Diagnosis Closure Incentive Program

1. Diagnosis Closure Incentive Program April 2013

2. What is the Diagnosis Closure Incentive Program? • The Blues’ Diagnosis Closure Incentive Program gives an incentive to Medicare Advantage primary care physicians who identify all of a patient’s acute and chronic conditions each year. This includes patients with: • BCN Advantage HMO-POSSM and BCN Advantage HMOSM • BCBSM’s Medicare Plus Blue PPOSM • Doing so helps: • CMS accurately provide risk scores for each patient • Health care providers identify appropriate treatments and actions • The Blues improve the overall quality and affordability of health care delivery What we’re targeting

3. Diagnosis gaps – a closer look • The program focuses on identifying and closing diagnosis gaps • A gap can be: • A suspected or historical diagnosis that has not been addressed or coded in the current year • An unconfirmed diagnosis that may or may not be applicable to the member • Gaps identified by the Blues between January through September 2013 are eligible for payment • Closing the gaps helps to paint an accurate picture of what is happening with each patient

4. How the program works…. • Who is eligible? • Primary care physicians with one or more Blues Medicare Advantage patients with at least one open diagnosis gap identified by the Blues are eligible for the incentive • What is the incentive? • These eligible physicians will receive $100 for closing 100% of the patient’s diagnosis code gaps • How will these gaps be identified? • Diagnosis gaps will be identified in the new Diagnosis Evaluation report on Health e-BlueSM

5. How to close a gap Gaps can be closed through one of the following methods: • Confirming the diagnosis code: • By submitting a claim with the diagnosis code • Through Health e-Blue entry • Through an electronic medical record interface (available after May 2013) • By completing and submitting a paper Diagnosis Evaluation report (available to providers who don’t have access to Health e-Blue) • By submitting a paper medical record • Notifying the Blues that the patient does not have the condition: • Through Health e-Blue • Sending a “delete record” on an EMR file (available after May 2013) • By completing and submitting a paper Diagnosis Evaluation report (for those without Health e-Blue)

6. What does Health e-Bluelook like? • Providers log in to Provider Secured Services on bcbsm.com • Then click BCN Health e-Blue or click BCBSM Medicare Advantage Health e-Blue (based on member’s coverage)

7. Health e-Blue Diagnosis Evaluation Panel If you don’t have access to Health e-Blue: Contact your BCN provider representative or BCBSM provider consultant for help applying.

8. More program details • In order to earn an incentive for closing a patient’s gaps: • All the patient’s gaps must be closed in 2013 and reported to the Blues by the early 2014 deadline (which will be announced by the Blues) • The gaps must be closed following a face-to-face visit • The diagnosed conditions must be addressed at the face-to-face visit • Coding and documentation must follow CDC and CMS standards • Important note: Gaps closed by InovalonTM (vendor) will not result in a provider incentive payment Detailed information about the incentive program is available through the BCN and BCBSM Medicare Advantage Diagnosis Closure Incentive Materials available in the Resources section of Health e-Blue.

9. Questions?