Posted in BCBS Empire NY, Training, Updates

BCBS (NY): Proper coding for INR In-home patient monitoring

This following policy is part of BCBS (NY) administrative policy guidelines (07/01/2021)

This blog post is for providers that need to meet the INR (in-home) monitoring quality measure.

What you will learn?

  1. What is INR monitoring Quality measure?
  2. Proper coding for in-home INR monitoring
  3. Documentation requirements to meet the INR in home monitoring measure

What is INR (International normalized ratio)?:

International normalized ratio (INR) is blood-clotting test. It is a test used to measure how quickly your blood forms a clot, compared with normal clotting time.


International normalized ratio is part of the 2021 Quality Measure Set (Pharmacy Quality Alliance (PQA) measures.

The QRS measure set is comprised of clinical quality measures, including the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) measures and Pharmacy Quality Alliance (PQA) measures.

Previously, patients taking warfarin (brand name Coumadin) were heading off to the lab or clinic every few weeks for an international normalized ratio (INR) blood test. However, currently there is a small, portable device that patients on warfarin, can now self-test with a finger prick drop of blood.

Is there a provider type restriction for this quality Measure?

No, there is not provider type restriction.

As a provider, which proper codes should I use for INR in-home patient monitoring?

Below please see the proper codes that providers should use for INR in-home patient monitoring.

Meeting INR monitoring Quality Measure:

Definition: The percentage of members 18 years of age and older who had at least one 56-day interval of warfarin therapy and who received at least one international normalized ratio (INR) monitoring test during each 56-day interval with active warfarin therapy.

INR quality measure requirements.

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Posted in HEDIS Measures, Training, Updates

BCBS Empire NY Medicaid: Summary of changes for HEDIS Measures from NCQA (2020/2021)

Source: Empire Health Plus Plan (NY Managed Medicaid Plan)

Revised measures:

  • The former Well-Child Visits in the First 15 Months of Life (W15) measure was revised to Well‑Child Visits in the First 30 Months of Life (W30). It includes two indicators:
    • Well-child visits in the first 15 months — children who turned 15 months during the measurement year with six or more well-child visits
  • Well-child visits for ages 15 to 30 months — children who turn 30 months during the measurement year with two or more well-child visits
  • The former Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) and Adolescent Well-Care Visits (AWC) measures have been combined into Child and Adolescent Well-Care Visits (WCV):
    • The percentage of members 3 to 21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year

Key measure changes:

  • Controlling High Blood Pressure (CBP and CDC-CBP)
    Telephone visits, e-visits and virtual check-ins are now acceptable settings for blood pressure (BP) readings. Digital BP readings reported by the member are considered numerator compliant.
  • Telehealth updates
    NCQA has updated telehealth guidance in 40 HEDIS® measures for HEDIS measurement years 2020 and 2021. The purpose of these changes is to:
    • Support increased use of telehealth caused by the pandemic.
    • Align with guidance from Centers for Medicare & Medicaid Services and other stakeholders.

Posted in Training, Updates

AMP HEDIS Measure -metabolic monitoring for children and adolescents on antipsychotics

What is AMP HEDIS Measure?

1. The percentage of patients 1 to 17 that had two or more antipsychotic prescriptions and had both of the following in the measurement year:

+Had at least one test for blood glucose: blood glucose test, or HbA1c test

+ Had At least one cholesterol test, or LCL-C test

Eligible population ages: 1 to 17 years of age as of December 31 of the measurement year.

Qualifying Numerator codes that can be found on NCQA website.

Below is a partial list:

September 2020 – OLU_Newsletter_FINAL for remediation

How to successfully meet this measure:

  • Use NCQA coding tips to actively reflect care rendered. Routinely tell members who are on an antipsychotic medication to have their blood glucose or cholesterol tested at least annually.
  • Follow up with the parents of your patients to discuss and educate on lab results.
  • Coordinate care with the behavioral health specialists treating your patients.
Source: Aetna September 2020 Provider Communications