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November 2015
Year-end submission dates nearing for Diagnosis Closure Incentive Program
Important note about closing diagnosis gaps
When using Health e-Blue’s Diagnosis Evaluation panel to confirm or deny a patient condition, be sure you’re 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’re not actively treating the condition. The suspected or historic condition must be addressed during a patient visit. You must confirm that either the patient no longer has the condition or the condition doesn’t exist.
Keep in mind that if a prior year service date is entered for a 2015 diagnosis gap, the diagnosis gap will open with the next refresh and the gap closure won’t count toward your 2015 incentive payment.
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.
Schedule patient visits by end of year
Be sure to see your Blue Cross and BCN Medicare Advantage patients before the end of the calendar year to document and close diagnosis and treatment opportunity gaps. Information about gap closures should be submitted via Health e-BlueSM under Panel – Diagnosis Evaluation and Treatment Opportunities by Condition/Measure by Jan. 28, 2016. You may also submit a claim as part of your documentation.
Close all diagnosis gaps
All the diagnosis gaps included in the 2015 Diagnosis Closure Incentive for Jan. 1 through Sept. 30, 2015, are listed on Health e-Blue under Panel – Diagnosis Evaluation. To earn incentives, physicians must close all the diagnosis gaps (identified through Sept. 30, 2015) that exist for a patient through a face-to-face visit before the end of 2015. Physicians can also notify Blue Cross or BCN that the patient doesn’t have the suspected or previously reported diagnosis.
Diagnosis gaps will continue to appear on Health e-Blue from Oct. 1 through Dec. 31, 2015. While we’ll continue to display new gaps, physicians are responsible for closing diagnosis gaps identified before Oct. 1 to earn an incentive.
More information is available in the Resources section of Health e-Blue, select 2015 Diagnosis Closure Incentive Program. A frequently asked questions and fact sheet can also be found on web-DENIS within BCBSM Provider Publications and Resources by clicking on Patient Care Reporting.
Submit diagnosis closure patient data
Diagnosis and treatment opportunity closures must be submitted to Blue Cross and BCN by the following dates:
Method |
Deadline |
Claim submission |
Received by Feb. 29, 2016 |
Health e-Blue |
Entered by Jan. 28, 2016 |
If you don’t have access to Health e-Blue, sign up today. If you have questions, contact your provider consultant.
Looking ahead
The Diagnosis Closure Incentive Program will continue in 2016. 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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