FAQ Directory: HEDIS

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4.15.2014 HEDIS and ICD-10 The ICD-10 implementation date has been delayed. Will NCQA include ICD-10 codes in HEDIS 2015?

No. Because of the delay in ICD-10 implementation, ICD-10 codes will not be used during the HEDIS 2015 measurement year (the 2014 calendar year) and therefore will not be included in the HEDIS 2015 Value Set Directory.

Purchasers of HEDIS 2015 technical specifications will receive a separate file with ICD-10 codes proposed for inclusion in future releases of HEDIS, but the codes will not be considered part of the 2015 measure specifications.

HEDIS 2014

2.14.2014 Osteoporosis Management in Women Who Had a Fracture When determining the eligible population, step 4 states to exclude members with a dispensed prescription to treat osteoporosis (Table OMW-C) during the 365 days (12 months) prior to the IESD. Does this include only osteoporosis prescriptions dispensed during the 365-day look-back period, or may it include an osteoporosis prescription that was dispensed prior to the look back period but is still “active” during the 365 days?

Members with an “active” prescription for osteoporosis treatment (Table OMW-C) during the 365 days prior to the IESD meet the step 4 exclusion criterion. The prescription does not need to be dispensed during the 365-day look-back period. NCQA does not specify how long organizations must look back prior to the IESD to identify an “active” prescription; organizations determine the look-back period, which should be applied consistently across all members.

HEDIS 2014

2.14.2014 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents For the BMI percentile indicator, does documentation of >99% or <1% meet criteria?

Yes. Documentation of >99% or <1% may be used when reporting because an exact BMI percentile value is evident (i.e., 100% or 0%). These examples are not considered ranges or thresholds, which are not permitted when reporting the BMI percentile indicator. Examples of non-permitted ranges and thresholds are "75-80th percentile" and ">90th percentile" because the exact BMI percentile value is not evident.

HEDIS 2014

2.14.2014 Inpatient Utilization General Hospital/Acute Care In step 4, the text under the "Medicine" bullet states for the Newborns/Neonates MS-DRG Value Set, "Do not include newborn care rendered from birth to discharge home from delivery; only report newborn care rendered if the baby is discharged home from delivery and is subsequently rehospitalized." In HEDIS 2013, this instruction also applies to "Total Inpatient." Should newborn care rendered from birth to discharge home from delivery also be excluded from Total Inpatient?

Yes. Exclude newborn care rendered from birth to discharge home from delivery before reporting Total Inpatient (step 3).

HEDIS 2014

2.14.2014 Non-Recommended Cervical Cancer Screening in Adolescent Females In the Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS) measure, how should the optional exclusions be handled given that a lower rate indicates better performance?

Based on the current guideline, organizations should look for optional exclusions only where administrative data indicate that the specified numerator service or procedure did not occur. For the NCS measure, the optional exclusions indicate a justification for screening so it is not inappropriate care if these members are screened. Therefore, the optional exclusions in the NCS measure were intended to be required exclusions. In HEDIS 2015, these members must be removed from the eligible population regardless of numerator compliance. NCQA Measure Certification for NCS is based on the HEDIS 2014 optional exclusion guideline, test decks will not be updated until HEDIS 2015 and vendors may not recertify. Vendors who still need to certify NCS must comply with the current test decks. If an organization chooses to remove these optional exclusions from the NCS eligible population (i.e., treat them as required exclusions) for HEDIS 2014, the organization should work with their HEDIS Compliance Auditor to identify and remove these members.

NCQA Measure Certification for NCS is based on the HEDIS 2014 optional exclusion guideline, test decks will not be updated until HEDIS 2015 and vendors may not recertify. Vendors who still need to certify NCS must comply with the current test decks. If an organization chooses to remove these optional exclusions from the NCS eligible population (i.e., treat them as required exclusions) for HEDIS 2014, the organization should work with their HEDIS Compliance Auditor to identify and remove these members.

HEDIS 2014

12.16.2013 Cervical Cancer Screening In step 2 of the Administrative Specification, organizations identify women 30-64 years of age as of December 31 of the measurement year who had cervical cytology and a human papillomavirus (HPV) test, with service dates four or less days apart during the measurement year. When counting service dates, is the date of the cervical cytology considered day one or day zero of the four-day count?

The date of the cervical cytology is considered day zero. For example, if the service date for cervical cytology was December 1 of the measurement year, the HPV test must include a service date on or between December 1 and December 5 of the measurement year.

HEDIS 2014

12.16.2013 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Is a BMI growth chart sufficient for the physical requirement of the developmental history component?

No. Growth charts (height, weight, BMI or BMI percentile) do not meet criteria for physical developmental history for the W34 measure. The intent of the developmental history component (physical and mental) is to determine if the child was assessed for specific age-appropriate physical and mental developmental milestones, which are behaviors or physical skills seen in children as they grow and develop. For the W34 measure, examples of mental developmental milestones include ability to speak understandably, identify colors and define words appropriately. For the W34 measure, examples of physical developmental milestones include the ability to hop, throw a ball, draw and make a block tower. Documentation of "developing appropriately" or "normal development" meets criteria for both physical and mental development. Documentation of "growing appropriately" (without notation about "development") does not meet criteria for physical or mental developmental history.

Additional examples can be found in the Appendices of the Bright Futures Pocket Guide Guidelines for Health Supervision of Infants, Children, and Adolescents (http://brightfutures.aap.org/pdfs/bf3%20pocket%20guide_final.pdf).

HEDIS 2014

12.16.2013 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 2014

12.16.2013 General Guidelines Are HbA1c and LDL-C tests where the member collects a blood sample at home and sends it to a lab for results calculation allowed for HEDIS reporting?

No. Tests where the blood sample is collected by the member are considered self-administered tests and are not eligible for use in HEDIS reporting.

HEDIS 2014

11.15.2013 General Guidelines Have the dates been extended for primary source verification (PSV) and final approval of supplemental data for HEDIS 2014?

Yes. Data collection and entry of all nonstandard and member-reported supplemental data must stop on March 3. PSV and final approval must be completed by March 14, for member-reported supplemental data, and by March 28, for nonstandard supplemental data. PSV may not occur before March 3 unless all supplemental data processes, collection and entry have stopped. Supplemental data approval and PSV may not occur, under any circumstances, before January 1 and receipt of the Roadmap.

HEDIS 2014

11.15.2013 Value Set Directory The Summary of Changes spreadsheet in the HEDIS 2014 Volume 2 Value Set Directory lists LOINC code 72732-0 as added to the Sexual Activity Value Set, but that code is not in the Volume 2 Value Sets to Codes spreadsheet.

LOINC code 73732-0 was added to the Sexual Activity Value Set; it was entered incorrectly (as 72732-0) in the Summary of Changes spreadsheet. We apologize for the inconvenience.

HEDIS 2014

11.15.2013 Volume 2 Technical Update In the Volume 2 Technical Update memo, the term "discharged alive" was replaced with "discharged" in measures that include discharges for AMI or CABG. Does this mean that members who died prior to discharge should be included in the measures?

No. Removal of the language "discharged alive" does not mean that deceased members should be included in measures. As with other HEDIS measures, deceased members who do not meet continuous enrollment or anchor date criteria should not be included in the measures Eligible Population. The term "discharged alive" was removed in order to make language consistent across AMI, CABG and PCI (the term had been removed from PCI in the July 1 release of the publication; NCQA received questions about why it was removed from PCI but not from AMI or CABG). In 2015, NCQA intends to remove the term "discharged alive" from all remaining references (i.e., PBH, FUH and all measure descriptions).

HEDIS 2014