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
FAQ Directory: HEDIS
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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?
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?
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?
1.16.2013 Medical Record Review Validation What records are included in Group F (Exclusions)?
MRRV Group F (Exclusions) includes all optional and required exclusions and valid data errors found during medical record review. It does not include records excluded through administrative data or that belong to employees or their dependents. Other hybrid medical record exclusions that should not be reviewed in Group F are exclusions for CBP and the HbA1C Less Than 7% indicator. Because of the large volume, auditors review exclusion rates for these indicators separately. See the instructions in Volume 5, page 65 for reviewing CBP and HbA1c<7%.
HEDIS 2013
1.16.2013 General Guidelines Are home-test kits that collect biometric values allowed for HEDIS reporting?
Only tests administered by a qualified provider may be used for HEDIS reporting. Self-administered tests (including home-test kits) where the patient performs the test and obtains the result are not eligible for use in HEDIS reporting.
Results from a home test kit where a qualified provider uses the kit to conduct a test or determine the results in the office are eligible for HEDIS reporting. If any home test is billed by a qualified provider using a code specified in the measure, it is eligible for use in HEDIS reporting; the code alone indicates compliance.
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?
1.16.2013 Medical Record Review Validation Can the plan choose to rotate a measure that failed MRR validation?
The intent of measure rotation is to reduce chart review, not be a means to select the best rate possible. However, NCQA does not specifically prohibit this approach. Please note, if the reason for failing can be seen as possibly affecting other measures in the group, the auditor may elect to review those other measures.
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)?
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 Medical Record Review Validation If during MRR validation, a plan fails two samples, and informs the auditor they corrected the problem, what follow-up items are required to validate that the corrections were appropriate?
The auditor may use one or more methods to validate the chart error corrections. Follow-up actions should include:
· reviewing the error investigation and results
· reviewing policies and procedures to correct the error
· reviewing the corrected sample to ensure the updated numerator counts are correct and performing final hybrid rate review
· re-sampling charts for a new validation
Examples:
1. For the exclusions or data errors in the diabetes measure records, the auditor identified a pattern: she found two cases where the chart reviewer said the members did not have diabetes, but the chart showed that both members had elevated blood sugars and above average HbA1c results. One member had a PCP diagnosis of metabolic syndrome that placed him in the measure. The other member had a diagnosis of insulin resistance. The auditor required the plan to re-review all CDC exclusions and submitted charts for the remaining correct exclusions from the measure. The auditor approved reporting.
2. For the two MRRV samples, there were two errors found _ one in each sample. The auditor required the plan to do an analysis and demonstrate corrective actions.
The plan reported that one abstractor made the errors by incorrectly identifying the prior years CDC eye exams. The plan re-reviewed 100% of that abstractors hits and reversed 12 hits to misses. The plan had originally reported 100 admin hits and 200 hybrid hits for CDC eye exam. Of the 200 hybrid hits, 160 were measurement year eye exams, and 40 were negative retinopathy cases from the prior year. The auditor pulled another sample of 16, found no errors, and confirmed that the reported rate for the measure dropped from 73% to 70% as a result.
The auditor approved reporting.
3. The auditor found four errors in the first sample for AWC. He notified the plan and required them to do an analysis and demonstrate corrective actions. The plan submitted:
· the error investigation and results
· the policies and procedures that corrected the error
· a new sample of 16 that proved to have zero errors
· a new sample of 16 that proved to have zero errors
The auditor approved reporting.
HEDIS 2013
1.16.2013 Medical Record Review Validation If a plan has one failed medical record during MRR validation, and a second sample also fails, do the measure and all the measures in that group receive an NR?
If a plan fails the test – one error in each of two samples – and cannot correct the error and resubmit the correction to the auditor, the plan may not use the Hybrid Method for reporting that measure. The plan can report the administrative rate or report an NR for that measure. The auditor must determine whether the error affects all the other measures in the group and their reportability.
HEDIS 2013
1.16.2013 General Guidelines Can Health plans collect data from charts for a supplemental database and use the results for administrative rates?
Looking at charts is one way to collect data for a supplemental database (note: this activity should be distinguished from and not include chart review activities for the hybrid measures). All data in the supplement database, regardless of how it was collected, should be treated as administrative data. With the exception of standard data sources such as EHRs and state registries, supplemental databases should not be used during chart review for the hybrid measures.
HEDIS 2013
