For HEDIS 2018 reporting, for methadone, the MED conversion factor of "3" should be used as listed in the NDC list; not the factors listed in Table UOD-A. We will reevaluate using the sliding scale conversion factors for HEDIS 2019.
HEDIS 2018
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11.15.2017 Use of Opioids at High Dosage In the HEDIS 2018 Volume 2 Technical Update memo Table UOD-A includes a variable ranging from 4-12 for the MED Conversion Factor for methadone based on mg/day of methadone used. However, in the HEDIS 2018 NDC MLD Directory all NDCs for Methadone under the medication list "Opioid Medication" have a MED Conversion Factor (column M) of 3. For performing the MED calculation in UOD, which MED Conversion Factor should be used for methadone?
11.15.2017 Supplemental Data Is it acceptable to flag records in a supplemental data file as paid or denied when there is no payment attached to the records in the file?
No. It is not acceptable to classify a supplemental data source as paid or denied unless it is known whether the data in the data source were paid or denied. This is especially true when the data are being used for measures that require claims payment statuses (e.g. LBP, NCS). Organizations should not assume services were denied services just because there isn't a payment status associated with them. For measures where payment status is required, the auditor must be able to validate that the payment status is accurate.
HEDIS 2018
11.15.2017 General Guidelines General Guideline 17 says that "Members with dual commercial and Medicaid coverage must be reported in the commercial HEDIS reports. These members may be excluded from the Medicaid HEDIS reports." If a member has primary insurance in a Medicaid plan and secondary insurance in another Medicaid plan at any time during the measurement year, should the secondary Medicaid plan report the member in their HEDIS report?
To meet criteria for dual coverage, the member should have dual coverage at the end of the continuous enrollment period (dual coverage is assessed on a measure-by-measure basis). For example, if a measure's continuous enrollment period ends on December 31 of the MY and has dual Medicaid and commercial enrollment on that date, then the member may be excluded from the Medicaid HEDIS reports for the measure and only be reported in the commercial product line (General Guideline 23 in HEDIS 2018 Volume 2). In cases where the member is dually enrolled in two Medicaid plans, the secondary Medicaid payer would have the choice to exclude the member if the primary Medicaid coverage was offered through a different organization.
HEDIS 2018
11.15.2017
Transitions of Care The HEDIS 2018 Volume 2 Technical Update memo indicates the following change in the Transitions of Care specifications: In the first sentence of the third paragraph, replace “date/time” with “date.”
Should this change also apply to the first bullet in the “Note” section of the technical specifications that reads, “The following notations or examples of documentation do not count as numerator compliant:
*Documentation of notification that does not include a time frame or date/time stamp.”
11.15.2017 Reporting Requirements The HEDIS 2018 Volume 2 Technical Update memo announced the retirement of “Annual Monitoring for Patients on Persistent Medications (MPM)” for Medicare and the name change from “Inpatient Hospital Utilization (IHU)” to “Acute Hospital Utilization (AHU).” This caused a discrepancy between the CMS Reporting Memo and HEDIS 2018 Volume 2 Technical Specifications. Will CMS release a clarification on what must be reported for HEDIS 2018 for Medicare?
Yes. CMS released a clarification on October 11, 2017, through HPMS, announcing that MPM was retired and is not required for HEDIS 2018 reporting; it also clarified that “Inpatient Hospital Utilization” is now “Acute Hospital Utilization” and should be reported as the updated measure. If you have additional questions, contact CMS at HEDISquestions@cms.hhs.gov.
HEDIS 2018
11.15.2017
Hospitalization for Potentially Preventable Complications On Page 37 of the HEDIS 2018 Volume 2 Technical Update memo, the “Number of Chronic ACSC Non-Outliers and Acute ACSC Non-Outliers” and “Number of Chronic ACSC Outliers and Acute ACSC Outliers” reporting categories have the same description.
Should the first reporting category listed above state ‘non-outlier’ instead of ‘outlier’?
11.15.2017 Weeks of Pregnancy at Time of Enrollment The HEDIS 2018 Volume 2 Technical Update memo includes a RAND number for the “Weeks of Pregnancy at Time of Enrollment” measure. Is this correct?
11.15.2017 Guidelines for Calculations and Sampling The footnote on page 45 of HEDIS 2018 Volume 2 indicates that the lowest Prior Year rate from “Prenatal and Postpartum Care” and “Frequency of Prenatal Care” should be used to reduce the sample size for PPC. Given that FPC was retired with the HEDIS 2018 Volume 2 Technical Update, should the PPC MRSS use the lower rate of the Postpartum and Prenatal care indicators?
10.15.2017 ECDS Must the eMeasure section in the Roadmap be completed for ECDS measures?
Plans work with their NCQA-Certified auditor to complete the most appropriate section of the Roadmap for the data source. The eMeasure section is intended for use by data aggregators and EHR vendors, but may be adapted and modified. Plans should work with auditors or contact NCQA with specific questions about the eMeasure Roadmap or Audit Roadmap Section 5.
HEDIS 2018
10.15.2017 Breast Cancer Screening, Colorectal Cancer Screening, Controlling High Blood Pressure, and Osteoporosis Management in Women Who Had a Fracture The Medicare Monthly Membership File includes a run date and a payment date. Which date should be used to determine that a member had an LTI flag during the measurement year?
10.15.2017 ECDS If the same data source is used as ECDS and as supplemental data, are health plans required to submit separate Roadmaps/documentation?
Plans should work with their NCQA-Certified auditor to accurately identify all data sources being considered for HEDIS reporting, whether the source is used for ECDS measures or for other HEDIS domain measures. If a plan completed an Audit Roadmap (Section 5) and will use the data source for both supplemental data and ECDS, this should be noted.
HEDIS 2018
10.15.2017 ECDS What is ECDS?
Electronic Clinical Data Systems (ECDS) are a network of databases containing plan members’ personal health information and records of their experiences with the health care system. ECDS may also support other care-related activities, directly or indirectly, through various interfaces that include evidence-based decision support, quality management and outcome reporting.
HEDIS 2018