HEDIS Vital for Health Plan Assessment

by | Posted: Jan 27, 2014 | Medical Coding

Share this post:

HEDIS for Accurate Health Plan Comparison

HEDIS is a vital set of measures that define the effectiveness of a health plan in America, and is important for prospective health plan members, healthcare providers and health plans themselves to measure health plan performance and their ability to serve user needs better. This is affirmed by the fact that over 90% of health plans in the US use HEDIS to measure their performance on various important care and service dimensions. HEDIS is a collection of 75 measures spread across 8 care domains. HEDIS makes accurate comparison between health plans possible thanks to its specifically defined measures.

HEDIS measures cover breast cancer screening, diabetes care, use of asthma medication, management of antidepressant medication, high blood pressure control, and adolescent and childhood immunization status.

Care Domains Covered by HEDIS

The eight care domains covered by HEDIS include:

  • Care effectiveness
  • Care access or availability
  • Patient satisfaction with the care experience provided
  • Stability of the health plan
  • Service use
  • Care cost
  • Informed choices in health care
  • Clarity of health plan information

HEDIS Coding

HEDIS coding deals with coding reimbursement claims with the CPT-4 Procedure Codes and the ICD-9 Diagnosis Codes (from October 1, 2014 providers will have to shift to ICD-10 Diagnosis codes and Procedure codes). These codes provide the claim and encounter information required for payment as well as care quality goals measurement for NCQA accreditation purposes. The right NCQA-approved codes must be used for the purpose of indicating the maintenance of HEDIS quality while meeting care goals. Submit the HEDIS report only when you are absolutely confident about the accuracy of the information. Prepare the bills only with CPT-4 or ICD-9 codes to avoid miscalculations caused by improper bills.

Comprehensive HEDIS coding is one of the major services provided by a reliable medical billing and coding company. It helps serve the needs of healthcare providers as well as health plans.

Meghann Drella

Join Us Our Newsletter

Stay informed with our latest updates and insights.


By submitting, you consent to receive emails with a SafeUnsubscribe® link included.

Related Posts

How to Code for Dermatomyositis – A Common Rheumatology Disorder

How to Code for Dermatomyositis – A Common Rheumatology Disorder

Regarded as a chronic inflammatory disease, dermatomyositis affects the muscles and skin. It can affect adults and children and is most commonly seen in females than males. Accurate and compliant medical billing and coding is critical not only for appropriate...

ICD-10 Coding for Thrombophilia: Best Practices & Common Pitfalls

ICD-10 Coding for Thrombophilia: Best Practices & Common Pitfalls

Thrombophilia is a medical condition that increases the risk of developing abnormal blood clots in the veins or arteries. Accurate ICD-10 coding for thrombophilia is crucial for proper documentation, appropriate billing, and optimal patient care. Following the right...

How to Code Thrombophilia – A Common Vascular Condition

How to Code Thrombophilia – A Common Vascular Condition

A common vascular disorder, Thrombophilia is a condition where the blood in the veins and arteries has an increased tendency to form clots. The condition refers to a hypercoagulable state - an abnormality in blood coagulation that increases the risk of clot formation....