Medicare Advantage Diagnosis Closure Incentive program continues in 2018

Blue Cross Blue Shield of Michigan and Blue Care Network are continuing the Medicare Advantage Diagnosis Closure Incentive program this year for dates of service on or after Jan. 1, 2018.

The program applies to Medicare Advantage patients, including those covered by:

• Blue Cross Medicare Plus Blue^SM PPO
• Medicare Plus Blue^SM Group PPO
• BCN Advantage^SM HMO-POS
• BCN Advantage^SM HMO

The program rewards participating primary care doctors for having annual, face-to-face visits with Blue Cross and BCN Medicare Advantage patients to evaluate, document and code diagnoses according to standards set by the Centers for Medicare & Medicaid Services.

Doctors will receive a financial incentive for closing diagnosis gaps identified by Blue Cross and BCN. A gap is a suspected or previous condition that hasn’t been documented and coded in the current year.

Diagnosis Evaluation Panel

The Diagnosis Evaluation Panel on Medicare Advantage Health e-Blue^SM or BCN Health e-Blue^SM — found in the Provider Secured Services area of bcbsm.com — lists patients who are suspected of having a condition, based on one of the following, but whose diagnoses haven’t been submitted to Blue Cross or BCN in the current year:

• Pharmacy claims
• Medical claims
• Other supplemental data sources
• Prior-year diagnoses

An identified gap can be closed after a face-to-face visit with the patient in 2018. During this visit, the doctor should manage, evaluate, assess or treat the condition and document the diagnosis in the patient’s medical record following CMS guidelines. Then close the gap through one of the following methods:

• Confirm the diagnosis code:
• By submitting a claim with the diagnosis code
• Through Health e-Blue
• By submitting the patient’s medical record
• Check Health e-Blue to confirm that the patient doesn’t have the suspected condition.

You shouldn’t close a gap because you’re not actively treating the condition. Only close a diagnosis gap if you’ve:

• Conducted an office visit
• Addressed the condition
• Determined that the patient no longer has the condition or the suspected condition doesn’t exist

Information on Health e-Blue is refreshed monthly so doctors can track their progress in closing identified diagnosis gaps.

Rewards for closing gaps

Blue Cross and BCN will pay doctors $100 for each Medicare Advantage member with one or more gaps identified between Jan. 1 and Sept. 30, 2018, and for whom all gaps are closed during a face-to-face visit by Dec. 31, 2018.

More information about this incentive program will be posted on Health e-Blue for Medicare Advantage primary care doctors in the first-quarter 2018.

If you don’t have access to Health e-Blue, you can request it on the application for Provider Secured Services and complete the section for Health e-Blue. For more information, go to How do I get access to Provider Secured Services?

If you already have access to Provider Secured Services and Health e-Blue and just need to update users, fill out this authorization form and fax it to the number on the form.

web-DENIS member care alerts

When checking patient eligibility and benefits on web-DENIS, check your member care alerts. The alerts have been updated to include 2018 patient gaps in care.

These alerts are color-coded to help you identify patients’ needs quickly, and they display a printable list of diagnosis gaps and treatment opportunities for patients.

2017 incentive payment

If you participated in the 2017 Diagnosis Closure Incentive program, your incentive payment will be mailed to you by the end of the third quarter in 2018.

Training available

We can provide training to doctors and their office staff about proper documentation, coding guidelines and the importance of closing gaps for Medicare Advantage patients. The training is available only to Michigan providers at this time.

Follow these steps to access online training resources:

1. Log in to web-DENIS.
2. Click BCBSM Provider Publications and Resources.
3. Click Newsletters & Resources.
4. Click Patient Care Reporting, and in the Training Resources section select any of these training links:
• Online training for risk adjustment, documentation and coding
• eLearning module: Online training: Best Practices for Medical Record Documentation
• Documentation and ICD-10 coding tips for professional offices

The 30-minute, eLearning module includes a 10-question assessment. If you score 80 percent or better, you’ll receive one continuing education credit from the American Academy of Professional Coders.

These presentations are also available in BCN Provider Publications and Resources under the Other Resources menu. Click on Patient Care Reporting for Risk Adjustment.