1. BlueShield of Northeastern New York Make every visit a preventive visit March 20, 2013

2. Welcome

3. We will cover: Evidence based clinical guidelines about an effective well visit Administration and documentation of immunizations Lead Screening Coding P4P Opening Remarks

4. Children are our future!

5. Let’s talk about some Regional statistics The graphs will show the Commercial and Medicaid specific statistics and the NYS Medicaid averages Lets take a look at the data in the next few slides in the context of thinking about changes that could be made to improve care Regionally all plans are scoring poorly

6. Regionally

11. Systems Providers Patients Barriers

12. Henry M. Neilley, MD, FAAP

13. Best Practice

14. Health and developmental history Physical exam Immunizations Lead screening – children under 2 yrs Health Education / Anticipatory Guidance Components of a well visit

15. Accurate appointment time frame Reminder systems to decrease no shows Optimization of EMR systems Parent preparation for the well visit – both the parent and the doctor/office Relationship building with child/parent Preparing for a comprehensive well visit

16. Know the components that make up a well visit Determine how much can be covered in one visit – how likely is the patient to return for another visit? Know what immunizations can be given when a child presents sick Importance of documentation as it relates to a sick and/or well visit Suggestions for combining a well and sick visit

17. Missed opportunities Parental concerns Appointment scheduling Transportation Barriers

18. Lisa Phillips, BSN

19. Overview of child and adolescent immunizations – changes in the 2013 schedule Importance of following the schedule Importance of entering in NYSIIS – immunizations and lead screening VFC program and how to order Immunizations and more

20. There is a copy of immunization schedule in your packet Let’s review some pertinent updates in this schedule 2013 updates

21. Documentation NYSIIS - New York State Immunization Information System

22. The Vaccine for Children (VFC) Program In your packet there is a reminder on how to order Any questions related to ordering this VFC vaccine? Don’t forget to bill for the administration of the VFC vaccine VFC Vaccines for Children

23. Kathryn Glasser, CPC

24. Choosing codes Coding resources online Coding documents in handout packet After the seminar Coding: best practices

25. Sick (E&M) vs. Well (Preventive) Provide the services Document what was provided Code what was documented The Chicken or the Egg

26. www.bsneny.com Provider > Login > Payment and Operations Clinical Editing > Clinical Edit Search - represents the relationship(s) between CPT codes and the supporting clinical rationale for their bundled or unbundled states Code Resources > Code and Comment - provides detailed coverage information for a specific CPT code Coding Resources

27. Clinical Edit Search Request

28. Clinical Edit Result

29. Code and Comment Sample 1

30. Code and Comment Sample 2

31. Code and Comment Key – Sample

32. Practice Specific Questions Contact the Provider Relations Department to speak with your representative. BSNENY Providers 518-220-5601

33. BlueShield is here to help you! Reminders via phone and mail are made regarding immunizations Pediatric Disease Management nurses available

34. P4P – what’s new in 2013 –Implementation of new analytics tool –Pinpoint gaps in care –Revise methodology –Generate reports BlueShield is here to help you!

35. P4P measures –Childhood Immunizations –Lead Screening –Use of Appropriate Medication for People with Asthma –Appropriate Treatment for children with URI –Appropriate Testing for children with Pharyngitis –Chlamydia Screening BlueShield is here to help you!

36. Questions

37. Thank You! A division of HealthNow New York, Inc. An independent licensee of the BlueCross BlueShield Association. BlueShield and the Shield symbol are registered trademarks of the BlueCross BlueShield Association.