HEDIS^® Tip Sheet

Compliance for 7-Day and 30-Day Follow-Up

Any of the follow-up visits with a mental health provider may count as a follow-up visit: 

• Outpatient visit.
• An intensive outpatient visit or partial hospitalization.
• A community mental health center visit.
• Electroconvulsive therapy.
• Telehealth visit.
• An observation visit.
• Transitional care management services.
• A visit in a behavioral healthcare setting.
• Telephone visit with a mental health provider.
• Psychiatric collaborative care management.

Notes

• The 30-day follow-up rate is part of the BlueAlliance and BlueAlliance Care + Program.
• The denominator is based on acute inpatient discharges for a principal diagnosis of mental illness or intentional self-harm.  
• Follow up visits that occur on the same day as discharge do not count toward measure compliance. 

Exclusions

• Readmissions/direct transfers to a nonacute inpatient care setting within the 30-day follow-up period regardless of the primary diagnosis for readmissions.
• Members in hospice during the measurement year.
• Members who died during the measurement year. 

Best Practices

• Utilize EMR flags and reporting to assist in tracking patients in need of follow-up visits and those who cancel or do not show up for appointments so appropriate outreach can be made.
• Educate providers/patients on the importance of mental health follow up.
• Schedule follow up visits as soon as possible and educate patients, utilizing teach back methods, on the importance of keeping follow-up appointments.
• Include caregivers, if applicable, in understanding discharge and follow-up instructions.
• Develop systems for outreach such as case managers to encourage follow-up appointments OR assist with re-scheduling missed appointments.
• Utilize established systems for outreach to coordinate with behavioral health practitioners.