Medicare AdvantageDocumentationMedium impact
Diabetic measures
Blue Cross Blue Shield of Rhode Island·RI · Endocrinology, Family Medicine, Internal Medicine +3 more·Physician
Effective date
Aug 1, 2026
We identified it
Aug 1, 2026
Summary
This policy emphasizes three key quality measures for diabetes care (KED, GSD, EED) that are part of the Medicare Stars program, effective August 1, 2026. The policy requires coordinated tracking and documentation of kidney function monitoring, glycemic control assessment, and diabetic retinal exams to close quality gaps and improve Star ratings.
Action Required
By July 31, 2026: Care coordination and billing teams must implement tracking systems to monitor the three diabetic quality measures (KED—kidney function monitoring, GSD—HbA1c assessment, EED—retinal eye exams). Actions: (1) Update EMR to flag patients with open gaps in these measures; (2) Establish pre-visit planning protocols to identify patients needing testing at the start of the year; (3) Create bundled lab order templates for kidney function and glucose monitoring; (4) Implement patient education materials explaining the importance of these tests; (5) Coordinate with providers and clinical staff to ensure documentation of completed measures. While this is not a billing code change, failure to track and document these measures will result in lower Star ratings, reduced incentive payments, and potential plan performance penalties.