Answers to HEDIS® Tech Spec Questions

In Affinite Quality, HEDIS & Quality Management by Marketing

All in all, NCQA’s comprehensive updates to dozens of HEDIS® technical specifications will create better outcomes and more actionable data insights. Health plan quality, billing, and outreach professionals, however, have raised a few reporting and implementation questions.

Many of these questions concern when new measurements take effect, which have been revised, and which no longer must be included in plan reports. We provide an overview of these provisions in an early blog post. In our continuing effort to keep payers apprised the changes and interpretations of the new guidelines, we address some of the questions NCQA has encountered recently:

Do blood pressure readings taken by the member need to meet the member-reported requirements included in General Guideline 39? 

  • No. Self-administered blood pressure reading is one of the concessions NCQA made in light of the difficulties presented by COVID-19. General Guideline 39, which states that these readings must be collected by a PCP or other specialist while taking the patient’s history does not apply to readings taken at home. If the result is documented in the member’s medical record, it is acceptable so long as no exclusion criteria apply.

Given that the hybrid reporting option was retired from the Well-Child Visits in the First 30 Months of Life (W30) & Child and Adolescent Well-Care Visits (WCV) measures, what are the required data elements for supplemental data? 

  • Infants may show greater susceptibility to COVID-19, making WC30 visits even more critical. Services and documentation in medical records and other supplemental data must be clinically the same as those described in the measure’s administrative specification codes. The organization is responsible for determining this, and it is subject to review by the auditor.

When reporting a measure as hybrid, should the data element “Number of numerator events by administrative data in eligible population (before exclusions)” be equal to the sum of “Numerator events by administrative data” and “Numerator events by supplemental data”? 

  • Yes, so long as the organization loads its supplemental data before approval. If the organization loads supplemental data after approval, the “Number of numerator events by administrative data in eligible population (before exclusions)” will be equal to “Numerator events by administrative data.” We discussed earlier the reasons NCQA allows hybrid reporting and why health plans may or may not want to take advantage of the rule this reporting season.

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Kelly Cieciorka MPA, HSA
Director of Quality

Kelly is the Director of Quality and Product Owner of Affinitē Quality™. She is responsible for guiding the quality product’s development and partnering with customers for successful implementation and optimization of the solution. Affinitē Quality is Vital Data Technology’s year-round HEDIS® and plan-defined quality management and submission module fully certified by NCQA for 2020 HEDIS measures.

She graduated from the University of San Francisco with a master’s degree in public administration. She has an undergraduate degree in pre-med and biology from the University of California, Santa Barbara.

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