Discover five essential strategies to help your primary care practice thrive—boost quality performance, enhance patient outcomes, and succeed in today’s value-based care environment. These proven approaches can help you streamline operations, strengthen patient relationships, and meet evolving care standards. Set your practice up for long-term success in 2025 and beyond.
Confirm that your office information is up-to-date
It is critical for HealthCare Partners (HCP) to have accurate office and billing information for all HCP-contracted PCPs and Specialists. Both our members and your patients need accurate information about the providers and facilities in their plans when they wish to access healthcare services. Maintaining accurate and up-to-date information will ensure that we send our communications, as well as our payments, to the proper locations.
To notify HCP of practice demographic changes:
Submit demographic changes directly and securely using doForms. Enter your NPI# and TIN# into the appropriate fields, then select your name from the “Provider Lookup” field. Your demographic information will populate. You can then confirm or edit fields as needed. Once completed, click “Submit” at the top right of the page.
If registered for our Provider Portal, update your information by clicking on the “Office” tab and selecting the “Edit” icon.
For questions or issues, call (516) 394-5639.
Positively affect your HEDIS Stars & Quality
Encourage your patients to kick off the new year with a focus on their health by scheduling their Annual Wellness Visit (AWV), physical examination, and any overdue preventive screenings. Help them proactively manage chronic conditions to support their overall well-being.
To aid in this process:
- Incorporate physical inactivity screening during the AWV or physical examination.
- Vaccinate patients against influenza, Pneumonia, Tetanus, Shingles, COVID-19, and provide COVID booster shots.
- Some measures, such as Care of Older Adults, can be completed by phone using our COA Overview and Form located on HCP’s website under Quality Tools > HEDIS Coding Guides and Tip Sheets > COA.
- Digital blood pressure readings taken by patients can be documented in your progress notes.
- Perform lab testing to close gaps for the current measurement year.
- Send all lab requests to Quest Diagnostics.
- Consider FOBT, FIT-DNA testing for Colorectal Cancer Screening
- Monitor Diabetes Care with A1c and urine protein tests.
Streamline and shorten your claim processing time with Availity
HCP’s preferred method of claims submission is electronic through Availity. We encourage you to register with Availity so you can experience streamlined claims, improved response time, and enhanced correction capabilities. You will even be provided with a record of your claim upload!
Contact Availity to get started at (800) 283-4548.
Follow these documentation and compliance tips
HCP 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. Since all documentation will be permanent in the patient’s records whether entered manually or via computer, coding precision is essential for providing exceptional care to our members. Specific guidelines and standards must be followed to improve the accuracy of a medical record.
- Not showing all documentation for work performed during an encounter can lead to documentation of a less specific diagnosis that may also be inaccurate. Keep in mind:
- Diagnoses documented with no complications, medication, or status is a less accurate description of a patient’s condition.
- – Specificity of active complications, medications, and status of care can lead to more accurate entries.
- – Only one component of monitoring, evaluation, assessment, and/or treatment (M.E.A.T.) must be documented to count as evidence that a chronic condition is being addressed during a visit. If it is a new condition or exacerbation of a chronic condition, your note should reflect full E&M documentation.
- Check the medical record to ensure the appropriate information is included:
- Patient’s name, DOB, or other unique 2nd identifier
- Date of service (month, day, and year of encounter)
- Description of the medical condition to the highest specificity in addition to status and/or treatment plan
- Rendering provider name and credentials Note: “Dr.” and “Physician” are not approved credentials; include legible provider signature with date
Utilize the Quality Resources and Tools Page of our website
Familiarize yourself with our available in-office support services and tools to assist your practice. Visit the Quality Resources page for access to tools such as the AWV Form, HEDIS Coding Guides & Tip Sheets, Diagnosis Coding Guides and Tip Sheets, Behavioral Health Tools, and more. The Clinical Quality Support page details how we collaborate with providers and their office staff to ensure all patients receive the support needed to improve their health outcomes.
Best Practices
Steps to keep in mind to ensure a successful year.
- Offer an Annual Physical Exam for all patients
- Perform an Annual Wellness Visit (AWV) for every Medicare Advantage patient
- Maintain same-day availability for patients in case of urgent medical issues
- When your patient is in the hospital, schedule a post-discharge visit within 7 days with medication reconciliation
- Schedule high-utilizers/high-risk patients at least once every 90 days
- Reach out to your non-user patients to help them schedule PCP appointments
- Refer patients:
- To Preferred Specialists
- To free-standing radiology facilities vs. hospital-based radiology centers
- Help patients avoid the ER by suggesting urgent care centers for non-life-threatening issues
- Close as many quality and risk gaps as possible during every visit
- Send all lab requests to Quest Diagnostics, our preferred in-network laboratory contract and their affiliate, Ameripath, for outpatient lab testing