Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Diagnosis Closure Incentive Program April 2013

What is the Diagnosis Closure Incentive Program? The Blues’ Diagnosis Closure Incentive Program gives an incentive to Medicare Advantage primary care physicians who identify all of a patient’s acute and chronic conditions each year. This includes patients with: –BCN Advantage HMO-POS SM and BCN Advantage HMO SM –BCBSM’s Medicare Plus Blue PPO SM Doing so helps: –CMS accurately provide risk scores for each patient –Health care providers identify appropriate treatments and actions –The Blues improve the overall quality and affordability of health care delivery 2 What is actually happening with a patient Known and reported diagnoses Unknown, unreported or not applicable diagnoses (gaps) What we’re targeting

Diagnosis gaps – a closer look The program focuses on identifying and closing diagnosis gaps A gap can be: –A suspected or historical diagnosis that has not been addressed or coded in the current year –An unconfirmed diagnosis that may or may not be applicable to the member Gaps identified by the Blues between January through September 2013 are eligible for payment Closing the gaps helps to paint an accurate picture of what is happening with each patient 3

How the program works…. 4 Who is eligible? Primary care physicians with one or more Blues Medicare Advantage patients with at least one open diagnosis gap identified by the Blues are eligible for the incentive What is the incentive? These eligible physicians will receive $100 for closing 100% of the patient’s diagnosis code gaps How will these gaps be identified? Diagnosis gaps will be identified in the new Diagnosis Evaluation report on Health e-Blue SM

How to close a gap Gaps can be closed through one of the following methods: Confirming the diagnosis code: –By submitting a claim with the diagnosis code –Through Health e-Blue entry –Through an electronic medical record interface (available after May 2013) –By completing and submitting a paper Diagnosis Evaluation report (available to providers who don’t have access to Health e-Blue) –By submitting a paper medical record Notifying the Blues that the patient does not have the condition: –Through Health e-Blue –Sending a “delete record” on an EMR file (available after May 2013) –By completing and submitting a paper Diagnosis Evaluation report (for those without Health e-Blue) 5

What does Health e-Blue look like? Providers log in to Provider Secured Services on bcbsm.com Then click BCN Health e-Blue or click BCBSM Medicare Advantage Health e-Blue (based on member’s coverage)

Health e-Blue Diagnosis Evaluation Panel If you don’t have access to Health e-Blue: Contact your BCN provider representative or BCBSM provider consultant for help applying.

More program details 8 In order to earn an incentive for closing a patient’s gaps: All the patient’s gaps must be closed in 2013 and reported to the Blues by the early 2014 deadline (which will be announced by the Blues) The gaps must be closed following a face-to-face visit The diagnosed conditions must be addressed at the face-to-face visit Coding and documentation must follow CDC and CMS standards Important note: Gaps closed by Inovalon TM (vendor) will not result in a provider incentive payment Detailed information about the incentive program is available through the BCN and BCBSM Medicare Advantage Diagnosis Closure Incentive Materials available in the Resources section of Health e- Blue.

Questions? 9