FAQ Directory: HEDIS

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2.16.2013 Adult BMI Assessment May a member's weight and BMI be noted on different dates of service in the medical record?

Yes. Weight and BMI may be noted on different dates of service as long as they are documented in the medical record during the measurement year or year prior to the measurement year.

HEDIS 2013

2.16.2013 Adult BMI Assessment If the member's weight is documented in the medical record during the measurement year or year prior to the measurement year, may the organization calculate BMI at a later date?

Yes. The BMI may be calculated by the organization at a later date. It must be calculated and documented in the medical record during the measurement year or year prior to the measurement year to be eligible for use in HEDIS reporting.

HEDIS 2013

2.16.2013 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents May a member's height, weight and BMI percentile be noted on different dates of service in the medical record for the BMI Percentile indicator?

Yes. Height, weight and BMI percentile may be noted on different dates of service as long as they are documented in the medical record during the measurement year.

HEDIS 2013

2.16.2013 Comprehensive Diabetes Care If no result is documented for an eye exam in the year prior to the measurement year, can the organization infer that the exam was negative for retinopathy?

No. Documentation of an eye exam that does not include a result does not count as a negative result and is not eligible for use in HEDIS reporting.

HEDIS 2013

2.16.2013 General Guidelines If an organization finds an undated lab result in a progress note, can the progress note date be used as the lab result date?

No. An undated lab result may not be used for HEDIS reporting. To be eligible for use, the date the test was performed (e.g., the date the sample was drawn) or the result date (e.g., the date the lab calculated the result) must be documented.

HEDIS 2013

2.16.2013 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents If height and weight are documented in the medical record during the measurement year, may the organization calculate BMI percentile at a later date?

Yes. The BMI percentile may be calculated by the organization at a later date. It must be calculated and documented in the medical record during the measurement year to be eligible for use in HEDIS reporting.

HEDIS 2013

2.16.2013 Care for Older Adults For the functional status assessment indicator, the fourth bullet requires notation of at least three of the four components: cognitive status, ambulation status, sensory ability and other functional independence. For "sensory ability," must all three components (hearing, vision, speech) be documented to meet the criterion?

Yes. All three components must be evaluated to fulfill the sensory ability component.

HEDIS 2013

1.16.2013 Medical Record Review Validation Can auditors provide plans with the measures selected for over-read earlier than May 1? What if the plan finishes MRR earlier?

The current timeline says that the auditor selects the measures for review on May 1 and not before; however, if the auditor reviews the health plans internal timelines, and finds that the plan expects to finish MRR early, it is acceptable that the auditor send the measure list when all chart review is complete and he has received a final count of numerator hits for each hybrid measure. For example, if the plan finishes all chart chases on April 29 and provides the numerator count lists, the auditor can select the measures for validation and start the process early.

Note: If the auditor allows for an earlier MRRV timeline, the plan may have to adjust other deadlines affected by this change.

HEDIS 2013

1.16.2013 General Guidelines Should Medicare Advantage (MA) members who elect the hospice benefit and choose to remain enrolled in the MA plan be excluded from MA HEDIS denominators?

No, not for HEDIS 2013 reporting; however, beginning with HEDIS 2014, exclude MA members who elect the hospice benefit available through original Medicare. This change will be in the HEDIS 2014 Volume 2 specifications.

HEDIS 2013

1.16.2013 General Guidelines Is there a deadline for updating administrative rates with new sources of supplemental data?

Yes, the December Update included a modification to the audit timeline that requires all supplemental database activities be concluded by 5/1 in the reporting year. NCQA requires this deadline to allow sufficient time for audit review and possible corrections. The update should be made in the HEDIS Audit Timeline in Volume 5, on page 52 and in Volume 2, on page 17. This sentence should be added: "Auditor finalizes approval of Supplemental Databases, policies, procedures, and content (data)." by May 1.

HEDIS 2013

1.16.2013 Medical Record Review Validation For measures that are heavily or entirely reliant on MRR data (e.g., COA, ABA, WCC, CDC BPs), if an organization attempts MRR validation and fails, or is able to retrieve a only small percentage of charts, can they report an administrative rate as low as 0% (assuming no other issues are identified)?

A low administrative rate, even 0%, can be reported, if the plan wants to submit such a rate and the auditor finds no bias or other problems in the administrative process.

HEDIS 2013

1.16.2013 Medical Record Review Validation What happens if a plan doesnt report any measures in a group?

The auditor selects one measure from each measure group that applies to the health plan, and exclusions from the exclusions group. If the plan doesnt report any measures in a particular group, the auditor will use his discretion, based on past performance and current progress, to determine if an additional measure should be selected from a group already used.

HEDIS 2013