FAQ Directory: HEDIS

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10.15.2017 ECDS May we use claims for ECDS reporting?

Administrative claims are considered an ECDS data source if the payment system is automated and data are accessible by the practitioner/practitioner group that is accountable for clinical services provided to plan members (e.g., if claims are used to identify an inpatient stay, the primary care provider must be able to access the details of the stay). Report all measure results identified by claims in the “Administrative claims” source system of record (SSoR) category.

HEDIS 2018

10.15.2017 ECDS Does the denominator only include plan members covered by ECDS who are in the initial population?

Yes. The denominator should be all members covered by ECDS who do not meet exclusion criteria.

HEDIS 2018

10.15.2017 ECDS How are ECDS different from supplemental data?

The ECDS reporting method uses much of the same data classified as supplemental for other HEDIS measures, but ECDS measures adhere to different reporting rules from those in other HEDIS domains. Unlike supplemental data used for HEDIS, data for ECDS reporting are classified by source and are used to report all measure elements (e.g., denominator, exclusions, numerator).

HEDIS 2018

10.15.2017 ECDS Clarify “data must be accessible by the health care team at point of care.”

To qualify for HEDIS ECDS reporting, practitioners/practitioner groups that are accountable for clinical services provided to members must be able to access all ECDS data used by a health plan for quality measure reporting.Qualifying modes of access may be as simple as a provider’s phone request for member information, or as sophisticated as an integrated decision support system.

HEDIS 2018

10.15.2017 ECDS What is ECDS?

Electronic Clinical Data Systems (ECDS) are a network of databases containing plan members’ personal health information and records of their experiences with the health care system. ECDS may also support other care-related activities, directly or indirectly, through various interfaces that include evidence-based decision support, quality management and outcome reporting.

HEDIS 2018

10.15.2017 ECDS How are ECDS measures different from the eMeasures in Meaningful Use?

HEDIS ECDS and eClinical Quality Measures (eCQM) developed for Meaningful Use are specified using the same data standards. eCQMs are specifically designed to use data extracted from an EHR, and HEDIS ECDS measures use multiple data sources to complete the picture of member experience across the care continuum.

HEDIS 2018

10.15.2017 Children With Chronic Conditions When assessing Prescreen Status Code criteria, does the visit code and diagnosis code have to be on the same claim?

Yes; because the Prescreen Status Code criteria requires a code to be in conjunction with another code, the codes must be on the same claim (claims on the same date of service cannot be combined to meet criteria).

HEDIS 2018

10.15.2017 Transitions of Care Please clarify the September 15 FAQ stating that SNPs and MMPs are not required to report the TRC measure because it does not appear in Table 3 of the CMS reporting requirements memo. Are SNP and MMPs plans required to report TRC in their contract-level submission?

Yes. Contracts that offer SNP and MMP plan benefit packages are required to report TRC in their contract-level submission, as described in Table 2 of the CMS HEDIS 2018 Reporting Requirements memo.

HEDIS 2018

10.15.2017 Unhealthy Alcohol Use Screening and Follow-Up In the updated measure specification that was released with the HEDIS 2018 Volume 2 Technical Update, the Data Elements table includes a stratification for ages 44-64. Should this age stratification be 45-64?

Yes. The correct age stratifications are 18-44, 45-64, 65+.

HEDIS 2018

10.15.2017 Breast Cancer Screening, Colorectal Cancer Screening, Controlling High Blood Pressure, and Osteoporosis Management in Women Who Had a Fracture The Medicare Monthly Membership File includes a run date and a payment date. Which date should be used to determine that a member had an LTI flag during the measurement year?

Use the run date to determine that a member had an LTI flag during the measurement year.

HEDIS 2018

10.15.2017 ECDS Is the “care team accessibility” requirement fulfilled if a member’s health record is available online and the provider can access it with the member present or with the member’s consent?

Yes. If a member’s record is available on request to any member of the care team, the requirement is met.

HEDIS 2018

10.15.2017 ECDS May we use depression screening performed by case managers who are employees of a health plan and are not part of an external provider group directly serving the member?

Yes. Data collected by care/case managers employed by a health plan are appropriate, and are reported in the Case Management category in the measure report.

Care/case managers are considered part of the member’s care team because they help members manage a condition and/or their use of health care services.

HEDIS 2018