Delivering Quality Care: Caring for the Colon

Mar. 31, 2021

To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates.

Colorectal cancer is the third most common cancer in the U.S., and the third leading cause of cancer deaths. Nearly one-third of adults ages 50 to 75 don’t get recommended colorectal screenings, according to the Centers for Disease Control and Prevention (CDC) Learn more about third-party links. Discuss the importance of colorectal cancer screenings with your patients and encourage them to ask questions about colon health and cancer prevention.

Why is colorectal cancer screening important?

Colon cancer usually has no symptoms in its early stage. Screening before symptoms present themselves can catch the disease when treatment is most effective. The five-year survival rate for treatment of the earliest stage of colorectal cancer is about 90%.

Closing care gaps

Colorectal cancer screening is a Health Effectiveness Data Information Set (HEDIS®) measure developed by the National Committee for Quality Assurance (NCQA) Learn more about third-party links. The NCQA recommends screening adults ages 50 to 75 with any of the following tests:

  • Annual fecal occult blood test (FOBT)
  • Stool DNA (FIT-DNA or Cologuard®) every three years
  • Flexible sigmoidoscopy every five years
  • Computed tomography (CT) colonography every five years
  • Colonoscopy every 10 years

View our preventive care guidelines on colorectal cancer screenings.

Best practices

  • In your patients’ records, document the date a colorectal cancer screening is performed or include the pathology report indicating the type and date of screening.
  • Discuss with patients why it’s important to return for follow-up visits.
  • Reach out to patients who cancel appointments and help them reschedule as soon as possible.
  • Use the proper codes when filing claims. Proper coding can help identify gaps in care, provide accurate data and streamline your administrative processes.

Checking eligibility and benefits

Member eligibility and benefits should be checked using Availity® Provider Portal Learn more about third-party links or your preferred vendor before every scheduled appointment. Eligibility and benefit quotes include members’ coverage status and other important information, such as applicable copays, coinsurance and deductibles. Ask to see members’ ID card and photo ID to guard against medical identity theft.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

HEDIS is a registered trademark of the NCQA.

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