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December 2013
Here’s what you need to know about Diagnosis Closure Incentive and Performance Recognition Program
Schedule patient visits by end of year
Be sure to see your Blues Medicare Advantage patients before the end of the year to document and close diagnosis and treatment opportunity gaps. Information about gap closures should be submitted via Health e-BlueSM under Panel – Diagnosis Closure and Treatment Opportunities by Condition/Measure Panel by Jan. 24, 2014. You may also submit a claim as part of your documentation. In addition, if you received a paper Member Diagnosis Closure and Treatment Opportunities report in the mail, you should fax it to 1-866-707-4723.
Blue Cross Blue Shield of Michigan and Blue Care Network are nearing the conclusion of this year’s incentive programs for primary care physicians who close diagnosis and treatment opportunity gaps for their Blues Medicare Advantage patients. Here are the details you need to know.
Diagnosis Closure Incentive Program
All of the diagnosis gaps included in the 2013 Diagnosis Closure Incentive for the period of Jan. 1 through Sept. 30, 2013, are listed on Health e‑BlueSM under Panel – Diagnosis Evaluation. In order to earn incentives, physicians must close all the diagnosis gaps (identified through Sept. 30, 2013) that exist for a patient through a face‑to‑face visit before the end of this calendar year. Alternatively, they can notify the Blues that the patient doesn’t have the suspected or previously reported diagnosis.
Diagnosis gaps will continue to appear on Health e-Blue Oct. 1 through Dec. 31, 2013. While new gaps will continue to be displayed after September, physicians are responsible for closing diagnosis gaps identified prior to Oct. 1 for purposes of earning an incentive.
More information is available in the Resources section of Health e‑Blue by clicking on 2013 Diagnosis Closure Incentive Program and FAQ. A fact sheet can also be found on web‑DENIS within BCN Provider Publications and Resources by clicking on BCN Advantage.
Performance Recognition Program
Treatment opportunity gaps included in the 2013 PRP incentive for the period Jan. 1 through Dec. 31, 2013, are listed on Health e‑Blue under the Treatment Opportunities by Condition/Measure Panel. In order to earn incentives, physicians must close treatment opportunities that exist for a patient before the end of this calendar year.
More information is available in the Resources section of Health e‑Blue by clicking on 2013 BCBSM MA PPO PRP Booklet and Exhibits or BCN 2013 BCN Advantage Incentive Program booklet and specifications.
Diagnosis and treatment opportunity closures must be submitted to the Blues by the following dates:
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Method |
Deadline |
Claim submission |
Received by Feb. 28, 2014 |
Health e-Blue |
Entered by Jan. 24, 2014 |
Paper Member Diagnosis Evaluation and Treatment Opportunities report (for BCBSM out-of-state physicians and in-state physicians without access to Health e-Blue) |
Faxed or postmarked by Jan. 31, 2014 |
Paper medical record (for BCBSM physicians) |
Faxed or postmarked by Jan. 31, 2014 |
If you don’t have access to Health e‑Blue, sign up today. If you have questions, please contact your provider consultant or provider representative.
Details about next year’s PRP Incentive will be announced soon while information about the Diagnosis Closure Incentive program will be announced next year. In the meantime, physicians are encouraged to continue to check Health e-Blue for patient conditions, schedule face-to-face office visits and close historical or suspected patient diagnosis and treatment opportunity gaps in the coming year.
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