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Follow-Up After Emergency Department Visit for Mental Illness (FUM)

What is the FUM — HEDIS® Measure?

Based on current NCQA HEDIS recommendations for best practices, members ages 6 years and older with an Emergency Department (ED) visit and principal diagnosis of mental illness or intentional self-harm diagnosis, should have received two follow-up visits during the measurement year.

The following will meet compliance:

7-Day Follow-Up:

A follow-up visit with any practitioner within seven days after the ED visit (eight total days)

  • Per HEDIS specifications, include visits that occur on the date of the ED visit1

30-Day Follow-Up:

A follow-up visit with any practitioner within 30 days after the ED visit (31 total days)

  • Per HEDIS specifications, include visits that occur on the date of the ED visit1

Best Practices

  • Schedule follow-up appointments as soon as possible, particularly for those patients recently discharged from the ED.
  • Train patients and staff on the “Teach-Back Method” to ensure patients and caregivers review and understand discharge instructions and the next steps in their care for follow-up.
  • Encourage patients to bring their discharge paperwork to their first appointment.
  • Educate patients about the importance of follow-up care and adherence to treatment recommendations.
  • Coordinate care with behavioral health practitioners by sharing progress notes and updates.
  • Contact patients who cancel appointments and assist them with rescheduling as soon as possible.
  • Set flags, if available, in electronic health records or develop a tracking method for patients due or past due for follow-up after discharge visits.
  • Use the same diagnosis for mental illness at each follow-up (a non-mental illness diagnosis code will not fulfill this measure).

NCQA HEDIS Population Definition for This Measure

Population: Members ages 6 years and older on the date of the ED visit with a principal diagnosis of mental illness or intentional self-harm on or between January 1 and December 1 of the measurement year.

Line of Business: Commercial, Medicaid, Medicare1

To learn more about your practice’s current HEDIS performance, 2022 HEDIS Value sets for this or other measures, or for assistance in compliance with the HEDIS guidelines, please email BH_HEDISTeam@HorizonBlue.com or visit https://www.horizonblue.com/providers/resources/guidelines/hedis-measurement-year-my-2022-provider-tips-optimizing-hedis-results

Reference: Follow-Up After Emergency Department Visit for Mental Illness (FUM), NCQA HEDIS 2022 Tech Specifications