HEDIS audits: meeting the challenge.
The Health Plan Employer Data and Information Set (HEDIS) is a tool to measure and report managed care performance. HEDIS has become the industry standard for assessing and comparing the quality of managed care organizations (MCOs), so it is imperative that MCOs collect and communicate HEDIS data correctly and efficiently. Several primary issues face MCOs in compiling HEDIS data. In particular, this article examines the HEDIS audit process and outlines the preparation required to undergo an audit, common errors uncovered in the audit process, and steps that can be taken to ensure compliance with HEDIS technical specifications.
Bishop
W
W
Ernst & Young, Dallas, TX, USA.
Park
K
K
Rector
J
J
Faulkner
M
M
D014487:Centers for Medicare and Medicaid Services, U.S.; D003625:Data Collection; D006264:Health Benefit Plans, Employee / Q000592:standards*; D008329:Managed Care Programs / Q000458:organization & administration / Q000592:standards*; D008330:Management Audit; D008485:Medical Audit; D010934:Planning Techniques; D011786:Quality Control; D019984:Quality Indicators, Health Care; D014481:United States