Provider Central

Every year, the Centers for Medicare & Medicaid Services (CMS) publishes Star Ratings to measure the quality of health and drug services received by Medicare members. To rate Medicare Advantage plans, CMS uses:

• Health Effectiveness Data and Information Set (HEDIS®′) scores
• Results from patient experience and health outcomes surveys
• Data provided by the plans and their network providers

The Find Health & Drug Plans tool at Medicare.gov includes Star ratings for each plan to help consumers search and compare quality. (CMS also has a Five-Star Quality Rating System for nursing homes.)

Resources:

• New! Medicare Advantage 5-Star Provider Playbook
  This guide contains actionable, evidence-based information, tips, and best practices to help you coordinate your patient’s care and improve health outcomes. Contents include:
  • Star measures and who the measures affect
  • CPT code suggestions to use as applicable
  • Recommended best practices to close gaps in care
  • Details on the patient experience surveys that CMS conducts annually with Medicare beneficiaries and recommended best practices to improve performance.
• Experience and Outcomes Surveys
• HEDIS