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CSMS-IPA 4th Quarter 2022 Newsletter

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Steps to Year End Value Based
Payment Success

The end of the year finish line for meeting measures and earning incentives is in sight. Reach out to your CSMS-IPA Resource if you need guidance or assistance completing value-based tasks. Your practice can achieve success by following three simple steps:

1. Schedule Annual Preventative Visits for All Patients
Medicare Advantage
Annual Wellness Visits (AWVs) are an opportunity to gain information about the patient including medical and family history, health risks, and to review the patient’s wellness, and develop a personalized prevention plan. In just one visit you can:

Close gaps in care by ordering preventive health tests.
Assess the progression of chronic illness.
Identify Social Determinants of Health issues.
Diagnose new conditions.
Code and document chronic conditions to the highest level of specificity.
Make referrals to specialty care and community resources.

Commercial
A comprehensive preventative evaluation which is age specific. This visit includes:

A comprehensive history and physical exam findings.
A description of the status of chronic, stable problems that are not “significant enough to require additional work,” according to CPT.
Notes concerning the management of minor problems that do not require additional work.
Notes concerning age-appropriate counseling, screening labs, and tests.
Orders for vaccines appropriate for age and risk factors.

Annual Visit Resources

Your IPA monthly reports and population health tools can help you identify patients who need annual visits.
Click here for annual visit reference guide and coding table

2. Code and Document Hierarchical Chronic Conditions (HCCs)
HCCs are part of a risk adjustment model used by CMS to estimate patient health resource use and to calculate reimbursement to payers.

Important factors in HCC coding include:

Recoding chronic conditions every year - If a condition such as an amputation is not recoded yearly, CMS does not include it in the risk model.
Specific coding for chronic conditions disease progression and complications.
Thorough documentation in patient medical record.
Historically the top HCC areas in need of more accurate and complete coding within the IPA are:
- COPD
- CHF
- Vascular Disease
- Morbid Obesity
- Type 2 Diabetes without complications

HCC Resources

Use your population health tools and reports to help identify HCCs that were captured previously, and specificity accurately describes the disease state.
Click here to read Introduction to Medicare Advantage risk adjustment
Participate in HCC education.

3. Close Gaps in Care
Gaps in Care identify missing recommended preventive care services including tests, clinical results for specific testing and medication adherence for certain chronic conditions.If a plan specifies the need for a mammogram within a specific time frame, but a patient has not yet gotten one, a preventive gap in care exists or HEDIS specifies that a patient with hypertension should have a blood pressure of less than 140/90. If the practice does not document this blood pressure through CPT 2 coding or data entry in a population health tool a gap in care is present. Test results that need CPT 2 coding and/or an entry into a population health tool to close a gap in care are A1c, Diabetic Retinal Eye Exam, Blood Pressure and Kidney Health Evaluation for Patients with Diabetes.

Gap in Care Resources:

Click here to see this sample document for coding tips
Monthly Gaps in Care Reports from CSMS-IPA.
Your IPA Resource, who can help you manage and prioritize your list of GIC and can assist you with entering GIC information into population health tool.

Other Important Year End Reminders and Information

CAPHS Surveys – CAPHS stands for Consumer Assessment of Healthcare Providers and Systems. Payers will be sending out CAPHS patient experience surveys to your patients. Your practice should educate patients that they may receive such a survey. It is helpful for the patients if you use the words in the survey when doing patient interviewing and teaching.

Key survey questions

Urinary Incontinence
Physical Health Improvement
Mental Health Improvement

DCE Participants - Are you participating in the Direct Contracting Entity (DCE)? If so, please be sure to submit 837 lists to QHI quarterly. This will assist with patient alignment.
Cigna Collaboration Partners – CSMS-IPA has sent a short survey to participating practices seeking information on your most recent Patient Experience Survey. We appreciate your cooperation in completing this survey.
National Suicide Hot Line Operational - The federal government has created a national Suicide Hot Line. Callers can dial 988 and be connected to a counselor. Free materials about suicide prevention are available at www.samhsa.gov/find-help/988

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ABOUT CSMS-IPA

The Connecticut State Medical Society - IPA (CSMS-IPA) is the largest and only statewide IPA in Connecticut and one of the largest in the nation. The CSMS-IPA is comprised of approximately 7,000 physician members. The CSMS-IPA is governed by a 27-member physician Board of Directors.

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CONTACT US

Corporate Office
127 Washington Avenue
East Building, Lower Level
North Haven, CT 06473
Phone: (203) 562-7228
Fax: (203) 624-6665

Operations Office
1 Corporate Drive, Suite 315
Shelton, CT 06484
Phone (203) 225-1291
Fax (203) 925-2652