Advanced illness and frailty exclusions allowed for HEDIS® star measures
The National Committee for Quality Assurance (NCQA) allows patients to be excluded from select HEDIS® star quality measures due to advanced illness and frailty. They acknowledge that measured services most likely would not benefit patients who are in declining health.
You can submit claims with advanced illness and frailty codes to exclude patients from select measures. Using these codes also reduces medical record requests for HEDIS data collection purposes.
Read the Advanced Illness and Frailty Exclusions for HEDIS Star Measures Guide for a description of the advanced illness and frailty exclusion criteria and a list with some of the appropriate HEDIS-approved billing codes.
Healthcare Effectiveness Data Information Set. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).