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As HEDIS® season comes to an end, you always seem to have an infinite number of things to remember to ensure your submission is accurate, locked on time, and approved by your auditor. In the last few days, you might have faced auditor questions, IDSS or PLD errors, executive team members who need status updates, or perhaps something new that you’ve never experienced before.
In the final edition of our blog series, “from the HEDIS 2017 trenches,” Ashley McNairy, product director for Verscend’s Quality Improvement solutions, offers this checklist to help you remember all the little details before the final deadline of June 15.
1. Complete any corrective action plans that may have resulted from MRRV. Are there any follow-ups not completed from the hybrid validation? Are all auditor questions or follow-up actions completed?
2. Resolve all IDSS warnings and errors. First, do all the values in IDSS match the values in your HEDIS software? We highly recommend that you perform measure validation before locking. Most importantly, are the hybrid numerators the same values that were submitted on May 15? Auditors will require explanation if the values mismatch. When you uploaded your IDSS XML file, did you receive any errors or warnings? If yes, which ones need to be addressed and corrected? If they are not resolved, do you have proper documentation to explain why the message is showing?
3. Make sure PLD files match the IDSS values. Before submitting your PLD files to your auditor, did you make sure the values matched your IDSS values? If the values did not match, were you able to “balance” the PLD report and correct the variances?
4. Upload the Medicare PLD without error. After your auditor has signed off on the Medicare PLD file, did you receive any errors when uploading to the Centers for Medicare & Medicaid Services (CMS)? If so, what needs to be corrected to be submitted? We highly recommend that you do not mark “final” on the IDSS site until the Medicare PLD file has been accepted. You don’t want to unmark final for IDSS because of a small PLD correction.
5. Answer auditor questions. Throughout this blog series, we have written about the importance of continuous auditor communication during HEDIS season. If you followed this approach, you and your auditor should have been talking well before plan lock. If not, make sure you reach out to them to ensure all questions have been addressed. They might ask about variances, warnings, or errors from the IDSS upload, or even errors from your PLD file. Make sure everything is resolved in time.
6. Apply plan lock by 11:59 p.m. ET on June 8. If you aren’t in the Eastern time zone, make sure you take the time zone difference in to account to meet the deadline for plan lock.
7. Have your attestation signed and submitted by 11:59 p.m. ET on June 15. The correct personnel at your company must sign and submit your attestation on time. It’s not a pleasant experience for anyone when the CEO leaves for that week-long vacation starting June 12 without signing the attestation.
8. Consider state submissions. Are you responsible for other submissions? Do you need to submit your HEDIS measures to the state, or do you submit non-HEDIS measures? For non-HEDIS measures, have you reviewed your measure rates and addressed any variances with your auditor? Do you have the submission form ready to go so you will meet the deadline? Many of these submissions occur on June 15 or shortly afterwards, so don’t let up too soon.
We hope your HEDIS 2017 season was a resounding success, but even the most well-oiled quality machine has room for improvement. Stay tuned as Verscend continues to offer tools and tips on our blog throughout the off-season to help you prepare for HEDIS 2018—and to keep quality front and center for your organization year-round.
Struggling to build your quality program into more than just a seasonal “check the box” task? Check out our infographic for tips that can help you transform routine quality measurement and reporting activities into a true strategic advantage by proactively influencing quality metrics.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).