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October 2014
Reminder: Conduct patient visits by year-end to close diagnosis gaps for 2014 incentive
Important note about closing diagnosis gaps
When using Health e-Blue’s Diagnosis Evaluation panel or other methods to indicate that a diagnosis gap is closed because the condition does not exist, be sure that you are closing a diagnosis gap only if you have conducted an office visit and the patient no longer has the suspected (or historic) condition. A gap cannot be closed solely for the reason that you are not actively treating the condition. The suspected or historic condition must be addressed during a patient visit and you must confirm that the patient no longer has the condition or that the suspected condition does not exist.
Blue Cross Blue Shield of Michigan and Blue Care Network are nearing the conclusion of this year’s Diagnosis Closure Incentive Program 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.
Be sure to see your Blues Medicare Advantage patients before the end of the year to document and close diagnosis and treatment opportunity gaps. It’s important that all member conditions are addressed each year during an office visit, and that diagnosis code data is accurately documented and reported, following M.E.A.T. (manage, evaluate, assess and treat) guidelines to support medical necessity.
Information about gap closures should be submitted via Health e-BlueSM under Panel – Diagnosis Closure and Treatment Opportunities by Condition/Measure Panel by Jan. 22, 2015. 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.
All the diagnosis gaps included in the 2014 Diagnosis Closure Incentive for Jan. 1 through Sept. 30, 2014, are listed on Health e-BlueSM under Panel – Diagnosis Evaluation. To earn incentives, physicians must close all the diagnosis gaps (identified through Sept. 30, 2014) that exist for a patient through a face‑to‑face visit before the end of 2014. Following a face-to-face visit, you can also confirm that the patient does not have the condition, if applicable.
Diagnosis gaps will continue to appear on Health e-Blue from Oct. 1 through Dec. 31, 2014. While we’ll continue to display new gaps, 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; select 2014 Diagnosis Closure Incentive Program. An FAQ and fact sheet can also be found on web-DENIS in the Newsletters and Resources section by clicking on Medicare Advantage resources.
Diagnosis and treatment opportunity closures must be submitted to the Blues by the following dates:
Method |
Deadline |
Claim submission |
Received by Feb. 27, 2015 |
Health e-Blue |
Entered by Jan. 22, 2015 |
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. 30, 2015 |
Paper medical record (for BCBSM physicians)
- Diagnosis closure submission
- Treatment opportunities submission
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- Faxed or postmarked by Jan. 30, 2015
- Faxed or postmarked by Jan. 15, 2015
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If you don’t have access to Health e-Blue, sign up today. If you have questions, contact your provider consultant.
Physicians who close 100 percent of all identified gaps for each attributed patient will receive $100 per patient. Your incentive payment will be mailed to you by the end of third quarter 2015.
New 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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