Certified Risk Adjustment Coder (CRC)

How is HEDIS® data typically collected?

1. Via patient surveys only

2. Exclusively through medical claims

3. Through surveys, chart reviews, and insurance claims

4. Only during hospitalizations

The correct answer is: Through surveys, chart reviews, and insurance claims

HEDIS® (Healthcare Effectiveness Data and Information Set) data is collected through a comprehensive approach that encompasses multiple methods to ensure accuracy and completeness. The choice that states the correct answer reflects the multi-faceted process involved in data collection for HEDIS. HEDIS data is utilized to measure performance on various dimensions of care and service, so relying solely on one method, such as patient surveys or medical claims alone, would limit the effectiveness of the data collected. The inclusion of surveys allows for direct feedback from patients regarding their experiences and outcomes, chart reviews provide in-depth clinical details about patient care, and insurance claims contribute billing and clinical information observed during patient encounters. This combination ensures a well-rounded view of patient care quality, encompassing both subjective experiences and objective clinical data. Thus, the methodology outlined in the correct answer is critical for achieving a robust understanding of healthcare performance, which is essential for quality measurement and improvement initiatives.