12
BlueLine | Summer 2016 Continued next page Giving Back for Innovation and Excellence On April 21, the Florida Blue Foundation announced the honorees of the Sapphire Awards from among 13 finalists and 112 nominees from around the state. The awards, totaling $350,000, honor outstanding individuals, programs and nonprofit organizations in community health care, or health care- related fields, whose work is distinguished by leadership, innovation, and achievements in community health. An independent panel of experts with state and national expertise in community health best practices selected the honorees in each category. Honorees include an Orlando-area program that increases access to dental care, a pediatric mobile clinic in Miami, a Tampa group that focuses on quality perinatal care, and a psychiatrist from Jacksonville who worked with the homeless population. You can watch these great videos in the links below. The winners, runners-up, and honorable mentions in each of the three categories are: Individual Category Winner - Richard Christensen, Jacksonville $50,000 (watch video) Runner-up - Doug Kent, Bay and Gulf counties, $20,000 Runner-up - Jasmin Denise Shirley, Fort Lauderdale, $20,000 Honorable mention - Bakari Burns, Orlando, $10,000 Honorable mention - Aggie Pappas, Fort Lauderdale, $10,000 Honorable mention - Bret Smith, Kissimmee, $10,000 Organization Category Winner - Florida Perinatal Quality Collaborative, Tampa, $50,000 (watch video) Runner-up - HANDS of St. Lucie County, Fort Pierce, $20,000 Runner-up - Osceola County Council on Aging, Kissimmee, $20,000 INSIDE THIS ISSUE Feature Article ADMINISTRATIVE UPDATES 2 Help Patients Avoid Higher Out-of-Pocket Health Care Expenses New Authorization Service Codes Important Changes for Colonoscopy Claims BlueCard Manual Provides Everything You Need to Know About the Program Accept Member ID Cards During Emergency/Natural Disasters Availity Web Portal Gets a Facelift Search Engine Optimization Tips for Your Practice Update Your Provider Information Today Putting Your Provider Communications Feedback in to Action MEDICAL NOTES 6 Florida Hospitals Receive Recognition for Excellence PLANS AND SERVICES 6 What You Need to Know About myBlue Use Participating Lab Providers PROGRAMS 7 Radiation Oncology Authorization Requirements Health Risk Assessment Form - $150 Offer Disease Management Programs can Help Your Patients BlueLine For Physicians and Providers SUMMER 2016

BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

  • Upload
    others

  • View
    0

  • Download
    0

Embed Size (px)

Citation preview

Page 1: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

BlueLine | Summer 2016

Continued next page

Giving Back for Innovation and Excellence On April 21, the Florida Blue Foundation announced the honorees of the Sapphire Awards from among 13 finalists and 112 nominees from around the state. The awards, totaling $350,000, honor outstanding individuals, programs and nonprofit organizations in community health care, or health care-related fields, whose work is distinguished by leadership, innovation, and achievements in community health. An independent panel of experts with state and national expertise in community health best practices selected the honorees in each category.

Honorees include an Orlando-area program that increases access to dental care, a pediatric mobile clinic in Miami, a Tampa group that focuses on quality perinatal care, and a psychiatrist from Jacksonville who worked with the homeless population. You can watch these great videos in the links below.

The winners, runners-up, and honorable mentions in each of the three categories are:

Individual Category • Winner - Richard Christensen,

Jacksonville $50,000 (watch video)

• Runner-up - Doug Kent, Bay and Gulf counties, $20,000

• Runner-up - Jasmin Denise Shirley, Fort Lauderdale, $20,000

• Honorable mention - Bakari Burns, Orlando, $10,000

• Honorable mention - Aggie Pappas, Fort Lauderdale, $10,000

• Honorable mention - Bret Smith, Kissimmee, $10,000

Organization Category• Winner - Florida Perinatal

Quality Collaborative, Tampa, $50,000 (watch video)

• Runner-up - HANDS of St. Lucie County, Fort Pierce, $20,000

• Runner-up - Osceola County Council on Aging, Kissimmee, $20,000

INSIDE THIS ISSUE

Feature Article

ADMINISTRATIVE UPDATES 2

� Help Patients Avoid Higher Out-of-Pocket Health Care Expenses

� New Authorization Service Codes

� Important Changes for Colonoscopy Claims

� BlueCard Manual Provides Everything You Need to Know About the Program

� Accept Member ID Cards During Emergency/Natural Disasters

� Availity Web Portal Gets a Facelift

� Search Engine Optimization Tips for Your Practice

� Update Your Provider Information Today

� Putting Your Provider Communications Feedback in to Action

MEDICAL NOTES 6

� Florida Hospitals Receive Recognition for Excellence

PLANS AND SERVICES 6

� What You Need to Know About myBlue

� Use Participating Lab Providers

PROGRAMS 7

� Radiation Oncology Authorization Requirements

� Health Risk Assessment Form - $150 Offer

� Disease Management Programs can Help Your Patients

BlueLine For Physicians and Providers

SUMMER 2016

Page 2: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

2 | BlueLine Summer 2016

ADMINISTRATIVE UPDATES

Continued from cover

Program Category• Winner - Bithlo Transformation

Effort: Dental Care Access Program – Florida Hospital, Orlando, $50,000 (watch video)

• Winner - Pediatric Mobile Clinic - University of Miami, Miami, $50,000 (watch video)

• Runner-up - MBF Child Safety Matters - Monique Burr Foundation, Jacksonville, $20,000

• Runner-up - Smiles Across Miami - Nova Southeastern University, Fort Lauderdale, $20,000

Florida Blue Foundation is a trade name of Blue Cross and Blue Shield of Florida Foundation, Inc. Florida Blue Foundation is a separate, philanthropic affiliate of Florida Blue, Florida’s Blue Cross and Blue Shield Company. The Foundation and its parent are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information about the Foundation, please visit floridabluefoundation.com.

- See more here.

INSIDE THIS ISSUE

PHARMACY 9

� Commercial and Other Pharmacy Program Updates

� Medication Guides

QUALITY & COMPLIANCE 9

� Accreditation Update

� Working Together to Achieve the Triple Aim

� Tools to Help You Manage Your Florida Blue Patient Risk Factors

EDUCATION BACK COVER

� Website Education Opportunities

� News and Information at Your Fingertips

Help Your Patients Avoid Unnecessary Out-of-Pocket Health Care ExpensesIt happens too often. A member is billed for services they thought were in-network but were really out-of-network. Please remember to refer your patients (our members) to participating providers.

A great example of this is a member who recently called to inquire about her enormous lab bill. She takes pain medication and is required to have a urinalysis on a regular basis. She has seen the same pain management specialist for over a year. Since the specialist was in-network, the member thought her monthly urinalysis was completed in-network too since she had always left her specimen on-site. No one told her it was going off-site for analysis and she never thought to ask whether the analysis was performed on or off-site.

Our member never received a bill for her lab work until nearly a year into her care. She started receiving invoices from a lab “she never visited”. There was one invoice for $336; another for $255; another for $376; and on and on. In total, our member was being charged for

over $10,000 of lab work. When she inquired, she learned her urinalysis had always been delivered been delivered to an off-site lab that was not a participating provider.

Although we consistently educate our members about being smart health care consumers, in this case, the patient didn’t know or remember to ask if her labs were in-network.

Please remember to talk to your patients about in-network and out-of-network services. Referring to in-network providers will help your patients maximize their benefits and avoid being billed in full or balance-billed.

Make sure you refer your patients to participating providers such as:

• In-network practitioners and ambulatory surgical centers;

• Quest Diagnostics for lab work;

• AmeriPath for anatomical pathology services; and

• DermPath Diagnostics for dermatopathology services.

Page 3: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

Visit Floridablue.com/providers 3

ADMINISTRATIVE UPDATES

Important Changes for Submitting Routine or Screening Colonoscopy ClaimsWe made recent changes that impact submitting claims for routine/screening colonoscopy services performed at an ambulatory surgical center. These changes impact the 51-modifer and expanded the number of diagnosis fields used to identify screening colonoscopy claims.

For details, please refer to the bulletin posted on our website at floridablue.com; select “Providers” (top of the page), “Tools & Resources”, “Bulletins & FAQs”, and then select “Billing and Administrative”.

New Authorization Type of Service CodesOn May 15, 2016, the Inpatient and Outpatient Authorization screens in Availity®1 were changed to reflect a number of enhancements including new types of service codes for authorizations. For details, please

refer to the bulletin posted on our website at floridablue.com; select “Providers” (top of the page), “Tools & Resources”, “Bulletins & FAQs”, and then select “Billing and Administrative”.

1Availity, LLC is a multi-payer joint venture company. For more information or to register, visit Availity’s website at availity.com.

BlueCard Manual Provides Everything You Need to Know About the ProgramBlueCard® is a national program that enables members to obtain health care services while traveling or living in another Blue Plan’s service area. It applies to all covered inpatient, outpatient, and professional health care services. The BlueCard program links participating health care providers with Blue Plans across the country through a single electronic network for claims processing and reimbursement.

Remember to check the online BlueCard manual on our website at floridablue.com; select Providers (top of the page), Tools & Resources, Provider Manual, Physicians and Provider Manual, and then BlueCard program (left navigation bar), or go to availity.com; select Florida Blue Payer Spaces, Resources, and then Provider Manual BlueCard Program. You’ll find everything you need to know about the program including submitting claims, obtaining authorizations, and member ID alpha prefixes.

Page 4: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

4 | BlueLine Summer 2016

ADMINISTRATIVE UPDATES

Search Engine Optimization Tips to Help Your PracticeGain more operational knowledge, more patients, and increased revenue for your health care business. Online visibility can be a challenge, but it’s especially challenging and competitive in the health care industry. If consumers can’t find you at the moment they’re looking for a provider, you’ve missed your opportunity to get them into your office. Not only do you have to develop relevant and helpful content, but it has to be optimized appropriately so people will actually see it in the search engines (i.e., Google).

As a health care provider, your web presence is much more than just your practice’s name (brand). Having a website that is actually attracting consumers to your site and driving patients into your office is critical.

You want to maximize your search engine optimization (SEO).

Read the 7 Urgent SEO Tips Providers Need To Know from Victoria Edwards, Digital Content Strategist at Florida Blue.

Equally important, is making sure your online provider directory information is up-to-date with Florida Blue. Keeping this information with us current is critical. When you regularly verify your information with us, including your website, you are ensuring greater search visibility so patients are able to find you the moment they need you.

To update your URL, see the next article, “Update Your Provider Information Today!”.

Accept Member ID Cards During Emergency/Natural DisastersIt’s hurricane season! That means it’s time to accept ID cards from Florida Blue or other Blue Plan members during an emergency or disaster – even if you’re unable to communicate with us. Here are a few general guidelines to remember if you’re unable to follow normal business procedures.

Accept the Card Guidelines

1. Verify member eligibility and benefits electronically through Availity.

2. If you can’t verify member eligibility and benefits electronically, contact the Florida Blue Provider Contact Center at (800) 727-2227.

3. If you’re unable to verify member eligibility and benefits electronically or by phone:• Accept a valid Florida Blue ID card and picture

ID, or

• Accept a Florida Blue universal application, acknowledgement/acceptance letter and picture ID.

4. If you can’t submit claims electronically:• Hold electronic claims for 14 calendar days or

until service is restored.• If you convert electronic claims to paper claims,

purge the electronic claims from your system to avoid duplicate claim submissions.

More information, including electronic alternatives and guidelines for obtaining authorizations can be found in a bulletin posted on our website at floridablue.com, select “Providers” (top of the page), “Tools & Resources”, “Bulletins & FAQs”, and then select “Billing and Administrative”.

Availity Web Portal Gets a FaceliftThis summer, Availity will introduce an improved home page for the web portal. The new design moves the navigation menus from the left side of the screen to the top, and provides quick access to the most commonly used apps in the portal.

More than 8,000 portal users participated in a pilot test of the new home page, and their feedback was used to make the tool intuitive and interactive.

You can get a sneak peek at the new home page – updates and improvements will continue to be added as more users provide feedback.

Page 5: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

Visit Floridablue.com/providers 5

ADMINISTRATIVE UPDATES

Update Your Provider Information Today!The Centers for Medicare & Medicaid Services (CMS) now requires health plans, like Florida Blue, to conduct quarterly outreach to contracted providers to validate their provider information.

Whether its for you or on behalf of your group, updating your information in Availity is easy, secure, and fast!

Already Registered with Availity ? Log on to Availity.com, select View and Update Your Provider Information to verify the information below is correct:• Street address & phone

number

• Ability to accept new patients

• Other changes that may affect availability to patients

Not Registered with Availity?Visit Availity.com and register. You can then provide all the current information.

Benefits of Updating Your Information:• Patients and prospective

patients will easily find your accurate provider information online.

• By also updating your email address, you will receive important Florida Blue email notifications with news and information you need to know.

Survey Results are In! Putting Your Provider Communications Feedback into ActionIn February, you were asked to take part in an email survey regarding our various methods for delivering communications to you and your preferences on how you like to receive information. Thank you to the 1,236 providers and other clinical and business office staff who responded to our survey.

Your feedback will help us improve the way we share information with you. See the results of the survey and what we plan to do with your feedback in the bulletin posted on our website at floridablue.com; select “Providers” (top of the page), “Tools & Resources”, “Bulletins & FAQs”, and then select “Other”.

Page 6: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

6 | BlueLine Summer 2016

MEDICAL NOTES

PLANS AND SERVICES

6 | BlueLine Summer 2016

Florida Hospitals Recognized for Excellence For more than 10 years, the Blue Distinction Centers (BDC+/BDC) for Specialty Care programs have helped members needing care find quality providers for their specialty care needs in the areas of bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacements, maternity, spine surgery, and transplants. Many hospitals in Florida continue to be acknowledged for excellence by both the Blue Cross and Blue Shield Association and Florida Blue.

Hospitals are recognized as either Blue Distinction Center Total Value (BDC+) meeting both quality and cost effective criteria or Blue Distinction Center (BDC) meeting quality requirements. Specialty designated hospitals are assessed using a combination of submitted and publicly

available quality information and cost measures derived from Blue Cross and Blue Shield companies’ medical claims.

According to the Blue Cross and Blue Shield Association, the research shows those designated as Blue Distinction Centers demonstrate better quality and improved outcomes for patients compared to other facilities. On average, BDC+ facilities are also 20 percent more cost-efficient than non-BDC+ designated health care facilities.

For more information about the program, visit bcbs.com/bluedistinction. Blue Distinction Specialty designations are displayed locally on the floridablue.com and nationally on the bcbs.com provider directories.

What You Need to Know About myBlue Things to Remember About the myBlue HMO Plan. • As a myBlue primary care physician (PCP), you are

responsible for coordinating access to all medical services for your myBlue patients.

• PCP’s who are part of a multi-specialty group must issue a referral your myBlue-covered patient to visit a specialist within the same group.

• myBlue-covered patients must have a referral and/or authorization on file. If this is not on file, your patient may not be covered for services. Authorizations are required for most services, except for:

• Obstetrician/gynecologist, podiatrist, chiropractic or dermatology (first five visits only)

• myBlue pharmacy coverage includes CVS and Navarro pharmacies only as participating providers. Prescriptions filled at any other pharmacy are not covered.

How to Help myBlue-Covered Patients• Contact your newly assigned patients and schedule

them for a wellness checkup.

• Contact your patients after an emergency room visit or hospitalization.

• Coach and counsel patients on wellness activities and develop care management treatment plans.

• Monitor preventive care and disease management for patients.

Helpful myBlue Resources:• myBlue HMO FAQs for Providers

• myBlue Manual

• myBlue - What You Need to Know Quick Reference

Page 7: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

Visit Floridablue.com/providers 7

PLANS AND SERVICES

PROGRAMS

Use Participating Lab Providers To help your Florida Blue patients effectively control their out-of-pocket health care costs, it is important to refer lab services to participating providers for non-emergency situations. For most members, use of non-participating labs greatly increases their out-of-pocket expenses. (See story on page 2, “Help Your Patients Avoid Unnecessary Out-of-Pocket Health Care Expenses“).

In your Agreement with us, you agreed to refer our members to participating providers under most circumstances. The preferred providers for most of our plans include:

• Quest Diagnostics for lab work;

• AmeriPath for anatomical pathology; and

• Dermpath Diagnostics for dermatopathology .

To review additional participating laboratory providers, please refer to our Online Provider Directory website at Providersearch.FloridaBlue.com/providersearch/pub/index.htm.

Quest Diagnostics makes a broad range of routine and advanced tests convenient for you and your patients. One of the tests, ImmunoCap® specific IgE testing, helps you identify allergic triggers that affect asthma and develop an exposure reduction plan for the patient’s well-being. Unlike skin prick testing, ImmunoCap testing can be performed with a simple blood test and patients can continue to take antihistamines and other medications. Please remember that clinical history guides what allergens are selected for testing; it is important to select tests and interpret results in the context of each patient’s medical history.

As a reminder, when submitting laboratory referrals, only use valid ICD-10 diagnosis codes. Failure to provide valid ICD-10 diagnosis for each test may cause delays in members receiving services or lab results.

For more information regarding lab referrals, please refer to the Manual for Physicians and Providers on floridablue.com.

Radiation Oncology Authorization Requirements The radiation oncology utilization management program, managed on our behalf by AIM Specialty Health, ensures radiation therapy treatment plans are clinically appropriate for each patient’s specific condition; are conducted in the most efficient manner; and delivered according to nationally recognized clinical guidelines. For details you can access the bulletin posted on our website at floridablue.com, select “Provider” at the top, “Tools & Resources”, “Bulletins & FAQs”, and then select “Products & Programs”.

Health Risk Assessment Form Program - Receive $150!*When you conduct your Medicare patient’s annual wellness exam, the Affordable Care Act (ACA) requires that a health risk assessment be included as part of the visit. The assessment helps to identify health behaviors and risk factors known only to the patient (i.e., smoking, physical activity, and nutritional habits). Providers can then give tailored feedback to help reduce risk factors, and the potential diseases related to these risk factors. We support our providers in administering a health risk assessment and are pleased to offer our Health Risk Assessment Form program where primary care

physicians can receive $150 per member per year for completing an assessment form*.

We have worked with Availity to make this process as user friendly as possible by pre-populating the assessment form with the patient’s demographics, risk coding gaps, and HEDIS and Stars gaps. We encourage you to take advantage of this program. For details, refer to the bulletin at floridablue.com; select “Providers” (at top), “Tools & Resources”, “Bulletins”, then select “Products and Programs”.

*For members identified as eligible by Florida Blue only. Form may be subject to review.

Page 8: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

8 | BlueLine Summer 2016

PROGRAMS

Our Disease Management Programs can Help Your PatientsDid you know we have Disease Management Programs available to your Florida Blue patients identified with asthma, diabetes, cardiovascular disease, congestive heart failure, and COPD?

A program has been developed for each one of these conditions to assist your patients and their families to better understand and cope with their chronic condition(s) by:

• Reinforcing the patients treatment plan

• Promoting healthy behaviors and lifestyle changes

• Providing support from our nurses and other health care staff to ensure your patients can understand how to best manage their condition and periodically evaluate their health status

• Sharing information about upcoming events such as health fairs

• Providing periodic newsletters to keep patients informed of the latest information on their condition

• Promoting educational information and tools that can assist your patients in understanding and managing the medications you prescribe, understanding the importance of obtaining necessary preventive screenings, and how to effectively plan for follow-up visits with reminders as to when visits will occur

Our programs also offer education and support for the management of co-morbid conditions such as emotional health, exercise, nutrition, smoking cessation, stress management, weight management, and medication compliance to improve quality of life.

Membership in any of the programs is voluntary. If at any time your patients wish to stop participating in the program, they can contact their case manager.

Referrals to our case management programs can be made by calling (800) 955-5692, Option 4 or by secure email: [email protected]

Page 9: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

Visit Floridablue.com/providers 9

PHARMACY

QUALITY AND COMPLIANCE

Commercial and Other Pharmacy Program Updates Effective July 2016Several changes to Florida Blue’s pharmacy programs were implemented July 1, 2016. The changes affect medications that require prior authorization, the Responsible Quantity Program, Responsible Steps and the pharmacy coverage exclusions list.

The changes are summarized in a provider bulletin posted on our website at floridablue.com; select “Providers” (top of the page), “Tools & Resources”, “Bulletins & FAQs”, and then select “Pharmacy News”.

Medication GuidesMember plans come with a medication guide (Formulary). It lists all the drugs a plan covers, plus any special rules to follow with certain medications.

Each plan has its own medication guide, which is updated monthly, and available at floridablue.com; select “Providers” (top of the page), “Tools & Resources”, “Medical & Pharmacy Info” (left margin), and then select “Medication Guides”.

PHARMACY

Accreditation UpdateWhile we work together to ensure positive member experiences that support healthy living, we continue committed to quality measures per national and state regulatory requirements. We had many accreditation and regulatory compliance efforts in the first half of the year. This includes leading three accreditation and regulatory reviews to ensure standards were met. For details you can

access the bulletin posted on our website at floridablue.com; select “Providers” at the top, “Tools & Resources”, “Bulletins & FAQs”, and then “Compliance”.

Questions regarding HEDIS review or the HEDIS and Medicare Stars measures should be directed to Angela Hicks, Florida Blue HEDIS Manager, RN, BSN, MSN at (800) 555-8228, ext. 50818.

1BeHealthy Florida, Inc. (formerly BeHealthy America, Inc.) was purchased by an affiliate of Florida Blue in 2015 and is now conducting business under the name Florida Blue Preferred HMO. As part of this transaction, Florida Blue Preferred HMO entered into a strategic arrangement with Alignment Healthcare for population health management.

Florida Blue Preferred HMO offers a BlueMedicare Preferred HMO health plan for members who are over the age of 65.

Page 10: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

10 | BlueLine Summer 2016

QUALITY AND COMPLIANCE

Working Together to Achieve the Triple Aim… Improved Care Quality, Lower Costs, and a Better Patient Experience As providers transition to value-based care and share in more risk for the quality and overall cost-effectiveness of their patient care, it is more important than ever to establish a trusting payer-provider relationship.

At the end of the day, we are both working to achieve a common goal: improved care quality, lower costs, and a better patient experience. By working together, we can leverage each other’s strengths and do just that!

For example, this might include sharing our capabilities in care management programs, quality metrics, data analytics, and how we are engaging patients and members. Together, we can identify high-risk, high-cost individuals that need more focused, hands-on care and begin that outreach. Consistent outreach and communication between all parties of the care team – patient, provider, and payer – ensures recommended screenings and treatments are delivered at the right time and the right place.

One way we can work together now is through our quality measures. The role you play in Medicare Stars and HEDIS is very important. We need your support in responding to medical records requests as part of the annual review process. This helps us confirm the quality of care received by our members.

How YOU Impact Star Ratings:

• Make sure patients receive routine screening tests and preventive services.

• Help patients manage their chronic conditions, such as high blood pressure, arthritis, and diabetes.

• Help patients choose safe medications; use the High Risk Medication (HRM) alternative list.

• Ensure patients continue to take their medications (especially oral diabetic, cholesterol, HTN ACE/ARB).

• Submit claims and document all services thoroughly and accurately (risk adjustment information).

• Understand the impact you and your office staff have on your patient’s satisfaction with their health experience, which is reflected in CAHPS® (Consumer Assessment of Healthcare Providers and Systems) and HOS (Health Outcomes Survey) surveys.

• Find more information about Medicare Stars Quality Metrics.

How YOU Expedite the HEDIS® process Improvements:

• Deliver appropriate care within the specified timeframes.

• Properly document all care in the patient’s medical record.

• Code all claims correctly as this may reduce the number of records requested for the review.

• Respond to our medical record request within 5-7 days.

• Find more information about HEDIS.

“Alone we can do so little; together we can do so much”

- Helen Keller

Page 11: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

Visit Floridablue.com/providers 11

How We’re Reaching Out to Our Members to Improve Their HealthWe are actively reaching out to our BlueMedicare members to remind them to contact their doctor to schedule an annual wellness visit and talk to them about screenings, immunizations, and medications. In some cases, we are providing the added service of scheduling our member’s wellness visit on their behalf – while they take part in our three-way phone call. We hope you are noticing an increase in these types of visits. Your patients’ first step to healthy living is scheduling that visit and establishing a trusting relationship with you.

You may also notice your patients are asking more questions during their wellness visit. That’s because we’re educating members on what types of questions they may want to discuss. For additional details on how we are reaching out to our BlueMedicare members see the related bulletin posted on our website at floridablue.com, select “Providers” (top of the page), “Tools & Resources”, “Bulletins & FAQs”, then select “BlueMedicare/Medicare Advantage”.

Health Risk Assessment - $150 OfferBecause you play such a critical role in improving our member’s health, we are offering $150 per form/identified member to primary care physicians who complete our Health Risk Assessment form (through Availity). For more details about this offer, refer to the article on page 7, “Health Risk Assessment Form Program - Receive $150”.

Working Together for a Better FutureLooking ahead, there are many ways we can work together. When we trust one another, learn from each other’s capabilities and expertise, and work together in new, innovative ways, we can get one step closer to achieving the triple aim: improved quality of care, lower costs and a better patient experience. This is far beyond what we could achieve on our own.

Tools to Help You Manage Your Florida Blue Patient Risk Factors Let’s work together to improve the quality of health care for your patients and our members. Please find links to the risk factor measure tip sheets below to find acceptable forms of documentation, diagnosis and more.

Body Measurement Index (BMI)Obesity is a complex chronic disease affected by environmental, genetic, physiological, metabolic, behavioral, and psychological components. The Center for Disease Control (CDC) considers Adult BMI (Body Measurement Index) an efficient and effective method to assess excess body fat using weight and height calculations as a first step to weight management.

As we support the HEDIS and Medicare Stars Adult BMI measure in the primary care setting, we urge doctors to perform an Adult BMI assessment at least every two years for their patients between the ages of 18-74, and document findings in the medical record.

For additional information on this measure, please refer to the BMI HEDIS measure tip sheet >>.

Controlling Blood PressureWe are encouraging BlueMedicare members to schedule their annual wellness visit with their doctor. Please be sure and talk with your at-risk patients about the risk factors of this “silent killer”, high blood pressure, and how they can prevent or control it.

We support using the Controlling Blood Pressure HEDIS and Medicare Stars measure in the primary care setting. This measure focuses on members 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled.

For additional information on this measure, please refer to the Controlling Blood Pressure HEDIS measure tip sheet >>

Page 12: BlueLine Newsletter Summer Issue 2016 · see it in the search engines (i.e., Google). As a health care provider, your web presence is much more than just your practice’s name (brand)

EDUCATION

900-1582-0616

Website Education Opportunities Whether you have recently joined our provider network(s), added a clinician to your practice, added a new line of business, or hired new staff members in your office, there are plenty of online training sessions available to you at floridablue.com; select “Providers”, “Tools & Resources”, and then “Online Training”.

New Interactive Online Lessens for Coding Chronic Conditions This summer new interactive online lessons for coding chronic conditions will be added to our Revenue Program Management’s education and training library available through the Availity Learning Center. The new topics address:

• Behavioral Health

• Chronic Kidney Disease

• Data Sources for Coding

• Cardia Arrhythmias

Interactive online lessons for coding chronic conditions are also available on the following topics:

• Diabetes

• Cancer

• COPD

• Rheumatoid Arthritis

Also available is a recently released video on how we can help you with accurate coding and documentation, and the compliance and management of patients with chronic conditions.

You can access the online training and video through the Availity learning center at availity.com. Select, “Payer Spaces/Florida Blue” located in upper right corner. Next, select “Applications” and “Open” in the “Learn with Florida Blue” box. Here you will select “Catalog” to search for or browse for courses. More lessons are planned for release so check back often to see what’s available.

News and Information at Your Fingertips To find all your Florida Blue news and information, simply visit floridablue.com and select “Providers” at the top of the web page to gain access to helpful services, tools and information.

• Tools and resources (provider manual, forms, news bulletins, FAQs, Bluemail emails, online training, clinical programs information and more)

• Registration information

• Availity online services (update your provider information, verify eligibility and benefits, submit claims and more)

• Compliance information

• Provider data management (view and update your demographic records)

• BlueLine (quarterly newsletter with the latest news and information on plans and services, programs, claims and billing and more)

Remember to Update Your Email Address Today!Simply log on to availity.com, select View and Update Your Provider Information. This ensures you receive our latest news and updates.