FAQ Directory

No. The HEDIS 2015 Value Set Directory will not include invalid ICD-9 codes; it will only include ICD-9 codes that are valid for billing. The HEDIS 2014 value sets included invalid ICD-9 codes; these will be removed, effective with HEDIS 2015.

This applies to the following Programs and Years:

Thank you for bringing this to our attention. Unfortunately, the age breakdown in the brackets are historical, and the new guidelines that came out last year do not sync easily with them. For MY 2014, we can consider eliminating the age breakouts and simply collecting the overall versions of these measures.

Unfortunately, it is too late to change the file layout at this point because plans and POs are in the midst of programming. For MY 2013, women who are 30 should be included in the “Too Frequently No Hyst: Ages 24-30” row; women who are 31-65 should be included in the “Too Frequently No Hyst: Ages 31-65” row.

This applies to the following Programs and Years:

No. Because of the delay in ICD-10 implementation, ICD-10 codes will not be used during P4P MY 2014 and therefore will not be included in the P4P MY 2014 Value Set Directory.

Purchasers of the P4P MY 2014 Value Set Directory will receive a separate file with ICD-10 codes proposed for inclusion in future releases of P4P specifications, but the codes will not be considered part of the MY 2014 measure specifications.

This applies to the following Programs and Years:

Yes. RR 5, Element C is NA for individual plans and family plans offered under the Exchange because they are purchased directly by individuals and not plan sponsors.

This applies to the following Programs and Years:

A mental, behavioral or emotional disorder according to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, in members 18 years and older, that results in functional impairment which substantially interferes with or limits one or more major life activities (e.g., maintaining interpersonal relationships, activities of daily living, self-care, employment, recreation) that have occurred within the last year. All of these disorders may have acute episodes as part of the chronic course of the disorder. An organization may also use its state's definition or the definition of another appropriate regulatory authority.

This applies to the following Programs and Years:

The 120-day rule should also apply to Rate 3, step 3 of the ECS measure. If there are multiple cervical cytology and HPV co-tests during the three or four years prior to the measurement year, and these occur within 120 days of each other, count only the first test.

This applies to the following Programs and Years:

The Cervical Cancer Value Set was not included in the MY 2013 P4P Value Set Directory. The codes included in the Hypertension Value Set are:

• ICD-9-CM 180.0.
• ICD-9-CM 180.
• ICD-9-CM 180.1.
• ICD-9-CM 180.8.
• ICD-9-CM 180.9.
• ICD-9-CM 233.1.
• ICD-9-CM V10.41.

The other NCS Value Sets can be found by filtering for Value Set Name in the P4P Value Sets to Codes tab of the P4P VSD file. These Value Sets for NCS already exist as part of other measures. The Cervical Cancer Value Set will be included in the next release of the P4P Value Set Directory, which will also list the NCS measure separately.

This applies to the following Programs and Years:

The MY 2013 P4P Value Set Directory is correct. ICD-9-CM 91.46 and CPT 88155 were deleted from the Cervical Cytology value set and ICD-9-CM V76.47 was added to the Hysterectomy value set. These changes were not listed in the MY 2013 P4P Measure Updates.

This applies to the following Programs and Years:

A physician organization (PO) may select three definitions to use in determining the denominator for the MUHIT measures: the definition of “primary care practitioner,” or the CMS definition of “eligible professional” for Medicare or the CMS definition of “eligible professional” for Medicaid. All three definitions include physicians.

If a PO uses the “primary care practitioner” definition, it must include all physicians who are considered PCPs and are serving the commercial HMO/POS population. Because pediatricians serve as PCPs for children, they are included.

If a PO uses the CMS “eligible professional” definitions, all physicians serving the commercial HMO/POS population must be included. Because the focus of P4P is the commercial population, physicians are not required to have attested to CMS or the state for MU, to be included.

This applies to the following Programs and Years:

The delegation agreement between an organization and its delegate must: 1. Specify activities performed by the delegate in detailed language relative to applicable NCQA standard categories. 2. Specify functions not delegated, but retained by the organization. Organizations may include a general statement in the agreement addressing retained functions (e.g., the organization retains all other QI functions not specified in this agreement as the delegates responsibility). Existing agreements may be updated with an addendum or communication (e.g., e-mail, spreadsheet, table) between the organization and the delegate, indicating that responsibilities were mutually agreed upon before the delegation agreement was final and outlining the responsibilities of each entity.

This applies to the following Programs and Years:

Yes. Exclude newborn care rendered from birth to discharge home from delivery before reporting Total Inpatient (step 3).

This applies to the following Programs and Years:

Yes. Documentation of >99% or <1% may be used when reporting because an exact BMI percentile value is evident (i.e., 100% or 0%). These examples are not considered ranges or thresholds, which are not permitted when reporting the BMI percentile indicator. Examples of non-permitted ranges and thresholds are "75-80th percentile" and ">90th percentile" because the exact BMI percentile value is not evident.

This applies to the following Programs and Years: