The Referral You Made Doesn’t Count: A Practical Look at HEDIS

By Elizaveta Bannova, CPC, CPCO, CPMA, CFPC, Billing Department, WCH

Ask most physicians what HEDIS is and you’ll get some version of “the quality scores the health plans care about.” That’s not wrong, but it undersells how much of a practice’s revenue and compliance exposure actually rides on it. A recent WCH Service Bureau webinar, again led by Elizaveta Bannova, goes deep enough into the mechanics to expose a few things that trip up even experienced practices — starting with the fact that a referral, on its own, usually closes nothing.