No. Data collected using NLP needs to be audited back to the legal health record. CCDs are not considered the legal health record or proof of service, and are not a replacement for an electronic health record.
HEDIS MY 2022
FAQ Directory: HEDIS
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12.15.2022 Auditing Data Collected Using Natural Language Processing (NLP) Is a Continuity of Care Document (CCD) acceptable for primary source verification when auditing data collected by NLP?
12.15.2022 Advance Care Planning (ACP) When using supplemental data, does an advance care plan executed before the measurement year meet criteria?
No. The measure requires evidence of an advance care plan during the measurement year, dated during the measurement year. If the advance care plan is scanned into the EMR and dated in the measurement year, it meets criteria. If the plan is found in the EMR or member record from a prior year, it does not meet criteria unless there is dated evidence that it was reviewed or discussed during the measurement year.
HEDIS MY 2022
12.15.2022 Transitions of Care (TRC) When using the fifth bullet to meet criteria for Medication Reconciliation Post-Discharge, if documentation indicates that the medication reconciliation was performed during a post-op/surgery follow-up visit by the surgeon who performed the surgery or the provider who admitted the member, or if the surgery is for a procedure that is typically performed inpatient, does this count as evidence that the provider was aware of the hospitalization at the time of the visit?
No. Medication reconciliations performed during a post-op/surgery follow-up visit alone do not meet criteria even if the visit was performed by the provider who admitted the member or who performed the surgery, or if the procedure is typically performed inpatient. The intent is that medical record documentation must support awareness of the hospitalization (denominator event) at the time of the medication reconciliation, even if the provider admitted the member or saw the member during the hospitalization, or if the procedure is typically performed inpatient.
HEDIS MY 2022
12.15.2022 Sampling Guidelines—Multiple Measures using a common sample If members are deceased are they removed from all measures that use the same sample?
Yes. If multiple measures use the same sample, a deceased member is removed from all related samples. For example, deceased members who are removed from the Childhood Immunization (CIS) sample would also be removed from the Lead Screening (LSC) sample. Similarly, deceased members who are removed from the Hemoglobin A1c Control for Patients With Diabetes (HBD) sample would also be removed from Blood Pressure Control for Patients With Diabetes (BPD) and Eye Exam for Patients With Diabetes (EED) samples. This FAQ was previously posted in November 2022 and was updated to remove the reference to the KED measure.
HEDIS MY 2022
11.15.2022 Lead Screening in Children (LSC) In the MY 2022 specifications for Lead Screening in Children (LSC), there are data elements for ExclusionAdminOptional and ExclusionMedRecsOptional. This measure does not have optional exclusions. Are these data elements in error?
11.15.2022 Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) and Unhealthy Alcohol Use Screening and Follow-Up (ASF-E) In the data elements reporting tables for Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) and Unhealthy Alcohol Use Screening and Follow-Up (ASF-E), the reporting instructions for the initial population and exclusions data elements state, “For each Metric and Stratification.” However, these measures have the same initial population and exclusions reported for each metric. Should the reporting instructions state “For each stratification, repeat per metric”?
Yes. The reporting instructions for the initial population and exclusions data elements for ASF-E and DSF-E for MY 2022 and MY 2023 are incorrect. The reporting instructions should state, “For each stratification, repeat per metric” for the initial population and exclusions data elements. Refer to the PDF for the corrected data elements tables.
Note: The information is correct in IDSS (the validations check "For each stratification, repeat per metric” for the initial population and exclusions data elements).
**This FAQ applies to both HEDIS Volume 2 MY 2022 and HEDIS Volume 2 MY 2023
HEDIS MY 2022
10.14.2022 Statin Therapy for Patients With Cardiovascular Disease (SPC) and Statin Therapy for Patients With Diabetes (SPD) Should we exclude members with a history of allergies or intolerance to statins (including to the PCSK-9 inhibitor) from the SPC and SPD measures?
The Statin Therapy for Patients With Cardiovascular Disease (SPC) and Statin Therapy for Patients With Diabetes (SPD) measures include an exclusion for members with myalgia, myositis, myopathy or rhabdomyolysis during the measurement year. However, an allergy or history of an intolerance to a statin medication is not considered an exclusion for the measure.
The general guidance NCQA received from our experts, as well as guidance from the American College of Cardiology , is that patients with atherosclerotic cardiovascular disease should be rechallenged on lower statin doses and alternative statins before being put on non-statin therapies (e.g., PCSK-9 inhibitors) due to statin intolerance. The decision-making process might vary from case to case. Although we incorporated exclusions for muscle-related statin side effects, we acknowledge that the measure may not address all instances of true statin intolerance. We will consider all feedback on this issue, while also ensuring that changes to the measure are valid, scientifically sound and true to the measure's intent (to measure the quality of cardiovascular care provided at the population level).
HEDIS MY 2022
10.14.2022
General Guideline 16: Deceased Members The deceased member exclusion is now required for MY 2023. The last bullet in the Notes section states, “This is a member-level exclusion. For episode-based measures, if one event does not meet numerator criteria, remove all member events/episodes from the measure.”
Does this mean that for episode-based measures that if one event meets numerator criteria the member can remain in the measure?
9.15.2022 Quality Compass Medicare Include CAHPS Data Does the Medicare dataset include CAHPS data?
9.15.2022 Quality Compass Access When will I receive access to Quality Compass?
Access to the data is granted as soon as payment is received by check or credit card.
The default email address used for access will be the individual’s whose information was included under the “Ship To” section completed at checkout Login and password information will be emailed to the default user after NCQA sets up the account. The default user, also known as the Administrative User, will have access to manage the additional licensed users on the account.
HEDIS MY 2021
9.15.2022 Follow-Up After Emergency Department Visit for Substance Use (FUA) Should the Residential Program Detoxification Value Set be used when reporting the FUA measure? It is not listed in the Value Set Directory.
Yes. The Residential Program Detoxification Value Set and codes will be included in the Update release of the Value Set Directory on March 31, 2023. The OID for the value set is 2.16.840.1.113883.3.464.1004.2408, and it includes two HCPCS codes:
- H0010 Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) (H0010)
- H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) (H0011)
HEDIS MY 2023
9.15.2022 Antibiotic Utilization for Respiratory Conditions (AXR) The Antibiotic Utilization for Respiratory Conditions (AXR) does not include age stratifications and total rate bullets. Was this intentional?
No. A correction will be in the MY 2023 Technical Update. The Ages section in the Eligible Population should read as follows:
Members who were 3 months of age or older as of the Episode Date. Report three age stratifications and a total rate:
- 3 months–17 years.
- 18–64 years.
- 65 years and older.
- Total.
The total is the sum of the age stratifications.
HEDIS MY 2023
