We partner with providers and their office staff to ensure all patients receive the support they need to improve their health outcomes.
Quality Programs and Supports
Your Provider Relations Specialist provides ongoing support to you regarding Quality and Risk Adjustment Programs. They ensure the highest standard outcomes by sharing information regarding your open gaps in care and RAF score for your HCP eligible patients.
How can the Provider Relations Specialist assist you and your office staff?
- By supporting you and your office staff with Provider Incentive Program (PIP)
- By sharing and reviewing tools with you and your office staff, which assist you with your medical record documentation.
- By sending you your gaps in care reports to help you achieve your quality goals and make progress towards your incentives.
- By assisting you with scanning and/or faxing your medical records for all Risk Adjustment and Quality-related initiatives.
Coordination of Quality Gap Closure Activity
The Quality Outcomes Associate (QOA) outreach to your patients to ensure effective use of health plan benefits and to improve patient health outcomes within the Medicare and Medicaid populations. The QMA staff contacts and educates your patients about annual services that are needed to close gaps in care.
How can the QOAs assist you and your office staff?
- By assisting your patients with scheduling appointments for preventive services and chronic conditions management with your office.
- By entering necessary referrals and authorizations for your patients for preventive screenings, such as colonoscopies.
- By contacting your patients with open gaps in care and educating them on the services they need to stay healthy. When we are unable to reach the patient, the QOA staff will follow up with a letter.
- By sending your patients a letter reminding them of their open gaps in care and encouraging them to bring the letter to their appointment with you. You may use this as a guide to ensure all quality gaps are closed.
- By contacting your office to retrieve medical records to close gaps in care, which will help you achieve your quality goals and make progress towards your Quality Incentive.
Chart Review and Abstraction
The Quality Interventions Nurses (QIN) perform chart abstraction from your medical records to capture gaps in care that have been addressed and provide feedback on opportunities to improve the capture and documentation of preventive screenings and chronic condition management in your medical records.
The Quality Operations Specialist (QOS) outreaches to you and your patients to implement specific initiatives and/or programs to address and analyze areas we can improve performance and maintain continuous quality improvement.
How can the QIN & QOS assist you?
- By developing tools, articles, and tip sheets to assist you with medical record documentation to satisfy open gaps in care.
- By sharing feedback on missed opportunities based on their review and findings of your medical records and specific quality initiatives.
Please contact the HealthCare Partners Quality Team at (833) 989-1358 toll-free between 9:00 a.m. and 5:30 p.m. EST, Monday through Friday. We look forward to partnering with you to achieve your quality goals.
Risk Adjustment Programs and Supports
HealthCare Partners has a dedicated team of specialists, analysts, clinicians, and other personnel committed to ensuring that risk scores for HCP members are appropriate for the acuity of our members. Increased coding accuracy helps HCP identify members who may benefit from disease and medical management programs. More accurate health status information can be used to match healthcare needs with the appropriate level of care.
Our portfolio of retrospective and prospective programs and other support services include coding and documentation education, medical record reviews, in-home assessments, and advanced data-driven technology available to our providers.
For additional details and information, please contact the HealthCare Partners Risk Adjustment Hotline: (516) 394-5660.
Coding and Medical Record Documentation
HealthCare Partners has a dedicated team of coding analysts who review, verify and ensure the accuracy and completeness of medical records while extracting appropriate and specific ICD-10 diagnosis codes. Coding precision is essential for providing exceptional care to our members.
For additional details and resources for medical record documentation, please contact the HealthCare Partners Risk Adjustment Hotline: (516) 394-5660.