How Can Your Practice Achieve High HEDIS Scores?

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The Health Effectiveness Data and Information Set (HEDIS) is healthcare’s most essential and widely used tool for measuring quality clinical performance, evaluating patient risk, closing gaps in care, and assessing patient satisfaction. Measuring the effectiveness of your care delivery is vital in determining if your practice is taking the proper steps towards your patients’ needs. As the healthcare industry moves toward value-based care, improving your HEDIS score is becoming increasingly important.

What is the Provider’s Role in HEDIS?

Documentation is vital in meeting HEDIS quality measures and improving care performance. As a provider, your role is to document all healthcare services provided in the patient’s electronic medical record. Proper documentation is essential since a medical record follows a patient as they move throughout the healthcare system. It serves as a communication tool among providers and other healthcare professionals involved in the patient’s care. It allows healthcare providers to plan a patient’s treatment and evaluate the efficacy of that treatment.

Health plans collect data for HEDIS reporting through submitted claims. It is the provider’s responsibility to code claims accurately, and proper documentation helps you achieve that.

Medical record submission is another method of data collection for HEDIS reporting. If the submitted claims are not sufficient for data collection, health care plans sometimes require providers to furnish medical records of eligible patients. Since the National Committee for Quality Assurance (NCQA) sets deadlines for healthcare plans to collect data, practices must submit medical record requests on time.

Additionally, providers need to ensure certain procedures and appropriate care are given within the designated time frame. For example, measure W30 requires assessing the physical, emotional, and social development of a child who turned 30 months within the reporting year.

Your HEDIS scores show your commitment to quality care. With a high HEDIS score, payers are more likely to partner with you since they want to ensure that their plans only offer excellent service.

How Can You Achieve a High HEDIS Score?

doctor figuring out how can you achieve a high hedis score

Patient outreach and engagement play an important role in improving your HEDIS score. When patients take part in their health, they have better outcomes and are more likely to participate in preventive care and schedule regular primary care visits. Using automated engagement tools reduces the administrative burden that HEDIS brings.

Health plans typically have beneficiary incentive programs to help drive a patient’s engagement. Practices need to collaborate with health plans and strategize an outreach program. For example, San Francisco Health Plan (SFHP) credits its HEDIS success through direct patient outreach wherein they directly call patients to remind them of annual exams and screenings. The members, in turn, receive gift cards after completing the recommended service.

NCQA’s HEDIS training program helps practices make the most out of each measure. The on-demand modules include a wide range of topics, including HEDIS audit, upcoming digital measures, population outreach, and more. For strategies specifically for healthcare practices, Meditab’s recent webinar, “HEDIS 101: Your Strategic Guide to Ensuring Compliance and Higher Scores,” discusses insights on how to improve HEDIS scores.

Watch HEDIS Webinar

The Technology & Team You Need for Better HEDIS Reporting

HEDIS services at Meditab

HEDIS measures vary year after year. Staying up to date with the newest measures doesn’t always guarantee a high score, and knowing the best way to meet HEDIS measures is not always straightforward. Let the right team and innovative technology guide you through every step of the process.

Meditab’s Quality and Risk Adjustment (QRA) team provide all the tools and support you need to comply with every HEDIS measure. As experts in HEDIS and other compliance programs, the QRA team identifies the measures you need to work on, ensures claims are coded correctly, provides regular HEDIS star reports, and more. Before the start of the measurement year, the QRA team conducts HEDIS training for providers and staff to understand each measure’s requirement. In the case of a HEDIS audit, the team can help comply with the required documents.

Improving HEDIS scores requires a personal touch. We understand that your onsite staff is already swamped with their daily tasks. Our team can reach out to your patients and guide them to schedule and show up for appointments on your behalf.

Meditab’s core practice software, IMS, is an all-in-one EHR, practice management, and billing software. With an integrated billing system, processing claims is more effortless and seamless. Providers can also customize visit notes in IMS to capture required HEDIS data accurately. With various automation features, IMS alerts providers when screenings and annual exams are due and sends patients an automated text reminder. IMS Medical Record Request Manager streamlines the record request process, ensuring timely submission.


To learn more about HEDIS and how you can achieve a high score, book a consultation today and see how our team can help.

Book a Free HEDIS Consultation



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