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

Welcome

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

Children are our future!

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 Regionally all plans are scoring poorly

Regionally

Systems Providers Patients Barriers

Henry M. Neilley, MD, FAAP

Best Practice

Health and developmental history Physical exam Immunizations Lead screening – children under 2 yrs Health Education / Anticipatory Guidance Components of a 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 Preparing for a comprehensive well 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 Suggestions for combining a well and sick visit

Missed opportunities Parental concerns Appointment scheduling Transportation Barriers

Lisa Phillips, BSN

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 Immunizations and more

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

Documentation NYSIIS - New York State Immunization Information System

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 VFC Vaccines for Children

Kathryn Glasser, CPC

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

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

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 Coding Resources

Clinical Edit Search Request

Clinical Edit Result

Code and Comment Sample 1

Code and Comment Sample 2

Code and Comment Key – Sample

Practice Specific Questions Contact the Provider Relations Department to speak with your representative. BSNENY Providers

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

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

Questions

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