FAQ Directory: HEDIS

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9.15.2021 Guidelines for Calculations and Sampling: Hybrid Measures How should exclusions be applied when found during an administrative data refresh for hybrid measures?

Per General Guideline 32, there are two ways to apply exclusions after samples have been pulled and chart review has begun. Because the sample must be reproducible, the members remain in the eligible population but are removed from the sample and reflected in the denominator. Organizations should indicate the exclusions by reporting them as valid data errors. When the population is larger than the MRSS, replace those members with members from the oversample.

Remember that the denominator is used to calculate and report the measure. All exclusions and replacements are reflected in the denominator calculation. The following are examples:

Example 1:
Eligible population = 300
MRSS = 300
Oversample Rate = 0%
Oversample Records Number = 0
Number of valid data errors = 3
Oversample Records Added = 0
Denominator = 297

Example 2:
Eligible population = 5,800
MRSS = 411
Oversample Rate = 5%
Oversample Record Number = 21
Number of valid data errors = 11
Oversample Records Added = 11
Denominator = 411

HEDIS MY 2022