Yes. Unless the measure specification directs otherwise, use diagnosis and procedure codes from both facility and professional claims to identify an admission or discharge event.
HEDIS 2016
FAQ Directory: HEDIS
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10.15.2015 Technical Update In the Technical Update memo, the following language was added to Persistence of Beta-Blocker Treatment After a Heart Attack and Follow-Up After Hospitalization for Mental Illness: “Use only facility claims to identify discharges and diagnoses for denominator events (including readmissions or direct transfers). Do not use professional claims.” For other measures that use the same method and value sets to identify a discharge (or an admission), should the organization use both facility and professional claims?
8.14.2015 General Guidelines Given the addition of the “Numerator events by supplemental data” data element, how will the reported rate be calculated?
The reported rate calculation is the sum of all numerator events by administrative data, medical record data and supplemental data, divided by the eligible population for administrative measures, or by the denominator for hybrid measures (i.e., reported rate = numerator events by administrative data + numerator events by medical record data + numerator events by supplemental data / eligible population or denominator).
HEDIS 2016
8.14.2015 General Guidelines Are members with a hospice benefit excluded from Medicare HEDIS reporting?
8.14.2015 General Guidelines Will the “Numerator events by supplemental data” data element be collected for all measures in Volume 2?
No. For HEDIS 2016 reporting, this new requirement was added to only the Effectiveness of Care (EOC) and EOC-like measures. “EOC-like measures” refers to the Utilization measures that have the same structure as and follow the same guidelines as the measures in the EOC domain (i.e., Frequency of Ongoing Prenatal Care, Well-Child Visits in the First 15 Months of Life, Well-Child visits in the Third, Fourth, Fifth and Sixth Years of Life, Adolescent Well-Care Visits). While supplemental data may be used for other measures, NCQA is not currently collecting this data element for other measures at this time.
HEDIS 2016
8.14.2015 General Guidelines For measures that require multiple events to meet criteria (e.g., CIS), how are the data classified if some events come from an administrative or medical record data source and some come from a supplemental database?
7.16.2015 General Guidelines Where can customers find additional information about Electronic Clinical Data Systems (ECDS) and the Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS) measure for HEDIS 2016?
4.16.2015 Policy Clarification Support (PCS) Website URL Is there a new Web site URL for the PCS system?
Yes. The PCS system will be moved to a new Web site—http://my.ncqa.org—by the end of April. Customers who access the old PCS site will be automatically rerouted to the new site. The new site takes the same login and password; you will not need to change them.
HEDIS 2015
12.15.2014 CAHPS Health Plan Survey 5.0H, Child & Adult Version Has the CAHPS survey sample frame validation process changed?
Yes. Starting in reporting year 2015, NCQA requires that all Licensed Organizations apply a password lock to the validated and approved sample frame file used for conducting the commercial and Medicaid Child and Adult CAHPS and the Qualified Health Plan (QHP) Enrollee surveys. Survey vendors may not pull a sample from an unlocked file.
HEDIS 2015
11.14.2014 CAHPS Health Plan Survey 5.0H, Child Version To collect results for Children With Chronic Conditions, more than 12 questions must be added to the CAHPS child survey. How can an organization collect results for the Children With Chronic Conditions (CCC) measure without exceeding 12 supplemental questions?
A version of the child survey that includes the CCC questions is part of HEDIS. If an organization uses the “With CCC” version of the questionnaire, the CCC items are considered part of the CAHPS 5.0H questionnaire and are not included in the count of 12 supplemental questions.
HEDIS 2015
11.14.2014 Osteoporosis Management in Women Who Had a Fracture CMS required the use of temporary HCPCS code Q2051 (Injection, Zoledronic acid, 1 mg) from July 1–December 31, 2013. This code is not included in the Osteoporosis Medications Value Set. May organizations map this code and use it for HEDIS 2015 reporting?
10.15.2014 Relative Resource Use for People With Asthma Should the same change be made to the RAS measure that is also made to step 2 in the Event/Diagnosis section of the ASM, MMA and AMR measures in the HEDIS 2015 Volume 2: Technical Update?
Yes. In the Eligible Population section, replace the text in step 2 with the following: A member identified as having persistent asthma because of at least four asthma medication dispensing events, where leukotriene modifiers or antibody inhibitors were the sole asthma medication dispensed in that year, must also have at least one diagnosis of asthma (Asthma Value Set), in any setting, in the same year as the leukotriene modifier or antibody inhibitor (i.e., the measurement year or the year prior to the measurement year).
HEDIS 2015
