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The HEDIS® 2017 season is more than halfway done. Are you on track for the reporting deadline? Our Verscend experts are here to share their insights on effectively managing your measurement and reporting process in our monthly blog series, “from the HEDIS 2017 trenches.” Here, Jenna Fitcher, product director for Verscend’s Quality Improvement solutions, discusses best practices for the administrative refresh.
Some health plans choose to refresh monthly (incremental loads), some will only refresh once in April, and some won’t refresh at all. However, there are good reasons to refresh, and often.
Plans perform an admin refresh to account for claims that might have been missing or were not processed when the HEDIS production run was completed due to claims runout/lag. An admin refresh will also update your sample/hybrid information. If more samples become administratively compliant, the health plan could benefit from reduced medical record review.
Timing on the admin refresh can be critical since your hybrid samples will change. Make sure you know the downtime for updating samples so you can factor it into the schedule.
Enrollment and membership data should have stayed the same from the production run. If you choose to update this data, however, know that these changes could result in different eligible populations and sample members.
Here are a few additional things to keep in mind:
Talk to your vendor about what to use to help track your results. A strong partner should be able to recommend reports that will help you track the above scenarios. At Verscend, we have several tables and reports to help clients through the admin refresh process to ensure that they are maximizing their time and effort, given the time crunch we all feel as we near the end of the HEDIS season. Of course, starting the season with a thorough project plan is essential to keep all parties on track and adhere to critical deadlines.
Stay tuned in May for our next report “from the trenches.”
Want to know more about Verscend’s “Best in KLAS” Quality Improvement solutions? Download our brochure.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).