FAQ Directory: HEDIS for the Quality Rating System

Filter Results
  • Save

    Save your favorite pages and receive notifications whenever they’re updated.

    You will be prompted to log in to your NCQA account.

  • Email

    Share this page with a friend or colleague by Email.

    We do not share your information with third parties.

  • Print

    Print this page.

expand all

12.15.2020 Follow-Up After Hospitalization for Mental Illness (FUH) What time frame should be used to identify acute and nonacute readmissions or direct transfers when identifying the event/diagnosis?

Use a 30-day period. Replace the reference to “7-day follow up period” with “30 days after discharge (the denominator event)” in both the “Acute readmission or direct transfer” and “Nonacute readmission or direct transfer” sections of the specification. This ensures that the same Eligible Population criteria are used for all organizations that report the FUH measure (regardless of product line).

**This FAQ applies to QRS MY 2020.

EXCHANGE MY 2020

12.15.2020 Appropriate Testing for Pharyngitis (CWP) Is the episode date excluded if the member does not receive antibiotics on or up to three days after the Episode Date?

Yes, the episode date is excluded. Add the following text to the event/diagnosis after step 3:
Exclude Episode Dates if the member did not receive antibiotics on or up to three days after the Episode Date.

**This FAQ applies to QRS MY 2020.

EXCHANGE MY 2020

11.16.2020 VSD for the Quality Rating System The same OID is listed for the Systolic Greater Than or Equal To 140 Value Set and the Systolic Less Than 140 Value Set in the QRS Value Set Directory. Is this correct?

No. The value set OID for the Systolic Greater Than or Equal To 140 in the QRS Value Set Directory is incorrect and should be changed to 2.16.840.1.113883.3.464.1004.1242.

EXCHANGE MY 2020

11.16.2020 Prenatal and Postpartum Care (PPC) Step 3 of the event/diagnosis states, “Determine if enrollment was continuous 43 days prior to delivery through 56 days after delivery, with no gaps.” Is this correct?

No. Replace this with, “Determine if enrollment was continuous 43 days prior to delivery through 60 days after delivery, with no gaps.”

EXCHANGE MY 2020

1.15.2020 Controlling High Blood Pressure The CBP measure lists the following exclusions in the eligible population:

• Medicare members 66 years of age and older as of December 31 of the measurement year who meet either of the following:
– Enrolled in an Institutional SNP (I-SNP) any time during the measurement year.
– Living long-term in an institution any time during the measurement year as identified by the LTI flag in the Monthly Membership Detail Data File. Use the run date of the file to determine if a member had an LTI flag during the measurement year.

Should these exclusions be removed from the CBP measure specifications?

 Yes. Remove the bullets that include I-SNP and LTI exclusions for Medicare members from the specifications. They are not intended for the Exchange population.

EXCHANGE 2020

11.15.2019 Well-Child Visits in the First 15 Months of Life Should the “Number of required exclusions” row be removed from the Data Elements Table in the Well-Child Visits in the First 15 Months of Life (W15) measure?

Yes. Remove the “Number of required exclusions” row in the Data Elements Table.

EXCHANGE 2020

10.15.2018 Immunizations for Adolescents Are issuers required to report Combo 1 for the Quality Ratings System in the Immunizations for Adolescents (IMA) measure?

No. HEDIS for QRS requires collection of only Combination 2 and related antigens. Change the reference in the Description from “two combination rates” to “one combination rate.” In the Data Elements Table, change “Each of the 5 rates” to “Each of the 4 rates.”

EXCHANGE 2019

10.15.2018 Appropriate Treatment for Children With Upper Respiratory Infection Should the “Numerator events by supplemental data” row be removed from the Data Elements Table in the Appropriate Treatment for Children With Upper Respiratory Infection (URI) measure?

Yes. Remove the “Numerator events by supplemental data” row in the Data Elements Table.

EXCHANGE 2019

10.15.2018 Proportion of Days Covered Should the upper and lower Confidence Interval data elements be removed from the reporting tables in the Proportion of Days Covered (PDC) measure?

Yes. NCQA removed confidence intervals from all measures and data collection (IDSS) in HEDIS 2019; this applies to all related products using IDSS, including the QRS PDC measure.
Organizations that want to calculate or use confidence intervals must use the other data element fields and calculate confidence intervals for internal analysis.

EXCHANGE 2019

10.15.2018 Use of Imaging Studies for Low Back Pain Should the “Numerator events by supplemental data” row be removed from the Data Elements Table in the Use of Imaging Studies for Low Back Pain (LBP) measure?

Yes. Remove the “Numerator events by supplemental data” row in the Data Elements Table.

EXCHANGE 2019

10.15.2018 Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Should the “Numerator events by supplemental data” row be removed from the Data Elements Table in the Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis (AAB) measure?

Yes. Remove the “Numerator events by supplemental data” row in the Data Elements Table.

EXCHANGE 2019

1.15.2017 Relative Resource Use for People with Diabetes Should Marketplace plans report the Relative Resource Use for People with Diabetes (RDI) measure for 2017?

No. The RDI measure will be removed from the Quality Rating System. For Marketplace plans, CMS will issue guidance, including, but not limited to, FAQs, updates to the 2017 Technical Guidance and the 2017 Call Letter.

EXCHANGE 2017