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

What is the FUM — HEDIS® Measure?

Based on current 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 7 days after the ED visit (8 total days)

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

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 visit

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, Medicare

To learn more about your practice's current HEDIS performance, 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 Provider Tips for Optimizing HEDIS Results Booklet.