Medical Coding News

Complete Revenue Cycle Management for
Medical & Dental Clinics, Practices and Hospitals

  • Shared Vision: Your Business is our Business
  • Cloud Based Billing Software or Work on Yours
  • Certified Coders: ICD 10 Coders
  • Real Support with Dedicated Managers
Contact OSI Today!
Ask about our free trial to see firsthand how our services can benefit your practice.

HEDIS, the most widely reported set of performance measures in the healthcare industry, is used by health plans, medical groups, federal and state governments. The Healthcare Effectiveness Data and Information Set (HEDIS) data is responsible for evaluating the performance of a healthcare system. To make HEDIS stay current with the developments in healthcare, the National Committee for Quality Assurance (NCQA) comes out with a new measurement set each year in its HEDIS Measure Development Process. NCQA’s Committee on Performance Measurement (which includes the representatives of employers, health plans, consumers, and others) debates on the content of HEDIS, and decide collectively on what HEDIS measures need to be included during a year.
A Summary of HEDIS Changes in 2013

HEDIS Measures – Developments in 2013

New Measures

NCQA added the following HEDIS measures for Commercial and Medicaid reporting in 2013.

  • Adherence to Antipsychotic Medications for Individuals With Schizophrenia
  • Asthma Medication Ratio
  • Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia
  • Diabetes Monitoring for People With Diabetes and Schizophrenia
  • Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications

All these measures except Asthma Medication Ratio are used for only Medicaid reporting. Asthma Medication Ratio is used for both Commercial and Medicaid reporting.

Once the HEDIS measures are developed, they are not publicly reported by NCQA for a minimum of one year, and the process may take longer if there are complexities involved. Such measures are known as first-year measures. The above-mentioned measures are all first-year measures. However, individual states may use them for reporting the results of a specific organization.

Retired Measure

The publicly reported measures are continuously monitored by NCQA staff. Each measure is re-evaluated every three years. If the Committee on Performance Measurement (CPM) finds that a measure that is no longer important or has a high and uniform performance rate, they will retire that measure. Here is the measure which has been retired in 2013.

Call Abandonment (CAB) – NCQA decided to retire this measure as its performance rates are high and there are several other mechanisms available for assessing the customer service.

The CAB measure previously counted calls received by the Managed Care Organization call centers and the number that are answered within 30 seconds or abandoned before being answered.

Overall Changes in Reporting

Several codes are added and deleted for individual HEDIS measures as a part of recent changes. The other modifications include revised wording and clarifications in certain definitions. Following are the major changes made on HEDIS reporting set.

  • The date for NCQA data submission and Medicare patient-level detail file submission was changed to Monday June 17, 2013 from Saturday, June 15, 2013
  • Included guidance for reporting CMS initial core set of child heath quality measures for plans Medicaid and Children’s Health Insurance Program (CHIP) product lines
  • Inclusion of high level description of new medical record review validation process and 2013 HEDIS Audit Timeline
  • Plan-lock deadline of June 7, 2013 changed to a requirement
  • Clarified that incorrect billing practices should not be corrected using supplemental databases
  • Clarified that health assessments used as supplemental data are considered as member-reported data, and subject to the same requirements
  • Clarified that organizations can refresh data for administrative-only measures, but have to apply the refresh to every applicable measure

Measures for Rotation

To reduce the burden of reporting, a set of measures are allowed to report for a particular year or some specified interval, which is called rotation of measures. NCQA allows a designated set of measures to Commercial and Medicaid organizations for rotation. Here are the measures which are eligible for rotation in 2013 HEDIS Reporting.

  • Adult BMI Assessment
  • Childhood Immunization Status (CIS)
  • Cholesterol Management for Patients With Cardiovascular Conditions (CMC)
  • Colorectal Cancer Screening (COL)
  • Comprehensive Diabetes Care (CDC)
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Lead Screening in Children (LSC)

If you want to maximize HEDIS reimbursement from accurate HEDIS coding, then it is very important to consider these changes. It is advisable to seek the services of a professional medical coding company to maximize your HEDIS rate.