BCBSRI is committed to making it easier for your practice to be successful in all areas of quality improvement. Together, we can achieve our shared goal of improving health outcomes by identifying and addressing open care gaps. By now, you should have received the 2019 PCP Quality Incentive Program (PQIP) booklet – PQIP makes incentives available to primary care providers (PCPs) who demonstrate support of quality improvements that are outlined by nationally recognized programs and measures.
Hints for HEDIS (and more) is a reference tool to help better understanding of:
- Definitions, specifications, and exclusions of the many quality measures
- Billing codes used to report gap closure
- Collection and reporting methodologies
- Tips and best practices to maximize gap closure
Our Quality Concierge Team (QCT) is also available to answer questions, provide updates, assist in the interpretation of monthly gaps in care reports and detail summaries, research member attribution issues, and provide overall HEDIS support to you and your practice. Our QCT nurses can be reached at QualityHEDIS@bcbsri.org or (401) 459-1005.
Below are some general tips and information that can be applied to most HEDIS measures:
- Use your monthly Gaps in Care reports to contact patients who are due for an exam or are new to your practice.
- Implement pre-visit planning to achieve patient, staff, and provider readiness to ensure a meaningful visit. This includes five main processes:
- Scheduling and pre-registration
- Financial readiness (insurance verification, eligibility, authorizations)
- Clinical readiness (pre-visit testing, patient instructions)
- Logistical readiness (appointment confirmations, reminders, pre-check-in options)
- Patient arrival and check-in
- Develop reminder systems for members who are due for screenings and/or tests.
- Take advantage of the 2019 PQIP booklet, CPT category II coding cheat sheet, and online resources to help your practice understand HEDIS measures, compliance, and requirements.
- Schedule the member’s next well-visit/preventive care at the end of the current appointment.
- Assign a quality or HEDIS staff member to perform internal reviews and serve as a point of contact.
- Most electronic health records (EHRs) are able to create alerts and flags for required HEDIS services. Be sure to have all these prompts turned on or check with your software vendor to have these alerts added.
- Consider extending your office hours into the evening, early morning, or weekend to accommodate working patients.