Yes. The sentence should be changed to read, “Evidence that the information was filed in the EMR and is accessible to the PCP or ongoing care provider on the day of discharge or the following day meets criteria.”
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11.15.2019 Transitions of Care - Receipt of Discharge Information The Note in the medication record specification states, “Evidence that the PCP or ongoing care provider communicated with the ED about the admission meets criteria.” Should the reference to “admission” in this sentence be changed to “discharge”?
11.15.2019 Well-Child Visits in the First 15 Months of Life Should the “Number of required exclusions” row be removed from the Data Elements Table in the Well-Child Visits in the First 15 Months of Life (W15) measure?
11.15.2019 General Guideline 37 General Guideline 37 states that if organizations use both pharmacy data (NDC codes) and clinical data (RxNorm codes) for reporting, they should deduplicate and count an NDC code and an RxNorm code for the same drug on the same date of service as only one dispensing event, to avoid double counting. How should organizations handle this where different drugs are included in the same medication list with no variable to differentiate between “same or different”?
For measures where different drugs are included in the same medication list with no variable to differentiate between “same or different,” the organization develops its own method. It is appropriate for the organization to assume that an NDC code and an RxNorm code on the same date of service are for the “same drug” and count as one dispensing event; however, this will not be tested as part of measure certification.
This applies to the following Programs and Years:
HEDIS 202011.15.2019 Mental Health Taxonomy Codes Why did NCQA include Mental Health taxonomy codes in the HEDIS 2020 Value Set Directory? Must we use those codes for transactional data?
The Mental Health Taxonomy Value Set was added in HEDIS 2020 to be used by organizations that report HEDIS using clinical (non-transactional) data. An organization that has taxonomy codes in transactional data may continue to map taxonomy codes not included in the VSD to taxonomy codes in the VSD, with auditor approval.
This applies to the following Programs and Years:
HEDIS 202011.15.2019 Transitions of Care - Notification of Inpatient Admission The medical record specification states, “Evidence that the information was filed in the EMR and is accessible to the PCP or ongoing care provider on the day of discharge or the following day meets criteria.” Should the reference to “discharge” in this sentence be changed to “admission”?
11.15.2019 System Generated Dates If during data collection an EHR system generates a date of the medical record report, may the system-generated date be used for medical record abstraction?
11.15.2019 Comprehensive Diabetes Care Does documentation of “HB1c” meet criteria when reporting the HbA1c testing indicator?
11.15.2019 Plan All-Cause Readmissions The PCR measure indicates that for commercial and Medicaid, organizations report only members 18–64 years of age. This is inconsistent with Table PCR-1/2/3: Plan Population and Outlier Rate (Medicaid, Commercial and Medicare, 18+) and Table PCR-A-1/2/3 : Plan All-Cause Readmissions Rates Among Nonoutlier Members by Age (Medicaid, Commercial and Medicare, 18+), which indicate that members ages 18 and older are reported for all product lines. Are these data element tables incorrect for commercial and Medicaid reporting?
Yes, the tables are incorrect. When reporting the PCR measure for the commercial and Medicaid product lines, only include members 18–64 years of age. The age ranges 65–74, 75–84, 85+ and 65+ Total included in the data element tables are only collected for Medicare reporting.
For commercial and Medicaid reporting, collect 18–44, 45–54, 55–64 and 18–64 Total.
This applies to the following Programs and Years:
HEDIS 202011.15.2019 Prenatal and Postpartum Care The Postpartum Care indicator states that documentation of “Resumption of physical activity and attainment of healthy weight” meets criteria. Does documentation need to include both resumption of physical activity AND attainment of healthy weight to meet criteria?
10.15.2019 Organization Responsibility for Chart Review HEDIS 2020 clarified that chart pursuit is recommended but is determined by the organization. Does this mean that chart pursuit is up to the organization?
10.15.2019 “Unknown” SES Category The SES stratification guidance in HEDIS 2020 Volume 2 indicates that the “Unknown” category may be used for only Puerto Rico plans or if the auditor approves a small number of unassigned members. Is there a specific number of Unknown members a plan is allowed to report?
Except for plans in Puerto Rico, which report all members in the “Unknown” category, it is expected that the member count in this category will be at or below 1%. If more than 1% of eligible members are assigned to the “Unknown” category, the plan must work with the auditor to identify why members are being categorized as “Unknown.”