Posted and filed under Coding.

Health plans that want to “do” HEDIS should anticipate its common stumbling blocks — and take steps to overcome them. The following are some key hurdles that health plans face when preparing HEDIS data:

What is HEDIS?

When the physician staff begin to receive timely specific request (fax or phone) for certain measure data. The question arises, what does this specifically mean and how does it relate to our physicians and patients? HEDIS stands for Healthcare Effectiveness Data and Information Set.

Here are 5 of the Most Common HEDIS Hurdles:

  1. Incomplete data. For some plans, this is a huge issue. For others, it is not such a big deal; however, this area greatly impacts the reporting of a specific measure.
  2. Reporting data correctly. Do you write or have programs that extract information from your software system? Are your programs robust? Is each extraction correct?
  3. Limited resources. If one quality-improvement person and a couple of programmers are putting their effort toward HEDIS, their ability to produce accurate HEDIS reports is limited because there is a limited amount of time.
  4. Inadequate information systems. Many systems were set up to capture only the data required to make a payment to a provider, not necessarily the coding required to report HEDIS measures.
  5. Lack of quality control during the process. Or, said in another way, plan ahead. HEDIS is often an ad hoc job, something that is performed once a year. Rather than just “borrowing” people from other areas and scrambling to meet deadlines, the quality of your data and overall process will be better if there is a chance to step back, look at the data and say, ‘Does this make sense?