HEDIS 101 for Providers

HEDIS 101 for Providers

Does HEDIS have your head spinning? If so, you’re not alone! That’s why HEDIS Nurses has taken the time to break down HEDIS and what it means for providers.

What is HEDIS and what does it help to do?

HEDIS stands for the Healthcare Effectiveness Data and Information Set. It is a set of standardized measures that are designed by the National Committee for Quality Assurance (NCQA) that are used as a tool by health plans in America to measure performance on certain aspects of care and service. Essentially, HEDIS allows consumers to compare the performance of health plans on an apples to apples basis.

Why does HEDIS matter to providers?

HEDIS matters to providers because it assists them in identifying and eliminating gaps in care. Providers can use HEDIS to improve processes to ensure timely and appropriate care for their patients. As their HEDIS rates go up, there is the potential to earn more revenue through par-for-performance models, which incentivizes them even further. In addition, rates can also be used to measure compliance with certain incentive programs.

What is the typical timeline for HEDIS?

HEDIS is a year-round effort that reaches across different platforms. From January to early May, health plans prepare for HEDIS. CAHPS survey administration starts in February, during which staff should collect medical records and review data.

From May to August, CAHPS surveys continue and HEDIS results and submitted, certified, and reported to the NCQA. This is when opportunities for improvement are identified.

Then, from September to December, the NVQA releases the Quality Compass results nationwide for Medicaid. This is also when supplemental data entry occurs.

As you can see, there are many moving parts when it comes to HEDIS, which is why it is important to stay up to date on everything.

What is the provider role in HEDIS?

Providers have an important role when it comes to HEDIS. They need to provide accurate care within the specified timeframes, and accurately code all claims. In addition, they should clearly document all of the care provided in patient medical records. It is also important to know the documentation requirements for HEDIS measures and respond to requests for medical records within 5 to 7 days.

Contact HEDIS Nurses for help with your HEDIS work today!

If you are struggling to keep up with your HEDIS work, HEDIS Nurses can help! We have over 2020 years of experience and can help with whatever your HEDIS needs are. From chart abstractions to full outsourcing of your medical records, we can do it all. We hire only the most knowledgeable and qualified candidates so rest assured that you are in good hands with HEDIS Nurses. Give a call today at (877) 328-2343 to discuss how we can help with your next HEDIS project.

To learn more about the reliable and quality HEDIS services that we offer, visit us on the web at HEDIS Nurses.