FAQ Directory

No. An undated lab result may not be used for HEDIS reporting. To be eligible for use, the date the test was performed (e.g., the date the sample was drawn) or the result date (e.g., the date the lab calculated the result) must be documented.

This applies to the following Programs and Years:

No. Documentation is required for 5% of PCPs/EPs reported as using certified software, but the same PCP/EP may be used for every measure. For example, the following scenarios are acceptable documentation:

• The PO has a global report for all PCPs/EPs for all 20 MUHIT measures. This report would be the only documentation required for Measures 1-20; the PO would simply need to attach this report to the survey and associate the same document with each measure.
• The PO has dashboard reports for individual PCPs/EPs, for all 20 MUHIT measures. If the PO has 60 PCPs on certified software, 5% of those 60, or 3 PCPs are required to have documentation. The PO may attach the dashboard reports, which detail all 20 MUHIT measures including threshold requirements, for 3 PCPs, and associate those three documents with each measure. There is no need to pick 3 separate PCPs for each measure.
• If the PO has access to the CMS attestation reports, these may be used as documentation for Measures 1-15. If the PO reports 60 PCPs/EPs on certified software, the PO may attach the CMS attestations for 3 PCPs (5% of the 60), and associate the three CMS attestations with each of Measures 1-15. Separate documentation may be required for the CMS menu items, if they are not specified in the CMS attestation.

This applies to the following Programs and Years:

Yes. The BMI percentile may be calculated by the organization at a later date. It must be calculated and documented in the medical record during the measurement year to be eligible for use in HEDIS reporting.

This applies to the following Programs and Years:

No. To be eligible the organization must perform the functions addressed in the Standards and Guidelines (e.g., QI, UM, CR, RR, and MEM, if applicable), either directly or through a service agreement. If the organization uses a service agreement, the agreement must specify functions covered and be effective before eligibility can be determined.

All other listed eligibility criteria also must be met.

This applies to the following Programs and Years:

Yes. QI 9, Element B is NA for perinatal care, care for children up to 24 months, care for children 2-19 years old and care for adults 2-64 years of age for Medicare product lines that only serve individuals who are 65 years and older.

This applies to the following Programs and Years:

Yes. CPT Category II code 4010F (ACE inhibitor or ARB therapy prescribed or currently being taken) may be used to identify ACE inhibitor/ARB therapy (Table CDC-N) for the Medical Attention for Nephropathy indicator for P4P MY 2012. This code will be added to the MY 2013 manual.

This applies to the following Programs and Years:

MRRV Group F (Exclusions) includes all optional and required exclusions and valid data errors found during medical record review. It does not include records excluded through administrative data or that belong to employees or their dependents. Other hybrid medical record exclusions that should not be reviewed in Group F are exclusions for CBP and the HbA1C Less Than 7% indicator. Because of the large volume, auditors review exclusion rates for these indicators separately. See the instructions in Volume 5, page 65 for reviewing CBP and HbA1c<7%.

This applies to the following Programs and Years:

No, not for HEDIS 2013 reporting; however, beginning with HEDIS 2014, exclude MA members who elect the hospice benefit available through original Medicare. This change will be in the HEDIS 2014 Volume 2 specifications.

This applies to the following Programs and Years:

The intent of measure rotation is to reduce chart review, not be a means to select the best rate possible. However, NCQA does not specifically prohibit this approach. Please note, if the reason for failing can be seen as possibly affecting other measures in the group, the auditor may elect to review those other measures.

This applies to the following Programs and Years:

The auditor selects one measure from each measure group that applies to the health plan, and exclusions from the exclusions group. If the plan doesnt report any measures in a particular group, the auditor will use his discretion, based on past performance and current progress, to determine if an additional measure should be selected from a group already used.

This applies to the following Programs and Years:

The HEDIS-based Medicare Star measure results are collected, aggregated and reported at the PO level using the same process as for the commercial P4P program, but they are not part of the commercial P4P program and are not listed in the P4P measure set document. MA results will be publicly reported; health plans may choose to use the results as the basis for performance incentive payments, although no standard P4P program for MA currently exists.

This applies to the following Programs and Years:

Yes, the December Update included a modification to the audit timeline that requires all supplemental database activities be concluded by 5/1 in the reporting year. NCQA requires this deadline to allow sufficient time for audit review and possible corrections. The update should be made in the HEDIS Audit Timeline in Volume 5, on page 52 and in Volume 2, on page 17. This sentence should be added: "Auditor finalizes approval of Supplemental Databases, policies, procedures, and content (data)." by May 1.

This applies to the following Programs and Years: