Tag: #HEDIS

Posted in #reimbursement, #unitedhealthcare, NY Providers, Payers and CPT reinbursement, Training

NYS UHC Community Plan OBGYN required codes

Posted on by KR2Medical Billing

Are you an OBGYN that practices in NYS and accepts UHC Community Plan? Then this blog post is for you.

As per UHC Community Health Plan announcement the claims need to be submitted with the additional codes:

0500F – Initial prenatal visit
0502F – Subsequent prenatal visit
0503F – Postpartum visit 

These codes are not reimbursed separately and are only used for HEDIS reporting.

Please do not forget to bill the proper OBGYN codes (global, etc) in order to get reimbursement.

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Posted in BCBS (Various States), NY Providers, Training, Updates

HEDIS Measure: Update Colorectal Cancer Screening for 2022

Posted on by KR2Medical Billing

Are you a primary care physician and is reporting HEDIS measures? Then this following blog post is for you.

In this blog post we will discuss the changes/updates that NCQA just released for HEDIS Colorectal Cancer Screening Measure.

Measure Description: Measures the percentage of members 45 to 75 years of age who had appropriate screening for rectal cancer. The Medicaid product was added to the administrative data collection method for this measure and the age range was changed to 45 to 75 years of age.

In order to meet this measure your patients need to fall in ANY of the following criteria:

  • Fecal occult blood test during the measurement year
  • Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year
  • Colonoscopy during the measurement year or the nine years prior to the measurement year
  • CT colonography during the measurement year or the four years prior to the measurement year
  • Stool DNA (sDNA) with FIT test during the measurement year or the two years prior to the measurement year

If you would like to report this measure via Electronic Clinical Data Reporting system you will need to select: Colorectal Cancer Screening (COL-E).

Reminder: please make sure to document all of needed information in the patient medical records.

#HEDIS #Cancer #primarycare #physicians #NCQA

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Posted in Training, Updates

HEDIS Measure: Well-child visits in first 30 months.

Posted on by KR2Medical Billing

Bringing young children to see the primary care physician, for a well-care visit is extremely important.

These visits track:

Prevention: wellness visits ensure children receive scheduled immunizations that prevent illness. It is also a great opportunity to discuss nutrition and safety in the home.

Growth and development. Evaluating children for growth and development enables parents to see how much their children have grown since the last visit. It is also an opportunity to share the children’s development, to discuss milestones, social behaviors, and learning.

Raising concerns. Offering parents an opportunity to share concerns at the start of the visit will help in your evaluation of the patient. They may want to talk about development, sleep and eating habits and behaviors.

Team approach. Regular visits create strong, trustworthy relationships among physician, parent, and child. The American Academy of Pediatrics (AAP) supports well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental, and social health of a child.

Description of the measure:

Describes the percentage of members who had to the following number of well-child visits with a PCP during the last 15 months.

The rates are reported as follows:

Well-child visits in the first 15 months: Six or more well-child visits with children who turned age 15 months during the measurement year.

Well-child visits for ages 15 to 30 months: Two or more well-child visits with children who turned age 30 months during the measurement year.

In order to receive credit for this measure the following DX should be used:

  • ICD-10:110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2

The following CPT codes should be used:

  • CPT: 99381-99382, 99391-99392, 99461

The following HCPCS should be used:

  • HCPCS: G0438-G0439, S0302

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