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:


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