BlueShield of Northeastern New York

Make every visit a preventive visitMarch 20, 2013

Welcome

We will cover:• Evidence based clinical guidelines about an

effective well visit • Administration and documentation of

immunizations • Lead Screening • Coding • P4P

Opening Remarks

Children are our future!

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

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

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

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

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

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

• Systems• Providers• Patients

Barriers

Henry M. Neilley, MD, FAAP

Best Practice

• Health and developmental history• Physical exam• Immunizations• Lead screening – children under 2 yrs• Health Education / Anticipatory Guidance

Components of a 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

Preparing for a comprehensive well 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

Suggestions for combining a well and sick visit

• Missed opportunities• Parental concerns• Appointment scheduling• Transportation

Barriers

Lisa Phillips, BSN

• 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

• There is a copy of immunization schedule in your packet

• Let’s review some pertinent updates in this schedule

2013 updates

• Documentation• Documentation• Documentation

NYSIIS - New York State Immunization Information System

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

Kathryn Glasser, CPC

• Choosing codes• Coding resources online• Coding documents in handout packet• After the seminar

Coding: best practices

• Sick (E&M) vs. Well (Preventive)

• Provide the services• Document what was provided• Code what was documented

The Chicken or the Egg

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

Clinical Edit Search Request

Clinical Edit Result

Code and Comment Sample 1

Code and Comment Sample 2

Code and Comment Key – Sample

Practice Specific Questions

• Contact the Provider Relations Department to speak with your representative.

BSNENY Providers518-220-5601

BlueShield is here to help you!

• Reminders via phone and mail are made regarding immunizations

• Pediatric Disease Management nurses available

• 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

BlueShield is here to help you!

Questions

Thank You!

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