How Do HEDIS Audits Get Scored?
Accounting isometric composition with charts documentation and human characters during audit on blue background vector illustration
Is your organization involved in a HEDIS Compliance Audit? If so, you probably have a lot of questions about the HEDIS Compliance Audit and what it means for your organization. Thankfully, Datafied is here to help. Keep reading to learn more about HEDIS audits and how Datafied can help you excel!
What are the two different parts of the HEDIS Compliance Audit?
There are two parts to a HEDIS Compliance Audit. Part 1 is the Information System Capabilities. During this stage, the auditor looks at the capabilities of the organization’s information system. This includes how the organization collects, stores, analyzes and reports the health information.
Part 2 is a look at the HEDIS Specific Standards. During this part, the auditor will look at how the organization complies with reporting practices for HEDIS specifications across the various domains of care.
What are the possible outcomes from a HEDIS Compliance Audit?
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- Reportable (rate or count): Reportable rate was submitted for the measure.
- NA (small denominator): Plan followed the specifications, but the denominator was too small to report valid rate
- NB (benefit not offered): P plan did not offer the health benefit required
- NR (not reported): Did not report the measure.
- NQ (not required to report): Plan was not required to report
- BR (biased rate): Calculated rate was materially biased
- UN (unaudited): Plan reported a measure that is not required to be audited
Who can assist with HEDIS work?
If you are struggling with your HEDIS work, you don’t want to get dinged in a HEDIS Compliance Audit. That is why you should get ahead of it and enlist help with your HEDIS work today. Thankfully, Datafied is here to help.
For help with your HEDIS work, contact Datafied today!
HEDIS audits are no small feat and can be very stressful. If you are looking to improve your HEDIS audit results or simply need help getting your documentation and data in order, Datafied is here to help. Through our division of HEDIS Nurses, we have qualified chart abstractors to assist health plans with their HEDIS work. With over 31 years of experience, you can trust us to get the job done. Whether you need help with a few small projects or want to outsource all of your HEDIS work, we are here to help! Give us a call today at 800-765-7510 to discuss your needs and determine how we may be able to assist.
To learn more about the reliable and quality document retrieval and management services that we offer, visit us on the web at Datafied.
