FAQ Directory: HEDIS

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12.02.2019 General Guideline 33: Measures That Require Results From the Most Recent Test or Measurement With General Guideline 33, organizations must use the most recent date when multiple dates of service for the same lab test are provided within a 7-day period. Which test is used in the following example, the September test or the December test?
A HbA1c lab claim on 12/30/2019 had a result date in the medical record on 1/3/2020. The member also had an HbA1c test with both the test and a result on 9/30/19.

Using General Guideline 33, the 12/30/2019 test is used as the most recent test while the 1/3/2020 result is within 7 days of the test, it is after the date threshold in the measure and may not be used. The result is counted as missing and the member is compliant for the HbA1c Testing and HbA1c Poor Control indicators. The member is not compliant for the HbA1c Control <7 for Selected Populations and HbA1c Control <8 indicators.
The 9/30/2019 test cannot be used as it is not the most recent.  

Note: Ensuring results in the year after the measurement year are not counted is not tested in HEDIS 2020 Measure Certification. 

HEDIS 2020