FAQ Directory: HEDIS

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1.14.2022 Continuity of Care Documents Can Continuity of Care Documents (CCDs)/style sheets generated from CCDs be used for hybrid abstraction?

No. CCDs are not considered a legal health record and may not be used for hybrid abstraction. 

HEDIS MY 2022

1.14.2022 Continuity of Care Documents Can Continuity of Care Documents (CCDs)/style sheets generated from CCDs be used for hybrid abstraction?

No. CCDs are not considered a legal health record and may not be used for hybrid abstraction.

HEDIS MY 2021

12.15.2021 Updated FAQs Were there previously posted FAQs that have been updated?

Yes. There were two previously posted FAQs that have been recently updated. One FAQ was posted in September and the second was posted in November. Both FAQs were updated and can be found on the FAQ page with the date of 12.3.2021.

HEDIS MY 2022

12.15.2021 General Guideline 32: Obtaining Information for the Systematic Sample Measures In which data element should exclusions be reported when exclusion information is found through a data refresh?

For HEDIS MY 2021 reporting, reporting exclusions in different categories found through a data refresh is flexible; for example, number of original sample records excluded because of valid data errors, number of administrative data records excluded and so on. Record counts must be able to be reconciled between the MRSS, the number of exclusions, records added from the oversample and the denominator.

For HEDIS MY 2022 reporting, exclusions found through administrative data in a data refresh must be reported in the number of administrative data records excluded data element; exclusions found through medical record data in a data refresh must be reported in the number of original sample records excluded because of valid data errors data element.

HEDIS MY 2021

12.15.2021 General Guideline 32: Obtaining Information for the Systematic Sample Measures In which data element should exclusions be reported when exclusion information is found through a data refresh?

For HEDIS MY 2021 reporting, reporting exclusions in different categories found through a data refresh is flexible; for example, number of original sample records excluded because of valid data errors, number of administrative data records excluded and so on. Record counts must be able to be reconciled between the MRSS, the number of exclusions, records added from the oversample and the denominator.

For HEDIS MY 2022 reporting, exclusions found through administrative data in a data refresh must be reported in the number of administrative data records excluded data element; exclusions found through medical record data in a data refresh must be reported in the number of original sample records excluded because of valid data errors data element.

HEDIS MY 2022

12.15.2021 Updated FAQs Were there previously posted FAQs that have been updated?

Yes. There were two previously posted FAQs that have been recently updated. One FAQ was posted in September and the second was posted in November. Both FAQs were updated and can be found on the FAQ page with the date of 12.3.2021.

HEDIS MY 2021

12.15.2021 Patient-Level Detail (PLD) File Cardiac Rehabilitation (CRE) is new to the CMS PLD file for MY 2021. Only one denominator is included, but the measure has two age bands. What should be reported for the measure?

For MY 2021 PLD submissions, include only data for the Total age band. This must align with the summary Total data reported in IDSS.

HEDIS MY 2021

12.03.2021 General Guideline 18: Deceased Members How should we apply the “deceased members” exclusion in General Guideline 18: Deceased Members for episode-based measures?

The guideline for deceased members (General Guideline 18) is a member-level exclusion. For episode-based measures, if one event does not meet numerator criteria, and the organization chooses to use this optional exclusion, remove all member events/episodes from the measure.

Note: This re-issued FAQ only applies to MY 2022 reporting.

HEDIS MY 2022

12.03.2021 Guidelines for Calculations and Sampling: Hybrid Measures How should exclusions be applied when found during an administrative data refresh for hybrid measures?

Per General Guideline 32, there are two ways to apply exclusions after samples have been pulled and chart review has begun. Because the sample must be reproducible, the members remain in the eligible population but are removed from the sample and reflected in the denominator. Organizations should indicate the exclusions by reporting them as the number of administrative data records excluded. When the population is larger than the MRSS, replace those members with members from the oversample.

Remember that the denominator is used to calculate and report the measure. All exclusions and replacements are reflected in the denominator calculation. The following are examples:

Example 1:
Eligible population = 300
MRSS = 300
Oversample Rate = 0%
Oversample Records Number = 0
Number of administrative data records excluded = 3
Oversample Records Added = 0
Denominator = 297

Example 2:
Eligible population = 5,800
MRSS = 411
Oversample Rate = 5%
Oversample Record Number = 21
Number of administrative data records excluded = 11
Oversample Records Added = 11
Denominator = 411

HEDIS MY 2022

12.03.2021 Guidelines for Calculations and Sampling: Hybrid Measures How should exclusions be applied when found during an administrative data refresh for hybrid measures?

Per General Guideline 32, there are two ways to apply exclusions after samples have been pulled and chart review has begun. Because the sample must be reproducible, the members remain in the eligible population but are removed from the sample and reflected in the denominator. Organizations should indicate the exclusions by reporting them as the number of administrative data records excluded. When the population is larger than the MRSS, replace those members with members from the oversample.

Remember that the denominator is used to calculate and report the measure. All exclusions and replacements are reflected in the denominator calculation. The following are examples:

Example 1:
Eligible population = 300
MRSS = 300
Oversample Rate = 0%
Oversample Records Number = 0
Number of administrative data records excluded = 3
Oversample Records Added = 0
Denominator = 297

Example 2:
Eligible population = 5,800
MRSS = 411
Oversample Rate = 5%
Oversample Record Number = 21
Number of administrative data records excluded = 11
Oversample Records Added = 11
Denominator = 411

HEDIS MY 2021

11.15.2021 NCQA DAV Data May organizations use NCQA-validated data resulting from Data Aggregator Validation (DAV) as standard supplemental data when reporting HEDIS measures?

Yes. NCQA DAV data may be used as standard supplemental data if the auditor receives a completed current year’s Roadmap Section 5 from the reporting entity using the data. The Roadmap must explain how data from the validated DAV entity is transferred to the reporting entity and what the entity does to the data. The Roadmap is completed by the health plan; no documentation is required from the DAV entity except for the final list of validated ingestion sites and clusters, along with the date they were approved. If the reporting entity processes the validated CCD in any way after receipt, the auditor must validate the file back to the original validated CCD to ensure that no data were changed.
If an NCQA-validated DAV entity includes data from an unvalidated data cluster, the auditor must validate that data, following the nonstandard supplemental data guidelines, before the data can be used for HEDIS reporting. The auditor may not perform PSV on any validated data files.
The NCQA DAV data definition will be included in General Guideline 31 for MY 2022.

HEDIS MY 2021

11.15.2021 General Guideline 18: Deceased Members How should we apply the “deceased members” exclusion in General Guideline 18: Deceased Members for episode-based measures?

The guideline for deceased members (General Guideline 18) is a member-level exclusion. For episode-based measures, if one event does not meet numerator criteria, and the organization chooses to use this optional exclusion, remove all member events/episodes from the measure.

HEDIS MY 2021