Medicare Advantage Diagnosis Closure Incentive program continues in 2017

Blue Cross Blue Shield of Michigan and Blue Care Network are continuing the Medicare Advantage Diagnosis Closure Incentive program this year, effective for dates of service on or after Jan. 1, 2017.

The program applies to Medicare Advantage patients, including those with Blue Cross Medicare Plus Blue^SM PPO, Medicare Plus Blue^SM Group PPO, BCN Advantage^SM HMO-POS and BCN Advantage^SM HMO coverage. It rewards participating primary care doctors for having annual, face-to-face visits with Blue Cross and BCN Medicare Advantage patients to evaluate, document and code diagnoses according to standards set by the Centers for Medicare & Medicaid Services.

Doctors will receive a financial incentive for closing diagnosis gaps identified by Blue Cross and BCN. A “gap” is a suspected or previous condition that hasn’t been documented and coded in the current year.

Diagnosis Evaluation Panel

The Diagnosis Evaluation Panel on Medicare Advantage Health e-BlueSM or BCN Health e-Blue^SM, found in the Provider Secured Services area of bcbsm.com, lists patients who are suspected of having a condition, based on one of the following, but whose diagnoses haven’t been submitted to Blue Cross or BCN in the current year:

• Pharmacy claims
• Medical claims
• Other supplemental data sources
• Prior-year diagnoses

Information on Health e-Blue is refreshed monthly so doctors can track their progress in closing identified diagnosis gaps.

Gap closure incentive
Blue Cross and BCN will pay doctors $100 for each Medicare Advantage member with one or more gaps identified between Jan. 1 and Sept. 30, 2017, and for whom all gaps are closed during a face-to-face visit by Dec. 31, 2017.

An identified gap can be closed after a face-to-face visit with the patient in 2017. During this visit, the doctor should manage, evaluate, assess or 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 patient’s medical record
• Notify Blue Cross or BCN that the patient doesn’t have the suspected condition through Health e-Blue

After a complete review, the doctor may document that the patient no longer has the condition previously identified.
More information about this incentive program will be posted on Health e-Blue for Medicare Advantage primary care doctors in the first quarter 2017.

If you don’t have access to Health e-Blue, you need to request it on the application for Provider Secured Services and complete the section for Health e-Blue. For more information, click here.

If you already have access to Provider Secured Services and Health e-Blue and just need to update users, fill out the Authorization to Add or Remove Health e-Blue Access (PDF) and fax it to the number on the form.

web-DENIS member care alerts

When checking patient eligibility and benefits on web-DENIS, check your member care alerts. The alerts have been updated to include 2017 patient gaps in care.

These alerts are color-coded to help you identify patients’ needs quickly, and they display a printable list of diagnosis gaps and treatment opportunities for patients.

2016 incentive payment

If you participated in the 2016 Diagnosis Closure Incentive program, your incentive payment will be mailed to you by the end of the third quarter in 2017.

Training available

Blue Cross and BCN can provide training to doctors and their office staff on proper documentation and coding guidelines, and the importance of closing gaps for Medicare Advantage patients.

Follow these steps to access online training resources:

• Log in to web-DENIS.
• Click on BCBSM Provider Publications and Resources.
• Click on Newsletters & Resources.
• Click on Patient Care Reporting, and in the Training Resources section, look for:
• Online training for risk adjustment, documentation and coding
• E-learning module: Best Practices for Medical Record Documentation
• Documentation and ICD-10 Coding Tips for Professionals

The 30-minute, e-learning module includes a 10-question assessment. If you score 80 percent or better, you’ll receive one continuing education credit from the American Academy of Professional Coders.

These presentations are also available in BCN Provider Publications and Resources under Patient Care Reporting for Risk Adjustment. Contact your BCN provider consultant for assistance.