Posted and filed under Healthcare, Payers.

As we approach the month of June, we also begin our downward slide towards the end of HEDIS season. HEDIS season, in all its glory, stretches through about 3 calendar seasons – and requires hard work from providers, chart reviewers, and record collection companies from December through October – depending on program enrollment, measures, and a whole host of other factors. It’s a grueling cycle, and one that must repeat year after a year. HEDIS (Healthcare Effectiveness Data and Information Set) is one of the industry’s best performance measurements and allows the NCQA (National Committee of Quality Assurance) to gauge the quality of patient care on an annual basis.

The importance of HEDIS season may not be lost on you, but your progress so far may be a little muddy. We’ve put together a quick guide of deadlines yet to come before the season comes to a close. Don’t worry – we’re in the home stretch!

June 2019

  • June 3: by 11:59 pm EST, IDSS Plan-lock must be applied for all commercial, Medicaid/Medicare, and Marketplace audit submissions. This will ensure there is enough time to validate health plan results.
  • June 17: CMS requires a Patient-Level-Detail (PLD) file validation for Medicare submissions. This must be submitted by 11:59 pm EST. Health plans must also submit final commercial, Marketplace, Medicaid/Medicare HEDIS results via IDSS by 11:59 pm EST. All commercial, Marketplace, Medicaid and Medicare Attestations must be submitted to NCQA by 11:59 pm ET via electronic signature.
  • June 30: Health plan Ratings data freeze. Ratings will be contingent upon HEDIS and CAHPS data and accreditation standard scores.

August 2019

  • Projected Health Plan Ratings released. Plans are required to confirm their rating and accreditation information.

September – October 2019

  • Final Health Plan Ratings are posted on NCQA’s Website.
  • NCQA releases the 2019 Quality Compass® Medicare and Medicaid editions.

There are still a number of markers standing between your practice or organization before you can sit back and relax (or begin preparing for 2020). At this point in the process you should have already made negotiations with the third-party data management companies that might try to hold your records hostage, and your data files should be cleaned up for the vendors working within your sphere. In fact, it might be a good idea to begin working on preparing these items for next year now, in order to eliminate any unnecessary delays in collections and review.

Whether you’re preparing to finish this year out strong or set yourself up for future success, we’ll see you next year.