Mount Carmel Health Partners HEDIS Tip Sheets | Page 31

HEDIS Tip Sheet
Exclusions:
• Fractures of the fingers, face, skull, or toes are not included in this measure.
• A diagnosis/claim for osteoporosis or filled prescription for osteoporosis in the twelve months prior to the
fracture within the eligible time period OR a BMD test [DEXA scan] within 24 months prior to the fracture.
• Hospice care in the measurement year.
Chart Review Tips:
• Look for any exclusions. If exclusions are identified, please note it for future reference.
• BMD tests [DEXA scan] can be found in the "Radiology" section of the chart.
• Osteoporosis medications can be found in the "Medications" section of the chart or noted in recent office
visit /progress note.
Member Outreach Tips:
• If the patient has had a fracture and has no exclusions, ask if she has had a BMD test or is taking medications for
the fracture. If she is not, encourage her to schedule an appointment with her doctor to discuss a BMD test
[DEXA scan] or medications to strengthen her bones.
Supplemental Data Tips
A list of Osteoporosis medications are shown below.
Description
Prescription
Biphosphonates • Alendronate (Fosamax)
• Alendronate-cholecalciferol (Fosamax Plus D)
• Calcium carbonate-risedronate (Actonel with calcium) • Ibandronate (Boniva)
• Risedronate (Actonel)
• Zoledronic acid (Reclast, Zometa)
Other agents • Calcitonin (Fortical, Miacalcin)
• Denosumab (Prolia, Xgeva) • Raloxifene (Evista)
• Teriparatide (Forteo)
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