* HQPAF program (2,757) Healthcare Quality Patient Assessment Form

Transcription

1 * RAF review program *Medigold (1,130) *CaDET RAF Educational Program *Humana MA (3,199) * HQPAF program (2,757) Healthcare Quality Patient Assessment Form *UHC MA/UHC MA ( 444) *Aetna MA (1211) *Anthem/Wellpoint MA (864) *Medigold (238)* 1

2 The process: A patient engagement coordinator (PEC) will work out of the CSO to identify Medigold patients scheduled for an appointment and to have access to the patients EHR. The PEC creates a Clinical Documentation Improvement Alert worksheet and delivers them to the practice in advance of the patient appointment. (See handout) The practice will need to have a mechanism to get this information in front of the provider, ideally at the time of the patient s appointment. One of our requirements is to have the PEC forms returned within 14 days of the patient s date of service. When the PEC drops off new documentation forms (s)he will pick up the completed ones. Qualifying Practices within AHN Ohio: Includes only practices with more than 70 Medigold lives Central Ave 71 Cooper Road 168 Dr. Nimeth 82 E. Main St 472 Fredericktown 74 Hilliard 83 Westerville 180 2

3 Activity Requirements due by December 31, 2015: 1. Return to the DDDS PEC no less than 75 percent (75%) of the DDDS Clinical Alerts with corresponding progress notes, within two (2) weeks of each date of service; and 2. Address and close no less than fifty percent (50%) of confirmations of diagnoses and CDI opportunities listed on the Clinical Alerts. (Confirmations of diagnoses and CDI opportunities can be closed by checking either the Yes or No box. Checking the Not Addressed box does not count toward the required percent of confirmations of diagnoses and CDI opportunities addressed); and 3. Treatment by Practice of no less than 25 percent (25%) of the Practice's attributed MediGold members. (Not all Medigold member will need to be seen) Assuming a 75% CDI return rate; 50% Diagnosis /Opportunities can be closed/confirmed and 25% of Medigold visit seen by 12/31/15. Estimated add-on revenue for each practice Central Ave 71 (18) $3,550 Cooper Road 168 (42) $8,400 Dr. Nimeth 82 (21) $4,160 E. Main St 472 (118) $23,600 Fredericktown 74 (19) $3,700 Hilliard 83 (21) $4,150 Westerville 180 (45) $9,000 3

4 CaDET RAF Educational program Humana MA (3,199) This program will put in place a sustainable process for appropriately capturing the health status of Medicare Advantage patients through: o o o Onsite provider education surrounding the HCC model. Certified coder chart review to assist in identifying chronic conditions and coding to the highest specificity. NextGen-integrated messaging to communicate un-reported chronic conditions. The presentation is usually best offered during the lunch hour, but could be scheduled at a different time of day if that is more practical for the physicians and staff. The on-site education and medical record review may last over the course of two days. CaDET RAF Educational program Humana MA (3,199) All physicians coders and NPPs are encouraged to attend. The first day is designated for the one hour education presentation and medical record documentation review. The second day would be devoted to any requested individual follow-up appointments with the educator and physicians, regarding clinical documentation improvement as related to their individual record reviews and any additional questions the physicians may have regarding Medicare Risk Adjustment documentation. Tim will help coordinate scheduling with this training. 4

5 HQPAF program (2,757) Healthcare Quality Patient Assessment Form two to eight pages of health plan specific information provided by the health plan. Includes: Patient identifying information Provider identifying information Early detection ( chronic illness or screenings to consider) i.e. Cognitive Function, Depression, physical activity Preventive Medicine Screening i.e. BMI, Breast CA screening Ongoing Assessment & Evaluation (diagnosis previously coded/ prescription claims processed). OV/ER visit history (prior 24 months) 3 year condition list list of ICD diagnosis codes billed in prior three years HQPAF program (2,757) Healthcare Quality Patient Assessment Form Summary of Results ( see handout) 2015 = 2,757 HQPAF opportunities More than 60% of the HQPAF are deployed at the practice level in the visit or scheduling workflow Avg HQPAF payment / provider = $ Avg HQPAF payment / provider = $2,574 UHC program pays a quality bonus with its HQPAF program 5

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