Medicare Advantage Diagnosis Closure Incentive program continues in 2014 for primary care physicians

Blue Cross Blue Shield of Michigan and Blue Care Network are pleased to announce that the Medicare Advantage Diagnosis Closure Incentive program will continue in 2014.

The incentive program again applies to Blues Medicare Advantage patients, including those with BCBSM Medicare Plus Blue PPO^SM, Medicare Plus Blue Group^SM PPO, BCN Advantage HMO-POS^SM and BCN Advantage HMO^SM coverage.

Here’s how it works
The Diagnosis Closure Incentive rewards attributed physicians for having annual face-to-face visits with Blues Medicare Advantage patients to evaluate, document and code diagnoses according to standards set by the Centers for Medicare & Medicaid Services. Physicians will receive a financial incentive for closing diagnosis gaps identified by the Blues.

The Diagnosis Evaluation Panel on Health e-Blue^SM lists patients who are suspected of having a condition based on pharmacy claims, medical claims, other supplemental data sources or prior year diagnoses, but the diagnosis hasn’t been submitted to the Blues in the current year. The report will be refreshed monthly so physicians can track their progress in closing these identified diagnosis gaps.

A suspected or historic condition that hasn’t been documented and coded in the current year is considered a “gap.”

The Blues will pay physicians $100 for each Medicare Advantage member with one or more gaps identified between Jan. 1, 2014, and Sept. 30, 2014, and for whom all gaps are closed during a face-to-face encounter by Dec. 31, 2014.

An identified gap can be closed following a face-to-face visit with the patient in 2014. During this visit, the physician should manage, evaluate, assess and treat the condition and the diagnosis should be documented in the patient’s medical record following CMS guidelines. The gap can then be closed through one of the following methods.

• Confirm the diagnosis code:
• By submitting a claim with the diagnosis code
• Through Health e-Blue
• By submitting a paper Member Diagnosis Evaluation and Treatment Opportunities Report (for those without access to Health e-Blue)
• By submitting a patient medical record
• Notify the Blues that the patient does not have the suspected condition:
• Through Health e-Blue
• By submitting a paper Member Diagnosis Evaluation and Treatment Opportunities Report (for those without access to Health e-Blue)

More information about this incentive program will be posted on Health e-Blue for Medicare Advantage primary care physicians in the first quarter 2014. If you don’t have access to Health e-Blue, sign up today on bcbsm.com/provider. Contact your provider consultant if you need assistance.

Web-DENIS member care alerts
When checking patient eligibility and benefits on web-DENIS, be sure to check your member care alerts, which have been updated to include 2014 patient gaps in care. These alerts, color-coded to help you identify patient needs quickly, display a printable list of diagnosis gaps and treatment opportunities for patients.

Training on documentation, coding and closing gaps
The Blues have staff available who can provide training to physicians and their office staff on proper documentation and coding guidelines and the importance of closing gaps for Medicare Advantage patients. Contact your provider consultant for more information.

Ask your provider consultant for a set of tip cards for your office called Documentation and Coding Tips for Professional Offices. The tip cards are also available electronically on web-DENIS. From the web-DENIS home page:

• Click on BCBSM Provider Publications and Resources.
• Click on Newsletters and Resources.
• Click on Provider Training.

2013 incentive payment
If you participated in the 2013 Diagnosis Closure Incentive program, your incentive payment will be mailed to you by the end of the second quarter.