Do you have time for a Quality Minute about transitional, follow-up care?

This is another article in our ongoing series of quick tips designed to be read in 60 seconds or less, and provide your practice with information about performance in key areas.

Transitions of Care

• If a member is transferred from an inpatient stay to a skilled nursing facility, a follow-up should occur following the discharge from the SNF. Over half of the SNFs in Michigan are sending admissions, discharges and transfers through the Michigan Health Information Network. We expect this to increase as Blue Cross Blue Shield of Michigan and Blue Care Network continue outreach to SNFs to encourage sending admissions, discharges and transfers.
• Procedure code *1111F can be billed as soon as medication reconciliation is performed and documented in the patient’s outpatient medical record. Therefore, you don’t need to wait for an office visit or all components of a transitional care management visit to be complete to bill *1111F.
• Procedure code *1111F is reimbursable for Medicare Advantage patients, and there is no member out-of-pocket cost.
• Transitional care management codes will satisfy both the Patient Engagement and Medication Reconciliation Post-Discharge components of transitions of care.

Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions

• Members will be in the denominator after each emergency department visit and could be in the denominator more than once.
• Blue Cross and BCN have worked with MiHIN to develop new ADT flags that identify high-risk member discharges for prompt post-discharge follow-up care.

For more information, see the Transitions of Care (TRC) or Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC) tip sheets. Here’s how to find them.

1. Log in to our provider portal (availity.com).**
2. Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo.
3. Click the Resources tab.
4. Click Secure Provider Resources (Blue Cross and BCN).
5. Click Member Care on the menu bar and then click Clinical Quality and Tip Sheets.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.