The document explains the importance of the Healthcare Effectiveness Data and Information Set (HEDIS) for health plans and prospective members as a standard for evaluating plan performance based on care quality, access, and member satisfaction. It outlines the three data collection methodologies used in HEDIS: administrative, hybrid, and survey (CAHPS), and emphasizes the necessity of accurate coding for effective measurement. It also promotes Outsource Strategies International as a provider of medical billing and coding solutions, aiding healthcare practices in meeting HEDIS requirements.

1. Understanding HEDIS Better
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2. 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.
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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Healthcare Effectiveness
Data and Information Set
- HEDIS

3. 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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4. 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 ICD-
10 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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5. 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.
Contact Us
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Tulsa, OK 74133
Main: (800) 670 2809
Fax: (877) 835-5442
E-mail: info@managedoutsource.com
URL: www.outsourcestrategies.com
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