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Publication Date: 
2020-12-04

This update provides information on Healthcare Effectiveness Data and Information Set (HEDIS) requirements and suggestions for closing gaps related to osteoporosis management in women (OMW). The information below is specific to the OMW HEDIS measure for Medicare Advantage (MA) plans only.

HEDIS Requirements 

Women 67-85 years of age, who have experienced a fracture* will have a bone mineral density (BMD) test or a prescription for a drug to treat osteoporosis within six months of the date of fracture. For women in this age group, consider conducting a BMD test every two years.

Claims Submissions: 

  • Receipt of a claim for BMD within six months of a fracture 
  • Receipt of a claim for medication to treat osteoporosis within six months of the fracture. 

Medical Record Documentation: 

  • A visit note with evidence of BMD test in the appropriate timeframe
  • A visit note with evidence of medication dispensed within the appropriate timeframe

*Note: Fractures of finger, toe, face and skull are not included in this measure 

Best Practices for Improved Osteoporosis Management 

  • If the patient has an upcoming visit, add appointment notes to address the fracture
  • If a follow up appointment has not been scheduled, please consider scheduling a discussion
  • Place an order for a BMD screening and follow up to ensure the patient completes it.  A referral for a BMD screening alone will not close this care gap; the service must be performed. 
  • Provide pharmacological therapy
  • Increase communication with patients about their fracture risk
  • Assess the patient’s risk of falling

For additional best practices regarding Osteoporosis please visit: 

If you have any questions, please reach out to a Blue Cross NC Quality Management Consultant at Quality.Management@bcbsnc.com or by fax at 919-287-5459