Understanding HEDIS For Ophthalmology – Review of Ophthalmology

An overview of HEDIS, covering insurance plans and the role of ophthalmologists and optometrists.

This article addresses the following questions:

• What does HEDIS stand for?
• Who utilizes the HEDIS tool?
• What type of rating do insurance plans receive?
• What is the significance of the rating to a health plan?
• How does the Centers for Medicare & Medicaid Services use HEDIS scores?
• Are third party-payers required to submit HEDIS data to the NCQA?
• How do ophthalmology and optometry play a role in HEDIS scores and Health Insurance Plan Ratings?
• How does the health plan know that the patient received these services?
• How do primary-care providers fit into this matrix if the primary objective is to have the plan receive a high rating?
• If ophthalmologists and optometrists can report on the eye exam component of the HEDIS measure, why are primary-care providers concerned about insufficient data being reported to the health plan for this measure?
• How are primary-care providers working to achieve compliant results to report?

This article was published in Review of Ophthalmology’s Medicare Q & A column, which is written by Corcoran’s Vice-President, Donna McCune, CCS-P, COE, CPMA. To view the entire article in Review of Ophthalmology, click on the link below:

https://www.reviewofophthalmology.com/article/understanding-hedis-for-ophthalmology