HEDIS^® Tip Sheet

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

Any of the following services with any practitioner, for a principal diagnosis of a mental health disorder or a principal diagnosis of intentional self-harm with any diagnosis of a mental health disorder may count as a follow-up visit:

• An outpatient visit.
• An intensive outpatient visit or partial hospitalization.
• A community mental health center visit.
• Electroconvulsive therapy.
• An observation visit.
• A telehealth visit.
• A telephone visit.
• An e-visit, or virtual check-in. 

Notes

• The 30-day follow-up rate is part of the BlueAlliance and BlueAlliance Care+ program.
• A member can be included in the measure more than once as the denominator is based on ED visits.
• If the member has more than one qualifying ED visit within a 31-day period, include only the first eligible visit.
• Follow-up visits must have a primary diagnosis (first diagnosis on the follow-up visit claim) of a mental health diagnosis code or principal diagnosis of intentional self-harm.  
• Follow-up visits that occur on the same day as the ED visit can count toward compliance.

Exclusions

• ED visits that result in an inpatient stay.
• ED visits followed by admission to an acute or nonacute inpatient setting on the date of the ED visit or within 30 days of the ED visit regardless of the primary reason for the admission.
• Members in hospice during the measurement year.
• Members who died during the measurement year.

Best Practices

• Encourage use of telehealth appointments for follow-up visits.
• 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. 
• Utilize EHR flags and reporting to assist patients in need of follow-up visits and those who cancel or do not show up for appointments so appropriate outreach can be made. 
• Assist members with scheduling an in-person or telehealth visit within 7 days of an ED visit.
• Consider referrals to case managers or social workers to help patients coordinate care.