RCM: Risk of Continued Opioid Use
Percentage with continued opioid use past acute period. Lower better.
Measure description
Percentage with continued opioid use past acute period. Lower better.
Eligible population
Opioid-naive starting opioids
Performance drivers
CDC opioid prescribing.
Documentation & PA strategy
Limit acute scripts to 7 days; reassess before refill.
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure RCM measure?
Percentage with continued opioid use past acute period. Lower better.
What drives performance on this measure?
CDC opioid prescribing.
How should clinicians document for this measure?
Limit acute scripts to 7 days; reassess before refill.
What is the eligible population?
Opioid-naive starting opioids
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