To use a case management system for ECDS reporting, the system must be verified by an NCQA-Certified auditor and demonstrate (e.g., policies and procedures) that all health care providers responsible for managing a member’s condition have access to information. It is not necessary to track whether the information was accessed, but there must be evidence that data are available on request.
HEDIS 2018
IP-ECDS coverage count includes all members in the initial population who are being managed by at least one provider with the capacity to send, receive and use electronic data for quality improvement purposes.The Initial Population includes all members (covered and not covered by ECDS) who are identified as eligible for the measure reported by the data source category used to determine eligibility.
HEDIS 2018
No. Organizations may not use other data sources (e.g., supplemental or medical record data) when excluding members living long-term in an institution. The LTI flag in the Medicare Part C monthly membership file is the only source that may be used to identify this exclusion. NCQA was informed by CMS that all Medicare plans receive this file monthly and have access to this flag. NCQA plans to clarify this in the HEDIS 2018, Volume 2 Technical Update Memo, scheduled for release on October 2, 2017.
HEDIS 2018
If the prescriber and/or pharmacy NPI is missing, count each dispensing event with a missing NPI as a different prescriber and/or different pharmacy when reporting the measure. NCQA plans to clarify this in the HEDIS 2018, Volume 2 Technical Update Memo, scheduled for release on October 2, 2017.
HEDIS 2018
The intent is to identify diagnostic or therapeutic procedures that require a medication regimen, a change in diet or a change in medication. For example, colonoscopy requires a change in diet (NPO on the day of procedure) and a medication change (a medication is taken to prep the colon). Dialysis, infusions and chemotherapy are all therapeutic procedures that require a medication regimen. A nebulizer treatment with albuterol is considered a therapeutic procedure that requires a medication regimen (the albuterol). Injection of lidocaine prior to mole removal is considered a diagnostic procedure (if the mole is being tested) or a therapeutic procedure (if removal of the mole is the treatment) that requires a change in medication (lidocaine administered for pain control during the procedure). A patient forgetting to take regular medications on the day of the procedure is not considered a required change in medication, and therefore the BP reading is eligible.
A BP taken on the same day that the patient receives a vaccination is eligible for use. A vaccination is considered preventive medicine and is not considered a therapeutic or diagnostic procedure.
HEDIS 2017
The intent is to identify diagnostic or therapeutic procedures that require a medication regimen, a change in diet or a change in medication. For example, colonoscopy requires a change in diet (NPO on the day of procedure) and a medication change (a medication is taken to prep the colon). Dialysis, infusions and chemotherapy are all therapeutic procedures that require a medication regimen. A nebulizer treatment with albuterol is considered a therapeutic procedure that requires a medication regimen (the albuterol). Injection of lidocaine prior to mole removal is considered a diagnostic procedure (if the mole is being tested) or a therapeutic procedure (if removal of the mole is the treatment) that requires a change in medication (lidocaine administered for pain control during the procedure). A patient forgetting to take regular medications on the day of the procedure is not considered a required change in medication, and therefore the BP reading is eligible.
A BP taken on the same day that the patient receives a vaccination is eligible for use. A vaccination is considered preventive medicine and is not considered a therapeutic or diagnostic procedure.
HEDIS 2017
Hospitals for which plans have discharges from but are not identifiable in Table HSIR should not be included in the hospitals reported in the category "Number of Contracted Hospitals With Reportable SIR." However, discharges from these hospitals should be included in “Total Inpatient Discharges” and in “Percentage of Total Discharges From Hospitals With Unavailable SIR.” Use Table HSIR posted on the NCQA Web site to make the determination; organizations do not need to refer to the Hospital Compare web site.
HEDIS 2017
Yes. Documentation of Tanner stage meets criteria for the physical exam and physical developmental components, but should not be double-counted toward both (if used as evidence of physical exam, it may not be used as evidence of physical developmental, and vice versa). Documentation of Tanner stage does not meet criteria for the Well-Child Visits in the First 15 Months of Life (W15) or Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) measures as sexual maturity rating is not recommended until 7 years of age.
HEDIS 2017
