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HEDIS 101: Understanding the Healthcare Effectiveness Data and Information Set

Posted on September 12, 2018

HEDIS 101: Understanding the Healthcare Effectiveness Data and Information Set

School is back in session and while we might not provide 400-page textbooks, HEDIS Nurses is here to get in on that back-to-school feeling. That’s why we’ve put together HEDIS 101: Understanding the Healthcare Effectiveness Data and Information Set. This crash course in all things HEDIS is a great refresher as we quickly find ourselves approaching another busy HEDIS season.

What is the Healthcare Effectiveness Data and Information Set?

HEDIS is a measurement tool that is utilized by health plans to evaluate member satisfaction and performance. It is administered and managed by the National Committee for Quality Assurance (NCQA) and new measures are introduced and updated on an annual basis. These rates are becoming more important every year and are something that you need to stay on top of.

How are HEDIS sores used?

You know HEDIS scores are important, but how are they actually used? Well, state purchases actually use this data to evaluate how effective health insurance providers are with their preventative health outreach. Physician scores are also used to provide evidence of preventative care. These scores are considered for physician profiling and other incentive programs.

When does HEDIS work talk place?

HEDIS work takes place all year, but there is a specific timeframe in place. In Q1 of every year, providers will be contacted with requests for medical records. The data must then be collected and a chart abstraction will take place, typically on or before May of that same year. That might not seem like much work, but if you fall behind on chart abstractions or other HEDIS work and leave it to the last minute, you can find yourself under the gun.

How does HIPPA play into HEDIS projects?

We all know that HIPPA is a major guiding force in the medical world and you might wonder how it factors into HEDIS. Well, HEDIS data collection and the release of information is permitted under HIPPA. Data collection for HEDIS does not require patient consent and authorization.

HEDIS Nurses Can Help with Your HEDIS Projects

If you are looking for help with your HEDIS projects during the busy season—or really during any season—contact HEDIS Nurses today. We specialize in connecting health plans with quality nurses experienced and well versed in all things HEDIS. Our nurses are highly skilled and can help with tasks from chart abstractions to full outsourcing of your HEDIS work. We know during the busy months that things can get stressful and overwhelming and HEDIS Nurses aims to alleviate some of that. HEDIS season will be here before you know it, so be sure to stay on top of it! To learn more about the services we offer or to get connected with a skilled member of our HEDIS team, contact us today at 877-328-2343.