Yes, documentation of " HB1c " is considered evidence of a HbA1c test and may be used when reporting the HbA1c testing indicator.
HEDIS 2020
FAQ Directory: HEDIS
Filter Results
11.15.2019 Comprehensive Diabetes Care Does documentation of “HB1c” meet criteria when reporting the HbA1c testing indicator?
11.15.2019 Plan All-Cause Readmissions The PCR measure indicates that for commercial and Medicaid, organizations report only members 18–64 years of age. This is inconsistent with Table PCR-1/2/3: Plan Population and Outlier Rate (Medicaid, Commercial and Medicare, 18+) and Table PCR-A-1/2/3 : Plan All-Cause Readmissions Rates Among Nonoutlier Members by Age (Medicaid, Commercial and Medicare, 18+), which indicate that members ages 18 and older are reported for all product lines. Are these data element tables incorrect for commercial and Medicaid reporting?
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
11.15.2019 Prenatal and Postpartum Care The Postpartum Care indicator states that documentation of “Resumption of physical activity and attainment of healthy weight” meets criteria. Does documentation need to include both resumption of physical activity AND attainment of healthy weight to meet criteria?
10.15.2019 Organization Responsibility for Chart Review HEDIS 2020 clarified that chart pursuit is recommended but is determined by the organization. Does this mean that chart pursuit is up to the organization?
10.15.2019 “Unknown” SES Category The SES stratification guidance in HEDIS 2020 Volume 2 indicates that the “Unknown” category may be used for only Puerto Rico plans or if the auditor approves a small number of unassigned members. Is there a specific number of Unknown members a plan is allowed to report?
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
10.15.2019 Medication Dispensed Date If pharmacy data are classified as supplemental and the medication dispensed date is not documented, may the “shipped date” be used as the “dispensed date”?
10.15.2019 Pharmacy Data and Medication Samples If pharmacy data are classified as supplemental, may the date when a provider gives free medication samples to a member be considered the “dispensed date”?
10.15.2019 Codes Found in Medical Records For General Guideline 31: Supplemental Data, does removal of the hybrid data elements requirement mean that codes found in the medical record may be used as proof of service even if there is no additional documentation of the service provided?
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
10.15.2019 Reporting of the Initial Population by Data Source A bullet in the Summary of Changes in the DRR, AIS and PRS measures states: Removed the collection of the “Initial Population” and “Denominator” data elements by SSoR in the Data Elements for Reporting tables. This contradicts the Data Elements tables of all three measures, which has the initial population reported by data source. Is the SOC correct?
10.15.2019 General Guideline 18: Deceased Members Is General Guideline 18: Deceased Members an optional exclusion? Must a deceased member be removed from all HEDIS measures?
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
10.15.2019 Supplemental Data and Rules for Allowable Adjustments In some cases, supplemental data are not allowed for regular HEDIS reporting, but may supplemental data sources be used when following the Rules for Allowable Adjustments?
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:
- For denominator calculation. The current restriction in regular HEDIS reporting is based on auditability, not on the data’s effect on the measure’s clinical intent. In Allowable Adjustments, files may be used if they meet all measure requirements.
- For Numerator calculation. The current restriction in regular HEDIS reporting is based on assessing paid claims vs. denied claims. In Allowable Adjustments, files may be used if they meet all requirements of the measure, even if the organization cannot determine payment status.
HEDIS 2020
9.16.2019 Cutoff Date for NDCs in the HEDIS 2020 MLD What is the cutoff date for including National Drug Codes (NDCs) in the HEDIS 2020 Medication List Directory (MLD)?
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