How is HEDIS score calculated?

HEDIS rates are measured by using either administrative or hybrid data. Administrative measures are calculated based on claims or encounter data submitted to the health plan. Hybrid measures are calculated using administrative data plus a sample of medical record data.

What is HEDIS chart review?

A HEDIS chart review is when the National Committee for Quality Assurance (NCQA) reviews a patient’s medical records to determine if the quality of care measures have been met. Medical chart reviews are also the data source used by the NCQA to determine any incentives or financial rewards for health plans.

Who submits HEDIS data?

NCQA collects HEDIS data from health plans, health care organizations and government agencies. Data are used to improve HEDIS measures and the health care system.

How does HEDIS work?

HEDIS measures how well health plans give service and care to their members. Here’s how it works: Health plans collect data about their performance on certain services and types of care. For instance, the plan keeps track of how many children get immunizations.

How often are HEDIS measures reported?

annually
Issued annually, the report offers three years-worth of performance data.

Who needs to report HEDIS measures?

All plans must report HEDIS/ CAHPS for the HEDIS reporting date after their first full year of Accreditation. Plans with fewer than 15,000 members are not required to report. All plans must report HEDIS/ CAHPS for the HEDIS reporting date in their third year of Accreditation.

What do we know about HEDIS reporting?

Because so many health plans collect large amounts of the same kinds of data for HEDIS reporting, it’s possible to compare them on a level playing field. Measures for HEDIS, which are revised every year, are strictly defined, as are the reporting guidelines. Here are 10 facts about HEDIS reporting. Measurements and domains.

Are all health plans collecting the same data for HEDIS?

Because so many health plans collect large amounts of the same kinds of data for HEDIS reporting, it’s possible to compare them on a level playing field. Measures for HEDIS, which are revised every year, are strictly defined, as are the reporting guidelines.

What are the different types of HEDIS measurements?

There are 81 different measurements for HEDIS. Each is grouped in one of five “domains of care”: Effectiveness of care. Access/availability of care. Experience of Care. Utilization and Relative Resource Use.