What does HEDIS stand for and what is its purpose?

• A. HEDIS is a medical coding standard used for claims processing.
• B. HEDIS stands for Healthcare Effectiveness Data and Information Set; used for standardized performance measures to compare plans and report quality.
• C. HEDIS is a patient satisfaction survey instrument.
• D. HEDIS is a financial framework for budgeting in hospitals.

Answer: (B)

HEDIS stands for Healthcare Effectiveness Data and Information Set, and its purpose is to provide standardized performance measures that allow health plans to be compared and their quality reported. It collects data on how well plans deliver evidence-based care, preventive services, access to care, and patient outcomes, using sources like administrative claims, medical records, and surveys. This standardized set enables apples-to-apples comparisons across plans and supports quality improvement and consumer/purchaser decision-making.

The other descriptions don’t fit: it isn’t a medical coding standard for claims processing, it isn’t primarily a patient satisfaction survey instrument (that role is filled by tools like CAHPS), and it isn’t a financial budgeting framework for hospitals.