HEDIS Audit 101. Introductions. We Are Attest. Jenna Morgan and Nichole Walker

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1 HEDIS Audit 101 Jenna Morgan and Nichole Walker Introductions We Are Attest Largest NCQA Licensed Organization CHCAs since inception Top performing & improvement minded clients Collaborative and Transparent 1

2 Objectives High- level HEDIS audit overview Attest audit approach Tools and resources Audit expectations Purpose of the HEDIS Audit Verifies processes conform to technical specifications Evaluates system capabilities and processes Ensures a fair comparison across organizations Reportable data that is accurate and reliable The Attest Way Transparent Collaborative Educational Value Oriented 2

3 HEDIS Audit Phases Pre- Onsite Onsite Post- Onsite Pre-Onsite November-December Kick Off Call January Roadmap* CAHPS & QRS Enrollee Survey Review Benchmarking Before Sampling February-March SDS Review Source Code Review Kick Off Call November-December Audit Logistics Discuss Any Major Changes ShareFile Queries Timeline Participation is Key! 3

4 Timeline NCQA-Driven Deadlines Tailored During Kick Off Call Some Target Date Flexibility Tracked Within Issue Log Issue Log Primary Tracking Tool Timeline Core Set Supplemental Data Sources Approvals Roadmap 1 st Major Audit Deliverable Information Management & Measure Reporting Organized by Sections Appendix 1 4

5 CAHPS & QRS Enrollee Survey January Plan Role Sample frame and CAHPS form Vendor deadline HOQ configuration Attest Role Sample frame review Approval letter with audit locked sample HOQ approval Benchmarking Review & Tool Benchmark early Standardized Excel output Identifies potential process or data issues Outlier Toolbox Rate Research Tool Requires Plan Action Validates Rates & Populations Troubleshooting High/ Low Rates High/ Low Eligible Populations 5

6 Outlier Toolbox Measure Identifier ABA EP Benchmarking EP Benchmarking Rate Benchmarking Rate Benchmarking High/ Low/ High/ Large Increase Low/ Measure Name Large Increase Large Decrease Large Decrease Adult BMI Assessment Confirm limited to Confirm that the age Confirm counting Confirm plan members with visits in criteria is correct members, not events considering 2 years of 2017 or 2018 Confirm all outpatient Confirm not counting data Confirm applied claims from all sources height and weight Confirm not looking optional exclusion loaded recordings instead of for only BMI on visit Confirm anchor date Confirm two years of BMI that qualified member is applied visits used Confirm weight for EP Confirm all Confirm all requirement for hybrid Confirm reviewers enrollment segments enrollment segments is being followed aren't looking for BMI linked correct, applies linked correct, applies Confirm plan pays for age-growth charts for to in-house and plans to in-house and plans applicable HCPCS >18 yr olds that 'normalize' that 'normalize' codes Confirm excluding enrollment data prior enrollment data prior Confirm not using for pregnancy in MY to loading in software to loading in software ranges and thresholds and PY Confirm that the age criteria is correct SDS & Source Code Reviews Supplemental Data Roadmap Section 5 2 Types PSV Source Code Core Set Onsite February-April Agenda Planning Sessions by Topic Rate Review Collaborative Experience 6

7 Post-Onsite - MRRV May-June MRRV Frozen Counts Sample Selection Post-Onsite Rate Finalization Issue Log Closure IDSS Rate Review Patient-Level Detail Review Final Audit Report NCQA Resources HEDIS Volumes 2, 3 & 5 Policy/Program Clarifications FAQs HEDIS User Groups Conferences & Webinars 7

8 Attest Resources Communications Manual Issue Log Outlier Toolbox Specialized Teams All Client Communications All Client Conference Calls Audit Expectations Timeline and Turnaround Time Accountability Transparency Collaborative Team Health Plan Attest Vendor HEDIS Audit Overview Attest Audit Approach Tools and Resources Audit Expectations Recap 8

9 Navigating the Workshop Main Sessions (Wednesday-Friday) Concurrent Sessions (Thursday) Option 1 Option 2 Option 3 Option 4 TRC Deep Dive Hybrid Pursuit Strategies How to QA Your Rates Troublesome Administrative Measures Enjoy the Workshop! 9