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Quality reporting is closely aligned with financial success for health plans across the country, amplifying the importance of keeping an eye on HEDIS metrics year-round. Although HEDIS measurement and reporting requirements and timelines are always subject to annual changes from NCQA, effective pre-submission planning streamlines the process and helps plans more easily achieve successful outcomes. Here are just a few of the best practices we discuss regularly with our clients at Verscend, based on the latest timeline from NCQA.
the ant and the grasshopper:
getting a jump on HEDIS 2018
watch the webinar
A thorough evaluation of the 2017 reporting process may reveal gaps in your current submission efforts. Use the summer and early fall to evaluate your process end-to-end, including any vendor services that you receive. Review your benchmarks to identify gaps in reporting and support from your vendor, and correct them well before December. If you decide it’s time to make a vendor change, do so on the same timeline. Make sure the vendors you’re considering can effectively manage the transition process, including data translation and rate reconciliation.
Staying ahead of ever-changing HEDIS reporting requirements and timelines is critical for a well-managed process. Connect with your auditors as soon as possible to better understand new requirements and validate the seasonal timeline. Review the new HEDIS specifications when they come out in July, as well as your vendor’s input specifications (Verscend’s first release is in August), as these changes may affect your overall project plan. Once the information is available, you can identify gaps in technology, processes, or people based on your assessment of the past season’s work. Consider whether additional programs or technology can improve your reporting next year. Initiate process steps to close gaps based on your assessment.
An administrative data refresh will ensure that you process the claims and supplemental data received later in the measurement year, not those included in your initial production run. This step is typically completed in March or April (depending on your claims lag) to give you enough time to review and validate the results. Make sure your auditor approves all supplemental data by March 30.
The medical record review validation (MRRV) process uses like-measure groupings to validate all hybrid abstraction. You need to send your auditor final numerator-compliant counts for all measures and exclusions by May 9, 2018. This is earlier than in years past, so make sure you account for this in your project plan.
Looking for insight on what you should be doing right now to make HEDIS 2018 as successful as possible? Watch our on-demand webinar, "the ant and the grasshopper: getting a jump on HEDIS® 2018."
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).