No. “Weeks of Pregnancy at Time of Enrollment (WOP)” was retired in HEDIS 2017; the RAND number was inadvertently included in the HEDIS 2018 Volume 2 Technical Update memo.
HEDIS 2018
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11.15.2017 Weeks of Pregnancy at Time of Enrollment The HEDIS 2018 Volume 2 Technical Update memo includes a RAND number for the “Weeks of Pregnancy at Time of Enrollment” measure. Is this correct?
11.15.2017
Hospitalization for Potentially Preventable Complications On Page 37 of the HEDIS 2018 Volume 2 Technical Update memo, the “Number of Chronic ACSC Non-Outliers and Acute ACSC Non-Outliers” and “Number of Chronic ACSC Outliers and Acute ACSC Outliers” reporting categories have the same description.
Should the first reporting category listed above state ‘non-outlier’ instead of ‘outlier’?
11.15.2017
Transitions of Care The HEDIS 2018 Volume 2 Technical Update memo indicates the following change in the Transitions of Care specifications: In the first sentence of the third paragraph, replace “date/time” with “date.”
Should this change also apply to the first bullet in the “Note” section of the technical specifications that reads, “The following notations or examples of documentation do not count as numerator compliant:
*Documentation of notification that does not include a time frame or date/time stamp.”
11.15.2017 Reporting Requirements The HEDIS 2018 Volume 2 Technical Update memo announced the retirement of “Annual Monitoring for Patients on Persistent Medications (MPM)” for Medicare and the name change from “Inpatient Hospital Utilization (IHU)” to “Acute Hospital Utilization (AHU).” This caused a discrepancy between the CMS Reporting Memo and HEDIS 2018 Volume 2 Technical Specifications. Will CMS release a clarification on what must be reported for HEDIS 2018 for Medicare?
Yes. CMS released a clarification on October 11, 2017, through HPMS, announcing that MPM was retired and is not required for HEDIS 2018 reporting; it also clarified that “Inpatient Hospital Utilization” is now “Acute Hospital Utilization” and should be reported as the updated measure. If you have additional questions, contact CMS at HEDISquestions@cms.hhs.gov.
HEDIS 2018
11.15.2017 Guidelines for Calculations and Sampling The footnote on page 45 of HEDIS 2018 Volume 2 indicates that the lowest Prior Year rate from “Prenatal and Postpartum Care” and “Frequency of Prenatal Care” should be used to reduce the sample size for PPC. Given that FPC was retired with the HEDIS 2018 Volume 2 Technical Update, should the PPC MRSS use the lower rate of the Postpartum and Prenatal care indicators?
11.15.2017 Supplemental Data Is it acceptable to flag records in a supplemental data file as paid or denied when there is no payment attached to the records in the file?
No. It is not acceptable to classify a supplemental data source as paid or denied unless it is known whether the data in the data source were paid or denied. This is especially true when the data are being used for measures that require claims payment statuses (e.g. LBP, NCS). Organizations should not assume services were denied services just because there isn't a payment status associated with them. For measures where payment status is required, the auditor must be able to validate that the payment status is accurate.
HEDIS 2018
11.15.2017 Use of Opioids at High Dosage In the HEDIS 2018 Volume 2 Technical Update memo Table UOD-A includes a variable ranging from 4-12 for the MED Conversion Factor for methadone based on mg/day of methadone used. However, in the HEDIS 2018 NDC MLD Directory all NDCs for Methadone under the medication list "Opioid Medication" have a MED Conversion Factor (column M) of 3. For performing the MED calculation in UOD, which MED Conversion Factor should be used for methadone?
10.15.2017 ECDS How do vendors get the ECDS technical specifications for the submission file format?
HEDIS ECDS technical specifications are available in the NCQA store in PDF format: http://store.ncqa.org/index.php/catalog/product/view/id/2822/s/hedis-2018-volume-2-measures-for-electronic-clinical-data-systems/. They are also available in HEDIS 2018 Technical Specifications for Health Plans, which can be purchased at the NCQA store.
Complete digital measure packages for HEDIS ECDS measures will be available for download at a future date.
HEDIS 2018
10.15.2017 ECDS Are we required to collect and report the source vendor for the data e.g., by vendor)and source system of record (e.g., EHR, HIE, case management, claims) when reporting ECDS categories?
Details about the data vendor or source EHR system are not required for ECDS reporting, but should be documented in the HEDIS Roadmap when identifying data sources for an NCQA-Certified auditor. Use of data from NCQA eCQM-Certified vendors will ensure that measure data extracted from these systems are considered standard.
ECDS data should be categorized by one of the four source record categories stated in ECDS General Guideline 2: Data Collection Methods (EHR, HIE/clinical registry, case management registry, administrative claims).
HEDIS 2018
10.15.2017 ECDS If case management information resides solely within the plan and is not shared with the PCP, may it be used as a supplemental data source for the numerator?
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 does NCQA mean by “information has to be accessible by the health care team at the point of care”?
To qualify for HEDIS ECDS reporting, practitioners and practitioner groups that are accountable for clinical services provided to members must have access to data used by plans for quality measure reporting, regardless of the SSoR.
NCQA does not currently specify a method of data access, but a core principle of ECDS reporting is that the information needed to deliver the highest-quality care must be available to the entire health care team responsible for managing a member’s health.
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. The care team’s ability to access data must be documented, to provide evidence that information is available whether or not it is accessed.
HEDIS 2018
