HEDIS Coding

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Accurate and Reliable Documentation for Quality Reporting

HEDIS Coding Services: Accurate and Reliable Documentation for Quality Reporting

The Healthcare Effectiveness Data and Information Set (HEDIS) is a standardized set of performance measures to assess the quality of care and service provided by health plans and healthcare organizations. Accurate HEDIS coding is crucial for health plans and healthcare organizations as it directly impacts their performance ratings and reimbursement. Outsource Strategies International (OSI) has the experience necessary to ensure proper coding to capture the quality and effectiveness of the healthcare services provided. Our U.S. based medical billing and coding company has certified coders who have a thorough understanding of the HEDIS measures and coding guidelines.

Developed and maintained by the National Committee for Quality Assurance (NCQA), HEDIS measures cover various aspects of healthcare, including preventive care, chronic disease management, and behavioral health. NCQA uses HEDIS data to improve HEDIS measures and the healthcare system.

OSI’s HEDIS support covers medical record review, extraction of relevant data points, assigning appropriate codes for accurate and consistent reporting, and compliance audits.

Ensure HEDIS coding accuracy and meet compliance requirements!

Comprehensive HEDIS Coding Services to Ensure Timely and Accurate Reporting

HEDIS consists of more than 90 measures across 6 domains of care which further classified into measures/sub-measures which include preventative care and condition-specific care:

Effectiveness of Care

Utilization and Risk Adjusted Utilization
Access/Availability of Care
Health Plan Descriptive Information
Experience of Care

Measures Reported Using Electronic Clinical Data Systems

  • Effectiveness of Care
  • Access/Availability of Care
  • Experience of Care
  • Utilization and Risk Adjusted Utilization
  • Health Plan Descriptive Information
  • Measures Reported Using Electronic Clinical Data Systems

Our professional coders accurately collect and report data for HEDIS measures, assisting health plans and healthcare organizations to meet HEDIS requirements and improve their overall performance. Our medical coding team:

Has expertise in ICD-10, CPT, CPT II, HCPCS and other relevant coding systems, ensuring that relevant procedures, diagnoses, and services are properly documented and captured in the claims data according to HEDIS specifications

Reviews patient charts, claims and other documents to identify and code specific healthcare services and outcomes required for HEDIS reporting
Has a thorough understanding of the specific measures put forward by the NCQA) and stay updated on any changes to HEDIS measures and coding guidelines
Performs regular audits, reviews, and checks to validate the coding accuracy and identify any discrepancies or errors
Focuses on timely and efficient reporting of data to meet submission deadlines
Comprehensive HEDIS Coding Services

Our experts can ensure accurate codes for HEDIS measures, which include but are not limited to the following:

  • Adults’ Access to Preventative / Ambulatory Health Services
  • Advance Care Planning
  • Antidepressant Medication Management
  • Asthma Medication Ratio
  • Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis
  • Blood Pressure Control for Patients With Diabetes
  • Breast Cancer Screening
  • Care for Older Adults
  • Cervical Cancer Screening
  • Child and Adolescent Well-Care Visits
  • Childhood Immunizations
  • Chlamydia Screening in Women
  • Colorectal Cancer Screening
  • Controlling High BP
  • Eye Exam for Patients With Diabetes
  • Glycemic Status Assessment for Patients With Diabetes
  • Immunizations for Adolescents
  • Kidney Health Evaluation for Patients With Diabetes
  • Medication Adherence for Cholesterol (Statins), Diabetes Medications and Hypertension
  • Metabolic Monitoring for Children and Adolescents on Antipsychotics
  • Osteoporosis Screening in Older Women
  • Pharmacotherapy Management of COPD Exacerbation
  • Prenatal and Postpartum Care
  • Risk of Continued Opioid Use
  • Statin Therapy for Patients with Cardiovascular Disease
  • Statin Therapy for Patients With Diabetes
  • Statin Use in Persons With Diabetes
  • Transitions of Care
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents
  • Well-Child Visits in the First 30 Months of Life

We can customize our HEDIS coding services to meet your specific needs, including addressing unique challenges, implementing custom reporting solutions, and providing ongoing support for quality improvement initiatives.

HEDIS/QIP

Our HEDIS coding solutions can support your Quality Improvement program (QIP). This is a broader, ongoing initiative aimed at continuously improving the overall quality of healthcare services using HEDIS data, helping your organization target and address specific areas for improvement in their healthcare delivery.

HEDIS Medical Record Review Services

OSI provides a comprehensive evaluation and analysis of medical records to assess the quality of care provided by healthcare organizations or health plans. Our HEDIS medical record review services can determine if specific healthcare services, procedures, and diagnoses meet the criteria set by HEDIS. The process involves;

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Extracting relevant data points from the medical records, such as patient demographics, diagnoses, procedures, and medications

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Comparing the extracted data against the specific criteria and guidelines defined by HEDIS measures
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Identifying areas of non-compliance, gaps in care, and opportunities for improvement

We offer HEDIS medical record review services on a regular basis, according to the preferred frequency.

Benefits of Partnering with OSI

Smooth workflow
Data collection, coding, and reporting compliance with CMS and state-required measures
Mock audit services
Comprehensive support to maximize HEDIS rates
Improved documentation
HIPAA-compliant services
Competitive pricing – enjoy cost savings of 30-40%
No long-term yearly contracts
Benefits of Partnering with OSI
Accurately collect, code, and report data for HEDIS measures!