The Healthcare Effectiveness Data and Information Set (HEDIS) measures how well health plans perform over a wide variety of categories. These scores assess how well a physician is able to provide high quality care to all of their patients. However, the whole process can be hard to navigate. You know how essential it is to maintain a high score, but actually achieving one can be more difficult.
How Are HEDIS Rates Measured?
Rates are measured in two ways, via administrative and hybrid data. Administrative measures examine claims data submitted to health plans, and hybrid combines this information with some medical record data. There are several measures that you can undertake to ensure that your HEDIS scores either stays strong, or even improves.
- Submit accurate and relevant data for every service provided
- Ensure patient medical records reflect all billed services
- Submit claim and encounter data on a timely bases
- Consider using CPT II codes to lower number of requests for medical records
It is important that you submit accurate data for every single service that is rendered. Even information that seems menial, can make an impact in your overall HEDIS performance score. Be sure to keep sufficient records that include all services provided.
When you are looking back at HEDIS projects, you will need to make sure that the billed services match the medical records. If a record is submitted detailing every service provided, but the same services aren’t listed in medical records, questions can be raised. Be sure that all of your files match up.
As with any type of performance measure, it is key to keep submitting documents in a timely manner. If you let records and files pile up, you will have a much bigger mess on your hands and might even struggle to get through the mountain of paper work. You are also more likely to make mistakes when dealing with massive volumes of documents.
Using the proper code, in this case CPT II codes, is key to achieving a higher HEDIS score. These codes enable you to receive less requests for records, which keeps you from worrying about more work piling up. The last thing you will want to have to do is add retrieving medical records to your already growing list of HEDIS tasks.
Do you need help with your coding and HEDIS projects?
If the tips listed above still make HEDIS tasks seem like too much to take on, consider letting Chart Review Nurses help you out. At Chart Review Nurses, we match quality nurses with health plans that are looking for assistance with their HEDIS projects. Instead of struggling through the process, let our certified nurses complete them for you. Just give us a call at (877) 328-2343, or submit an email inquiry to info@datafied.com to learn more. You can also visit our website at Hedis Nurses for more information.
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