From the HEDIS® 2019 trenches: the importance of an admin refresh

The HEDIS^® 2019 season is more than halfway done. Are you on track for the reporting deadline? Our Cotiviti experts are here to share their insights on effectively managing your measurement and reporting process in our monthly blog series, “from the HEDIS 2019 trenches.” Here, Jenna Fitcher, product director for Cotiviti’s Quality and Performance solutions, discusses best practices for performing an administrative refresh.

What are the benefits of completing an administrative refresh?

Some health plans choose to refresh monthly (incremental loads), some will only refresh once in April, and some won’t refresh at all. However, there are good reasons to refresh—and often.

Plans perform an admin refresh to account for claims that might have been missing or were not processed when the HEDIS production run was completed due to claims runout/lag. An admin refresh will also update your sample/hybrid information. If more samples become administratively compliant, your health plan could benefit from reduced medical record review.

Timing on the admin refresh can be critical since your hybrid samples will change. Make sure you know the downtime for updating samples so you can factor it into the schedule.

After an admin refresh is completed, what are the key items to validate?

Enrollment and membership data should have stayed the same from the production run. If you choose to update this data, however, know that these changes could result in different eligible populations and sample members.

Here are a few additional things to keep in mind:

• Administrative rates should be compared before and after. You should not see a decrease in rates unless data was backed out or not included.
• Did you gain any administrative hits in your hybrid measures, and can you now close out any retrieval efforts because of the gap closures? Some vendors, including Cotiviti, have the ability to track compliance changes at admin refresh.
• If your eligible populations are on the smaller side—say under 411—you may want to validate that your eligible population, MRSS, and denominator are all still matching. If for some reason a member fell out of the eligible population criteria, you will need to adjust your sample as well if this does not occur automatically.
• Pay close attention to new administrative exclusions that may have come through the claims lag data.

How can your quality measurement and reporting software vendor help?

Talk to your vendor about what to use to help track your results. A strong partner should be able to recommend reports that will help you track the above scenarios. At Cotiviti, we have several tables and reports to help clients through the admin refresh process to ensure that they are maximizing their time and effort, given the time crunch we all feel as we near the end of the HEDIS season. Of course, starting the season with a thorough project plan is essential to keep all parties on track and adhere to critical deadlines.

Cotiviti’s Quality Intelligence reduces quality measurement and reporting workflow to its most efficient and effective point. Download our fact sheet and learn why 68 percent of health plan members for whom HEDIS scores are reported run through our software.

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