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Understanding HEDIS Better
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When it comes to health plan performance, HEDIS is a very important term which prospective plan members, healthcare practices and health plans must consider. Healthcare Effectiveness Data and Information Set or HEDIS is a canon of vital performance measures that healthcare plans should live up to if they are to serve the needs of users well. They also enable prospective health plan members to compare the various plans and select the right one.
Healthcare Effectiveness Data and Information Set - HEDIS Reliability of HEDIS These performance measures were developed by the healthcare quality improvement organization, NCQA (National Committee for Quality Assurance) for rating health plans on the basis of the care quality, care access and member satisfaction they provide. HEDIS is considered such a reliable measure that over 90% of health plans in America employ it. HEDIS is basically eight measures spanning 75 care domains that deal with major health issues. The HEDIS measures have been specified for any one of the three methods of data collection which are Administrative, Hybrid and Survey.
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Administrative Methodology According to Administrative methodology, the health plan must identify the population that is eligible for the particular HEDIS measure with the use of electronic service records for including registration systems and insurance claims information from healthcare centers such as clinics, pharmacies, hospitals, labs and medical offices, and for determining the number of people that have received the service determined for that measure. Antidepressant Medication Management and Breast Cancer Screening are two of the measures captured through the Administrative data. The ICD-9 or CPT codes submitted must be those approved by the NCQA. This is important for the member to receive the required screening and for the healthcare provider to get the credit for having performed the screening. Hybrid Methodology
Hybrid methodology involves selecting a random population sample and
supplementing
the
data
gathered
through
administrative
methodology with the data gathered while conducting medical record reviews. Childhood Immunizations, Comprehensive Diabetes Care, and Prenatal and Postpartum Care are some of the measures captured through hybrid data collection methodology.
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CAHPS Survey The CAHPS (Consumer Assessment of Healthcare Provider) is a survey measuring member satisfaction with the care offered by health plans in fields such as customer service, claims processing and promptness and adequacy of care. Data collection in relation to CAHPS 4.0 survey must be carried out by an external survey organization approved by the NCQA. ICD-10 CMS requirements demand that healthcare providers switch to the ICD10 Diagnosis codes and Procedure codes from October 1, 2014. A plan has been created by the NCQA to identify the appropriate and valid ICD-10 codes for each of the HEDIS measures so that they can be included in the publications of HEDIS 2015. HEDIS Coding by a Reliable Medical Billing and Coding Company
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Accurate HEDIS coding solutions are provided by professional medical billing and coding companies. They also provide specialized solutions for all aspects involved in the HEDIS process including data collection, medical record retrieval and abstraction, detailed records auditing, real-time reporting as well as NCQA submission. They help healthcare practices by assigning the right ICD-9 as well as CPT codes, while also helping health plans by ensuring retrieval of the right documentation for supporting the appropriate HEDIS measure. They also ensure that the HEDIS data is submitted well before the deadline. About Outsource Strategies International Outsource Strategies International (OSI) is a reputable medical outsourcing solutions provider based in Tulsa, Oklahoma offering advanced
medical
billing
and
coding
solutions
for
hospitals,
physicians, physicians' groups, clinics and other healthcare entities. Find more details at: www.outsourcestrategies.com
Contact Us 8596 E. 101st Street, Suite H Tulsa, OK 74133 Main: (800) 670 2809 Fax: (877) 835-5442 E-mail: info@managedoutsource.com URL: www.outsourcestrategies.com