CommercialMarch 1, 2024
Cervical Cancer Screening (CCS) and Prenatal and Postpartum Care (PPC) for HEDIS
HEDIS® (Healthcare Effectiveness Data Information Set) is a widely used set of performance measures developed and maintained by NCQA (National Committee for Quality Assurance). These are used to drive improvement efforts surrounding best practices.
HEDIS 2024 Documentation for Cervical Cancer Screening (CCS)
Measure description: The percentage of women 21 to 64 years of age who were screened for cervical cancer using either of the following criteria:
- Women 21 to 64 years of age who had cervical cytology performed within the last 3 years.
- Women 30 to 64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
- Women 30 to 64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last 5 years.
What we are looking for in provider records:
- Documentation in the medical record indicating the date when the cervical cytology was performed and result or finding (2022 to 2024)
- Documentation in the medical record indicating the date when the hrHPV test was performed and result or finding (2020 to 2024)
- Documentation of HPV test can be counted as hrHPV testing along with result or finding
- Documentation of complete, total, or radical hysterectomy (abdominal, vaginal, or unspecified anytime in the member’s history through 12/31/2024).
- Documentation of vaginal hysterectomy (anytime in the member’s history through 12/31/2024).
- Evidence of hospice services in 2024
- Evidence patient expired in 2024
Please note: Documentation of hysterectomy alone does not meet the criteria, because it is not sufficient evidence that the cervix was removed.
Helpful Hints:
- Educate patient on importance of regular cervical cancer screening.
- OB/GYN and PCP should share cervical cancer screening results.
- Document date and result of member reported cervical cancer or HPV screenings.
HEDIS 2024 Documentation for Prenatal and Postpartum Care (PPC)
Measure description: The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year (2023) and October 7 of the measurement year (2024). For these women, the measure assesses the following facets of prenatal and postpartum care.
- Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit in the first trimester or within 42 days of enrollment with the Healthy Blue plan.
- Postpartum Care. A postpartum visit on or between 7 and 84 days after delivery.
What we are looking for in provider records for a prenatal care visit with a PCP or OB/GYN or other prenatal practitioner:
- Documentation in the medical record for deliveries of live births on or between October 8 of the year prior to the measurement year (2023) and October 7 of the measurement year (2024) must include a note indicating the date when the prenatal care visit occurred and evidence of one of the following:
- Documentation indicating the woman is pregnant or references to the pregnancy for example:
- Documentation in a standardized prenatal flow sheet
- Documentation of LMP, EDD, or gestational age
- Documentation of a positive pregnancy test result
- Documentation of gravidity and parity
- Documentation of complete obstetrical history
- Documentation of prenatal risk assessment and counseling/education
- Documentation of a basic physical obstetrical examination that includes auscultation for fetal heart tone, or pelvic exam with obstetric observations, or measurement of fundus height (a standardized prenatal flow sheet may be used).
- Evidence that a prenatal care procedure was performed such as:
- Screening test in the form of an obstetrical panel (must include all the following: hematocrit, differential WBC count, platelet count, hepatitis B surface antigen, rubella antibody, syphilis test, RBC antibody screen, Rh and ABO blood typing)
- Torch antibody panel alone
- A rubella antibody test/titer with an Rh incompatibility (ABO/blood typing)
- Ultrasound of a pregnant uterus
- Evidence of nonlive birth
- Evidence of hospice services in 2024
- Evidence patient expired in 2024
- Documentation indicating the woman is pregnant or references to the pregnancy for example:
What We Are Looking For In Provider Records For A Postpartum Care Visit With A PCP Or OB/GYN or other prenatal practitioner:
- Documentation in the medical record must include a note indicating the date when a postpartum visit occurred and one of the following:
- Pelvic exam
- Evaluation of weight, BP, breasts, and abdomen
- Notation of postpartum care
- Perineal or cesarean incision/wound check
- Screening for depression, anxiety, tobacco use, substance use disorder, or preexisting mental health disorders
- Glucose screening for women with gestational diabetes
- Documentation of any of the following: Infant care or breastfeeding, resumption of intercourse, birth spacing or family planning, sleep/fatigue, resumption of physical activity, attainment of healthy weight
- Evidence of nonlive birth
- Evidence of hospice services in 2024
- Evidence patient expired in 2024
Helpful Hints:
- Educate members on the importance of timely prenatal care.
- Schedule postpartum visit during final prenatal appointment or prior to discharge from hospital.
- Reach out to members to remind them of scheduled prenatal and postpartum appointments.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CM-048368-23-CPN48274
PUBLICATIONS: March 2024 Provider Newsletter
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