HEDIS Vital for Health Plan Assessment

by | Last updated Nov 21, 2023 | Published on Jan 27, 2014 | Medical Coding

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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.

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