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:
− 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 reconciliation on day of discharge through 30 days after discharge (31 total days) (the patient does not have to be present).
− 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.
HEDIS measures that cannot be completed during telehealth visits:
− 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.
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:
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:
The following diagram illustrates how our SRA teams prioritize vendor referrals by coordinating efforts among our programs, participating providers, and contracted vendors: