HEDIS Quality MeasuresWith the National Committee for Quality Assurance (NCQA) proposing several new Healthcare Effectiveness Data and Information Set (HEDIS) quality measures in 2017, payers and physicians need to focus on improving their quality scores and reimbursement with precise HEDIS coding and activity documentation.

The American College of Radiology Colon Cancer Committee has welcomed the recent addition of CT Colonography or virtual colonoscopy to the 2017 Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for colorectal cancer screening.

Computed tomography (CT) colonography or virtual colonoscopy involves the use of special x-ray equipment to inspect the large intestine for cancer and polyps. The NCQA’s inclusion of CT colonography in the 2017 Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for colorectal cancer screening will enable providers to use standard HEDIS criteria for documenting CT colonography quality data and its impact on their overall colorectal cancer screening rates. This will allow physicians, healthcare systems and plans to receive quality credit when patients are screened via CT colonography.

Up to 90 percent America’s health plans evaluate their performance on important dimensions of clinical care and customer service based on the Healthcare Effectiveness Data and Information Set (HEDIS) criteria. With value-based reimbursement becoming the standard in healthcare, reporting these quality measures has gained significance for payers and physicians. Accurate and timely HEDIS measurement and documentation is crucial:

  • to help health insurance companies evaluate performance on important aspects of care and service, assess quality, identify and improve areas to meet NCQA’s quality goals
  • to enable physicians’ practices to improve HEDIS scores and reimbursement

HealthCareBusiness reports that recent U.S. Preventive Services Task Force (USPSTF) colorectal cancer (CRC) screening recommendations assigned an “A” grade to colorectal cancer screening, including CT colonography as a recommended test. Under the Affordable Care Act, this “A” rating would call for payers that participate in insurance exchanges to cover virtual colonoscopy with no copay starting January 1, 2017.

Earlier in the year, the NCQA announced updating of several HEDIS quality measures for the 2017 edition. The changes include four new HEDIS quality measures and revisions to seven measures. The new measures include:

  • Standardized Healthcare-Associated Infection Ratio which reports standard infection ratios for four different healthcare-associated infections: central line-associated bloodstream infections, catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus bloodstream infections, and Clostridium difficile intestinal infections.
  • Follow-up after an emergency department visit for mental illness
  • Follow-up after an emergency department visit for alcohol and other drug dependence
  • Depression Remission or Response for Adolescents and Adults

Expert medical billing and coding services are available to help physicians’ practices report their services accurately and enhance reimbursement, and also enable healthcare plans to improve their HEDIS rating.