Medicare AdvantageDocumentationHigh impact
Osteoporosis Management in Women (OMW): Timely Follow-Up After a Fracture
Blue Cross Blue Shield of Rhode Island·RI · Geriatrics, Orthopedics, Rheumatology +3 more·Physician
Effective date
Sep 1, 2026
We identified it
Sep 1, 2026
Summary
This is a new Medicare Advantage HEDIS quality measure (OMW) effective September 1, 2026, requiring women ages 67-85 with qualifying fractures to receive a bone mineral density (BMD) test or osteoporosis medication within 180 days post-fracture. Billing teams must ensure accurate coding of BMD tests and osteoporosis treatments (including injectables like denosumab, abaloparatide, teriparatide, romosozumab, and zoledronic acid) to capture completed follow-ups and avoid performance gaps.
Action Required
Immediately (effective September 1, 2026): (1) Billing team must update documentation and coding protocols to accurately capture and code all qualifying BMD tests (CPT 76070-76074) and osteoporosis treatments including injectables (denosumab J3111, abaloparatide J3145, teriparatide J3472, romosozumab J3489, zoledronic acid J4694) when administered post-fracture. (2) Providers and clinical staff must review monthly OMW reports from the Medicare Advantage plan and identify women ages 67-85 with newly identified qualifying fractures (excluding finger, toe, face, skull). (3) Front desk/scheduling staff must prioritize BMD scan orders within the 180-day intervention window and coordinate member outreach to ensure completion before the deadline. (4) Billing team must verify that claims for qualifying treatments are submitted with appropriate coding to ensure they are recognized against the OMW measure. (5) Compliance staff should implement tracking for OMW gaps to monitor performance toward MY 2027 measurement year targets. Failure to complete BMD testing or osteoporosis treatment within 180 days of fracture will result in non-compliance with this Medicare Advantage quality measure, impacting plan performance scores and potential financial incentives.