No. The correct time frame for identifying palliative care is “at any time during the 365 days prior to the IPSD through 61 days after the IPSD.” This correction will be in the MY 2024 Technical Update.
HEDIS MY 2024
FAQ Directory: HEDIS
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10.16.2023 Palliative Care Timeframe for Risk of Continued Opioid Use (COU) The time frame for palliative care (bullets 2 and 3 under “Required exclusions”) in the COU measure states to identify palliative care during the measurement period. Is this correct?
9.15.2023 COL-E Age Stratifications in Characteristics The age stratifications listed under the “Characteristics” section of the COL-E header in Volume 2 are not the same as the age stratifications listed in the Data Elements for Reporting table. What are the correct age strata for the measure?
8.16.2023 Required Exclusions and Hybrid Reporting For HEDIS MY 2023, optional exclusions are now required exclusions. For hybrid measures, if a member meets exclusion criteria via medical record review, can the member be removed from the measure and replaced with a member of the oversample?
8.16.2023 Kidney Health Evaluation for Patients With Diabetes (KED) What is the intent of removing LOINC code 32294-1 from the Urine Albumin Creatinine Ratio Lab Test Value Set?
The KED measure provides actionable information for chronic kidney disease identification and management. General guidance from our experts is that tests included in the measure should align with guideline recommendations from the American Diabetes Association and the National Kidney Foundation. For this reason, only quantitative uACR tests are allowed and semi-quantitative tests are not considered measure compliant. Removing LOINC code 32294-1 from the value set maintains these coding parameters.
HEDIS MY 2024
8.16.2023 PCS Questions Do answers from the Policy Clarification Support system have an expiration date?
7.27.2023 Cervical Cancer Screening (CCS) In HEDIS MY 2023, the CCS exclusion for hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix is now a required exclusion. Does documentation of a hysterectomy in combination with documentation that the patient no longer needs Pap testing/cervical cancer screening sufficient to meet criteria as a required exclusion for HEDIS MY 2023 reporting?
No. Members with documentation of “hysterectomy” and documentation indicating that they no longer need Pap testing/cervical cancer screening must remain in the measure for MY 2023 reporting. Members with documentation of a “vaginal pap smear” and documentation of “hysterectomy” must also remain in the measure for HEDIS MY 2023 reporting. This is because the documentation must match the clinical specificity of the codes in the value sets and there are no codes that are clinically synonymous with these examples.
There must be evidence of a hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix in order to meet required exclusion criteria for MY 2023 reporting.
Documented “vaginal hysterectomy” or “complete/total/radical hysterectomy” that matches a definition in applicable value sets may be used to meet criteria, subject to auditor approval.
HEDIS MY 2023
2.16.2023 Diabetes Measures* Should patients who have not been diagnosed with diabetes but take diabetes medications for off-label use (e.g., weight loss, heart failure) be excluded from the diabetes measures?
For measures with hybrid reporting methodology (HBD, BPD, EED), members who have not had a diagnosis of diabetes but receive diabetes medications for conditions other than diabetes (e.g., weight loss, heart failure) may be identified as valid data errors and replaced with a member from the oversample.
To meet criteria for a valid data error for these measures, the medical record must contain no evidence of diabetes and must contain evidence to substantiate the data error (how the member wound up in the measure, why it is incorrect). It is expected that the medical record will not contain evidence of diabetes, and will contain documentation that the patient is on the medication, and why. This documentation, in combination with no other documentation of diabetes in the medical record, meets criteria for a valid data error. Valid data errors are subject to review by the auditor.
Valid data errors work for the Hybrid Method only because medical record data are used to ensure that the member does not have diabetes. For the administrative method, these members remain in the measure as medical records are considered supplemental data that may not be used for identifying valid data errors, or when reporting the HBD, BPD and EED measures using the administrative method, or the KED, SMD, EDH and SPD measures, which are administrative-only measures.
We are working to refine the diabetes denominator related to off-label medication use. The next annual HEDIS public comment period is planned for February–March 2023, but organizations may submit comments on any measure, at any time, through PCS (you do not need to wait until February).
*This FAQ applies to the following measures: Hemoglobin A1c Control for Patients With Diabetes (HBD), Blood Pressure Control for Patients With Diabetes (BPD), Eye Exam for Patients With Diabetes (EED), Kidney Health Evaluation for Patients With Diabetes (KED), Statin Therapy for Patients With Diabetes (SPD), Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD), and Emergency Department Visits for Hypoglycemia in Older Adults With Diabetes (EDH)
HEDIS MY 2022
12.15.2022 Advance Care Planning (ACP) When using supplemental data, does an advance care plan executed before the measurement year meet criteria?
No. The measure requires evidence of an advance care plan during the measurement year, dated during the measurement year. If the advance care plan is scanned into the EMR and dated in the measurement year, it meets criteria. If the plan is found in the EMR or member record from a prior year, it does not meet criteria unless there is dated evidence that it was reviewed or discussed during the measurement year.
HEDIS MY 2022
12.15.2022 Auditing Data Collected Using Natural Language Processing (NLP) Is a Continuity of Care Document (CCD) acceptable for primary source verification when auditing data collected by NLP?
12.15.2022 Sampling Guidelines—Multiple Measures using a common sample If members are deceased are they removed from all measures that use the same sample?
Yes. If multiple measures use the same sample, a deceased member is removed from all related samples. For example, deceased members who are removed from the Childhood Immunization (CIS) sample would also be removed from the Lead Screening (LSC) sample. Similarly, deceased members who are removed from the Hemoglobin A1c Control for Patients With Diabetes (HBD) sample would also be removed from Blood Pressure Control for Patients With Diabetes (BPD) and Eye Exam for Patients With Diabetes (EED) samples. This FAQ was previously posted in November 2022 and was updated to remove the reference to the KED measure.
HEDIS MY 2022
12.15.2022 Transitions of Care (TRC) When using the fifth bullet to meet criteria for Medication Reconciliation Post-Discharge, if documentation indicates that the medication reconciliation was performed during a post-op/surgery follow-up visit by the surgeon who performed the surgery or the provider who admitted the member, or if the surgery is for a procedure that is typically performed inpatient, does this count as evidence that the provider was aware of the hospitalization at the time of the visit?
No. Medication reconciliations performed during a post-op/surgery follow-up visit alone do not meet criteria even if the visit was performed by the provider who admitted the member or who performed the surgery, or if the procedure is typically performed inpatient. The intent is that medical record documentation must support awareness of the hospitalization (denominator event) at the time of the medication reconciliation, even if the provider admitted the member or saw the member during the hospitalization, or if the procedure is typically performed inpatient.
HEDIS MY 2022