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BlueShield of Northeastern New York

BlueShield of Northeastern New York. Make every visit a preventive visit March 20 , 2013. Welcome. Opening Remarks. We will cover: Evidence based clinical guidelines about an effective well visit Administration and documentation of immunizations Lead Screening Coding P4P .

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BlueShield of Northeastern New York

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  1. BlueShield of Northeastern New York Make every visit a preventive visit March 20, 2013

  2. Welcome

  3. Opening Remarks We will cover: • Evidence based clinical guidelines about an effective well visit • Administration and documentation of immunizations • Lead Screening • Coding • P4P

  4. Children are our future!

  5. Regionally all plans are scoring poorly Let’s talk about some Regional statistics • The graphs will show the Commercial and Medicaid specific statistics and the NYS Medicaid averages • Lets take a look at the data in the next few slides in the context of thinking about changes that could be made to improve care

  6. Regionally

  7. Regionally

  8. Regionally

  9. Regionally

  10. Regionally

  11. Barriers • Systems • Providers • Patients

  12. Henry M. Neilley, MD, FAAP

  13. Best Practice

  14. Components of a well visit • Health and developmental history • Physical exam • Immunizations • Lead screening – children under 2 yrs • Health Education / Anticipatory Guidance

  15. Preparing for a comprehensive well visit • Accurate appointment time frame • Reminder systems to decrease no shows • Optimization of EMR systems • Parent preparation for the well visit – both the parent and the doctor/office • Relationship building with child/parent

  16. Suggestions for combining a well and sick visit • Know the components that make up a well visit • Determine how much can be covered in one visit – how likely is the patient to return for another visit? • Know what immunizations can be given when a child presents sick • Importance of documentation as it relates to a sick and/or well visit

  17. Barriers • Missed opportunities • Parental concerns • Appointment scheduling • Transportation

  18. Lisa Phillips, BSN

  19. Immunizations and more • Overview of child and adolescent immunizations – changes in the 2013 schedule • Importance of following the schedule • Importance of entering in NYSIIS – immunizations and lead screening • VFC program and how to order

  20. 2013 updates • There is a copy of immunization schedule in your packet • Let’s review some pertinent updates in this schedule

  21. NYSIIS - New York State Immunization Information System • Documentation • Documentation • Documentation

  22. VFC Vaccines for Children The Vaccine for Children (VFC) Program • In your packet there is a reminder on how to order • Any questions related to ordering this VFC vaccine? • Don’t forget to bill for the administration of the VFC vaccine

  23. Kathryn Glasser, CPC

  24. Coding: best practices • Choosing codes • Coding resources online • Coding documents in handout packet • After the seminar

  25. The Chicken or the Egg • Sick (E&M) vs. Well (Preventive) • Provide the services • Document what was provided • Code what was documented

  26. Coding Resources www.bsneny.com Provider > Login > Payment and Operations • Clinical Editing > Clinical Edit Search - represents the relationship(s) between CPT codes and the supporting clinical rationale for their bundled or unbundled states • Code Resources > Code and Comment - provides detailed coverage information for a specific CPT code

  27. Clinical Edit Search Request

  28. Clinical Edit Result

  29. Code and Comment Sample 1

  30. Code and Comment Sample 2

  31. Code and Comment Key – Sample

  32. Practice Specific Questions • Contact the Provider Relations Department to speak with your representative. BSNENY Providers 518-220-5601

  33. BlueShield is here to help you! • Reminders via phone and mail are made regarding immunizations • Pediatric Disease Management nurses available

  34. BlueShield is here to help you! • P4P – what’s new in 2013 • Implementation of new analytics tool • Pinpoint gaps in care • Revise methodology • Generate reports

  35. BlueShield is here to help you! • P4P measures • Childhood Immunizations • Lead Screening • Use of Appropriate Medication for People with Asthma • Appropriate Treatment for children with URI • Appropriate Testing for children with Pharyngitis • Chlamydia Screening

  36. Questions

  37. Thank You! A division of HealthNow New York, Inc. An independent licensee of the BlueCross BlueShield Association. BlueShield and the Shield symbol are registered trademarks of the BlueCross BlueShield Association.

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