BlueShield of Northeastern New York
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Transcript of BlueShield of Northeastern New York
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BlueShield of Northeastern New York
Make every visit a preventive visitMarch 20, 2013
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Welcome
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We will cover:• Evidence based clinical guidelines about an
effective well visit • Administration and documentation of
immunizations • Lead Screening • Coding • P4P
Opening Remarks
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Children are our future!
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Let’s talk about some Regional statistics• The graphs will show the Commercial and
Medicaid specific statistics and the NYS Medicaid averages
• Lets take a look at the data in the next few slides in the context of thinking about changes that could be made to improve care
Regionally all plans are scoring poorly
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Regionally
2010
2011
2012
NYS Avg.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
80%
80%
69%
74%
79%
82%
75%
71%
Child Immunization(2 yrs of age - Combo 3)
Commercial Medicaid
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Regionally
2010
2011
2012
NYS Avg.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
84%
84%
80%
89%
83%
83%
83%
82%
Lead Testing - 3 Year Trend
Commercial Medicaid
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Regionally
2010
2011
2012
NYS Avg.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
81%
84%
85%
83%
95%
96%
96%
93%
Well Child Visits, First 15 months of life(5+ visits) - 3 year trend
Commercial Medicaid
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Regionally
2010
2011
2012
NYS Avg.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
78%
78%
78%
83%
86%
87%
87%
85%
Well Child Visits, 3-6 years - 3 Year Trend
Commercial Medicaid
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Regionally
2010
2011
2012
NYS Avg.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
54%
55%
55%
59%
62%
64%
63%
60%
Adolescent Child Visits - 3 Year Trend
Commercial Medicaid
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• Systems• Providers• Patients
Barriers
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Henry M. Neilley, MD, FAAP
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Best Practice
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• Health and developmental history• Physical exam• Immunizations• Lead screening – children under 2 yrs• Health Education / Anticipatory Guidance
Components of a well visit
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• Accurate appointment time frame• Reminder systems to decrease no shows• Optimization of EMR systems• Parent preparation for the well visit – both
the parent and the doctor/office• Relationship building with child/parent
Preparing for a comprehensive well visit
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• Know the components that make up a well visit
• Determine how much can be covered in one visit – how likely is the patient to return for another visit?
• Know what immunizations can be given when a child presents sick
• Importance of documentation as it relates to a sick and/or well visit
Suggestions for combining a well and sick visit
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• Missed opportunities• Parental concerns• Appointment scheduling• Transportation
Barriers
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Lisa Phillips, BSN
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• Overview of child and adolescent immunizations – changes in the 2013 schedule
• Importance of following the schedule• Importance of entering in NYSIIS –
immunizations and lead screening• VFC program and how to order
Immunizations and more
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• There is a copy of immunization schedule in your packet
• Let’s review some pertinent updates in this schedule
2013 updates
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• Documentation• Documentation• Documentation
NYSIIS - New York State Immunization Information System
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The Vaccine for Children (VFC) Program• In your packet there is a reminder on how to
order • Any questions related to ordering this VFC
vaccine?• Don’t forget to bill for the administration of the
VFC vaccine
VFC Vaccines for Children
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Kathryn Glasser, CPC
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• Choosing codes• Coding resources online• Coding documents in handout packet• After the seminar
Coding: best practices
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• Sick (E&M) vs. Well (Preventive)
• Provide the services• Document what was provided• Code what was documented
The Chicken or the Egg
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www.bsneny.comProvider > Login > Payment and Operations
• Clinical Editing > Clinical Edit Search - represents the relationship(s) between CPT codes and the supporting clinical rationale for their bundled or unbundled states
• Code Resources > Code and Comment - provides detailed coverage information for a specific CPT code
Coding Resources
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Clinical Edit Search Request
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Clinical Edit Result
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Code and Comment Sample 1
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Code and Comment Sample 2
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Code and Comment Key – Sample
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Practice Specific Questions
• Contact the Provider Relations Department to speak with your representative.
BSNENY Providers518-220-5601
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BlueShield is here to help you!
• Reminders via phone and mail are made regarding immunizations
• Pediatric Disease Management nurses available
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• P4P – what’s new in 2013– Implementation of new analytics tool– Pinpoint gaps in care– Revise methodology– Generate reports
BlueShield is here to help you!
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• P4P measures– Childhood Immunizations– Lead Screening– Use of Appropriate Medication for People with Asthma– Appropriate Treatment for children with URI– Appropriate Testing for children with Pharyngitis– Chlamydia Screening
BlueShield is here to help you!
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Questions
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Thank You!
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