Tips from HEDIS Operations

Published July 2024

MVP appreciates the care that you give to our Members and strives to support you with helpful tips that will keep them on the right track. The HEDIS Annual Review revealed opportunities for improvement in documentation practices and compliance for the following HEDIS measures:

Caring for Older Adults (COA)

• Medication Review: Remember to include a medication list along with notation that medications were reviewed/reconciled
• Functional Status Assessment: If a standardized FSA tool is not used, simply documenting that ADLs were assessed and the patient’s ability to perform them is compliant
• Pain Assessment: Notation of a pain score in the Vital Signs section of the record is compliant

For more information, please review the Care For Older Adults HEDIS measure requirements and Coding Reference Guide

Cervical Cancer Screening (CCS)

• When patients present for STI screening or HCG testing, please perform a Papanicolaou (PAP) and/ or HPV screening that is over-due. Remember that an HPV screening for eligible patients is compliant for FIVE years. A PAP alone is compliant for three years. 
• Exclusionary documentation of “hysterectomy” alone is not compliant. The type of hysterectomy must be documented to determine absence of cervix. If unknown, documentation of a GU exam showing “surgical absence of cervix” must be present. 
• “PAP not needed” and “vaginal” pap source are no longer accepted per NCQA 

Transitions of Care (TRC)

To satisfy this measure, documentation is required from acute and non-acute inpatient facility Providers. Two of the four sub-measures rely solely on documentation and cannot be satisfied with claims including:

• Notification of Inpatient Admission; and
• Receipt of Discharge Information 
• Copying the patient’s PCP on ED notes and all admission and discharge documentation will improve TRC ratings