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Quality Improvement
Focused coursework on improving the quality and safety of clinical care and services provided to plan members.
Featured Course
Strengthen your knowledge of quality measures and initiatives that support better patient outcomes and care delivery with the CareFirst Quality Toolkit.
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HEDIS 101 for Healthcare Delivery Partners
Self-Paced Module | 25 minutes | Primary Care Providers
An introduction to Health Effectiveness Data and Information Sets (HEDIS).
- HIPAA and HEDIS
- What is HEDIS and your role in HEDIS?
- Annual HEDIS calendar
- HEDIS data collection
- Hybrid and administrative HEDIS measures and required documentation
Clinical Documentation Improvement: Angina
Self-Paced Module | 15 minutes | Primary Care Providers
A deep dive into the types of Angina, coding and clinical documentation improvement practices.
- Associated coding and documentation options for coronary artery disease with and without angina
- Clinical and model differences of stable and unstable angina
- Classification of current and resolved angina
- Supportive documentation for angina
Clinical Documentation Improvement and Coding - Diabetes Mellitus: The Basics
Self-Paced Module | 10 minutes | All Medical Providers
A deep dive into specific disease states and the changes that could result in significantly different revenue, the importance of coding to the highest level of specificity and the need for appropriate documentation within the medical record to substantiate the codes being billed.
- Classify types of diabetes
- Explain uncomplicated diabetes
- Identify complications of diabetes mellitus
- Review documentation best practices
Clinical Documentation Improvement: Chronic Kidney Disease
Self-Paced Module | 20 minutes | Primary Care Providers
A deep dive into specific disease states and the little changes that could result in significantly different revenue, the importance of coding to the highest level of specificity, and the need for appropriate documentation within the medical record to substantiate the codes being billed.
- Chronic kidney disease overview
- Diagnostic criteria
- Racial differences in clinical calculations
- Stage progression
- Chronic kidney disease ICD-10 coding options
- End stage renal disease
- Acute kidney injury on chronic kidney disease
- Documentation best practices
- Clinical scenarios
Clinical Documentation Improvement: Major Depressive Disorder
Self-Paced Module | 15 minutes | All Medical Providers
A deep dive into disease states of Major Depressive Disorder, specific coding, and documentation.
- Major Depressive Disorder overview
- Diagnostic criteria
- Single and recurrent episode
- Episode severity
- Documentation best practices
- Accurate and comprehensive ICD-10 coding
- Additional considerations
Self-Paced Module | 30-45 minutes | Primary Care Providers
A deep dive into specific disease states and the changes that could result in significantly different revenue, the importance of coding to the highest level of specificity and the need for appropriate documentation within the medical record to substantiate the codes being billed.
Clinical Documentation Improvement: High Risk Diagnoses and Audit Best Practices - CEU Eligible
Self-Paced Module | 30-45 minutes | Primary Care Providers
A deep dive into high-risk diagnoses and audit best practices. This course also addresses the changes that could result in significantly different revenue, the importance of coding to the highest level of specificity and the need for appropriate documentation within the medical record to substantiate the codes being billed.
Self-Paced Module | 30-45 minutes | Primary Care Providers
A deep dive into specific disease states and the changes that could result in significantly different revenue, the importance of coding to the highest level of specificity and the need for appropriate documentation within the medical record to substantiate the codes being billed.
Self-Paced Module | 30-45 minutes | Primary Care Providers
A deep dive into specific disease states and the changes that could result in significantly different revenue, the importance of coding to the highest level of specificity and the need for appropriate documentation within the medical record to substantiate the codes being billed.
Transitions of Care (TRC) and FMC (HEDIS) Star Measures
Self-Paced Module | 15 minutes | Primary Care Providers
Review the components of TRC and FMC HEDIS measures and the various requirements and workflows necessary to be compliant for the Star measures.
- Transitions of Care Star Measure
- FMC Star Measure
- Requirements to be compliant with the Star measures
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
Self-paced |15 minutes | All Medical Providers
An overview of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey with a focus on provider influenced CAHPS measures.
- Define CAHPS and explain its importance
- CAHPS measures
- Strategies to improve CAHPS performance
- CareFirst Resources
Medicare Health Outcomes Survey (HOS) - How Providers Can Drive Results
Self-Paced Module | 15 minutes | All Medical Providers
An overview of the Medicare Health Outcomes Survey (HOS), focusing on the measures that help providers understand the HOS components, their impact on performance, and best practices for supporting members in these areas.
- An overview of the Medicare Health Outcomes Survey (HOS)
- Star Ratings
- HOS Specific Measures
- CareFirst Resources
PDF | Primary Care Providers
A comprehensive guide on Quality Measures, Best Practices, Risk Adjustment, and more.