Quality measures desktop reference for medicaid providers. Review medical records, abstract hedis measures and enter data using hard copyonline data collection forms. Cares policy change from fme to fme, and informafon and. Hedis measures performance in health care where improvements can make a meaningful difference in peoples lives. The category ii codes below make use of an alphabetical character as the 5th character in the string i. We created the hedis quick reference guide to help you increase your practices hedis rates and to use to address care opportunities for your patients. The informafon provided is in this document is for 2017 hedis period and is current at the fme this document was created. Quality measures desktop reference for medicaid providers please note. There are more than 90 current measures that span six domains of care and evaluate if health plans are providing necessary care related to issues including medication adherence, chronic disease. Benjamin hamlin at connecting michigan 2016 duration.
This section contains information related to cms medicare advantage part c reporting requirements. The course gives you an overview of the 2019 hedis process. For more information on the qarr technical specifications see the nysdoh website. Next level offers a hedis clinical auditor and abstraction training course. We offer an online hedis training that will prepare you to be a hedis professional. The tables below explain the national committee for quality assurance ncqa healthcare effectiveness data and information set hedis measures for two types of care. Please refer to for hedis program measures and guidelines as well as relevant statutes. Jun 15, 2018 carenational is now offering a hedis training and certification course, taught by hedis expert and cphq, kim williams. Hedis measures relate to many significant public health issues, such as. Links with this icon indicate that you are leaving the cdc website the centers for disease control and prevention cdc cannot attest to the accuracy of a nonfederal website. Pcp hedis quick reference guide for primary care providers hedis measure measure requirements recommended services adult bmi assessment aba hybrid measure patients 18 to 74 years old have a documented weight and calculated bmi in 2015 or 2016 bmi z68. Find helpful information regarding health, wellness, prevention and current regulations concerning your healthcare coverage. Pcp hedis quick reference guide universal american. Carenational is now offering a hedis training and certification course, taught by hedis expert and cphq, kim williams.
More specifically, the pqis use data from hospital discharges to identify admissions that might have been avoided through access to. Hedis 2016 technical specifications for physician measurement 3 2017 case management for longterm services and supports standards and guidelines or. Our next training begins july 20 th we are a group of experienced doctors and nurses who have devoted our careers to improving the quality of care. Share this page with a friend or colleague by email. However, in addition to the measure elements that you reported for qarr hedis in 2019 we are requesting that you include the providerpractice that was attributed to the member using your own plans attribution methodology for the ipc or tcgp arrangement. Apply to operations lead, managing member, analyst and more.
Administrative codes and documentation requirements are drawn from 2015 not intended to be a substitute for planrecommended clinical practice guidelines. Affinity strives to be the health plan of choice for its members and its providers known for assuring access to high quality, costeffective care. Procedural terminology cpt that october 1, 2015 september 30, 2016 training for home hemodialysis and peritoneal dialysis. Moorsalin munshi senior hedisqarr analyst emblemhealth.
Hedis annual timeline hipaa and hedis what is the providers role in hedis. In early august, the national committee for quality assurance ncqa announced updated quality measures for the healthcare effectiveness data and information set hedis in 2019. Now we are here to help you get into the hedis field through this selfpaced online training. Linking to a nonfederal website does not constitute an endorsement by cdc or any of its employees of the sponsors or the information and products presented on the website. The prevention quality indicators pqis identify issues of access to outpatient care, including appropriate followup care after hospital discharge. Final health plan ratings for all lines of business are published on the ncqa website by october 2017. Sep 1, 2018 collection guidelines for ncqas hedis measures and the pqa measure in the qrs measure set. Hedis the healthcare effectiveness data and information set is the gold standard in health care performance measurement, used by more than 90 percent of the nations health plans and many leading employers and regulators. The execusearch group is hosting a healthcare effectiveness and information set hedis quality assurance reporting requirements qarr training class, and youre invited to attend. The use of provider within this manual refers to entities and individuals contracted with empire that bill on a cms 1500. Member attribution will be refreshed, linking the member to the pps using the january 2016 file reflecting attribution results for july 2014 to june 2015 claims and. The office of management and budget omb has approved the use of technical specifications and datareporting templates to collect the 32 quality measures listed in the certified community behavioral health clinics ccbhcs certification criteria 2016 pdf 789 kb. If a required measure has only medicaid specifications, commercial.
Fidelis care does not reward providers or other individuals for issuing denials of coverage, and does not offer financial incentives to um staff based on decisions that promote underutilization of services. The lowstress way to find your next hedis quality training job opportunity is on simplyhired. Successfully perform manual functional testing to verify webbased enterprise. Calling all registered nurses, licensed practical nurses, and foreign mds. This manual describes in detail only the nysspecific measures.
We have highly qualified instructors with years of hedis experience. Ncqa hedis program requirements,applicable laws, and l. This selfpaced, online training is a stepping stone to a successful hedis career. Part 2 of the vision care provider manual for a list of modifiers with. Hedisqarr analyst emblemhealth april 2016 november 2016 8. Cahps survey a component of hedis how can aetna better. Hedis quick reference guide updated to reflect ncqa hedis 2016 technical specifications mhs health wisconsin strives to provide quality healthcare to our membership as measured through hedis quality metrics. Taken during an outpatient visit which was for the sole purpose of having a diagnostic test or surgical procedure performed e.
Each medicare advantage organization must have an effective procedure to develop, compile, evaluate, and report information to cms in the time and manner that cms requires. Medicaid nys vbp for qarrhedis in 2018, we are requesting that you include the providerpractice that was attributed to the member using your. The healthcare effectiveness data and information set hedis is a widely used set of performance measures in the managed care industry, developed and maintained by the national committee for quality assurance ncqa hedis was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks. We will work with you coders and billers to ensure hedis is on their mind. This manual is intended to support all entities and individuals that have contracted with em pire. Plans certified during 2016 are required to submit enrollment by product line and any other measures where members meet hedis eligibility criteria. Quality measures samhsa substance abuse and mental. The spreadsheet lists the hedis 2017 code changes by value set and includes the elements in the table below. Hedis is a set of standardized measures that specifies how organizations collect, audit and report performance. Weight assessment and counseling for nutrition and physical activity for childrenadolescents. Healthcare effectiveness data and information set wikipedia. Hedis makes it possible to compare the performance of. New york medicaid policy manual 2018 outline of medicare. Please always follow the state andor cms billing guidance and ensure the hedis codes are covered prior to submission.
Hedis is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance. Using any number from 1 to 10 where 1 is the worst possible and 10 is the best, please rate. Provide routine training with providers and staff members at facilities in collaboration with clinical quality team on hedisqarr measures as required. Services dfs prior to 2016 must report all qarr measures if there are residing in new york state in ppoepo. To promote understanding of these codes and their associated measures, users. New hedis quality training careers are added daily on. Quality assurance reporting requirements technical specifications manual for more information see the nysdoh website. Jun 10, 2014 amanda bleakney, senior managing director of health services, discusses the execusearch groups hedisqarr training program.
We know you are busy, which is why we have packaged some helpful forms and materials into this convenient. Hiv testing centers for disease control and prevention. How to learn hedis in order to apply for jobs quality. This course has been proven to be effective in training hedis professionals or hedis beginners who want to get their feet wet in quality measures. Ncqa established healthcare effectiveness data and information set hedis measures specifically for snps. Final hedis data covering services rendered in 2016 and prior will be submitted to ncqa by june 15, 2017. Hedis 2017 volume 3 value set directory user manual. We are pretty late in the hedis season, so one of two things can happen. Managed care health plans follow three sets of specifications when preparing qarr. The reports provide easytoread information on health plan performance with respect to primary and preventive health care, access to health care, behavioral health and enrollee satisfaction. Different learning formats and levels are available to suit your needs.
Oct 17, 2016 contract with cms to maintain ms drgs through 2016. Keep track of your health with yearround wellness tips. They may also be referred to as professional providers in some instances. Florida blue has listed the most commonly used codes seen in primary care, but there may be additional codes that meet exclusion criteria or numerator compliance. Fidelis care is committed to ensuring that members have the care and services they need.
Ccbhcs and their states are required to collect 21 of the measures for the. Introduction to hedis 2016 presented by the quality improvement department at gold coast health plan ventura countys medical managed care plan serving ventura county since july 1, 2011. The training is selfpaced and can be done in the comfort of your home. The execusearch group is hosting a healthcare effectiveness and information set hedisquality assurance reporting requirements qarr training class, and youre invited to attend. Hedis is a national committee on quality assurance ncqadeveloped tool used to measure performance on important dimensions of care and service. The course consists of online presentations, interactions with your classmates, assignments. Amanda bleakney, senior managing director of health services, discusses the execusearch groups hedisqarr training program. Reports on health plan performance are designed to help you choose a health plan that meets your needs and the needs of your family. Administrative codes and documentation requirements are drawn from 2015 note. As the developer of hedis, ncqa offers training on collecting hedis data, hedis annual updates, hedis measures, and best practices for improving hedis results. For health plans, hedis ratings can be very important. Technical specifications for more information on the technical specifications see ncqa website. Nov 30, 2011 the next thing to do is to go on the ncqa website and look at the hedis measures so that youre familiar with them.
We truly appreciate the care and support you provide to your patients who are todays options pffsppo members. Hedis certify a new online hedis training and certification. Developed a training manual for the departments new team members and gave training to over. We do not share your information with third parties. Managed long term care medicaid advantage and medicaid. The next thing to do is to go on the ncqa website and look at the hedis measures so that youre familiar with them. Mvp health care hedis 2018 coding reference guide for primary care 6 hedis 2018 preventive care measures appropriate care and associated codes to bill cpt and cpt ii icd10 hcpcs ub revenue adolescent wellcare visits admin awc the percentage of enrolled members 1221 years of age who.
Hedis 2017 volume 3 value set directory user manual 3 ncqa 2016 summary of changes codes the summary of changes codes spreadsheet identifies codes added to or deleted from a concept. Hedis 2020 quick reference guide coordinated care health. New york state department of health rates affinity 4 stars in nyc, long island and hudson valley. Apply today for the execusearch groups hedisqarr training.
Severity adjusted drgs applicable to the entire population 3mtm apr drgs 1990. Next level has a training program that is geared centered toward the nurse wishing to pursue a career as a clinical auditor or the healthcare worker that just needs a refresher course. For more information on the technical specifications for hedis volume 2 see ncqa website. An important part of quality improvement is keeping up with the latest in health care and learning from best practices. Hedis measures select examples how can you improve your hedis scores. There are over 306 hedis quality training careers waiting for you to apply. Stella yoon lead hedisqarr analyst emblemhealth linkedin. Healthcare effectiveness data and information set hedis.
Performed provider site visits to obtain required hedis documentation. Quality assurance reporting requirements technical specifications manual, and cahps specifications. We created the hedis quick reference guide to help you increase your practices hedis rates. Apply today for our annual hedisqarr training program. Metroplus health plan provider manual march 15, 2016.