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Quality Tools

In an effort to help you and your office staff with the increasing importance and complexity of quality and risk adjustment documentation and coding, HealthCare Partners created some valuable tools.

These tools will assist you and your office staff in reaching your quality and risk adjustment documentation and coding goals, while reducing time spent on administrative functions and increasing time available for patient care.

Annual Wellness Visit Form (AWV) and Coding Guide

Use the form to document your patients’ Annual Wellness Visits (AWVs) and to develop personalized prevention plans to help keep them healthy. Your personal progress notes, electronic medical records (EMR) or continuation sheet(s) can be used to supplement this form as needed.
Note: Appropriate coding for services rendered during the AWV have been included on the form for your reference.

2020 Coding Guides and Tip Sheets

These 2020 guides will give you and your office staff additional tools for risk adjustment, coding and documentation. These guides are intended to be used as a reference for frequently documented risk adjustable ICD-10-CM diagnoses and ensure diagnoses are substantiated within the clinical documentation guidelines.

Note: For Medicare and Medicaid’s full list of Telehealth Services, click here

Improving Telehealth Communications

These guides are intended to be used as reference toosl when conducting TELEHEALTH visits with your patients.

HEDIS® Coding Guide

This 2019 guide will give you and your office staff an additional tool for coding of HEDIS® measures. This guide is intended to be used as a reference for the current and most frequently used codes that meet HEDIS® requirements, resulting in minimized chart retrievals due to appropriate claims/encounter data submissions.

Desk References

These desk references provide guidelines for preventive health services, as well as condition/diagnosis documentation in the medical record.

Medical Record Documentation Best Practices

Medical Record documentation is imperative to providing accurate and timely patient care. Clear and concise documentation ensures seamless continuity of care.

Care of Older Adults

When looking to improve Care of Older Adults, providers should look at Advanced Care Planning, Medication Review, Functional Status Assessment and Pain Assessment. For detailed information, use this COA TOOL.

Patient Experience and Satisfaction

Behavioral Health Tools

Recognizing the signs of a behavioral health condition is not always easy. We are providing you with the following behavioral health screening tools to help you diagnose and refer individuals for further care. Utilizing these tools when appropriate and submitting the applicable codes will help you to satisfy HEDIS® behavioral health measures.

The purpose of the PHQ-2 is to screen for depression in a “first-step” approach. A PHQ2 score ranges from 0-6. A score of 3 is the optimal cut point when using the PHQ-2 to screen for depression. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past two weeks. The PHQ-2 includes the first two items of the PHQ-9.

Patients who score 3 or greater on the PHQ-2 should be further evaluated with the PHQ-9, other diagnostic instruments, or direct interview to determine whether they meet criteria for a depressive disorder.

AUDIT

The purpose of the AUDIT is to screen and identify excessive drinking and alcohol use disorders.  The AUDIT-C is a modified version of the AUDIT Tool.

Pediatric Screenings

HCP is working closely with our health plan partners to increase the quality and efficiency of pediatric screenings for children. This guide covers best practices for child screenings within their first 1,000 days of life. Topics covered include identification, prevention, diagnosis, treatment and follow-up care for lead screening, newborn hearing loss and developmental screening.  As part of this initiative, we are encouraging the use of CPT Code 96110 with a modifier CG or ICD-10 code Z13.41 for developmental screenings, and CPT Code 83655 for lead screenings. Early screening for these conditions is critical to growth and healthy development in children.

EmblemHealth-HCP Pediatric Pocket Reference

Articles

Find some useful information in these articles to support compliance with HEDIS® and CAHPS® measures. Learn more about specific topics: