Tag: #PCP

Posted in Training, Updates

Humana: change to Nurse Practitioner and PA credentialing requirements.

Posted on by KR2Medical Billing

This post applies to any NP or PA that are seeing Humana patients in the office.

The change is affective as of DOS 08/01/2021 and thereafter and applies to NP and PA no matter if they are part of a physician group and not solely acting as a primary care provider.

Effective 08/01/2021, nurse practitioners and and physician assistants are required to get credentialed with Humana, in order to see Humana members in network.

What you need to do?

Please visit Humana website for helpful guidelines or review Human credentialing policy: Humana.com/provider/medical-resources/join-humana-network/credentialing-facilities-and-organizations

If you need any help with the process or have any questions, please contact the us via email or phone:

Email: credentialinginquiries@humana.com – please include your full name, specialty, tax payer identification number (TIN)

Phone: 800-457-4708

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Posted in HEDIS Measures, Training, Updates

HEDIS Measure: Comprehensive Diabetes Care

Posted on by KR2Medical Billing

In this blog post we will explore the Comprehensive Diabetes Care HEDIS measure. .

What is New for 2020?

New measure Kidney Health Evaluation for Patient with Diabetes measure was added in 2020. This is a new measure. It evaluates the percent of members that are between 18 and 85 years of age that have diabetes and who received a kidney health evaluation, including estimated glomerular filtration gate test (eGFR) and a urine albumin-creating ration.

What is Comprehensive Diabetes Care Measure?

Measure that evaluates percentage of adult members between ages of 18 and 75 years of age (looks at both type 1 and type 2 diabetes) and who had each of the following:

  1. HbA1c testing
  2. HbA1c poor control (>9%)
  3. HbA1c control of (<8%)
  4. Retinal Eye Exam performed
  5. Blood Pressure Control (<140/90 mm/Hg)\

Documentation:

Record your efforts: document results of, all of the above mentioned test, in the patient’s medical record.

How to meet this measure?

  • Provide reminders to patients for upcoming appointments and screenings.
  • Draw labs in your office if available or refer patients to a local lab for screenings.
  • Refer patients to participating eye professionals for annual retinal eye exams.
  • Follow up on lab test, eye exams and specialist referrals and document in your chart.
  • Telephone visits, e-visits and virtual check-ins are acceptable settings for blood pressure readings and should be recorded in the chart.
  • Include Category II reporting codes on claims to reduce the burden of HEDIS medical record review.
  • Educate patients on topics (for example, home monitoring of blood sugar and blood pressure, taking medications as prescribed, and other healthy lifestyle education like diet, exercise, and smoking cessation).

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Posted in Training, Updates

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

Posted on by KR2Medical Billing

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