April 2, 2020
The National Committee for Quality Assurance (NCQA) is allowing patients with advanced illness and frailty to be excluded from select HEDIS® star quality measures. They acknowledge that measured services most likely wouldn’t benefit patients who are in declining health.
You can now submit claims with advanced illness and frailty codes to exclude patients who meet the criteria, from select quality measures. Using these codes also reduces medical record requests for HEDIS data collection purposes.
For a description of the criteria and a convenient list with some of the appropriate HEDIS-approved billing codes, view the Advanced Illness and Frailty Exclusions Guide.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).