What is HEDIS Coding?

by | Last updated Aug 10, 2023 | Published on Oct 5, 2013 | Medical Coding

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The Healthcare Effectiveness Data and Information Set (HEDIS) is set of norms employed by most of the healthcare plans in the US for measuring performance in relation to service and care. HEDIS was created by the NCQA (National Committee for Quality Assurance) and is vital for locating gaps in the performance and making the required changes to improve customer satisfaction.

What is HEDIS?

HEDIS is a combination of 75 measures spanning 8 care domains. Accurate HEDIS coding for all the procedures within these measures is essential for organizations looking for NCQA accreditation, healthcare practices thinking of improving HEDIS rates, and MAOs (Medicare Advantage Organizations).

Details of HEDIS Coding

HEDIS coding is carried as follows: Reimbursement claims are coded with ICD-9 (Diagnosis Codes) and CPT (Procedure Codes). These are the codes that offer the encounter and claim information needed for payment and measurement of the quality of the care goals for the NCQA accreditation.

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The right ICD-9 and CPT codes approved by the NCQDA must be attributed for indicating that good care was provided. The HEDIS quality care goals need to be indicated through the claims data.

Bills must be prepared only with CPT-4 or ICD-9 codes. Only properly paid bills must be used in the HEDIS report. Improper bills would bring about miscalculation. The HEDIS report must be submitted only on confirmation of the accuracy of the information in that report. This will bring down the chances of obtaining revisions for the calculation of HEDIS scores. A professional medical coding company can help with HEDIS coding services to help insurers meet the quality goals set by NCQA and enable healthcare practices to maximize their HEDIS reimbursement.

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