In this section, you’ll find:
• Ways to improve Star ratings by using health information
• Benefits of using CPT II codes
• Sample CPT II codes for Star measures
• Benefits of supplemental data sharing
• Frailty and advanced illness exclusion information and sample value set codes
• Health Information Exchange overview
Providing health information can improve HEDIS measure rates and the overall Star rating. Click here to see a list of HEDIS measures and details.
Two tips to help ensure proper documentation.
CPT Category II codes:
*CPT II codes are updated annually according to HEDIS specifications published by NCQA.
Click here for a list of CPT II codes to document CAHPS-related conversations.
It’s happening more and more because payers and providers are working together.
What is supplemental clinical data?
This is data captured real time in medical records and other electronic data sources that you send to us. It supplements data we capture through traditional means, such as claims and encounters, and plays an important role in helping us to identify and report to you any gaps in care for your patients with Cigna Healthcare plans.
Ways to share supplemental clinical data
The fastest and most efficient way to share this data is by providing us with direct access to your electronic health record (EHR) system. We also recommend billing CPT II codes, when applicable. Some providers may elect to share data through Arcadia or the (HEDIS-approved template highlighted below.
− An advanced longitudinal record on patients.
− Transition-of-care insights, with timely alerts for patient admissions and discharges allowing for prompt follow up.
− Expansive EHR compatibility for a more efficient onboarding process.
Benefits of sharing data
When you send supplemental clinical data to us, you may:
How we use supplemental clinical data
We use clinical data to create reports that include patient-level information around coding and documentation opportunities and quality outcomes. The reports are refreshed regularly to include all available data from:
Documentations and coding resources
We offer a variety of education and resources to help providers submit accurate and complete coding. Visit MedicareProviders.Cigna.com > Provider Education > Documentation and Coding Resources.
For assistance submitting claims with all appropriate coding best practices, please contact your Provider Performance Enablement or Provider Education representative.
How to initiate supplemental data sharing
Contact your Provider Performance Enablement representative to determine which method aligns best with your current processes or EHR system.
Overview
As Medicare beneficiaries become older and frailer, the treatment goals established with their providers focus more on quality of life rather than prevention and detection of disease. In recognition of this, the National Committee for Quality Assurance (NCQA) has established exclusion guidelines for several HEDIS CMS Star Measures that allow for the removal of beneficiaries who are frail or have advanced illness.
The appropriate documentation and submission of the frailty and advanced illness CPT, HCPCS, or International Classification of Diseases, Tenth Revision (ICD-10) value set codes in the tables below will remove patients from the following measure denominators when submitted via claims in the measurement year.
Health Information Exchanges (HIEs) are local standardized data repositories through which hospitals, health care providers, and pharmacists can electronically document, track, and share patient health data. They are a convenient means to ensure key medical data such as admissions, discharges, and information associated with a visit is complete, current, and easily accessible. HIEs also improve the speed, quality, safety, and cost of patient care (HealthIT.gov).
In addition to supporting patient care, HIEs can enable high performance on three Star rating measures. These measures require timely communication about patient admission and discharge so that documentation and outreach occur within the designated timeframe. The measures are:
Benefits of an HIEParticipating in a local HIE can help providers:
Accessing your local HIE
Contact your state’s HIE representative. A list of state contacts and exchange service providers is available on the HealthIT.gov website. The website also includes news and updates on state Health Information Exchange Programs.
Speak with exchange service providers in your state or region. Service providers may differ specifics, such as:
Speak with your EHR vendor. Some vendors have incorporated the functionality of the HIE into their EHR. Things to consider:
Helpful resources
Regional and national admission and discharge information is updated in the CareAllies® enabled population health tool, Arcadia, in real time. You can access the recent admits and discharges report from the home page on a daily basis to conduct appropriate and timely follow up with patients who have had an event. If you are interested in gaining access to Arcadia or this report, please contact your Provider Performance Enablement representative.