FAQ Directory: HEDIS

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8.19.2020 Palliative Care Exclusion May supplemental and medical record data be used to identify members for the Palliative Care exclusion?

Yes. Although the required palliative care exclusion is intended to be identified using administrative data, medical record and supplemental data may also be used. If a member is identified as being in palliative care during hybrid medical record review, the member must be removed from the sample and replaced with a member from the oversample. Count the member in the “Number of medical records excluded because of valid data errors” data element.

If organizations use supplemental data to remove members in palliative care from administrative-only measures or hybrid measures, they must follow the supplemental data guidelines (General Guideline 31). Count these members in the “Number of required exclusions” data element.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.