HEDIS HYBRID

HEDIS

100

This book is updated annually and must be purchased each year. It includes HEDIS measures and descriptions.

What is HEDIS MY 2025 Volume 2 

Technical Specification book

200

What are the 3 domains of HEDIS?

What is:

• Effectiveness of Care
• Access/Availability of Care
• Experience of Care

300

This term is use for the last day to enter HEDIS data 

 What is: Pencils Down- 

400

What HEDIS measure will retires in CY 2025 

What is: (COA) Pain Assessment 

500

Data systems that may be eligible for HEDIS 

Electronic Clinical Data Systems (ECDS) Reporting

What are: 

1. Electronic health record (EHR)

2. Health information exchange (HIE)/clinical registry

3. Case management system 

4. Administrative

Reference

https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/

Harvest

100

The process of reviewing charts for compliant HEDIS information & data entry of findings

What is: Abstraction

200

What is the term us for processing  and  highlighting useful information in the medical record

Annotation

300

This term is use to remove member from the denominator

What is: Exclusion

400

What is the Term us to confirm the data entered information is correct and matches the attached medical record 

• Name
• DOB
• DOS
• Service Type
• Service Meets Measure Requirements

What is: Overread Process

500

A single chart can be the difference between a 4 Star and 5 Star

What is Every Chart Counts

HEDIS Measures

100

A 65-year-old male with a history of hypertension presents for a post discharge check-up.

• Medical Record Documentation:
• 
  
  • "Diagnosis: Hypertension"
  • "Vitals: BP 138/88 mmHg, Pulse 72 bpm, Respirations 16/min, Temperature 98.6°F"
  • "Physical Exam: Unremarkable"
  • "Medications: Lisinopril 20mg daily, Hydrochlorothiazide 25mg daily"
  • "Plan: Continue current medications. Schedule follow-up in 3 months."

Question:

Based on this scenario, can it be definitively determined that the patient's blood pressure was adequately controlled during this encounter, meeting the criteria for the HEDIS Controlling Blood Pressure (CBP) measure?

What is: Yes,  CBP 138/88 

200

A 72-year-old woman presents for an annual wellness visit. The physician documents the following in the medical record:

• Medical History: Hypertension, Type 2 Diabetes
• Physical Examination:
• 
  
  • "Visual acuity 20/40 OU uncorrected.
  • Pupils equal, round, reactive to light and accommodation.
  • Extraocular movements intact."
• Assessment:
  • "No significant visual complaints."
• Plan:
  • "Recommend the annual dilated eye exam."

Question:

Based on this scenario, can it be definitively determined that the physician performed an adequate eye examination as required by the HEDIS EDD measure?

No 

300

A prescribing practitioner or clinical pharmacist is able to conduct this type of medical record review.

What is Medication review. 

400

39. A 78-year-old patient is discharged from the hospital following hip fracture surgery. The discharge summary lists the following medications:

• Hospital Discharge Medications:
• 
  
  • Acetaminophen 500mg PO every 4-6 hours PRN pain
  • Oxycodone 5mg PO every 4-6 hours PRN breakthrough pain
  • Lovenox 30mg SC daily x 10 days
  • Aspirin 81mg PO daily

The patient's primary care physician's office notes the following in the patient's medical record 2 weeks after discharge:

• "Reviewed medication list with patient.
• Patient reports taking all medications as directed.
• Continued Acetaminophen and Aspirin as prescribed.
• Discontinued Oxycodone as directed.
• Added Calcium 500mg and Vitamin D 400 IU daily for osteoporosis prevention."

Question:

Based on this scenario, can it be definitively determined that a medication reconciliation was performed within 30 days of discharge as required by the TRC: Medication Reconciliation Post-Discharge measure?

Yes, because the physician reviewed the patient's medications and adjusted the regimen.

500

What are the sub components TRC

1. Notification of inpatient admission

2. Receipt of discharge information

3. Patient engagement 

4. Medication Reconciliation Post-Discharge