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October 2014
2014 Blues Medicare Advantage Performance Recognition Program updated
Blue Cross Blue Shield of Michigan and Blue Care Network have changed the 2014 BCBSM Medicare Advantage PPOSM and BCN AdvantageSM Performance Recognition Program for primary care physicians.
The changes are a result of revisions that the National Committee for Quality Assurance recently made to their guidelines for diabetes LDL-C testing and control, cardiovascular disease LDL-C testing and control, and glaucoma screening. The changes are noted below. The complete details can be found in BCBSM Medicare Advantage Health e-BlueSM or in BCN Health e-BlueSM in the Resources section.
Blues Medicare Advantage PRP changes
The following measures are being removed:
- Comprehensive diabetes care – LDL-C screening
- Comprehensive diabetes care – LDL-C control (<100 mg/dl)
- Cholesterol management for patients with cardiovascular disease – LDL-C Screening
- Cholesterol management for patients with cardiovascular disease – LDL-C control (< 100 mg/dl)
- The glaucoma screening bonus as a bonus incentive.
Beginning with dates of service Aug. 1, 2014, or after, the base PRP will be scored on the following five quality measures:
- Breast cancer screening
- Colorectal cancer screening
- Comprehensive diabetes care – A1C control <9%
- Comprehensive diabetes care – monitoring for nephropathy
- Comprehensive diabetes care – retinal eye exam
As a result of these changes, there will be two pay-as-you-go measurement periods with different incentive amounts this year.
Pay as you go… |
Covers dates of service… |
Includes… |
First payment |
January through July 2014 |
All nine original measures |
Second payment |
August through December 2014 |
Five remaining measures |
Contact your provider consultant if you have any questions about the Performance Recognition Program. | 