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QUALITY IMPROVEMENT

From the HEDIS® 2019 trenches: the final countdown

As the HEDIS® season comes to an end, you always seem to have an infinite number of things to remember to ensure your submission is accurate, locked on time, and approved by your auditor. In the last few days, you might have faced auditor questions, IDSS or PLD errors, executive team members who need status updates, or perhaps something new that you’ve never experienced before.

In the final edition of our blog series, “From the HEDIS 2019 trenches,” Jamison Gillitzer, product manager for Cotiviti’s Quality and Performance solutions, offers this checklist to help you remember all the little details before the final deadline of June 17. 

  1. Complete any corrective action plans that may have been resulted from medical record review validation (MRRV). Are there any follow-ups not completed from the hybrid validation? Are all auditor questions or follow-up actions completed? 
  1. Resolve all IDSS warnings and errors. First, do all the values in IDSS match the values in your HEDIS software? We highly recommend that you perform measure validation before locking. Most importantly, are the hybrid numerators the same values that were submitted for MRRV? Auditors will require explanation if the values mismatch. When you uploaded your IDSS XML file, did you receive any errors or warnings? If yes, which ones need to be addressed and corrected? If they are not resolved, do you have proper documentation to explain why the message is showing? 
  1. Make sure PLD files match the IDSS values. Before submitting your PLD files to your auditor, did you make sure the values matched your IDSS values? If the values did not match, were you able to “balance” the PLD report and correct the variances? 
  1. Upload the Medicare PLD without error. After your auditor has signed off on the Medicare PLD file, did you receive any errors when uploading to the Centers for Medicare & Medicaid Services (CMS)? If so, what needs to be corrected to be submitted? We highly recommend that you do not mark “final” on the IDSS site until the Medicare PLD file has been accepted. You don’t want to unmark final for IDSS because of a small PLD correction. 
  1. Answer auditor questions. Throughout this blog series, we have written about the importance of continuous auditor communication during HEDIS season. If you followed this approach, you and your auditor should have been talking well before plan lock. If not, make sure you reach out to them to ensure all questions have been addressed. They might ask about variances, warnings, or errors from the IDSS upload, or even errors from your PLD file. Make sure everything is resolved in time. 
  1. Have your attestation signed and submitted by 11:59 p.m. ET on June 17. The correct personnel at your company must sign and submit your attestation on time. It’s not a pleasant experience for anyone when the CEO leaves for that week-long vacation without signing the attestation. 
  1. Consider state submissions. Are you responsible for other submissions? Do you need to submit your HEDIS measures to the state, or do you submit non-HEDIS measures? For non-HEDIS measures, have you reviewed your measure rates and addressed any variances with your auditor? Do you have the submission form ready to go so you will meet the deadline? Many of these submissions occur near the HEDIS submission deadline, so don’t let up too soon. 

We hope your HEDIS 2019 season was a resounding success, but even the most well-oiled quality machine has room for improvement. Stay tuned for an upcoming webinar we’ll be hosting in July on “the continuous quest for quality.”

In the meantime, learn how quality measurement and reporting have evolved from an annual routine into a year-round strategic initiative for payers from our white paper on the changing quality improvement landscape. 

Read the white paper

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

WRITTEN BY

Jamison Gillitzer
Jamison Gillitzer is a product manager supporting Cotiviti’s Quality and Performance solution suite. His primary responsibilities are the successful delivery of our quality solutions to ensure they meet clients' needs in support of HEDIS, P4P, and other quality reporting initiatives. He also works to develop and enhance our capabilities to support evolving quality requirements. Jamison has a bachelor's degree in entrepreneurial management from the University of Minnesota and is PMC-III certified.

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