HEDIS Annual Review

Published October 2025

Key Insights Gained from 2024

The HEDIS Annual Review of Measurement Year 2024 (MY2024) identified areas of improvement in documentation and compliance related to specific HEDIS measures.

Care for Older Adults (COA)

1. Medication Review: Remember to include a medication list in each visit note. A notation stating that the meds were reviewed and reconciled is not enough without a corresponding list. In addition, compliance for this sub-measure can only be achieved if the medication review is conducted by either a prescribing practitioner or a clinical Pharmacist (PharmD). RPh and nursing staff reviews are not accepted per NCQA specifications.
2. Functional Status Assessment: If a standardized FSA tool is not used, simply documenting that ADLs were assessed and the patient’s ability to perform them is compliant. For more information about specific FSA screening tools, access the COA presentation linked above.

Note: The Pain Assessment indicator has been retired.

Cervical Cancer Screening (CCS-E)

When patients present for STI screening or HCG testing, please perform a PAP and/or HPV screening that is over-due. During MVP’s latest HEDIS review, it was overwhelmingly noted that this was a frequently missed opportunity. Remember that an HPV screening for eligible patients is compliant for FIVE years. A PAP alone is compliant for three years.

1. Exclusionary documentation of “hysterectomy” alone is not compliant: The type of hysterectomy must be documented to determine absence of cervix. If unknown, documentation of a GU exam showing “surgical absence of cervix” must be present.
2. “PAP not needed” and “vaginal” pap source are no longer accepted per NCQA as evidence of absence of cervix.

Transitions of Care (TRC)

To satisfy this measure, documentation is required from acute and non-acute inpatient facility Providers when relevant. Two of the four sub-measures rely solely on documentation and cannot be satisfied with claims; they are:

• Notification of Inpatient Admission
• Receipt of Discharge Information

1. Copying the patient’s PCP on ED notes and all admission and discharge documentation will greatly improve TRC ratings. The sub-measures will be compliant only if these documents are integrated into that outpatient record within 48 hours of admission and discharge. PCP practices should work to ensure this timeline is observed to meet compliance.
2. Conducted at the Provider Engagement visit can only be recognized if the provider notes show the reason for the visit is “Post-hospitalization.” Statements such as “Post-op f/u” do not indicate awareness of an inpatient stay. Documentation such as “hospitalization”, “inpatient stay” and “discharge” do so.