FAQ Directory: HEDIS

No, organizations may not continue to collect medical record data past May 15 and enter it into a supplemental database for use in the current HEDIS year.

HEDIS 2013

In response to USPSTF recommendations, NCQA has scheduled the CCS measure for reevaluation in 2012. The appropriate staff and panels will review updates and other relevant guidelines and will evaluate potential changes to the measure. Proposed changes, if any, will be posted for Public Comment in February 2013 and, pending final approval by the NCQA Committee on Performance Measurement, will be included in HEDIS 2014.

HEDIS 2013

Although the event/diagnosis criteria do not specifically state "and/or," it is implied. As long as there are two outpatient visits or two nonacute inpatient discharges, or one outpatient visit and one nonacute inpatient discharge, with a diagnosis of RA, the member meets the criteria for eligible population.

HEDIS 2013

No. GFR testing is not currently acceptable for the Medical Attention for Nephropathy indicator. Clinical experts determined that certain characteristics, such as age, sex and race, may impact the effectiveness of such tests for monitoring nephropathy. If a member was determined to have impaired kidney function based on a GFR test, it is expected that there would be other documentation in the medical record that would make the member compliant for the nephropathy indicator (e.g., documentation of a visit to a nephrologist or documentation of medical attention for any appropriate conditions listed in the specifications).

HEDIS 2013

Yes. For HEDIS 2013, NCQA will enforce a medical record review deadline of May 15 (the previous deadline was May 10). No charts will be accepted past this deadline, when auditors will begin to review records. Holding all plans to the same timeline ensures comparability among submissions.

HEDIS 2013

NCQA continually reviews the audit process to ensure that it meets all applicable reporting requirements and is the rigorous process expected by all stakeholders.

Responding to increasing pressure from incentive programs, and with CMS input, over the past year NCQA developed the audit policy described in the June 19 MRRV memo. This change will make a more exacting process that ensures enough time for auditing and reporting valid results.

HEDIS 2013

"Inclusive" means that the initiation visit is included when determining compliance for the Engagement of AOD Treatment indicator; therefore, the initiation visit is day 1 in the 30-day count. "After" means that the two additional visits must occur after the date of the initiation encounter. For example, if a members initiation visit occurred on August 1, the engagement visits must occur on August 2 through August 30.

HEDIS 2013

Although NCQA does not anticipate that rates will decrease, plans will need to start early and collect all data by May 15 to ensure that their rates are not affected.

HEDIS 2013

For HEDIS 2013, NCQA will adopt a new audit process that uses like-measure groupings for measure validation, includes hybrid measure exclusions, applies a different statistical test to the process and clearly defines MRR milestones to ensure consistency across plans.

HEDIS 2013

Communicate timeline changes and processes to staff; to your network of providers; to leadership at your plan; to medical record and copy vendors; and to your software vendor. Develop a plan and prepare with adequate resources for the HEDIS season. Add HEDIS performance guarantees with vendors to ensure clear understanding of goals and timelines.

HEDIS 2013

Yes. We sent communication to plans, auditors, vendors, physician groups, purchaser groups and state and federal agencies.

HEDIS 2013

No. If the MRR processwhich includes training, tools, interrater reliability checks, rater-to-standard tests and any other quality control processis different by plan, product or product line, the auditor must conduct separate MRRV for each process by following the new validation steps.

HEDIS 2013