No. HEDIS ECDS measures use Quality Data Model (QDM) 5.3 as the reference model, although NCQA is researching the use of FHIR as a possible option.
HEDIS 2018
FAQ Directory
Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.
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5.15.2018 ECDS Do you utilize FHIR to specify ECDS measures?
5.02.2018 Plan All-Cause Readmissions For the Count of Expected 30-Day Readmissions, we are using the calculation in Step 6 in HEDIS Volume 2 (pg. 384), but IDSS is calculating differently. Is this calculation correct?
The calculation for the Count of Expected 30-Day Readmissions is incorrect in Volume 2. IDSS currently calculates this field by using the formula "Count of Expected 30-Day Readmissions" = "Expected Readmission Rate" * "Count of Index Stays".
Please provide data for the Expected Readmission Rate and the Count of Index Stays and IDSS will use these values to generate the correct calculation.
HEDIS 2018
3.21.2018 VBP4P/ACO- Clinical Measure Data File Layouts In the MY 2017 PO and HP clinical measure data file layouts, the Cervical Cancer Screening (CCS) measure ID on tab (4) Clin Meas ID Table includes the following edit check:
Denominator for CCS must be equal to or less than CCO denominator.
Because there are different exclusions for the CCS and CCO measures, however, the denominators across the two measures may not match and the edit check would fail. The CCO measure includes additional required exclusions, which means that the CCS denominator would either be equal to or greater than (not less than) the CCO denominator.
We agree that the edit check in the data file layout may not be true. For MY 2017, the edit check should state:
| Denominator for CCS must be equal to or greater than CCO denominator. | |
Submissions that do not follow the corrected edit check will result in file rejection. VBP4P staff will make this correction and release a new version of the affected files on iha.org.
IHA 2017
3.15.2018 Transitions of Care If an organization reports the measure using the hybrid method and reports two indicators using administrative data from one provider, is the organization limited to only the medical record of that provider when searching for medical record documentation for the other indicators?
No. The Notification of Inpatient Admission and Receipt of Discharge Information indicators do not have to be documented in the same provider chart as the indicators that were reported administratively. Organizations may search the medical record of a different provider for those indicators that were not reported using administrative data.
HEDIS 2018
3.15.2018 Care for Older Adults If the medical record contains a notation of a type of advance care plan (e.g., advance directive, actionable medical orders, living will, surrogate decision maker, full code, DNR) with documentation of “yes” or “no,” does this meet criteria?
If “yes” is documented for a type of advance care plan, this is considered evidence that a member has an advance care plan in place and meets criteria. If “no” is documented, this is considered evidence that the member does not have this type of advance care plan in place and does not meet criteria. For example, documentation of “DNR – No” indicates “the member does not have a DNR,” and does not meet criteria. In addition, documentation of “no” is not considered evidence of an advance care planning discussion (asking if a member has an advance care plan in place and documenting “no” is not considered a discussion).
HEDIS 2018
3.15.2018 Plan All-Cause Readmissions There is a discrepancy between Step 7 in the Risk Adjustment Weighting section (page 384) and in all the PCR reporting tables for how to calculate the Expected Readmissions Rate. Which one is correct?
Organizations must use the formula in Step 7 to calculate the Expected Readmissions Rate for PCR. The reference in the PCR reporting tables of the “(Expected Readmissions/Den)” is incorrect. The data element should only be “Expected Readmissions Rate.” This removal of the incorrect calculation instruction will be made in the Interactive Data Submission System (IDSS) and data dictionaries.
HEDIS 2018
3.14.2018 VBP4P/MA- Medicare Advantage and Commercial Dual Eligibles If a member is enrolled in both commercial and Medicare Advantage lines of business, assuming both plans participate in VBP4P, in which lines should the member be reported?
HEDIS General Guideline 15: The “Working Aged” and Retirees says, “Include employees 65 years of age and older and retirees only in the product line that providers their primary coverage (Medicare or commercial).” Following this guidance, members with dual coverage in commercial and Medicare Advantage products should be reported in the plan that provides primary coverage (whether the same or a different plan). NCQA will provide further guidance on this issue in HEDIS 2019 and VBP4P will evaluate for inclusion for MY 2018.
Self-reporting POs that are unable to identify the primary insurer should use their best judgment; the overall impact is expected to be minimal and equal across plans and POs.
IHA 2017
3.14.2018 VBP4P/ACO- Clinical Measure Data File Layouts With regard to the the AMROV65 measure: The MY 2017 VBP4P manual states that the age span is 5–64, but the PO, HP and ACO layouts all indicate 5–65. Is this correct, or should the ID be “AMROV64” and the age span 5–64?
You are correct: The measure name should be AMROV64.
This is an error in the Clinical Measure Data File Layouts. The AMR total rate should only include members 5–64 years of age, in alignment with the AMR measure specifications. The correction is below. VBP4P staff will make this correction and release a new version of the affected files on iha.org.
| Commercial | AMROV64 | Asthma Medication Ratio: Ages 5-64 |
IHA 2017
2.15.2018 Adolescent Well-Care Visits Does sports participation meet the criterion for physical developmental history?
Yes. Documentation of participation in sports or in physical activity meets the criterion for physical developmental history. Bright Futures states that a goal of observing development in adolescents is to determine whether they are developing skills for becoming healthy adults—such as good nutrition and physical activity.
HEDIS 2018
2.15.2018 ECDS General Guidelines Should organizations include only paid claims for ECDS measures?
No. Organizations must include all paid, suspended, pending and denied claims for ECDS measures. Currently, ECDS General Guideline 4 states to include only services for which the reporting entity has paid or expects to pay, but because none of the other eligible sources require payment status, any claims should be accepted. The guideline is incorrect and will be corrected for HEDIS 2019
HEDIS 2018
2.15.2018 Transitions of Care A member is admitted to the hospital on December 30, 2016, and discharged in January 2017. To meet criteria, the Notification of Inpatient Admission must occur on either December 30 or 31, 2016, but the measure description states that the four elements must occur during the measurement year. Can we count the Notification of Inpatient Admission that occurs in the year prior to the measurement year?
Yes. In the scenario above, Notification of Inpatient Admission may be on the admission date or on the following date, even if it occurs in the year prior to the measurement year. The member in this example remains in the measure because the discharge date was in January 2017. Unless the patient’s PCP or ongoing care provider was involved in the patient’s care prior to the admission (e.g., conducted the patient’s pre-admission exam), a communication on the admission date or the date following meets criteria for the Notification of Inpatient Admission numerator.
HEDIS 2018
2.15.2018 Identifying a member for Complex Case Management When is a member identified as eligible to receive complex case management services?
A member is identified to receive complex case management services in PHM 2, Element D. The organization’s policies and procedures describes its method for categorizing membership for involvement in complex case management. Once identified, the organization must begin the initial assessment within 30 days and complete within 60 days to meet the PHM 5, Element D requirement.
HP 2018