According to HEDIS guidelines, may a chart reviewer use a referral to a GI when reporting compliance to the COL measure?

The correct response indicates that a chart reviewer may not use a referral to a gastroenterologist (GI) when reporting compliance with the COL (Colorectal Cancer Screening) measure according to HEDIS guidelines. This aligns with the emphasis on ensuring that the measures are strictly adhered to in certain defined contexts.

In the case of the COL measure, compliance is based specifically on the actual completion of screening tests for colorectal cancer, such as colonoscopies or stool tests, rather than merely a referral suggesting that a screening might take place in the future. Utilizing a referral alone does not demonstrate that the patient completed the necessary screenings, which is the vital criteria for accountability and performance measurement under HEDIS guidelines.

This rigor ensures that health plans and providers are focusing on actual health outcomes and screening completions, rather than referrals that may not lead to any definitive action. Thus, the integrity of the COL measure relies on confirmed completions rather than suggestive actions like referrals.