HEDIS

HEDIS

 

Are you collecting the HEDIS incentive with the Health Plans your Participate  with ?

 The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 81 measures across 5 domains of care. Because so many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an "apples-to-apples" basis

 

Sample below shows the requirements to meet the measure for  Comprehensive Adult Diabetes Care ( CDC ):

 The use of the following CPT CATII Codes will identify that a service was performed for the measure:

 

For HbA1c:

3044F: Most recent hemoglobin A1c (HbA1c) level less than 7.0% (DM)

3045F: Most recent hemoglobin A1c (HbA1c) level 7.0-9.0% (DM)

3046F: Most recent hemoglobin A1c level greater than 9.0% (DM)

 

For LDL-C:

3048F: Most recent LDL-C less than 100 mg/dL (CAD) (DM)

3049F: Most recent LDL-C 100-129 mg/dL (CAD) (DM)

3050F: Most recent LDL-C greater than or equal to 130 mg/dL (CAD) (DM

 

For Eye:

2022F: Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed (DM)

For Foot:

 

2028F: Foot examination

performed (includes examination through visual inspection; sensory exam with monofilament; and pulse exam - report when any of the 3 components are completed) (DM)

 

Understanding what is required for each HEDIS measure is key to the practice and your continued  participation with the various Health Plans. When the  Health Plans Score successfully  you the provider receive the incentive.

 

AccuChecker provides a HEDIS Module to assist you  in understanding each HEDIS measure and shows how to correctly code to qualify for the Measure.

 

www.accuchecker.com

For more details, a Free Trial or Webinar call : 305-227-2383  or 1-877-938-9311

 

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HEDIS and AccuChecker

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The AccuChecker OnLine is an Internet service with:

 

·         Procedures – CPT, Category II and HCPCS codes.

·         Diagnoses codes (ICD-9-CM and ICD-10-CM).

·         Free HOT-LINE SUPPORT.

·         HEDIS

·         PQRS ( P4P )

 

The HEDIS Module helps you identify the various Measures and how to correctly code to qualify the measure.

 

Understand what it takes to code for the Measure and what documentation should be in place.

 

Two Modules Available:         BASIC  or CLASSIC   

Two Versions Available :         STATE  or NATIONAL

  

You may purchase via  PAYPAL or CREDIT CARD

 

Accuchecker , the ONE resource for all your REIMBURSEMENT needs.

 

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HEDIS - Pediatric Care

HEDIS - Pediatric Care

Ø  Well-Child Visits in the First 15 Months of Life (W15)

Ø  Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)

Ø  Childhood Immunization Status (CIS)

Ø  Adolescent Well-Care Visits (AWC)

Ø  Immunizations for Adolescents (IMA)

Ø  Lead Screening in Children (LSC)

Ø  Annual Dental Visits (ADV)

Ø  Appropriate Treatment for Children with Upper Respiratory Infections (URI)

Ø  Appropriate Treatment for Children with Pharyngitis (CWP)

With all of the uncertainties surrounding health care today, it has become increasingly more important for Providers  to have a reliable method for determining how to capture the various Measurements and still deliver quality of care.  

Quality improvement, performance assessment, and transparent reporting have emerged as key

expectations in today’s health care environment. For that reason, the Healthcare Effectiveness Data and Information Set (HEDIS®) is used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. Public reporting of HEDIS and other core measures will also be mandated by the Centers for Medicare & Medicaid Services (CMS) in the future for Medicaid children enrolled in the Children’s Health Insurance Program (CHIP).

 

What can AccuChecker do for you?

Let’s improve Coding & Reimbursement Now 

• Determine what Measurements are required for your patient ?

• How to code to qualify the Measurement?

• Is the documentation correct? 

HEDIS = Incentive $$$$ for you the Provider 

For more details, please call : 305-227-2383  or  1-877-938-9311

 

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HEDIS and The Health Plans

HEDIS and The Health Plans

Health Plan works to promote preventive health care and to improve chronic care for their members. The effectiveness is measured by Healthcare Effectiveness Data and Information Set (HEDIS), a set of quality improvement indicators set forth by the National Committee on Quality Assurance (NCQA). HEDIS results are used to compare health plans both statewide and nationally. The goal is to reach the national Medicaid 90th percentile on all measures, which will result in bringing more patients to the providers.

Innovative programs created by health plans around the country are credited with boosting immunization rates to unprecedented levels, especially among infants and older children. But what makes these programs, which go by such names as "Getting Bigger," "Great Expectations for a Healthy Baby" and "Health Ride," so successful?

There are five typical characteristics.

First, they determine how many eligible children are up to date on immunizations at their second birthday, even if they suspect the rates will be low.

Second, they identify the factors associated with low coverage.

Third, by assessing their immunization activities and using criteria such as Health Plan Employer Data and Information Set (HEDIS) to collect, track and document data, they identify missed opportunities to vaccinate.

Fourth, these plans demonstrate commitment to developing innovative interventions designed to raise immunization levels.

Finally, they are committed to working toward the federal Childhood Immunization Initiative's goal for 2000 that at least 90 percent of children receive the recommended series of vaccinations by their second birthday, and to ensuring continuous accreditation of health plans by organizations such as the National Committee for Quality Assurance (NCQA).

 

Understanding how HEDIS effects the Health Plans is key. However, for the Health Plan to meet the HEDIS score, they require a partnership with the PCP. Does the provider understand how HEDIS works at the primary care level?  Is the PCP aware of the incentive ? Does the PCP fully understand what is required to qualify the measure?

AccuChecker OnLine CLASSIC is an Internet database subscription service with procedures, diagnoses (ICD-9 and ICD-10) Medicare fee schedules using RBRVS tables and coding techniques. Today , AccuChecker Online has a HEDIS Module and PQRS Module to help physician qualify for each Measure.

 

For a Free Trail or Webinar, contact our office.

 

 

For more details, please call : 305-227-2383  or  1-877-938-9311

 

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HEDIS and Generic Prescribing

Generic Prescribing Rate

 

Another aspect of care that we report to both primary care and specialist physicians who are eligible for the incentive programs is their prescription of generic (non-brand) drugs. Generics are FDA-approved and must be shown to be equivalent to the brand name. These drugs are usually less expensive than the brand-name drug and most prescription drug plans charge a lower copayment when a member receives a generic drug, saving the member money. CDPHP calculates the percentage of all prescriptions that a physician writes for generic drugs and reports that information to the physician if he or she has written more than 100 prescriptions in the previous year. We also report on the rate of generic prescriptions for specific types of drugs that have generic alternatives available. These classes are reviewed each year and may change based upon review of our current results.

THE EYE OPENER TO RISK MANAGEMENT OPERATIONS

MCAR – MANAGED CARE REPORTS

Timely solutions to funding, claims, pharmacy & distributions

 

Here are some of the options available:

 

·         Control over HEDIS requirements, alerting what measures apply to each member of the HMO panel and most importing identifying what measures are pending per member in the reporting period.

·         Summary analysis of funding and expenses including expected distributions, in minutes you know what is going on with your risk operation.

·         A PCP Analysis that shows performance for each PCP in the network from funding, expenditures to net amount after medical expenses. A simple and easy report that enables you to identify and compare all PCP’s performance.

·         MCAR produces a detailed analysis of charges payments and adjustments from Institutional, Professional and Pharmacy claims.

·         A key report - Summary Report showing what each member is costing the panel, a brief breakdown of medical expenses also showing when was the last time the patient came to the office, if ever.

·         A detailed analysis showing all activities for every member - HEDIS measure status, diagnosis codes with MRA evaluation plus each line item of expenses – YOU CAN VIEW THE PRECISE COST OF EACH MEMBER OF THE PANEL.

·         STOP LOSS verification.

·         MCAR Reports claims module – “The ADJUDICATOR” scrubs your professional, institutional and pharmacy claims and also prepares a contestation report requesting adjustments from the Plan.

 

 

For more details, please call : 305-227-2383  or  1-877-938-9311

 

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