September 2019
New advanced illness and frailty exclusions for certain HEDIS® star measures
The National Committee for Quality Assurance now allows providers to exclude patients from select Medicare Star Rating System measures that are also HEDIS® measures** due to advanced illness and frailty. NCQA acknowledges that some measured services won’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 these measures. Using the appropriate codes also reduces the number of medical record requests you may receive for HEDIS data collection purposes.
For a description of the criteria and a list of HEDIS-approved billing codes, view the 2019 HEDIS® Advanced Illness and Frailty Exclusions Guide.
**HEDIS®, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance, or NCQA.
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