HEDIS 2017 - Who Can Document

Moving through the doctor’s office you see Medical Assistants talking with patients, weighing them, asking questions.  You look up to see two scrub-clad people typing furiously.  Moving through the office, you pass an office labeled Business where coding manuals are strewed all around --- then as you turn a corner you come face to face with a starched white lab coat – looking very authoritative while turning in circles in the hallway talking to thin air. 

Assistants record information.  Nurses record information.  Doctors, nurse practitioners and physician assistants record information.  Coders code information.  Billers bill.

Whose document can be used for satisfying HEDIS (Health Effectiveness Data Information Set) measures? Here are the approved HEDIS providers as per NCQA (National Committee on Quality Assurance).  

Clinical Pharmacist

A pharmacist with extensive education in the biomedical, pharmaceutical, socio-behavioral and clinical sciences.  These pharmacists are experts in the therapeutic use of medications and are a primary source of valid information regarding safe, appropriate, and cost-effective use of medications.

Most clinical pharmacists have a Doctor of Pharmacy (PharmD) degree and many have completed one or more years of graduate training.  Some clinical pharmacists even have prescriptive authority.

Dental Practitioner

A practitioner with a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree and licensed to practice dentistry by a state board of dental examiners. Certified and licensed dental hygienists are considered dental practitioners.

Mental Health Practitioner

A practitioner who provides mental health services and meets any of the following criteria:

• An MD or Doctor of Osteopathy (DO) certified as a psychiatrist or child psychiatrist by the American Medical Specialties Board of Psychiatry and Neurology or by the American Osteopathic Board of Neurology and Psychiatry.  If not certified, has successfully completed an accredited program of graduate medical or osteopathic education in psychiatry or child psychiatry and is licensed to practice patient care psychiatry or child psychiatry.   
• An individual who is licensed as a psychologist in his/her state of practice.
• An individual who is certified in clinical social work by the American Board of Examiners, listed on the National Association of Social Worker’s Clinical Register or has a master’s degree in social work and is licensed or certified to practice as a social worker.
• A registered nurse (RN) who is certified by the American Nurses Credentialing Center as a psychiatric nurse or mental health clinical nurse specialist or has a master’s degree in nursing with a specialization in psychiatric/mental health, two years of supervised clinical experience and is licensed to practice as a psychiatric or mental health nurse.
• An individual with a master’s or a doctoral degree in marital and family therapy and two years of supervised clinical experience who is a licensed or certified counselor.  If licensure or certification is not required by the states of practice, eligible for clinical membership in the American Association for Marriage and Family Therapy.
• An individual with a master’s or a doctoral degree in counseling and at least two years of supervised clinical experience who is licensed or certified.  If licensure or certification is not required by the states of practice, is a National Certified Counselor with a Specialty Certification in Clinical Mental Health Counseling from the National Board for Certified Counselors (NBCC).

OB/GYN and other Prenatal Care Practitioners

Physicians certified as obstetricians or gynecologists by the American Medical Specialties Board of Obstetrics or Gynecology or the American Osteopathic Association or have successfully completed an accredited program of graduate medical or osteopathic education in obstetrics and gynecology.

Certified nurse midwives and nurse practitioners under the direction of an OB/GYN certified or accredited provider who deliver prenatal care services.

PCP - Primary Care Practitioner

A physician, nurse practitioner or physician assistant who offers primary care medical services.

Prescribing Practitioner

A physician, nurse practitioner, physician assistant or approved clinical pharmacist with prescribing privileges.

Primary Care Physician

• General or family practice physicians.
• Geriatricians.
• General internal medicine physicians.
• General pediatricians.  

Registered nurses and Licensed Practice nurses are not considered Primary Care Practitioners.  The only measure that can be satisfied by a licensed nurse is Medication Reconciliation Post-Discharge (MRP).  The exact phrase is “…conducted by a prescribing practitioner, clinical pharmacist or registered nurse…”.

Medical records in hard-copy (paper charts) must be signed and dated by the rendering practitioner attesting to the accuracy of the information.  Electronic records must have an approved electronic signature with accountability tied to the practitioner’s password as well as Tax ID number/Provider ID number.

Each HEDIS measure has specific guidelines.  Please review HEDIS 2017, Volume 2 published by NCQA. 

About The Author

Jane Jackson has more than  25 years experience in healthcare, including hospital-based care, home health, and managed care. She enjoys sharing her knowledge and can she be reached at Jane.Jackson@DailyDoseHQ.com. Also visit her blog, Daily Dose HQ.

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What Is The 5 Star Rating System For Managed Care? 

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