Yes, documentation of " HB1c " is considered evidence of a HbA1c test and may be used when reporting the HbA1c testing indicator.
HEDIS 2020
Yes, the tables are incorrect. When reporting the PCR measure for the commercial and Medicaid product lines, only include members 18–64 years of age. The age ranges 65–74, 75–84, 85+ and 65+ Total included in the data element tables are only collected for Medicare reporting.
For commercial and Medicaid reporting, collect 18–44, 45–54, 55–64 and 18–64 Total.
HEDIS 2020
Except for plans in Puerto Rico, which report all members in the “Unknown” category, it is expected that the member count in this category will be at or below 1%. If more than 1% of eligible members are assigned to the “Unknown” category, the plan must work with the auditor to identify why members are being categorized as “Unknown.”
HEDIS 2020
No. Codes alone (without additional documentation of the service provided) do not meet criteria for proof of service. If a provider performs a service, it is expected that additional documentation exists in the medical record or in the primary source document. Auditors must validate, through primary source verification, all elements required by the administrative measure specification.
HEDIS 2020
The exclusion in General Guideline 18 is optional. Members who die during the measurement year may be excluded from all measures, except the measures in the Health Plan Descriptive domain or the Risk Adjusted Utilization subdomain. However, if a member dies during the measurement year, the organization is not required to remove the member from all measures.
For example, if an organization identifies a deceased member during medical record review for the ABA measure, the member may be removed from the measure as a valid data error and replaced with a member from the oversample, but the organization is not required to remove the member from all other applicable HEDIS measures.
Additionally, there is no requirement to assess numerator compliance for deceased members and exclude the member only if they are not numerator compliant. NCQA does not prescribe how organizations identify deceased members using claim/encounter and enrollment data. Organizations must develop their own methods to identify these members.
HEDIS 2020
Yes. Supplemental data may be used for the denominator and the numerator when following the Rules for Allowable Adjustments. In general, the data are usable when the codes are in the value sets and the clinical intent of the measure is not changed, but there are restrictions for use of supplemental data in regular HEDIS reporting:
HEDIS 2020
Any NDC or RxNorm code that is in the U.S. National Library of Medicine’s RxNorm database as of September 1, 2019 will be considered for inclusion in the HEDIS 2020 MLD, which will be posted to the NCQA website on November 1, 2019. This is a change from past years’ cutoff date, which was September 30.
HEDIS 2020