Star Ratings and Quality Improvement

Each year The Centers for Medicare and Medicaid (CMS) publishes the Medicare Star Ratings to assist beneficiaries in selecting health care benefits that meet their needs and offer high quality care. On a scale of one to five, with five stars being excellent and one star being poor, the Star Ratings are made up of metrics that evaluate patient satisfaction, preventive health services, medication adherence, access to care and other administrative measures. Your partnership as a provider is essential to achieve a high star rating and to ensure that members receive all needed care in a timely manner, stay adherent to prescribed protocols and have a positive health experience. 

BlueCross BlueShield of South Carolina is committed to supporting Medicare Advantage providers by offering valuable resources, including a nurse known as a quality navigator to regularly visit your office and collaborate on how to improve health outcomes. The quality navigator will keep you informed of essential health plan programs, financial reward programs and new benefits available to Medicare Advantage members.  

As part of the Medicare Advantage quality program BlueCross BlueShield of South Carolina is required to track the completion of health services by annually collecting and reviewing medical records. We ask that your office promptly respond to all medical chart requests. To help relieve your administrative burden, you can grant the quality navigator direct EMR access so that the nurse can get needed medical record information. 

Together, we can achieve mutual goals of improving health outcomes and creating a positive health experience for every Medicare Advantage beneficiary. 

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