HUG 2007 Web Conference
Download
Report
Transcript HUG 2007 Web Conference
HEDIS 2014 Code Transition
Lori Andersen
Asst. Director, Policy Measures
Objectives
ICD-10 Status Update
Review the HEDIS 2014 Code Transition
Impacts on Volume 2 and other HEDIS
Publications
Questions
Feedback
2
ICD-10 Compliance Date
In 2012 CMS announced a Final Rule that
requires the use of ICD-10 codes effective
October 1, 2014
•
•
•
Claims for dates of service on or before September
30, 2014 will use ICD-9 codes
Claims for dates of service on or after October 1, 2014
must use ICD-10 codes
This change impacts HEDIS 2015 which collects
performance information about the 2014 calendar
year
NCQA will include ICD-10 codes in HEDIS 2015
3
ICD-10 Status Update
ICD-10 codes have been identified for all but
two measures
Final Review and Comment period scheduled
for July 1 – December 15, 2013
• Timing considerations
Impact Assessment planning underway
• Impacts on products that incorporate
trending
• Impacts on products that incorporate
performance based scoring
4
What’s Different?
Much greater specificity!
• Diagnosis codes increase from 13K to 68K
(92K in our resource)
• Procedure codes increase from 4K to 87K
Changes to format and structure
Concepts added
Concepts moved
Concepts deleted
5
HEDIS 2014
Effective with HEDIS 2014 code tables will be
removed from HEDIS publications and released
in an electronic format (Value Set Directory)
•
Value Set refers to the set of codes that identifies a
condition or procedure
HEDIS Volume 2 publication package will
include the Value Set Directory
•
Cost neutral
Value Set Directory includes all codes used to
report HEDIS, listed individually
•
•
Volume 2 lists ICD-9 code 401
Value Set includes 401.0, 401.1, 401.9
6
Why Change?
Feasibility
•
ICD-10: An increase in the number of diagnosis and
procedure codes, combined with the need to list
codes individually, makes tables very large.
Improvement
• Managing codes electronically will allow NCQA and
•
customers to manage a large volume of information
more efficiently and more accurately.
Using Value Sets standardizes terminology and
definitions across measures and products.
7
Specific Changes
Some HEDIS tables contain codes for a single
concept, and any code meets criteria for
reporting
•
All codes will be included in a single Value Set
Some HEDIS tables separate codes by
Description
•
•
If different Descriptions are required for reporting, a
Value Set will be created for each Description
If different Descriptions are not required for
reporting, a single Value Set will be created
Value Set naming convention
Value Set references in HEDIS Publications
8
Breast Cancer Screening
9
Breast Cancer Screening
10
Breast Cancer Screening
11
Specific Changes
Multiple tables combined into a single,
standardized Value Set
• Pregnancy
• ESRD
• HIV
• Outpatient
• Acute Inpatient
• Nonacute Inpatient
• ED
12
Pregnancy
13
Chlamydia Screening in Women
Value Sets:
Pregnancy
Pregnancy Test (a.k.a CHL-D)
Chlamydia Screening (a.k.a CHL-C)
Sexual Activity
14
Specific Changes
Codes for Visit Types will be combined into a
single, standardized Value Set
•
•
•
•
Outpatient, Acute Inpatient, Nonacute Inpatient, ED
HEDIS 2013 – codes are customized based on age
bands
HEDIS 2014 – a single, comprehensive set of codes is
used for all measures regardless of age criteria
• Codes not applicable to a measure will not occur
• 99382 (Preventive medicine evaluation ages 5-11):
will not show up in ABA EPOP
Will result in code changes to some measures (during
HEDIS 2014 transition year)
15
Facilitate Transition
Documentation will describe changes between
2013 Description and 2014 Value Set
• Codes for URI and acute nasopharyngitis (formerly
•
listed separately by Description in Table URI-A) are
combined into a single URI Value Set.
Codes for acute pharyngitis, acute tonsillitis and
streptococcal sore throat are combined into a single
Pharyngitis Value Set.
16
Facilitate Transition
A Summary of Changes for coding changes
will be provided
• In electronic format as part of the Value Set
Directory
• Considerations for HEDIS 2014 transition
year?
Will be provided:
• Value Sets used, by measure
• Measures that use the Value Set, by Value
Set
17
Facilitate Transition
Code definitions will be included in the Value
Set Directory when possible
•
CPT has licensing restrictions and cannot be
included
TBD – Value Set Directory format
• XML
• Excel
Ongoing communication with customers
Value Set Directory Support
18
Questions
19