will mail A1c and FIT at-home self-tests for them to complete and return.
The following diagram illustrates how our SRA teams prioritize vendor referrals by coordinating efforts among our programs, participating providers, and contracted vendors: