Colorectal Cancer Screening

Incentives are paid to the linked primary care provider (PCP) on an annual basis, following the end of quarter four. For additional information, refer to the CBI Technical Specifications.

• Administrative members at the end of the measurement period.
• Dual coverage members.
• Members who had colorectal cancer or a total colectomy any time during the member’s history through December 31 of the measurement year.
• Members in hospice, receiving hospice services or palliative care, or who died during the measurement year.
• Members 66 years of age and older as of December 31 of the measurement year who meet both frailty and advanced illness criteria:
  • Frailty: At least two indications of frailty with different dates of service during the measurement year.
  • Advanced illness: One of the following during the measurement year or year prior to the measurement year:
    • Encounter with an advanced illness diagnosis on at least two different dates of service.
    • Dispensed dementia medication.

Note: Laboratory claims with POS 81 will not be included in identifying eligible members with diagnostic codes for frailty or advanced illness.

Fecal occult blood test (FOBT)

• CPT: 82270, 82274

Flexible sigmoidoscopy

• CPT: 45330-45335, 45337, 45338, 45340-45342, 45346, 45347, 45349, 45350

Colonoscopy

• CPT: 44388-44394, 44401-44408, 45378-45382, 45384-45386, 45388-45393, 45398
• ICD-9: 45.22, 45.23, 45.25, 45.42, 45.43

CT colonography

• CPT: 74261-74263

Stool DNA (sDNA) with FIT

• CPT: 81528

Additional screening codes and exclusion codes are located in the CBI code set located in the CBI Technical Specifications.

Data for this measure is collected using claims, laboratory data, DHCS Fee-for-Service encounter claims, and provider data submissions via the Data Submission Tool (DST) on the Provider Portal. To find gaps in data:

• Run a report from your electronic health record (EHR) system; or
• Manually compile patient data. For example, download your Care-Based Incentives Measure Details report from the Provider Portal and compare it to your EHR/paper records.

This measure allows providers to submit colorectal cancer screenings, evidence of colorectal cancer or total colectomy from the clinic EHR system or paper records to the Alliance by the DST contractual deadline. To submit, upload data files to the DST on the Provider Portal. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Provider Portal.

Identify Patients Due

• Run population health management reports out of your EHR, including either active and inactive members or another time-bound filter. Many practices make patients inactive after 18, 24 or 36 months, which may miss patients due for their colorectal cancer screening.
• Develop prompts or flags that pop up to alert care teams when members are due for preventive health screenings during chart prep, or when a member presents in your health center.

Outreach for Patient Engagement

• Designate a care team member to outreach to patients due for colorectal cancer screening.
• Send targeted mailings, text messages or emails, and follow up with telephone calls to chronically noncompliant patients. Studies have shown that the best way to reach patients is by combining a variety of methods, so don’t just stop with the old reminder postcard. Pick up the phone or send a text.
• Promote test choice. Studies have shown that when provided with options, many patients choose stool-based testing over colonoscopy for colorectal cancer screening and are more likely to adhere to regular screening when they have a choice of tests.

When Patient Presents for Care

• Display culturally appropriate posters and brochures at an appropriate literacy level in patient areas to encourage patients to talk to providers about colorectal cancer screening.
• Ensure screening is ordered when it is due, regardless of the reason for the visit.
• For patients who completed their colorectal cancer screening at an outside clinic, assess and document the date, location and result of their last screening, and ask the patient to sign a release of records.
• Empower your medical assistants and nurses with standing orders to screen and identify patients currently due or past due for their colorectal cancer screening.
• Don’t forget to assess health literacy. A lack of understanding and/or language differences may create barriers in following a recommended care plan.
• A patient may choose to decline screening even if strongly encouraged by the health care team.
• A patient should be periodically reassessed and supported to complete screenings as per current guidelines.
• Document the current care plan and routinely provide a copy to the patient.

Post-Visit Follow Up

• Create prompts for screening in your EMR that do not turn off until results are received, rather than when a test is ordered.
• Initiate a patient follow up, recall system and/or log to ensure screening follow-through and results are received.

Creating an Inclusive Culture

• Access is key! Offer extended hours on weekends and evenings.
• Hire clinicians to accommodate language needs, gender preference and LGBT sensitivity of patients served.
• Encourage continuing medical education (CME) for providers that support culturally competent screening, culturally competent education and diagnosis screening follow up per national guidelines.
• Remember, cultural competence is not just limited to race, ethnicity and culture. Perceptions, values, beliefs and trust can also be influenced by factors such as religion, age, sexual orientation, gender identity and socioeconomic status.

• Alliance Cultural and Linguistic Services are available to network providers.
  • Language Assistance Services – request materials at 800-700-3874, ext. 5504.
  • Telephonic Interpreter Services – available to assist in scheduling members.
  • Face-to-Face Interpreter Services – can be requested for the appointment with
    the member.
  • For information about the Cultural and Linguistic Services Program, call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].
• Alliance Transportation Services for patients with transportation challenges.
  • Non-emergency medical transportation (NEMT), call 800-700-3874, ext. 5640 (TTY: Dial 711).
  • Non-medical transportation (NMT), call 800-700-3874, ext. 5577 (TTY: Dial 711).
• Tailoring Colorectal Cancer Screening Messaging: A Practical Coalition Guide.
• 2022 Messaging Guidebook for Black & African American People: Messages to Motivate for Colorectal Cancer Screening.
• 2017 Asian Americans and Colorectal Cancer Companion Guide.
• 2016 Hispanics/Latinos and Colorectal Cancer Companion Guide.
• A Provider’s Guide to Colorectal Cancer Screening.
• Colorectal cancer resource library.