MEASURE: Breast Cancer Screening
NUMERATOR: % of Denominator
that had a mammogram during the measurement year or the year prior to the
measurement year.
DENOMINATOR: Number of female
enrollees aged 42 to 69
It's applicable for Commercial, Medicare and Medicaid
It has a 45 day allowable gap in enrollment for the denominator. So if they don't have coverage with your plan for 46 days you can get them out of the population.
It does have exclusionary criteria:
Women who had a bilateral mastectomy or for whom there is evidence of two unilateral mastectomies
The data elements are pretty straight forward
Year
Collection
Eligible population
Numerator events by population
Now this is another straight forward measure on the surface. The provider needs to get the patient a mammogram screening every basically every two years and these records need to be verified.
The problem is that this can be an "uncomfortable" screening and compliance can be difficult to do. Once again you might have to deal with dual coverages in the older populations and reporting can be difficult.
Plus you may have several competing organizations offering these services that may not communicate. Below is an example
CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to breast and cervical cancer screening services to underserved women in all 50 states, the District of Columbia, 5 U.S. territories, and 12 tribes
It's applicable for Commercial, Medicare and Medicaid
It has a 45 day allowable gap in enrollment for the denominator. So if they don't have coverage with your plan for 46 days you can get them out of the population.
It does have exclusionary criteria:
Women who had a bilateral mastectomy or for whom there is evidence of two unilateral mastectomies
The data elements are pretty straight forward
Year
Collection
Eligible population
Numerator events by population
Now this is another straight forward measure on the surface. The provider needs to get the patient a mammogram screening every basically every two years and these records need to be verified.
The problem is that this can be an "uncomfortable" screening and compliance can be difficult to do. Once again you might have to deal with dual coverages in the older populations and reporting can be difficult.
Plus you may have several competing organizations offering these services that may not communicate. Below is an example
CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to breast and cervical cancer screening services to underserved women in all 50 states, the District of Columbia, 5 U.S. territories, and 12 tribes
It's a federal program but they may not communicate with your provider or the insurance company. It's just an example of where something very simple can get a bit complex. This is another example of where supplemental data can be used to provide additional information. You need evidence of this service has taken place and this must pass your HEDIS auditor scrutiny. I can't emphasis enough that you should have very clear channels of communication with your auditor and provide detail information of how
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