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HEDIS Measures Reporting Services

The Healthcare Effectiveness Data and Information Set (HEDIS) is one of health care’s most widely used performance improvement tools. According to the National Committee for Quality Assurance (NCQA), over 200 million people are enrolled in health plans that use HEDIS measures to assess quality. HEDIS includes more than measures across 6 domains of care.

  • Effectiveness of Care
  • Access/Availability of Care
  • Experience of Care
  • Utilization and Risk-Adjusted Utilization
  • Health Plan Descriptive Information
  • Measures Collected Using Electronic Clinical Data Systems
  • RM Healthcare HEDIS Reporting Expertise

    To support Health Plans' P4P and Star Program efforts, our team of Nurse Practitioners and Coders abstracts and reports on all HEDIS metrics (according to NCQA technical criteria). Medical record abstraction and HEDIS consulting are only two of the areas in which our team excels, and we also have a stellar record of evaluating the accuracy of other organizations’ reports of clinical quality metrics.

    To improve quality and star ratings, RM Healthcare offers a wide variety of HEDIS support services, such as chart abstraction, retrieval, and member engagement solutions like member education, office visit help, and more..

    New metrics are introduced, existing ones are removed, and existing ones are updated every year. In order to compile HEDIS scores, information about hospital stays, doctor's office visits, and surgical procedures is gathered through surveys, patient records, and insurance claims. For public reporting, HEDIS results must be audited by an auditing company certified by the National Committee for Quality Assurance (NCQA). The information gathered by HEDIS can be used to assess progress and establish future objectives. The purpose of this is to have doctors and hospitals submit claims and encounters using codes that make paper records unnecessary.

    Areas of Expertise:

    • Measures for Medical Record Data collection
    • Adult BMI Assessment, Medication reconciliation post-discharge, Care of Older Adults, Comprehensive Diabetic Care, Colorectal Cancer Screening, Cervical Cancer Screening, HEDIS Consulting, etc.
    • Abstract Medical Records, Medical Record abstraction on collected data.
    • Over reading & Validation

Our HEDIS Measures Reporting Services for Health Plans

HEDIS Abstraction Services, enable our Medicare, Medicaid, and commercial health plans customers achieve Star Rating and other Benchmarks. Our Services provide the following

  • Intervention to impact HEDIS data and timely closure of Gaps
  • Pursue Clinical data aggressively to ensure compliance rate
  • Care Coordination / education with Physicians to improve effectiveness of clinical care
  • Real-time “Gaps in Care” alerts generation

RM Healthcare handles more than 250,000 patient support calls each month