Measures
Med review does not need a provider signature if appropriate credentials are displayed
What is COA - Med Review?
The only required exclusion for MY2020
Member in Hospice (GG17)
Pos or Neg results for HTN Retinopathy count
CDC- Retinal Exam
Data abstracted manually from the member's chart
Non-Standard Supplemental Data
Td and serogroup B are examples of vaccines that should NOT be accepted for this measure
IMA
Result is not req'd if documentation of test is clearly part of “medical history” in med record (and completed w/i 1 of 5 allowable test/result timeframes)
COL
Is it compliant to have a billing code in med record w/o addtl documentation of the service provided?
Not compliant (GG 31 Supp Data)
Proof of one: use of ACE/ARB, results of urine albumin/protein, screening/monitoring
CDC - Attention to Nephropathy
Method uses administrative data (claims) and medical record review data
Hybrid Method
The eligible population for this measure must have an event between Oct. 8, PY - Oct. 7, MY. Name the measure and event.
PPC, live birth
Representative BP can be used for these 2 measures
CBP, CDC - BP
Date is specific enough to determine event occurred w/i the req'd timeframe
Date Specificity (GG 34)
Member must be at least 30 yrs on date test performed for a co-test to be compliant
CCS - PAP/HPV
Method uses Administrative Data (claims) and Standard Supplemental Data (electronically generated, stable files)
Administrative Method
PPC - Prenatal Care and Postpartum Visit
Member-reported result w/o date from remote visit would use DOS (for date)
CDC - BP
*mbr reported result w/o date at OV not allowed
Order Date and Documented Date are not eligible for HEDIS reporting
DOS for Lab Tests (GG33)
Reference to "hospitalization" or "IP stay" is not req'd (in the OP record) for this sub-measure
TRC - Patient Engagement after IP Discharge
Stable, electronically generated files containing member information
Standard Supplemental Data
The measure year is Jan. 1 - Dec. 1, 2020 and has 4 submeasures that MUST come from an OP record
TRC
MUST have most recent test result and can't be from a home test
CDC - A1c
Member-reported Ht, Wt, BMI% are acceptable if collected by PCP or specialist providing primary care service r/t condition assessed
Member-Reported Services and Biometric Values (GG39)
Documentation in record the member received the immunization “at birth” or “in the hospital” is compliant for immunizations that do not have a minimum age restriction (e.g., Hepatitis B)
CIS
Denominator group determined by automated rules and criteria
Eligible Population
There are 3 numerators for this measure which applies to members 3-17 yrs. Name measure and 3 numerators.
WCC: 1) BMI% (+ht,wt) 2) Nutrition Counseling 3) Phys Activity Counseling