2025 Medicare Stars Measure

Published January 2025

Embracing Electronic Clinical Data Systems (ECDS) for HEDIS reporting

ECDS reporting is part of the National Committee for Quality Assurance’s (NCQA) larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures. According to the NCQA, the HEDIS Hybrid data collection (medical record collection) will be phased-out in the coming years.

What are the types of ECDS?

• Electronic Health Records (EHR) – EHR systems store clinically-relevant information collected directly from a patient such as medical and treatment histories as well as biometric information and clinical samples and findings (e.g., pathology and laboratory reports)
• Health Information Exchanges (HIE) – HIEs include state HIEs, immunization information systems (IIS), public health agency systems, regional HIEs (RHIO), Patient-Centered Data Homes™ or other registries developed for research or to support quality improvement and patient safety initiatives
• Clinical Registries – Clinical registries collect information about people with a specific disease or condition, or patients who may be willing to participate in research about a disease
• Case Management Systems – Case management systems are shared databases that include information on Member assessments, care planning, care coordination, or monitoring of a Member’s functional status and care experience
• Administrative Claims Processing Systems – Data from administrative claim processing systems for all services incurred during the period defined by each measures participation as well as Member management files, Member eligibility and enrollment files, electronic Member rosters, internal audit files, and Member call service databases.

MVP is committed to working with our Providers and take advantage of electronic data streams to ensure accurate reporting of measures that require data not typically found in claims. Use the following code categories in billing for HEDIS compliance:

• CPT® Category II codes can be used for performance measurement. The use of CPT II decreases the need for record abstraction and chart review
• CVX codes represent the type of product used in an immunization. Every immunization that used a given type of product will have the same CVX, regardless of who received it
• LOINC codes and SNOMED codes do not appear on claims and are quickly becoming vital to HEDIS reporting, especially for ECDS measures.
  • LOINC codes—while typically associated with lab data, there are several behavioral health screenings that can only be represented by LOINC codes for the purposes of HEDIS reporting and can be extracted from EMR systems
  • SNOMED codes represent both diagnoses and procedures as well as clinical findings. SNOMED codes are the industry standard for classifying clinical data in EHR systems and can be extracted from EHR systems
  • Since LOINC codes and SNOMED codes can only be obtained through supplemental data feeds, it is important that health plans and the provider community embrace the sharing of these EHR data to ensure the quality of care our Members receive.

MVP encourages Provider practices to embrace ECDS reporting to reduce the burden of manually processing GIC submissions. Look for our HEDIS MY 2025 Clinical Coding Resource Guides for all billing staff, coming in early 2025.

To allow practices a gradual transition to ECDS reporting, MVP will continue to collect medical record documentation for these measures in 2025: BCS, CCS, CHL, COL, GSD, EED, BPD, and KED. However, we encourage Providers to begin using the guides to support coding for the MY2025 ECDS measures: BCS-E, CCS-E, COL-E, CIS-E, IMA-E.

Please read HEDIS MY 2025: What’s New, What’s Changed, What’s Retired.

Look for more tips and information in the spring 2025 issue of Healthy Practices. If you have GIC-related questions, please contact the MVP HEDIS Operations Team at mvpgapclosures@mvphealthcare.com.