Closing HEDIS gaps administratively cuts down on medical record review

Brian Clark:

Well, good morning everyone and welcome to the first of two webinars this month. The title of today's webinar is Closing HEDIS gaps administratively cuts down on medical record review. So there are two offerings for this webinar today at 10:00 AM Eastern standard time. And then tomorrow we'll have a repeat session at 2:00 PM Eastern on May 17th. Now prior to the webinar today, you received the slides via email from me. I just ask that you please follow along with us today. No need to take notes unless you'd like to just follow along with the slides that were sent to you. A little bit about myself. My name is Brian Clark and I'm your host. My title is quality translator and I work in quality management here at Aetna Better Health. Specifically, I work for the Pennsylvania plan and a little bit over two years ago, we started this webinars series targeted at our provider audience and we actually expanded as part of a company wide initiative to maximize administrative data capture.

Brian Clark:

And we're now presenting to over 10 States actually. I'll show you who we are presenting to here in a little bit. But a little bit more about myself, I have a bachelor's degree in media and professional communications and a certificate in corporate and community relations. And I've been working on improving outcomes of care for our members for the last seven years and HEDIS has always been my main focus. Presenting today is Diana Charlton, quality management nurse consultants. Diana is an RNBSN and she worked in oncology med surge and a surgical step down from a unit prior to that, the Better Health. Additional panelists with us today are Yvonne Faulkner and Jenny Montoya.

Brian Clark:

I'd like to welcome Illinois, Maryland, New Jersey, Ohio, Pennsylvania, Texas, Louisiana, Kentucky, Florida and Michigan. I'm very happy that you could fit this important webinar in your schedule today. The webinar will last approximately 35 to 45 minutes and then we'll have some time for questions and comments at the end as well as during the presentation. And I'm hearing just a little bit of background noise from one of the phones but if you could place yourself on mute, I'd appreciate that. So that is the vision statement or philosophy as to the way we manage healthcare is you don't join us, we join you.

Brian Clark:

And by joining you all on the line today in the webinar today, it's our hope that we're more effectively reaching our Aetna Better Health members. Now on the screen here you'll see the Aetna values wheel. At this time center of all that we do here at Aetna are the people that we serve, meaning our providers. You on the line with us today and our members and surrounding the center of the values wheel are our four core values, integrity, excellence, inspiration and caring. And as a company, our main goal is to build a healthier world while acting with integrity and aspiring each day to build that healthier world.

Brian Clark:

So the goal of the webinar today and obviously in all webinars in the series is to spark conversations with providers in multiple States nationwide while attempting to explore ways to cut down on the burden of medical record review and maximize administrative data capture. We just concluded the HEDIS medical record review season and we're just going through the HEDIS measures throughout the measurement year and looking at coding that captures care. So it's cut down on the burden of reaching out for records during that review time. That's the main goal in mind. Now, during the webinar we'll be pausing for Q&A participation is encouraged. I just asked that you utilize the Q&A box. If you want to test out the Q&A box right now, just hover your mouse over the top part of the middle of your screen and find the options for Q&A and then choose the participate dropdown option.

Brian Clark:

And then type any question or comment in the white box and sends to all panelists if you want to test that out right now maybe say hi Brian, or good morning or good to be with you. Something that lets me know that you're here and engaged with us. That would be nice. Hi Charlotte. Hi everybody. So let's move on to the next slide here. So this new webinar focuses on billing and coding for HEDIS measures of care. We're actually not going to be looking too much at the measure descriptions, but we're going to be looking at coding for all the measures that we have been discussing this year and we'll continue to discuss. So in this presentation we'll discuss how to increase administrative data capture well effectively coding for billing purposes, tips for Medicaid and Medicare FQHC and RHC billing and coding for over 20 HEDIS measures as well as the general overview of HEDIS and its importance in examining healthcare outcomes will be presented. That's what the agenda is for today.

Brian Clark:

But let's just have a little bit of a refresher as to what HEDIS stands for. So the H stands for healthcare, the E stands for effectiveness, the D data and I information and the S is set. So healthcare, effectiveness data and information set. So HEDIS was developed and is maintained by the national committee for quality assurance for the NCQA and it's a standardized way for health plans to document healthcare services provided to members. Now, some States may offer certain pay for quality programs based upon achieve HEDIS rates such as value based services, contracting or quality incentives programs.

Brian Clark:

And currently we are in HEDIS 2019. The review season that collects data, they're primarily in 2018 however, the HEDIS measure dictates the look back period of course. So HEDIS data it's collected two ways, claims or other administrative data and medical record review collection and claims are the fastest and the easiest way to collect HEDIS data and correct coding is very important. Correct coding allows the health plans to collect administrative data, which cuts down on the burden on the office, preparing records for the health plan during medical record review. And it cuts down on the burden on the health plan and the resources required in the cost involved with completing that review.

Brian Clark:

So who uses HEDIS data? The public may use HEDIS ratings when choosing a health plan. Prospective members might look at the HEDIS race of a health plan whenever they're trying to figure out hey, do I go with this plan or that plan or this plan or that plan. Regulatory bodies may use HEDIS data for accreditation or enrollment purposes and pay for quality programs are very often tied to HEDIS results in the scores. Some terms. Finally, I want to look at a few terms that we have mentioned in the webinars series and you might hear today administrative data that's healthcare information captured by means other than the medical records. So that would be like claims, immunization, data banks, historical encounters. Hybrid review is the HEDIS medical record review season that we just completed. That's when administrative data and medical record review are used to data's sky HEDIS guidelines. And the idea is to eventually whenever we look at a medical record to have a hit for a member. So that means when administrative data and or medical record meet all the HEDIS requirements for a specific measure.

Brian Clark:

So I think that's enough for me for right now. I wanted to pause for any questions or comments that we might need to address at this time. Madison John Lipski is a quality translator here at Aetna Better Health. She is going to be talking with the group today if we have any questions in the Q&A box, do we have anything we need to address Madison?

Madison John Lipski:

Not really. I just want to reiterate that if you did not receive a copy of the slide because we are getting comments about not receiving slides. Everything that you placed in the Q&A box is captured in a report. So if put the Q&A you did not receive the slides, we will be sure to send you a copy shortly after the webinar. That's the only thing I wanted to address out loud.

Brian Clark:

Yeah, thanks Madison. I sent out the slides about 45 minutes ago and if you registered within the last 45 minutes, I didn't have your email at that time so you didn't get included on that email that had the attachment with the slides. So I apologize. But you'll get a copy of the slides out to you after the webinar. So Diana, I think might as well pass the ball off to you. Diana is going to first start with the HEDIS data collection.

Diana:

Thank you Brian. And good morning everyone. Thank you for joining the call. My name's Diana, I'm one of the registered nurses at the Pennsylvania plan quality management department. And I'm going to be going over a high level overview of coding today and capturing data to close gaps. But first let's take a look at the different methods that HEDIS data is collected. So we did just complete the HEDIS season, which is a medical record review. So that was considered the hybrid review method of capturing data with regards to HEDIS. So this method of closing gaps is by going to the medical record if we're not capturing care or claims during the measurement year, the year prior. So if we do not need to go to the medical record to close gaps, we can close these gaps administratively on claims so we can close gaps on pharmacy claims, labs claims via diagnostic tests or encounters as long as we're capturing the appropriate recommended codes and the MCQs for that HEDIS measure

Diana:

Next slide. So we're going to be looking at two different product lines of insurance today with regards to closing gaps for HEDIS. The first one that we're looking at here is Medicaid. So what is Medicaid? Medicaid is a program that is funded by both the State and the federal government, provides healthcare coverage for the following populations, which include low income families and individuals, persons with disabilities, and the elderly. Next slide. Now since it is primarily funded by the State, the programs can vary by States. But there are minimum covered services that are required by the federal government for the State Medicaid plans. Some examples of the covered services would include inpatient and outpatient hospital services, family planning care, pediatric services, prescription drug costs, mental health care services as well.

Diana:

Next slide. The other line of business that we're going to discuss today is Medicare. So what is Medicare? Medicare is a federally funded program. It provides healthcare coverage for the following populations, which include people 65 years of age and older. Certainly younger people with disabilities, people with stage renal disease as well. Next slide. Now Medicare has four parts of the Medicare program that covers specific services. So part A, would be your hospital insurance. This covers inpatient hospital state, care is skilled nursing facility, hospice care, some home health care services as well. Part B, is your medical insurance, so certain doctor services, outpatient care, medical supplies and preventative services which all under the part B of Medicare plan.

Diana:

Next slide. There's also part C or the Medicare advantage plan. This is offered by private companies that contract with Medicare to provide all part A and B benefits. They can also offer prescription drug coverage. Some examples of private companies that might contract with Medicare would be your health maintenance organizations. Preferred provider organizations, private fee for service plans, special needs plans, Medicare medical savings account plan. The final part of Medicare is part D or your prescription drug coverage. Prescription drug coverage is offered by Medicare approved insurance or private company. This coverage is added to the original Medicare to some of the following plans. Your Medicare costs plans, your Medicare private fee for service plan, your Medicare medical savings account plan.

Diana:

Next slide. So after this brief overview of what Medicaid and Medicare are, we're going to look at some coding tips for closing gaps for both of these lines of business with regards to HEDIS. Now the MCQA offers coding tips for closing the various units measures that are focused on throughout the calendar year. So some things to consider would be for some measures that codes are submitted by labs or diagnostic centers, those would be the ones to cause the hits. So preventative coding for services not done during visits do not count. So an example would be billing for labs not yet completed. A measure that this would apply to could be your comprehensive diabetes care measure where we're looking to capture an A1C lab done during the measurement year. So the office would not build for the lab being drawn.

Diana:

The provider's office would not build for the lab being drawn. It would be the lab once this service is completed. Diagnoses will not count for measures where services required. So an example would be the ICD 10 codes for chlamydia section. This will not close the gap for the chlamydia testing measure as a test causes the numerator hit and not the diagnosis. Another example could be for the breast cancer screening measure. Diagnosis code for a number that already had breast cancer would not close the gap. We're looking to capture mammography or the test to close the gap for that measure. So these measures are based on the service and not the diagnosis. Also for some measures and ITD tend to put the number in the denominator, but pharmacy data, deterministic measure adherence. So these tips would be to follow up with patients to ensure medication adherence to close these gaps.

Diana:

Next slide. So over the next few slides we're going to be looking at some measures that are going to apply to both Medicaid and the Medicare plans. First groups, these are going to be codes that are submitted by the lab or diagnostic center that caused the numerator hits. So we're looking for certain labs to be done or testing to be done. So for the metabolic monitoring for children and adolescents on anti psychotics measure, we're looking for what glucose or A1C at cholesterol to be done. So these would be services that the lab would bill for. Breast cancer screening, we're looking for mammography to be done. The chlamydia screening and women were looking for the chlamydia test, which is usually your own tests. And then for led screening in children, we're looking for venous and capillary led tests. So we know that the providers are ordering these tests, but we need to capture the services via labs.

Diana:

Next slide. We have a cervical cancer screening, so we're looking for the service of a surgical cytology and a HPV test. So basically a path. For cardiovascular monitoring for people with cardiovascular disease and schizophrenia, we are looking for the lab to submit the code for an LDL or your cholesterol tests, the diabetes monitoring measures, which would be the next two. We're looking for HBA1C test, or it could be a blood glucose if the diabetes screen for people [inaudible 00:17:51] training or bipolar disorder. Next slide. The next group of measures that apply to both Medicaid and Medicare are the measures where the ICD 10 code, we'll put the number in the denominator, but pharmacy data determines the measured adherence. So for the avoidance of antibiotic treatment for adults with acute bronchitis, we're capturing the code for acute bronchitis, which would be an ICD 10 code.

Diana:

For this measure we want to see that if they just have a viral bronchitis but don't want to get any biotic prescribes. So whether or not that prescription is filled and built by the pharmacy is going to determine the measured adherence. For antidepressant medication management. The diagnosis of major depression would put the number in the measure, but we're looking to capture are they refilling their medications at the pharmacy? Those bill, those codes submitted from the pharmacy are going to close the gaps with these measures. For appropriate testing for children pharyngitis, it's similar to the avoidance of antibiotic treatment in adults with acute bronchitis with regards to the fact that the diagnosis for pharyngitis is going to put them in the measure, but we don't want to see antibiotics prescribed if it's a viral infection. Basically these measures are helping us to prevent superbugs essentially.

Diana:

Next slide. Medicaid management for people with asthma, the diagnosis would have for persistent. [inaudible 00:19:22] put them in the measure, but we want to make sure that they're staying on their asthma medication, so against pharmacy claims that are closing these gaps. We have a behavioral health measure that would fall into this category. That would be the adherence to any psychotic medications for individuals with schizophrenia. We have ICD 10 code examples for the schizophrenia diagnosis, but the filling of the prescriptions and then medication adherence is what closes the gap.

Diana:

Next slide. We have appropriate treatment for children with upper respiratory infections and the common cold diagnosis could put them in the measure, but again, if they're being prescribed antibiotics, we want to capture a strep test in order to close that gap. If they're being prescribed an antibiotic and there is no strep test done, that's going to show up on a gaps in care reports just as a red flag. Again, we want to prevent superbugs. Same with the appropriate treatment for children with upper respiratory infections. We have ICD 10 codes for diagnosis that would put the measure, but again, it's the pharmacy claims that close that gap.

Diana:

Next slide. This next measure, which is pharmacy therapy management of COPD exacerbation, there are three diagnoses that can put the member in the measure. We have COPD as the [inaudible 00:20:44] and bronchitis. So any of these diagnoses that are captured during an inpatient admission could put the number in the measure. But with regards to closing the gap for the measure, we're looking to see are they being prescribed a corticosteroid within 14 days after discharge and then a Bronco dilator within 30 days to manage these three disease processes.

Diana:

Next slide. The next category of measures would be these measures that the adherence is driven by outpatient visits being captured for the conditions. So follow care for children prescribed ADHD medication. We look to have three visits captured within the 10 months following the initiation of their ADHD medication. So during the first 30 days we want to capture an ADD scale on visit code and then in the nine months following that initial 30 day period, we look to capture two more visits. Here's some examples of the codes that can close [inaudible 00:21:43] claims. For the annual dental visit, we look to capture the CDP codes that would be likely submitted by the dentist providing care. And here's some examples for that.

Diana:

Next slide. So the next category would be your hybrid measures and this is both for Medicaid and Medicare. We go to the medical record if we are not capturing the care and claims. So for the adult BMI assessment, we have a BMI value code that can be used for members over 20. For members that are under 20 we want to capture a BMI percentile ICD 10 code, which we will show you those codes later on in the presentation. For the controlling high blood pressure measure, we need to capture the ICD 10 code for the diagnosis of hypertension. And then we look to capture the last blood pressure during the measurement year. So we can capture the systolic reading and the diastolic reading with some of these recommended CPT codes.

Diana:

Next slide. So the next measure that we have to go to the medical records for would be your comprehensive diabetes care measures. So we look to capture name, A1c test, be able to see results. The urine protein tests would be how we can close the gap for attention for [inaudible 00:23:06]. And then we have the diabetic retinal screening. So these are all the CPT codes for those three sub measures that can close the gap. But I want you to note that CPT codes for diabetic retinal screening will be submitted by an eye care professional such as an ophthalmologist. So if you're seeing a gap on your report that a member is not having an eye exam, that's a good time to refer them out and hopefully they get their eye exam and that stuff and that ophthalmologists will submit the codes.

Diana:

Next slide. So we have the [inaudible 00:23:41] measures here. The first one is a retired measure, but some States still may need to report on the frequency of ongoing prenatal care. So we have CPT codes for prenatal visits. The next measure would be your prenatal and postpartum care. And there are two sub measures to this maternity measure. The first one here, PPV or the postpartum visit. So we want to capture a postpartum visit within 21 to 56 days, fall on delivery. And we have here some CPT and ICD 10 codes that can close the gap for the postpartum visits. We also have a prenatal visit, some measure for this measure and that is to capture of prenatal visits during the first trimester or within 42 days of enrollment plants and by capturing some of these CPT codes for prenatal care during that timeframe demonstrates that that member had had timely care for their pregnancy. We do want to note that global billing and bundled coding use related to prenatal and postpartum care are State specific. Reach out to your point of contact for more information on billing code guidance in your State and Brian will be providing your points of contact at the end of the presentation.

Diana:

Next slide. We do have three well childcare measures that we will have to go to the medical record for during HEDIS review if we do not capture the care on claims. So for our lesson WellCare, we look to capture one of these CPT codes once during the measurement year that demonstrates they had a comprehensive WellCare visit. For well-child visits in the third, fourth, fifth, and six years of life. We both to capture the same CPT codes once during the measurement year close the gap that shows they have one comprehensive well visit for well-child care in the first 15 months of life. We can capture any of these codes on claims, but we need to capture the six or more times during birth through 15 months. Demonstrates that that child has six or more comprehensive well child visits. So W15 looks to capture the CPT code six times or more and adolescent well care and the well-child and third, fourth, fifth and six years of life. We just need to capture one of the codes once during the measurement year.

Diana:

Next slide. We have weight assessment and counseling for nutrition and physical activity for children adolescents. Or WCC is the acronym for this measure, so with this measure we look to capture three things. The BMI percentile, dietary counseling and surveillance and exercise counseling. We have ICD 10 codes that work for the BMI percentile and as I previously said for the ABA measure, if you have members under 20 we want to capture a BMI percentile ICD 10 code to close that gap. 10 codes will close the gap for BMI percentile for this measure as well and here are the ICD 10 codes for the dietary counseling and exercise counseling as well. I do want note that we are only offering a few MCQA coding tips today for the full listing. We want you to go to the MCQ website at mcqa.org or you can reach out to your point of contact that Brian will be providing at the end of the presentation.

Diana:

Next slide. Now we have hybrid measures that are for the Medicare only line of business. The first measure is going to be carer over adult or CLA. This measure looks to capture four items during the measurement year, advanced care planning, medication, review of functional status assessment, which would be your ADL and a pain assessment. Now once the bidding codes, we want you to note that in order for the medication review gap to close, we need to capture the medication review CPT or CPTQ to code as well as the medication was code to close that some measure gaps this measure.

Diana:

Next slide. We have medication reconciliation, post discharge or MRP. We have the CPT or CPTQ codes that we need to capture on a claim within 30 days of a discharge in the hospital that will close that gap. The TRC or transitions of care measure is for any member that is 18 years of age or older that was admitted to the hospital and we're looking to capture four things once they're discharged. Notification of inpatient admission receive discharge information, patient engagement after inpatient discharge and medication reconciliation. I'd want to note that the first two, some measures for the TRC measure, their administrative reporting is not available for this indicator, so we would need to go to the medical records to see that the member received the notification of inpatient admission on a day of admission or the day after, and then the receipt of discharge information. We would need to go to their medical record to confirm did they receive the discharge information on the day of discharge or the day after the other two. Some measures we have CPT and CPTQ two codes that can be submitted on claims.

Diana:

Next slide. We have colorectal cancer screening. And there are a couple of different ways you can close this gap. They can have a people full blood test during the measurement year. We'll signal it off to be during the measure here, four years prior colonoscopy during the measurement year or nine years prior CT colonography there's a four year look back for that. And fifth DNA test we have a two year look back and we have a CPT code that can be submitted on claims for these gaps to close them administratively. Next slide. So at this point before we go on to some billing tips, are there any questions in the Q&A at this time, Madison?

Madison John Lipski:

Hi Diana. So let me see. I'm just scrolling up here a little bit because we did have a couple of questions. Somebody asks, prenatal visits qualify as a physical and it was already answered by Leanna, but just in case anybody else had a question similar to that, the answer to that would be yes, as long as the physical one was performed along with the prenatal visit, and of course that you code it appropriately. Somebody asked, let me scroll down so I don't get it wrong. Somebody asks if you could give them the abbreviation for TRC on slide 32. What that stand for.

Diana:

Sure. So TRC is a Medicare only measure, and that stands for transitions for care. And that would be basically it's capturing data from transitioning from an inpatient admission and then the care following the discharge. So we're looking are they having followup care down with their PCP? Are they having a medication reconciliation done within 30 days? I hope that helps.

Madison John Lipski:

It does. And somebody, can pediatric primary care bill for the ADD standalone codes.

Diana:

I believe they can, that measure is directed with any or to any provider with prescribing authority for the ADHD medication so that PCP is able to prescribe those medications. They should be able to bill for those ADD standalone visits. We do have Leanna Putman who is the QM supervisor. So Leanna if you're able to clarify, I'll pass the ball to you if that's okay. But I believe as far as... yes, they should be able to bill for those codes.

Leanna Putman:

[crosstalk 00:31:44].

Diana:

Oh, go ahead. I'm sorry.

Leanna Putman:

I'll jump in. This is Leanna and that's absolutely correct. It is the followup often happens with general practitioners or pediatric practitioners necessarily strictly behavioral health practitioner. And that is accessible as Diana pointed out, it does have to be somebody with prescribing privileges. However, so strictly speaking, this psychologist would not qualify those codes would not qualify or would not create a hit for that. They're looking for providers who can order prescription.

Madison John Lipski:

There are a lot of questions coming in in the Q&A box that are actually States specific meaning that the answer to your question is going to depend on what State you are in. And that is from what I'm seeing for the rest of the questions, that's what most of them are. So if we're not able to answer your question on the webinar today because it's State specific or for other reasons, just know that your point of contact for your State, we'll be reaching out to you shortly to get those questions answered that we were not able to address today.

Diana:

And Madison I want to jump in also. There was one question I see in here that asks if the webinars are available for replay on the website?

Madison John Lipski:

Yes.

Diana:

Good. So we should let folks know that we are recording these and they will be available for a replay on demand from your website and Brian can talk more about that a little bit later on.

Madison John Lipski:

Yeah.

Diana:

All right. Thank you everyone for your questions. As Madison said if we're not able to answer your question now. We will be following up within 24 hours of the webinar to provide assistance and any clarification that you may need. So I guess Brian, we can move on now. And we're going look at some billing tips and this applies to both Medicaid and adult billing plan which would be your Medicare. So let's proceed onto the next slide.

Diana:

So some professional billing, general guidelines. So Medicaid is going to be the last pair to be built. So if a person has more than one insurance, we would expect Medicaid to be the last pair to be built. Most State claims for form two main parts.

Leanna Putman:

Pardon me Diana. I'm really sorry to interrupt. I was holding off here, but we had some comments about the feedback from your microphone. I don't know if you're on a headset to switch to your handset, there's a little bit of noise as you talk, if you could try to switch that up.

Diana:

I apologize. I'll try my handset here. One second.

Leanna Putman:

Thank you.

Diana:

I do apologize everyone. So I will start at the very beginning of the slide. Leanna's does this sound better?

Leanna Putman:

I think so. There might still be a little bit, but let's give it a try. It's definitely clearer.

Diana:

Okay, great. So moving on, we're going to look at some general guidelines with regards to billing. So Medicaid is going to be the last pair to be built. So if a person has more than one insurance, we would expect Medicaid to be the last pair to be billed for any coverage that primary insurance does not cover. Most State claim forms will have two main parts. So the first part will be information regarding the patient and or the insured person. The second part would be information regarding the healthcare provider. The claim must contain proper information on place to service the MPI number procedure performed in the diagnosis. We do want to refer you to your point of contact for state specific information such as a State claim form, claim submission protocols and reimbursement rates.

Diana:

Next slide. You can input codes from the following code that's on the claim, so the first one is the international classification diseases, test provisions, clinical modification class, or your ICD 10 CM codes. These are your diagnosis codes and they are to be entered on block 21 of the CMS 1500 claim form. We also have your place of service codes. These can include inpatient hospitals, nursing facilities, hospices, or just some examples that are more, but these are generally two digits long. Next slide. You can input codes from the healthcare common procedure coding system or your hick picks level two codes. These will describe supplies, services and products. Current procedural terminology or CPT codes can also be coded on claims. These would identify and categorize.

Diana:

I'm sorry, my monitor went to sleep here. Services and medical procedures. What you to take advantage of fully coding using the MCQA recommended CPT and hick pick codes, fully code for the services you provide on block 24D of the CMS 1500 claim form and again fully coding will help close gaps. So for example, if a member's coming in for a comprehensive well visit and we capture the well-child codes, likely that member has also had a BMI percentile assess and exercise counseling done as well, so it'd be good to code for those services as well just in case that number falls into the WCC measure.

Diana:

Next slide. Claims must be received within 180 days after the services were rendered. The resubmission of rejected original claims be received within 365 days after the services were rendered. Resubmission codes are entered on block 22 of the CMS 1500 claim form. Next slide. Is the provider perform the services, they can submit claims to capture care that was not previously reflected on the original claim and this can be done by submitting an adjustment to the original claim. You need to be sure to include all previously submitted service codes with appropriate bill amounts and adding in the new service lines with a $0 million amount.

Diana:

So this would be a good example of that adolescent well care visit that occurred and you see that all they were in the WCC measures. Well, we need to submit for that BMI percentile to close that gap. You can resubmit using this process. We do want to note that resubmitted claims and they come back with line items denied for previous payments being outside the range for timely submission. We want you to know that even though they may come back denied, this will not affect the HEDIS data capture as long as we're capturing that code, even if it's a denied claim, it's still going to close that HEDIS gap.

Diana:

Next slide. So moving on, we have some billing tips that are specific to your federally qualified health centers and rural health centers or your FQHC and RHDs. Next slide. You must build a CPT and hick picks itemization in addition to the T1015 clinic code in order to close gaps. That T1015 is a general clinic encounter code and unfortunately it will not close HEDIS gap on its own, so not itemizing services on claims can result in medical record requests or in HEDIS season in order to close gaps. So as I said, the T1015 code does not describe the services actually performed. So for example, going to well-child checks again to administratively capture care for AWC, W34 or W15 measures any of the following codes would need itemized on the claim. So you had the CPT codes from 99381, 399385, 99391, 499395 and 99461. Next slide. So at this point we can pause again for questions.

Madison John Lipski:

Okay, there is one Diana, I wanted to bring up out loud and see if we can answer it. And again, if we can't answer it, of course somebody will reach out to you. Somebody asks if you use and EPSDT code, do you still have to add these 713 and the 7182 codes to the claim. I'm not sure if that's something you know off the top of your head or if will have somebody reached out to them about that.

Diana:

I would say they would still need to submit because the codes that we're presenting are specific to the HEDIS measures and some of the ETFCPT codes may not close gaps or they may not be in the recommended codes from the NCQA to close gaps for those measures. So I would still recommend fully coding for the services they're providing in order to close gaps.

Madison John Lipski:

And the other questions we got and one of them I think we are going to have it their point of contact reach out to them.

Diana:

Okay. Well then at this point we can transition over to Brian who is going to present the points of contact. Thank you everyone for bearing with me through all that information.

Brian Clark:

Thank you Diana. And by the way, you were coming in much clearer once you switched over to your headset I believe so. That sounds great. Leanna mentioned recordings. We are recording today's webinar for viewing in the future recordings will be available soon. I'll send a link to the website that houses all the 2018 webinars so that you can access previous webinars. And what I'll do is I'm going to send out, I've almost like 30,000 emails between the 10 States. So I'm going to send out a link to all the emails of individuals that have attended the webinars series in the past, and those that we send the invites to. So more to come on that we're just working with marketing to get a website up and running that houses the previously recorded webinars. So that's exciting. So a point of contact, that person is someone at the health plan in your State.

Brian Clark:

They can inform you as to how to access your organization or your office has gaps in care reports, some of the concerns who at any time. Now, there are many HEDIS measures that we are addressing throughout the measurement year this year and your organization has a gap in care lists that you can look at and you want to utilize the coding steps that we're providing you here in this webinar. And also go to the NCQ website and at some point maybe get a copy of the 2018 HEDIS technical stuff, specifications for a list of more complete. So it's a full listing of the codes that are linked to each HEDIS measure. We're only addressing a few of the codes in this webinar series for the HEDIS measures. But anyway, the point of contact is a really good person to establish a relationship with.

Brian Clark:

Some of you can always turn to if you have a question or a comment. If there was a question or an issue or a comment that came through the Q&A box, it was a captured today and I have a report that I'll be going through and if we didn't get to answer a question, I'm going to be forwarding the question that did not get answered to your point of contact in your State and someone will be in contact with you via email to address that question. So if you are signing in from Florida, your point of contact is Michelle and there is her email. Texas, your point of contact is Joanna. Pennsylvania, representative in Pennsylvania is Diana. She was a speaker today and Louisiana that would be Frank. In Michigan, that would be Dante. Illinois, you can reach out to either Anya or Diana from Pennsylvania. Maryland, that would be Dawn and New Jersey that would be Sammy. In Ohio, one of two individuals. You can reach out to those if you'd like to as well. Sarah or Valerie and Kentucky that would be Cathy.

Brian Clark:

So I appreciate you attending today. But here's a sneak peek into what we are going to be discussing in the future. Obviously there is a repeat session tomorrow at 2:00 PM of this same webinar offering. In June, we will be focusing on takeaways from HEDIS season 2018 the medical record review, the project in review. We're going to be going over some good agenda topics, what we've learned and what we can maybe improve upon in the future for 2019 medical record review and it's going to be an open forum.

Brian Clark:

We're going to have a lot of questions that we're going to pose at the audience and we want to share the responses to the questions. How did you think the review went? What can we do to improve things? And we'll look at a couple aspects of the review that were included this year and see if basically that went smooth this year or can we improve something for next year? Anyway, just an idea as to what to expect for June. July, We are going to be looking at back to school physicals and HEDIS measures effecting the young population of members zero to 11 years of age and ETSCT screenings will also tell a hypothetical case story and look out HEDIS is addressed at the office.

Brian Clark:

So I appreciate everyone attending today and we're going to leave the Q&A box open for another 10 to 15 minutes and address as many questions as we can. If you need to get going, go ahead and do so. I'll give you back about 10 minutes and please forward on the invitations to this webinar to any interested contacts within your organization that might benefit from attending this webinar. I would appreciate that. And Diana, thank you for presenting today and Leanna, thanks for stepping in for some Q&A support and Madison, thanks for manning the Q&A box. And thank you all for attending. Have a great day.