FAQ Directory: HEDIS

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7.15.2013 General Guidelines Where can customers find additional information about the supplemental data changes for HEDIS 2014?

7.15.2013 Care for Older Adults If there is a list of medications in the progress note, is a prescribing practitioner or clinical pharmacist's signature alone considered evidence that the list was reviewed for the medication review indicator?

The medication review indicator requires both a medication list and evidence that it was reviewed by the appropriate practitioner. The presence of a medication list with the appropriate practitioner's signature is compliant if it is dated during the measurement year. The practitioner's signature is considered evidence that the medications were reviewed.

HEDIS 2014

7.15.2013 Prenatal and Postpartum Care For the PPC measure, a Pap test alone is acceptable for the Postpartum Care rate. Is documentation of a Pap test compliant for women under the age of 21?

NCQA is aware that recent guidelines recommend pap tests NOT be performed for women under 21 years of age under general circumstances. However, for the PPC measure, a pap test will remain in the specifications as a way to determine that postpartum care occurred. NCQA allows documentation of only a Pap test because this test indicates that a pelvic exam was performed. This measure includes deliveries in any age group.

NCQA is re-evaluating the PPC measure based on clinical practice guideline updates. Any changes will be included in future HEDIS specifications.

HEDIS 2014

2.16.2013 Adult BMI Assessment If the member's weight is documented in the medical record during the measurement year or year prior to the measurement year, may the organization calculate BMI at a later date?

Yes. The BMI may be calculated by the organization at a later date. It must be calculated and documented in the medical record during the measurement year or year prior to the measurement year to be eligible for use in HEDIS reporting.

HEDIS 2013

2.16.2013 General Guidelines If an organization finds an undated lab result in a progress note, can the progress note date be used as the lab result date?

No. An undated lab result may not be used for HEDIS reporting. To be eligible for use, the date the test was performed (e.g., the date the sample was drawn) or the result date (e.g., the date the lab calculated the result) must be documented.

HEDIS 2013

2.16.2013 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents May a member's height, weight and BMI percentile be noted on different dates of service in the medical record for the BMI Percentile indicator?

Yes. Height, weight and BMI percentile may be noted on different dates of service as long as they are documented in the medical record during the measurement year.

HEDIS 2013

2.16.2013 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents If height and weight are documented in the medical record during the measurement year, may the organization calculate BMI percentile at a later date?

Yes. The BMI percentile may be calculated by the organization at a later date. It must be calculated and documented in the medical record during the measurement year to be eligible for use in HEDIS reporting.

HEDIS 2013

2.16.2013 Adult BMI Assessment May a member's weight and BMI be noted on different dates of service in the medical record?

Yes. Weight and BMI may be noted on different dates of service as long as they are documented in the medical record during the measurement year or year prior to the measurement year.

HEDIS 2013

2.16.2013 Comprehensive Diabetes Care If no result is documented for an eye exam in the year prior to the measurement year, can the organization infer that the exam was negative for retinopathy?

No. Documentation of an eye exam that does not include a result does not count as a negative result and is not eligible for use in HEDIS reporting.

HEDIS 2013

2.16.2013 Care for Older Adults For the functional status assessment indicator, the fourth bullet requires notation of at least three of the four components: cognitive status, ambulation status, sensory ability and other functional independence. For "sensory ability," must all three components (hearing, vision, speech) be documented to meet the criterion?

Yes. All three components must be evaluated to fulfill the sensory ability component.

HEDIS 2013

1.16.2013 Medical Record Review Validation If a plan has one failed medical record during MRR validation, and a second sample also fails, do the measure and all the measures in that group receive an NR?

If a plan fails the test – one error in each of two samples – and cannot correct the error and resubmit the correction to the auditor, the plan may not use the Hybrid Method for reporting that measure. The plan can report the administrative rate or report an NR for that measure. The auditor must determine whether the error affects all the other measures in the group and their reportability.

HEDIS 2013

1.16.2013 Medical Record Review Validation For measures that are heavily or entirely reliant on MRR data (e.g., COA, ABA, WCC, CDC BPs), if an organization attempts MRR validation and fails, or is able to retrieve a only small percentage of charts, can they report an administrative rate as low as 0% (assuming no other issues are identified)?

A low administrative rate, even 0%, can be reported, if the plan wants to submit such a rate and the auditor finds no bias or other problems in the administrative process.

HEDIS 2013