November 01, 2022

Indiana Medicaid: Schedule follow-up after ED visit for substance use

Improve care delivery by scheduling post-discharge appointment within 7 days of ED visit

Patients with behavioral health problems who do not receive timely follow-up care after substance use emergency department (ED) visits are much more likely to be readmitted to the ED. Lack of timely follow-up can result in negative outcomes such as continued substance use, relapse, high utilization of intensive care services or even mortality.

The Follow-Up After Emergency Department Visit for Substance Use (FUA) HEDIS® measure is used to measure attendance to a qualified post-discharge appointment within 7 days of discharge for members ages 13 or older. A visit with a provider must have the principal diagnosis of substance use (FUA) on the follow-up visit claim. It is essential for patients to attend a follow-up visit within 7 days of discharge. The day of discharge also counts as a qualified follow-up visit. To count toward the FUA measure, the aftercare visit must occur between the day of discharge and day 7.

Qualified post-discharge appointments include:

  • Outpatient appointment with primary care provider
  • Outpatient appointment with behavioral health provider
  • Partial hospitalization programs, intensive outpatient programs, outpatient electroconvulsive therapy
  • Telemental health appointments

How you can impact the HEDIS FUA measure

To impact the HEDIS FUA measure and improve care delivery, be sure to:

  • Use correct documentation and coding
  • Maintain appointment availability for your patients with recent ED visits
  • Contact patients who cancel their follow-up appointments and reschedule them as soon as possible and within 7 days

Additionally, if you suspect one of your patients may be struggling with substance use or abuse, we recommend screening them prior to diagnosis. By screening patients, you can help identify those who may need additional care to recover.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Finding news icon

Discover more news

Personalized news icon

Get personalized news