Reducing the burden of medical record review

Brian Clark:

Good morning everyone, and welcome to the first of two webinars for January 2018. The title of today's webinar... Is my live work here? Okay, good. The title of today's webinar is reducing the burden of medical record review preparation for HEDIS 2018. We actually presented this offering in December, but we thought it would be beneficial to all attendees to present it in January too. This is the first offering January 10th, 2018 at 10:00 AM and the second one is next... Let's see, 17th is a Wednesday at 3:30. Prior to the webinar today, you received the slides via email from me. Please follow along with us. My name is Brian Clark and I'm your host. My title is quality translator and I work in the quality management department here at Aetna Better Health. Also presenting today is Diana Charlton. Diana is a RN here at Aetna Better Health and she works in the quality management department as well.

Brian Clark:

The goal of this webinar today and all webinars in the series is to start conversation with providers in multiple states nationwide. We have a lot of attendees on the line from multiple States. We're attempting to explore ways to cut down on the burden of medical record review and maximize administrative data capture in the HEDIS webinars series this year while prepping for HEDIS 2019. Now, we'll go over the agenda for this specific webinar shortly in more depth. I'd like to welcome Maryland, New Jersey, Ohio, Pennsylvania, Texas, Louisiana, Kentucky, Florida, and Michigan for the webinars today. Just very happy you could take the time to be with us today for this important webinar. The webinar will last approximately 30 to 40 minutes. This is a little bit of a shorter webinar than our typical webinars that focus on a particular member populations. We'll have some time for questions during the presentation and at the end.

Brian Clark:

Participation is encouraged, just want to make sure that you know how to participate. Please utilize the Q and A box. Hover your mouse over the top part of the middle of your screen and find the option for Q and A, choose to participate down option and then type your question or comment in the white box and send to all panelists. Aetna's vision statement or philosophy as to the way we manage health care is you don't join us, we join you. By joining you all on the line today, it's our hope that in this webinar environment that we're more effectively reaching our Aetna Better Health members. On the screen here, you'll see the Aetna values wheel. At the center of all that we do here at Aetna are the people that we serve, meaning our providers and our members. Surrounding the center of the values wheel are our four core values, integrity, excellence, inspiration and caring. As a company, we act with integrity and aspire each day to excel and build a healthier world. That is the goal in mind.

Brian Clark:

Okay, so here is today's agenda. First off, Diana, will go over a brief overview, a description of HEDIS and the purpose of HEDIS. Then we'll look at what to expect during medical record review during 2018, which is fascinating approaching. The preferred method of record returns, closing gaps via MRR. We'll look at it preparation for 2019 and then as always in the webinars series, we focus on NCQA approved coding. The National Committee for Quality Assurance set out a set of codes that captures care for HEDIS purposes and we will be highlighting some codes today. Then I will introduce you all to your health plan point of contact, if you have not established a relationship or reached out to your point of contact yet. You'll be able to at least find out who that person is, should you have any question or comment or have any issue within your organization or your office that needs address in your state. All right, so now I would like to introduce Diana Charlton. She works in the quality management department here alongside me and Diana is a nurse and she will take the ball from here. Diana.

Diana Charlton:

Thank you, Brian. Good morning everyone and thank you for joining us today. First portion of my part of the presentation today will be the description and purpose of HEDIS, so next slide please. What does HEDIS stand for? We all have heard the acronym HEDIS, but it actually stands for the healthcare effectiveness data and information set. That's quite a mouthful, so usually why it is referred to by HEDIS. Next slide. What is HEDIS? HEDIS or healthcare effectiveness data and information set is developed and maintained by the National Committee of Quality Assurance. It is a standardized way for health plans to document healthcare services provided to the members as well. I'd also want to note that HEDIS is a tool that is used by more than 90% of America's health plans to measure performance on important dimensions of care service.

Diana Charlton:

Now, these dimensions of care service, they address a broad range of important health issues. Among them are some of the following examples such as asthma medication use, controlling high blood pressure, comprehensive diabetes care, breast cancer screening, any depressant medication management, childhood and adolescent immunization status, childhood and adult weight or BMI assessment. We're going to be going over some of these topics today later in the presentation regarding these measures for HEDIS 2018, and HEDIS 2018 collects data for caregiving primarily in 2017. Next slide. Who uses HEDIS data? The public may HEDIS ratings when they're choosing a health plan. Regulatory bodies may use HEDIS data for accreditation or enrollment purposes.

Diana Charlton:

Provider pay for quality programs are often tied to HEDIS scores. I also like to add that health plans also use HEDIS results to see where they need to focus their efforts in upcoming years. Also, all data is rigorously audited by certified auditors using a process designed by the NCQA. This process will ensure this data validity for all groups that rely on the data for the above purposes. Next slide. How is HEDIS data gathered? It can be collected in two ways. The first way is claims or other administrative data. These would include pharmacy data, lab reports or claims, diagnostic imaging reports, encounters, inpatient and ED admissions, immunization registries. These are all captured through coding on claims. The other method would be medical record review, or this is also known as a hybrid review.

Diana Charlton:

For Aetna, we don't capture through claims or other administrative data, we have to go to the medical records during the review season, which is right around the corner. Next slide. The medical record review or collection. The first step is getting the list of members out to the offices from the health plan. These would be members that have not had their gaps close for huge measures through coding. The lists can be disseminated out to your practices in usually three ways. It's going to be either by fax blast, by secure email, or by mail. Next slide. At this point, we're stopped for question and we'd like you to type your response in the chat box. What is your practices preferred method of list dissemination? In other words, how do you like to get the list of members that you need to send records for the health plan work?

Madison:

Okay, Diana, we are seen a lot of answers right now for email. I do see some for fax, somebody said fax or mail. Emails seems to be the most popular. There's one for spreadsheet, by portal. A lot of emails and faxes though.

Diana Charlton:

Yeah, email's nice because you can usually send it in an Excel sheet form. It's easily to filter and manipulate, so that you can a group the members by practices if you're a centralized contact for medical records. That is a very nice way to get the list is by secure email and it is spreadsheet form. At this point Brian, I guess we can proceed to the next part which would be medical record review/collection, how we get the medical records back. There's multiple ways that Aetna Better Health can receive records from the practices once they've pulled the records from the pool list. You can send it back to us via a secure fax or email, portal upload, remote access or data sharing.

Diana Charlton:

Third party copy services, some of these could be CIOX or MRO or some of the examples that are third party copy services that you can work with. You can also mail the records back or the plan can come onsite. They would send auditors onsite to pull the records out of your EMR. We could either scan them into our computers or fax them back to the plan for abstraction. Next slide. Here's another pause for a question. Please type your response in the chat box. Which methods do you use to submit records during HEDIS season? Do you send them back via secure fax or email, portal upload, remote access, third party copy services such as CIOX, MRO or RRS, mail could be paper or disk, or onsite.

Madison:

Okay. We're getting the variety of answers. I do see one for third party. I do see a lot of... I see one for onsite. Portal upload, that's on here a few times. Mailing, onsite, fax, one person said fax, mail and onsite. There's a good variety of all of the options.

Diana Charlton:

Great. As you can see, there are a number of options that we can work with the practices on getting the records back. We want to be sure to close the gaps and improve HEDIS scores both for the practices and the health plans. Next slide. Here's another pause for general questions regarding the content that we've discussed up till now. If you have any questions, you can type them in the Q and A box at this time.

Madison:

Diana, there's only one question I'm seeing right now, and that is can the provider charge the insurance for mailing expenses?

Diana Charlton:

That would be dependent on the provider contract, I believe with the health plans. For that, I would want to refer that person to their point of contact for their state, so that we can get the best answer to them.

Madison:

Okay. Right now, that's all that we have and just so everybody knows, if we don't get to a question that you've typed, everything is recorded. We'll make sure we reach out to your point of contact and they typically contact you within 24 hours, but we will try to answer as many of your questions today as we can.

Diana Charlton:

Thank you very much, Madison for manning the Q and A and the chat box.

Madison:

You're welcome.

Diana Charlton:

In the next portion that we'll proceed on to is closing gaps via Medical Record Review or MRR. Next slide. This section is going to be focusing on, as I said, closing via MRR, and this is going to be for the upcoming HEDIs season, which is right around the corner this year. We're going to be covering a number of measures today that we would go to the medical record to close if we do not capture the care via coding on claims in 2017. First, we have the pediatric measures, which are Well Care and Weight Assessment. AWC is Adolescent Well Care, W34 is Well childcare in the third, fourth, fifth, six years of life. WCC is Weight assessment and counseling for children and adolescents.

Diana Charlton:

We also have another Well Care measure, which is W15 or Well childcare in the first 15 months of life. We also have immunizations, which is CIS and IMA. CIS is Childhood Immunization Status and IMA, Immunizations for Adolescents. Then we're going to look at some adult measures which would be Adult BMI Assessment or ABA, Controlling High Blood Pressure or CBP, Comprehensive Diabetes Care or CDC. Women's health measures would be after the adult measures and those are going to be your Cervical Cancer screening or CCS, Frequency of Ongoing Prenatal Care or FPC and Prenatal and Postpartum Care or PPC. Next slide. For closing gaps via Medical Record Review, what do we want you to send for the pediatric measures and these slides are going to break down the requests and kind of simplify it for you.

Diana Charlton:

When we're asking for Well Care and Weight Assessment, specifically for adolescent well care, W34 for WCC, just send all the outpatient visits with the PCP or pediatrician that that member had in 2017. Our abstracters can go into multiple visits and find components of the measures because they can occur on different visits and we can close the gaps through researching all the visits for that calendar year. For Well Care or W15, we're looking for outpatient visits from birth with the PCP or pediatrician. For the W15 measure, we're looking for six or more well child visits to occur during the first 15 months of life, so that's why we're asking for the outpatient visits from birth through 15 months in 2017. The components of Well Care visits can also occur during six visits. Even if we are saying that it's just a well care measure, still send the sick visits so we can see if there's any components in the sick visit that can meet the metrics for that measure.

Diana Charlton:

For the immunization measures, which are CIS and IMA, immunization record and evidence of blood screening is what we would need for the CIS measure and just the immunization record for IMA. Next slide. Now, we're moving on to the adult measures and what do we want you to send? When we're requesting records for the Adult BMI Assessment or ABA measure, we're looking for 2016 or 2017 progress note indicating that the member had a height, weight and BMI during a visit with their PCP. This measure does have a two year look back period. That's why we can go back to 2016 to find a BMI, if they did not have one measured in 2017. Next measure is Controlling High Blood Pressure or CBP, so we're looking for three components, diagnosis or problem list indicating that they have a diagnosis of hypertension, progress or office notes from 2016 through June 30th of 2017 indicating a diagnosis of hypertension, and documentation showing the last blood pressure in 2017.

Diana Charlton:

I wanted to do a little bit more explaining on this measure here specifically with that second bullet point. We're looking for diagnosis occurred prior to June 30th because we want to see if the members are following up with their PCP throughout 2017 and that their last blood pressure in 2017 is in good control. For example, let's say the member came in on June 30th and then they came in on November 5th, and that November 5th visit would be their last appointment in the year. We would take that blood pressure from November 5th and then the visit from June 30th or it could be prior that shows the member came in for hypertension. Next slide please. The next measure for adults would be diabetes or Comprehensive Diabetes Care or CDC. This measure has a few different components that we need to meet in order to close the measure for HEDIS purposes. What do we want you to send? First, we'd like to see all lab reports for 2017.

Diana Charlton:

Specifically we're looking for to A1c tests and urine tests for protein. Documentation showing the less blood pressure in 2017, we want to make sure that that blood pressure is in good control, less than one 40 over 90. Medication list for 2017 and then their eye exam reports from 2016 and 2017. Now with the eye exam, we do have a two year look back like we did with ABA. Specifically with the eye exam, if they had a negative retinopathy screening in 2016, that would count as a HEDIS measure for 2017. If the member came in 2016 and they did have diabetic retinopathy, we'd want them to follow up with their eye care provider in 2017 for a yearly appointment. That's why we asked for the two reports. If they came in 2016 and they were negative for retinopathy, that would close the gap. Next slide. Now, we're going to transition to the women's health measures. First measure is Cervical Cancer Screening. What we want you to send would be all PAP reports from 2013 through 2017, so this measure does have a four year look back period.

Diana Charlton:

We're looking for in the past report that includes the date of service and the test results. If you don't have the PAP reports, 2013 to 2017 progress or office notes from the PCP or OB/GYN visits would count. We'd need to see notations of refusal of PAP screening or PAP screening data service and results in those progress notes, or we can send a problem list or past surgical history because it's the member. There are certain exclusions for this measure. If the member had a specific surgical procedure where they have no residual cervix, then they would be excluded from the measure. The next grouping of women's health measures are FPC and PPC. These are your maternity measures. We're looking for all prenatal and postpartum care for delivers between November 6th, 2016 and November 5th, 2017. We're looking for labs and progress notes or notation of the non-live birth. Next slide. At this point, we can pause. We did just go over a whole bunch of information. If you have any questions right now, please type them in the Q and A box.

Madison:

We do have a few questions coming in, Diana. One or a couple specifically regarding how this information pertains to home health care and somebody said how does this apply to them being that they go out to the home to see the patient after the doctor has already seen them?

Diana Charlton:

Okay. All right. For that one, I also want to direct you to your point of contact for clarification. It really would depend on the measure that that member's falling into because a lot of the measures do have to occur during an outpatient PCP setting, but really, it does depend on the specific measure that that member is falling into. If you have specific questions on certain... If you're being sent gaps in care reports and your home health agency, I would definitely want you to reach out to your point of contact so they can better educate you on those HEDIS measures and answer any questions that you may have regarding that specific member.

Madison:

Then we did have one regarding ophthalmologists and if they receive incentive for eye exam or is that an incentive that a PCP would receive.

Diana Charlton:

Again, I apologize. Anything related to incentives, we'd want to direct them to their point of contact for the state because the P for Q programs are not necessarily universal, crossing over into the different states. We want your point of contact to reach out to you on that because I don't want to give any misinformation. I worked for the PA plan, so what we have could be different for Texas, for example.

Madison:

We do have a lot of questions of that nature. As Diana said, we'll be sending everything to your point of contact. If you would like your point of contact, you can request it. I can put it in the Q and A for you and Brian will be going over all of the point of contact at the end of the webinars as well.

Diana Charlton:

Thank you so much. We just don't want to give any misinformation because things could differ from state to state. At this time, I guess we can proceed to the next slide, Brian, which would be preparation for 2019. We've been discussing how are we going to close gaps for HEDIS 2018, but now we're going to transition and let's start planning for the future in 2019 and what can we do to decrease the burden of record requests and collections from the offices in the health plan? We can proceed to the next slide. One way to prepare for 2019 would be to fully code in 2018 to decrease medical record review burden in 2019, so how do you know who needs to have gaps closed?

Diana Charlton:

One way would be the gaps in care reports access. You can access them through the provider report management tool or Tableau, those are two possibilities. Again, some of the way that the gaps and care reports are uploaded could vary from state to state, so we'd want you to reach out to your point of contact, but those are just two examples that are 24/7 on the go access that you can log into the portal and pull down your gaps and care reports. Through those gaps in care reports, you'll be able to see which members fall into which measures, which gaps you have and let's say if it's a member that has not come in yet for a well care visit and you get them in, we want you to pull a code for that visit to close the gap.

Diana Charlton:

It's an additional support for regarding gaps in care or even NCQA approve coding tests for closing gaps would be your point of contact. The monthly HEDIS webinars that Brian hosts and also some additional educational documents that could include things like prescription of the HEDIS measures that are the measures of focus for the year and also some of those NCQA approved coding tips. Next slide. At point, we have another pause for questions and please type your response in the chat box. How often do you access your gaps in care reports for member outreach and gaps in care closure?

Madison:

Okay. Now we're starting to get answers and there's some options for a monthly, weekly, quarterly. Somebody said option E, they don't know how to access their gaps in care reports. Weekly seems to be a common answer and I am seeing a lot of answers for option E as well.

Diana Charlton:

Okay. Well, one that is beautiful, we have people that are accessing the reports and that they've been shown how to do that. For anyone on the call that does not know how to access your gaps in care reports, that is being captured and we will have your point of contact follow up with you following up after the webinar to educate you on how to get those useful reports so we can use them for member outreach. Next slide. I've mentioned before NCQA Coding Tips and now we're going to go over some examples. I would want to say, NCQA or the National Committee for Quality Assurance has a full listing of codes on their website, so we'd want you to go to ncqa.org to access the full listing of approved coding tips for each of the measures.

Diana Charlton:

What I'm going to present are just some of the examples. Next slide. As we've previously said, fully coding on claims will reduce the burden of medical record requests during HEDIS season. We don't want to tie up your fax lines, your phone lines, trying to close gaps by sending record requests out. We do know that patients are calling in if they're sick and we don't like to type the phone line, so we want to work with you to try to close some of these gaps using codes and then we can avoid those records requests for HEDIS 2019. Next slide. Here's some NCQA approved coding tips, closing gaps through coding starting in 2018.

Diana Charlton:

We're 2018 now, so it's good time to get started in preparation for 2019 and I'm going to have some of the key measures are listed here and what some of the codes are that will close those gaps. For breast cancer screening we're looking, does the member have a mammography? We see some CPT and HCPCs codes that can be used on submitted claims that will close the member out for that gap. For chlamydia screening, we have the chlamydia tests, CPT codes that can be used and then for follow up care for children prescribed ADHD medication. This is not a measure that we discussed previously in the webinar for medical record review.

Diana Charlton:

This particular measure is administrative capture only, so we're looking to see if they are getting ADD Stand Alone Visits with their prescribing provider for their medications and those CPT codes for these Stand Alone Visits are listed here on the screen. Next slide. For the welfare measures, and these would include your AWC or Adolescent Well Care, WC15 or World Childcare in the first 15 months life and W34 which are your well visits from the third, fourth, fifth year life. The CPT codes on the screen here can be used for all three of those HEDIS measures to close out the gaps. For the Adult BMI assessment, we have ICD-10 codes or BMI values, which are listed on the screen.

Diana Charlton:

If these are captured on claims, then it will close out the gaps for the ABA measure for that member. Next slide. For WCC or weight assessment and counseling for nutrition and physical activity for children/adolescents, quite a mouthful, we have three components of the measure that we need to close out. First, we need to close out a BMI percentile, so this measure in particular has to be a percentile for this age group. This is for children age three to 17, so NCQA recommends that their gap is closed using these ICD-10 codes for BMI percentile. We also are looking to close out the nutrition counseling component.

Diana Charlton:

Some of the CPT codes are listed here on the screen. Then we also look to close out gaps for Physical Activity Counseling and here's some HCPCs codes that you close out that gap. Next slide. The Comprehensive Diabetes Care measure, we do have a number of components that need closed. I had mentioned before, we're looking for an eye exam, controlled blood pressure, A1c tests and then also urine tests for protein to see how those kidneys are functioning. Right here, we only have the examples for the A1c tests, the CPT codes, the results, which are CPT codes and the CPT codes for urine protein.

Diana Charlton:

I'd want to say that if you want to see the full listing of codes, go to the NCQA's website or you can reach out to your health plan point of contact and they can work with you and providing you the full listing of codes. Next measure would be Cervical Cancer Screening or CCS. I want to note that the ICD-10 diagnosis code will not count as submitted alone. You ICD-10 diagnosis code for cervical cancer screening must be accompanied by the CPT codes from the labs and what we have listed here, the CPT codes that the lab will submit once processing and analyzing the PAP or HPV test. Next slide. Final grouping of measures, I believe for this part would be your maternity measures which are FPC or Frequency of ongoing Prenatal Care.

Diana Charlton:

I do want to note that this is a retired HEDIS measure, but some states may require a frequency of ongoing prenatal care as a performance measure, so they say still may be sending out gaps in care reports to close this measure. We also have PPC or Prenatal and Postpartum Care. That measure looks to capture a prenatal visit during the first trimester or within 42 days of enrollment with the plan. Then we're looking to capture a postpartum care visits, 21 to 56 days following delivery. Here's some of the CPT codes that can close out the standalone prenatal visit for both FPC and the prenatal portion of the PPC measure. Then we have CPT codes for the postpartum visits that we can use to close those gaps on claims. Next slide. At this point, we can pause again for questions and if you have any questions, please type your question in the Q and A box.

Madison:

We did have a couple of questions. One was asking if they code for a refusal of the immunization, does that close the gap. If they code it as a refusal?

Diana Charlton:

It would not close the gap, but when we go to medical record review, we would close out that member for capturing that code. The measure itself only will close out if they captured the actual administration of the immunization. When we get the notation of refusal from the providers, we can manually close out that measure during medical record review and then we won't be requesting records for that member anymore. For the closing the gap out via codes, the NCQA does not at this point have a code for refusal that is approved.

Madison:

Somebody asks, I wanted to bring this stuff out loud just in case anybody else had this question. Somebody asked, if there's a list of all the guidelines for Aetna HEDIS.

Diana Charlton:

Do they mean just a general outline for all the HEDIS measures? Kind of a one stop shop for all, what the guidelines are for the specific measures that we would outreach for?

Madison:

That seems to be my understanding of the question, yes.

Diana Charlton:

Okay. Well, I can speak for Pennsylvania that we do have one of those kind of one stop shop reference guides. I cannot speak for the other plans at this point in time. We would want to refer you out to your point of contact for that.

Madison:

Let's see here. I think a lot of the questions will probably have to go to everybody's point of contact, but again, everything's recorded and they do reach out to you within 24 hours.

Diana Charlton:

Thank you very much, Madison for manning the chat box and the QA box.

Madison:

You're welcome.

Diana Charlton:

All right. Brian, I guess we can proceed onto the next section, which is you presenting the points of contact. Thank you everyone for bearing with me with all of that information.

Brian Clark:

Thanks Diana. I just want to mention that the webinars are recorded every month and the way that you can locate a copy of the recorded webinars is go to your plans, Aetna Better Health website, so go to, for instance, Pennsylvania's website or Texas. Aetna better health of Texas, Pennsylvania, Louisiana. Type into Google and go to this site and then click on four providers. Then in the search bar, type the word webinar in and what you'll find is a list of all the recorded webinars as well as the schedule for 2018 of webinars. Just to let you know, we do record the webinars series and you do have access to the schedule. As Madison mentioned, for any question or comments that did not fully get answered today, it was most likely it was states specific and your point of contact will be outreached to buy me to make sure that they're aware that this question did not get answered during the webinar and for them to follow up with you.

Brian Clark:

Right now, what I want to do is introduce you all to your points of contact in your state. You should have a copy of this webinar. I sent it out about an hour. Actually, it was about half hour before the webinar today. You can reference who your point of contact is in that PDF document that I sent to you. Anyway, I'll highlight who Florida's contact is. That would be Michelle. Texas, that would be Joanna. You have an email that you can reach out to your point of contact. In Pennsylvania, your point of contact is Diana. She was presenting today. Louisiana, your point of contact is Frank. In Kentucky, that would be Kathy. Ohio, your two points of contact there's Sara and Valerie. Michigan, that would be Dante'. Illinois, your point of contact is Anya. In Maryland, that would be Don and New Jersey, please reach out to Sami.

Brian Clark:

The next webinar will be on Wednesday next week on the 17th. We'll be presenting again this webinar, so it'll be the repeat session of medical record review. What to expect during the review and a look forward into HEDIS 2019. That webinar starts at 3:30. Next month, we will be presenting HEDIS measures of care effecting 21 and older males and female members with an additional focus on hypothetical case stories involving Aetna members who come in to the office and get care, and we will show you how many HEDIS measures can be addressed in one visit among other topics. There'll be two offerings for February's webinar, in the morning and in the afternoon. I encourage you to forward any invitations that get sent to you that you feel might need passed along to someone within your organization, so that they can attend as well and I invite all previous registrants or attendees to the series.

Brian Clark:

If you've attended today, you'll get another invitation in the future for the webinars series. I hope you found that today's webinar was beneficial and worth your time and we'd love to have you back for the webinar in February and please pass along the invitation that you received for today's webinar, which actually had the invite in it for next week as well to any interested colleagues within your organization. Well it is, let's see here. 10:37 I said we probably go about 30 to 40 minutes then I was pretty much on point with that. I will give everyone back some time, and in the meantime I actually am going to keep the Q and A box open for another 10 to 15 minutes. We will be answering any question or comment that comes in that we can, that isn't state specific. If we don't get to your question, we will within 24 hours get a response to you. Madison, is there anything in the Q and A box right now that we can address?

Madison:

Let's take a look here. There's a lot of questions coming in right now, which is good. One is, I'm not sure if this is something we can answer on the phone right now or not, but can they bill preventative visit codes with nutrition and physical activity together?

Brian Clark:

Hey Diana. Are we referring to bundle codes here? Is that what the question is referring to, physical activity and nutritional counseling? I think it would depend on the office, how many codes they can submit at once on one submission. Am I correct?

Diana Charlton:

Well, when they say preventative, I just want to confirm that the counseling is actually taking place or are they speaking for a future reference? The gaps can only be closed when the service actually occurs.

Brian Clark:

That's very important-

Diana Charlton:

I do know what the WCC measures specifically with the physical activity component. We have some inquiries going out to national right now on some of the codes that can be accepted for that. What I would like to do is once we get confirmation back in general on that measure, we can send it out to the points of contact and then they can disseminate it out to the providers, because I do know that specifically with the physical activity component of that measure, we have some questions going out on if any different codes could be accepted.

Brian Clark:

Thanks Diana. Yeah, that's a good plan of attack, I guess.

Diana Charlton:

Yeah. That measure's a little tricky with specifically with the physical activity component and the nutrition because the codes that we have right now are kind of very specific in the descriptions for the CPT codes. It's kind of funny we actually have questions going out about that right now. Well, like I said, once we get confirmation we can send that out to the points of contact and they'll get it out to the providers.

Brian Clark:

Sounds good. Madison, anything else in the Q and A box?

Madison:

Right now, I think it's all things that we are going to have to refer to their points of contact, but I do encourage people, if you guys keep having questions, please continue to type them in the Q and A box.

Brian Clark:

For all those that need to get going, I hope you enjoy the rest of your day. Hope it's a productive one and we will see you in the next webinar. Thanks everyone.