FAQ Directory: HEDIS

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12.14.2018 Controlling High Blood Pressure The Controlling High Blood Pressure measure includes optional exclusion criteria under the Hybrid methodology. May organizations apply optional exclusion criteria for both the administrative and hybrid reporting methods?

Yes. The intent is to allow organizations to apply the optional exclusion for both the administrative and hybrid specifications. When using the administrative specification, organizations must use the codes in the value sets to identify members who meet optional exclusion criteria. When using the hybrid specification, organizations should look for evidence of ESRD, kidney transplant, dialysis, pregnancy or a nonacute inpatient admission during the measurement year in order to identify members who meet optional exclusion criteria.

Keep in mind that all exclusions are subject to auditor review.

HEDIS 2019