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BlueShield of Northeastern New York. Make every visit a preventive visit March 20 , 2013. Welcome. Opening Remarks. We will cover: Evidence based clinical guidelines about an effective well visit Administration and documentation of immunizations Lead Screening Coding P4P .
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BlueShield of Northeastern New York Make every visit a preventive visit March 20, 2013
Opening Remarks We will cover: • Evidence based clinical guidelines about an effective well visit • Administration and documentation of immunizations • Lead Screening • Coding • P4P
Regionally all plans are scoring poorly 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
Barriers • Systems • Providers • Patients
Components of a well visit • Health and developmental history • Physical exam • Immunizations • Lead screening – children under 2 yrs • Health Education / Anticipatory Guidance
Preparing for a comprehensive well visit • 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
Suggestions for combining a well and sick visit • 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
Barriers • Missed opportunities • Parental concerns • Appointment scheduling • Transportation
Immunizations and more • 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
2013 updates • There is a copy of immunization schedule in your packet • Let’s review some pertinent updates in this schedule
NYSIIS - New York State Immunization Information System • Documentation • Documentation • Documentation
VFC Vaccines for Children 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
Coding: best practices • Choosing codes • Coding resources online • Coding documents in handout packet • After the seminar
The Chicken or the Egg • Sick (E&M) vs. Well (Preventive) • Provide the services • Document what was provided • Code what was documented
Coding Resources www.bsneny.com Provider > 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
Practice Specific Questions • Contact the Provider Relations Department to speak with your representative. BSNENY Providers 518-220-5601
BlueShield is here to help you! • Reminders via phone and mail are made regarding immunizations • Pediatric Disease Management nurses available
BlueShield is here to help you! • 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! • 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
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