Category: HEDIS Measures

Posted in EmblemHealth NY, HEDIS Measures, NY Providers, Payer Updates

Hedis Measure: Controlling Blood Pressure Controlling Blood Pressure

Posted on by KR2Medical Billing

Are you a provider that participates in reporting HEDIS measures? Then this blog post is for you!

What is this measure: the measure assesses if adults (18-85) with hypertension have their blood pressure adequately controlled, below 140/90 mm Hg. and below 130/80 Hg.

Documentation Requirements:

1. Adults 18-85 with a hypertension diagnosis. 

2. At least two visits during the measurement period with hypertension diagnoses, with a controlled reading occurring on or after the second diagnosis. 

3. Don’t forget to remove the members fhat were identified to have a nonacute inpatient admission during the measurement period.

4. Using remote devices to meet this HEDIS measure- some payers cover remote blood pressure devices ex. Emblem Health- place an order for the remote device through an In network DME provider- the cost cannot exceed $40. For this measure the patient read reading does not meet the medical criteria- the information should be transmitted to the provider from the device.

Coding: peoper codes to report the blood pressure measurements

  1. Systolic Blood Pressure CPT II:
    3074F – blood pressure less than 130 mmHg
    3075F – blood pressure 130-139 mmHg
    3077F – blood pressure greater than or equal to 140 mmHg
  2. Diastolic Blood Pressure CPT II:
    3078F – blood pressure less than 80 mmHg
    3079F – blood pressure 80‐89 mmHg
    3080F – blood pressure greater than or equal to 90

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Posted in HEDIS Measures, Training

HEDIS ADD measure requirenments.

Posted on by KR2Medical Billing

HEDIS ADD measure requirenments:

This measure tracks patients that are between 6-12 years old and had had at least 3 f/u visits within 10 months of the first ADHD medication prescription being dispensed.

  1. F/U visit with the prescribing provider within the 30 days of the medication being dispensed
  2. Two more follow up visit within the next 9 month

In addition to providers explaining the medication options and side effects, they should also schedule mo they visits, if needed, to make sure a good routine is in place and then every 3 months, for the first year.

Behavioral therapy, psychotherapy, family therapy, social skills therapy, etc should also be discussed with the patient and the parent.

In addition there should be collaboration with other providers and the school.

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Posted in #reimbursement, BCBS (Various States), BCBS Empire NY, Cinga Insurance, EmblemHealth NY, HEDIS Measures, NY Providers, Training

HEDIS Measure: Immunizations for Adolescent

Posted on by KR2Medical Billing

This measure represents the percentage of children who turned 13 years old and received the following immunizations before their 13th birthday.

  • One dose of meningococcal vaccine
  • One tetanus, diphtheria toxoids and one acellular pertussis vaccine (Tdap): and
  • Completed the human papillomavirus (HPV) series.*

*HPV requires 2 shots, at least 146 days apart.

Meningococcal recombinant (serogroup B) (MenB) vaccines- DO NOT COUNT towards the HEDIS measure.

For Meningococcal Serogroups A, C, W, Y:

  • At least one meningococcal serogroups A, C, W, Y vaccine, with a date of service on or between the member’s eleventh and 13th birthdays
  • Anaphylaxis due to the meningococcal vaccine any time on or before the member’s 13th birthday meets criteria

For Tdap: generic documentation (Tdap/Td) can be counted towards this HEDIS measure.

  • At least one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, with a date of service on or between the member’s tenth and 13th birthdays.
  • If patient has anaphylaxis due to Tdap vaccine during or before pt turns 13 years old
  • Encephalitis due to the tetanus, diphtheria, or pertussis vaccine

For HPV:

  • At least two HPV vaccines on or between the member’s ninth and 13th birthdays and with dates of service at least 146 days apart
  • At least 3 HPV vaccines – w/ different DOS before or on the date when patient turns 13 years of age
  • Anaphylaxis due to the HPV vaccine any time on or before the member’s 13th birthday meets criteria

Accepted documentation:

  • A note with the specific antigen/vaccine and the date of administration of the vaccine
  • A certificate of immunization prepared by an authorized health care provider or agency with information of each vaccine and their administration dates

Not accepted documentation:

A note that says the member is up to date and does not have the actual vaccines listed w/ administration dates

Via Anthem (NY) provider news.

PROVIDERS-some things you can do in your practice in order to meet this measure:

  • Have standing orders for adolescent vaccines- the visit can be performed by a Nurse
  • Use appointment reminders to schedule vaccine appointments
  • For HPV  vaccines make sure to schedule a f/u appt for the next dosage.
  • Educate parents on the importance of the vaccines and their on time administration.

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