This guidebook is not an attempt to practice medicine or provide specific medical advice, and it should not be used to make a diagnosis or to replace or overrule a qualified health care provider’s judgment. The content in this guidebook is for reference and educational purposes only.
Introduction to the CMS Five-Star Quality Rating System
How providers can raise Star ratings
Raising Star ratings through health conversations with your patients
Sharing data improves accuracy and Star ratings
Pharmacy measures can be a Star maker
The importance of patient follow ups
Provider group case study
Closing HEDIS-based care gaps virtually opens Stars improvement opportunities
Your office staff can be Star generators
Details on how Stars are measured
Cigna Healthcare works with you to raise Stars together
Frequently asked questions
Appendix
360 Comprehensive Assessment information
CPT II Codes for HEDIS measures
Frailty and advanced illness exclusions for HEDIS measures
CAHPS measure
HOS measures
HEDIS measure technical specifications
Pharmacy measures