For measures with stratifications, use the total rate when reducing sample sizes. For measures with multiple indicators and stratifications, use the lowest total rate across indicators when reducing sample sizes.
HEDIS MY 2021
FAQ Directory: HEDIS
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2.15.2022 Guidelines for Calculations and Sampling: Hybrid Measures When reducing sample sizes for measures with stratifications, which are used: the total rates or the stratified rates?
2.15.2022 Cervical Cancer Screening (CCS) For cervical cancer screening, should we exclude transgender women (male to female, never had a cervix)?
Administrative data, codes in the Absence of Cervix Diagnosis Value Set (e.g., ICD-10-CM Diagnosis code Q51.5 [agenesis and aplasia of cervix]) may be used to exclude transgender members from the measure. If the medical record documents that the member was born male (e.g., transgender male to female), this is evidence that the member does not have a cervix, meets optional exclusion criteria and may be removed from the measure. Medical record documentation of cervical agenesis or clinical synonyms (e.g., evidence a patient was born without a cervix) may also be used to exclude these members. These members should remain in the measure if the organization is unable to find the appropriate documentation.
HEDIS MY 2021
2.15.2022 COVID-19 Is HEDIS changing data collection strategies for HEDIS MY 2021 due to COVID?
1.14.2022 Continuity of Care Documents Can Continuity of Care Documents (CCDs)/style sheets generated from CCDs be used for hybrid abstraction?
1.14.2022 Continuity of Care Documents Can Continuity of Care Documents (CCDs)/style sheets generated from CCDs be used for hybrid abstraction?
12.15.2021 Updated FAQs Were there previously posted FAQs that have been updated?
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?
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.
HEDIS MY 2021
12.15.2021 Updated FAQs Were there previously posted FAQs that have been updated?
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 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 2021