improve hedis® rates for the annual children & adolescent ... · w34 61.80 65.51 64.23 67.40...
TRANSCRIPT
Improve HEDIS® Rates
for the Annual Children &
Adolescent Wellness
Measures
HEDIS® Measures
• HEDIS® is a widely used set of standardized
performance measures, which are developed
and maintained by the National Committee for
Quality Assurance (NCQA), and utilized by more
than 90 percent of America's health plans to
measure performance on quality of care and
service indicators.
Low Performing Measure
• Gold Coast Health Plan’s (GCHP) HEDIS® 2012 & 2013
measurement year rates for the following two children
and adolescent wellness measures fell below NCQA’s
25th percentile and the Department of Healthcare
Services (DHCS) Minimum Performance Level (MPL):
Well-Child Visits in the 3rd, 4th, 5th & 6th Years of
Life (W34)
Weigh Assessment & Counseling for Nutrition and
Physical Activity in Children & Adolescents (WCC)
2012 & 2013 HEDIS® Rates
Measure 2012 Rate 2012 MPL 2013 Rate 2013 MPL
W34 61.80 65.51 64.23 67.40
WCC: BMI 42.09 29.20 43.80 37.96
WCC: Nutrition 42.09 42.82 43.31 47.45
WCC: Physical Activity 30.41 61.63 28.71 34.55
W34 = Well-Child Visit in the 3rd, 4th, 5th, and 6th Years of Live WCC = Counseling for Nutrition & Physical Activity in Children & Adolescents MPL = Minimum Performance Level (25th Percentile) Rates in Red < MPL/25th Percentile
HEDIS® Definitions for
the WCC & W34 Measures
Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life (W34)
• This measure evaluates the percentage of members, 3-6 years of
age, who had one or more well-child visits with a PCP during the
measurement year and the provider of care assessed and
documented ALL of the following:
► Health and developmental history
► Physical Exam
► Health education and anticipatory guidance
• One rate reported
• Data audited to identify compliance with measure:
► Claims and encounter data
► Medical records
Codes to Identify W34
Description ICD-9-CM
Diagnosis
CPT HCPCS
Routine Child Health Exam V20.2
Routine Medical Exam V70.0
Medical Exam, NEC V70.3
Health Exam, Group Survey V70.5
Health Exam, Pop. Survey V70.6
General Medical Exam, NEC V70.8
General Medical Exam, NOS V70.9
Annual Wellness Visit G0438, G0439
Office Visit 99381-99385, 99391-99395, 99461
Weight Assessment & Counseling for
Nutrition & Physical Activity in Children & Adolescents (WCC)
• This measure evaluates the percentage of members, 3-17 years of age, who had an outpatient visit with a PCP or OB/GYN and who received ALL of the following three services during the measurement year. ► BMI percentile (ages 3-15) or BMI value (ages 16-17)
► Counseling for nutrition
► Counseling for physical activity
• Three separate rates are reported for each service.
• Data reviewed to identify compliance with measure: ► Claims and encounter data
► Medical records
Codes to Identify WCC
Description ICD-9-CM
Diagnosis
CPT HCPCS UB Revenue
Body Mass Index, Pediatric V85.5
BMI Percentile, Pediatric <5% V85.51
BMI Percentile, Pediatric 5% to
<80%
V85.52
BMI Percentile, Pediatric 85% to
<95%
V85.53
BMI Percentile, Pediatric ≥ 95% V85.54
Counseling for Nutrition V65.3 97802-97804 G0270-G0271,
G0447, S9449,
S9452, S9470
Counseling for Physical Activity V65.41 G0447, S9451
Outpatient Visits 99201-99205, 99211- 99215,
99241-99245, 99341-99345,
99347-99350, 99381-99387,
99391-99397, 99401-99404,
99411-99412, 99420, 99429,
99455-99456
G0402, G4038,
G4039
0510-0523,
0526-0529,
0982-0983
How to Improve HEDIS®
Rates for the
Annual Children &
Adolescent Wellness Measures
Improve HEDIS® Rates GCHP Practitioners can improve their HEDIS® rates for these two measures by:
1. Scheduling patients for their annual children and adolescent wellness exams.
2. Recording the appropriate clinical documentation in the medical records.
Assess children aged 3-6 years of age for all of the following:
►Health and developmental history
►Physical Exam
►Health education and anticipatory guidance
Assess children and adolescents aged 3-17 years of age for all of the following:
►BMI percentile (ages 3-15) or BMI value (ages 16-17)
►Counseling for nutrition
►Counseling for physical activity
3. Timely submission of claims and encounter data with the appropriate billing codes.