AETNA BETTER HEALTH Brian Clark
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1 AETNA BETTER HEALTH Brian Clark Diana Charlton The webinar will begin shortly. January 20181
2 Reducing the burden of medical record review - Preparation for HEDIS 2018 Dates of webinar offerings: January 10, :00 AM EST January 17, :30 EST 2
3 Housekeeping Mute on/off Participate Type Responses in Chat Box to All Panelists WebEx Q&A Send to All Panelists 3
4 Our values Integrity We do the right thing for the right reason. Inspiration We inspire each other to explore ideas that can make the world a better place. People we serve Excellence We strive to delive r the highest quality and value possible through simple, easy and relevant solutions. Caring We listen to and respect our customers and each other so we can act with insight, understanding and compassion. 4
5 Today s agenda Agenda Description & purpose of HEDIS Medical record review 2018 Preferred method of record returns Closing Gaps via MRR Preparation for 2019 NCQA coding Health plan point of contact 5
6 Description & purpose of HEDIS 6
7 HEDIS What does HEDIS stand for? Healthcare Effectiveness Data and Information Set 7
8 What is HEDIS? HEDIS (Healthcare Effectiveness Data and Information Set) is: Developed and maintained by the National Committee for Quality Assurance (NCQA) A standardized way for health plans to document health care services provided to members HEDIS 2018 collects data for care given primarily in
9 Who uses HEDIS data? The public may use HEDIS ratings when choosing a health plan Regulatory bodies may use HEDIS data for accreditation or enrollment purposes Provider pay-for-quality programs are often tied to HEDIS scores. 9
10 How is HEDIS data gathered? HEDIS data is collected two ways: Claims and other administrative data Pharmacy Labs Diagnostics imaging Encounters Inpatient/ED admissions Immunization registries Medical Record Review - (Hybrid review) 10
11 Medical record review 2018 (February May 2018) Medical record review/collection List dissemination Fax Blast Secure Mail 11
12 Question please type response in the chat box. What is your practice s preferred method of list dissemination? 12
13 Medical record review 2018 Medical record review/collection Record returns Secure Fax/ Portal Upload Remote access / Data share Third party copy services Mail Onsite 13
14 Question please type response in the chat box. Which method do you use to submit records during HEDIS A- Secure Fax/ B- Portal Upload C- Remote access D- Third party copy services (CIOX, MRO, RSS) E- Mail (paper, disc) F- Onsite 14
15 Questions? Please type any questions that you may have at this time in to the Q/A box. 15
16 Closing gaps via MRR 16
17 HEDIS Measures Covered Today Pediatric Measures Well Care & Weight Assessment (AWC, W34, WCC) Well Care- (W15) Immunizations- (CIS, IMA) Adult Measures Adult BMI Assessment (ABA) Controlling High Blood Pressure (CBP) Comprehensive Diabetes Care (CDC) Women s Health Measures Cervical Cancer Screening (CCS) Frequency of Ongoing Prenatal Care (FPC) Prenatal and postpartum Care (PPC) 17
18 Closing HEDIS Gaps via MRR What to send for pediatric measures Well Care & Weight Assessment AWC; W34; WCC Outpatient visits with PCP/Pediatrician in 2017 Well Care- W15 Outpatient visits from birth with PCP/Pediatrician. Immunizations- CIS; IMA CIS- Immunization record and evidence of lead screening IMA- Immunization record 18
19 Closing HEDIS Gaps via MRR What to send for adult measures Adult BMI Assessment - ABA 2016 or 2017 progress notes indicating height, weight, BMI Controlling High Blood Pressure - CBP Diagnosis/problem list indicating hypertension Progress/office notes from 2016 through 6/30/2017 indicating diagnosis of hypertension Documentation showing last blood pressure in
20 Closing HEDIS Gaps via MRR What to send for members with diabetes Comprehensive Diabetes Care CDC All lab reports for A1c and urine tests for protein Documentation showing last blood pressure in 2017 Medication list for 2017 Eye exam report from 2016 and
21 Closing HEDIS Gaps via MRR What to send for women s health measures Cervical Cancer Screening CCS All PAP reports from Documentation must include the DOS and test results progress/office notes from PCP or Ob/Gyn visits - Notations of refusal of PAP screening or PAP screening DOS and results Problem list and past surgical history FPC and PPC All prenatal and postpartum care for deliveries between 11/6/16-11/5/17 - Labs and progress notes - Notation of non-live birth 21
22 Questions? Please type your question in the Q/A box. 22
23 Preparation for
24 Preparation for 2019 Fully code in 2018 to decrease medical record review burden in 2019 Gaps in Care Report Access - Provider Report Management Tool - Tableau Additional support - Point of contact - Monthly webinar - Educational documents 24
25 Question please type response in the chat box. How often do you access your gaps in care reports for member outreach and gaps in care closure? A - Weekly B - Monthly C - Quarterly D Rarely or never E - I don t know how to access our gaps in care reports 25
26 NCQA Coding Tips 26
27 NCQA Coding Tips Fully coding on claims Reduces the burden of medical record requests during HEDIS season. 27
28 NCQA Coding Tips Closing gaps through coding in 2018 Breast Cancer Screening (BCS) Test Code Class Codes Mammography CPT ; ; Mammography HCPCs G0202; G0204; G02026 Chlamydia Screening (CHL) Test Code Class Codes Chlamydia Test CPT 87110; 87270; 87320, ; Follow-up Care for Children Prescribed ADHD Medication Visit Type Code Class Codes ADD Stand Alone Visits CPT , , 99078,
29 NCQA Coding Tips Closing gaps through coding in 2018 Well Care Visit Code Class Codes Well-care CPT , , ABA (Adult BMI assessment) Test Code Class Codes BMI Value ICD-10 Z68.1; Z Z68.29; Z Z68.39; Z Z
30 NCQA Coding Tips Closing gaps through coding in 2018 WCC (Weight assessment and counseling for nutrition and physical activity for children/adolescents) Test Code Class Codes BMI Percentile ICD-10 Z68.51-Z68.54 Nutrition Counseling CPT Physical Activity Counseling HCPCs G0447; S
31 NCQA Coding Tips Closing gaps through coding in 2018 CDC (Comprehensive Diabetes Care) Test Code Class Codes HbA1c Tests CPT 83036; HbA1c Results CPT 3044F; 3045F; 3046F Urine Protein CPT 82042; 82043; 82044; 84156; 3060F; 3061F CCS (Cervical Cancer Screening) ICD 10 diagnosis code will not count if submitted alone. ICD 10 diagnosis code must be accompanied by CPT code from the lab. Test Code Class Codes Cervical Cytology CPT 88141, 88142, 88143, 88147, 88148, HPV Tests CPT 87620, 87621, Absence of cervix CPT 59125, 56308, 57540,
32 NCQA Coding Tips Closing gaps through coding in 2018 Maternity (FPC) - Frequency of ongoing prenatal care Retired HEDIS measure (some states may require FPC as a performance measure) (PPC) Prenatal and postpartum care Visit Type Code Class Codes Standalone prenatal visit CPT 99500; 0500F; 0501F; 0502F Postpartum visit CPT 57170; 58300; 59430; 99501; 0503F 32
33 Questions? Please type your question in the Q/A box. 33
34 End of Webinar Q/A How to access your health plan point of contact Utilize the Q/A box now! Type in your name, your comment/question, your state, county, and your to All Panelists Someone will be in touch with you within 24 hours after the Webinar 34 46
35 Who is my point of contact in my state? Point of contact by state Florida Michelle Delarosa Health Care Quality Management Consultant Texas Joanna Rhodes Director Provider Relations 35
36 Who is my point of contact in my state? Pennsylvania Diana Charlton Quality Management Nurse Consultant Louisiana Frank Vanderstappen Manager Health Care QM Kentucky Kathy Recktenwald Quality Management Nurse Consultant 36
37 Who is my point of contact in my state? Ohio Sara Landes Director Quality Management Valerie Smith HEDIS Manager Michigan Dante Gray Manager Health Care Quality Management 37
38 Who is my point of contact in my state? Illinois Anya Alcazar Director Quality Management Maryland Donald Miller Health Care QM manager New Jersey Sami Widdi Health Care Quality HEDIS manager 38
39 Next month s webinar HEDIS measures of care affecting 21 and older male and female members Two offerings: morning and afternoon 39
40 Thank you for attending today s Webinar
June Thank you for attending today s Webinar. We will begin shortly. June Brian Clark. Diana Charlton. Debbie Barkley Aetna Inc.
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