A bi-weekly newsletter from your physician organization
Friday, Feb. 14, 2020
Complex care management training scheduled
Michigan Center for Clinical Systems Improvement (Mi-CCSI) has been approved to provide the MICMT Complex Care Management (CCM) course training.

This course provides a framework for the complex care management role, elements of integration
into the ambulatory care setting and enhancing care management skills. The course also meets the requirement for BCBSM provider delivered care management (PDCM) and Priority Health care management incentives.

Space is very limited (previous training sold out). Register for the next local training soon!

Tuesday, April 21, 2020
8am-4:30pm
Ascension Oakland Hospital Education Building; Madison Heights, MI

Target audience : RN, MSW, NP, PA, Pharm-D care team members working as complex care managers in the ambulatory setting

Update on webinar dates and topics
Want some tips on improving quality metrics? Need assistance using Wellcentive and ADT insights? Check out The Physician Alliance education program line up !

Based on member feedback, several education webinars merged to better streamline topics and serve our membership. Please note new program and dates :


Quality/PDCM/Wellcentive/ADT webinar series
Education updates and Q&A time included. Webinars are 12-1pm on the second Tuesday of the month.
March 10 ( register )
April 14 ( register )
May 12
June 9
July 14
August 11
September 8
October 13
November 10
December 8


Lunch with the Coder: Coding tools to increase revenue webinar
Wednesday, March 11; 12-1pm
Gain tips and insight to help improve your coding, helping to increase revenue. Highlights include:
  • Help reduce healthcare spending, the real weight of HCC coding accuracy
  • Revenue integrity is a team effort
  • Decrease payer denials
  • Recommendations for better coding​

Click here for an updated flyer highlighting key programs. Current TPA education opportunities and open registration links are also listed on the website .
CODING CORNER: Updates to select HEDIS quality measures
In October 2019, the National Committee for Quality Assurance released value set changes for the following HEDIS® quality measures:

• Comprehensive Diabetes Care, or CDC: HbA1c control
• Comprehensive Diabetes Care, or CDC: Retinal eye exam
• Controlling High Blood Pressure, or CBP

Comprehensive Diabetes Care
CDC : HbA1c : Two new procedure codes ( 3051F and 3052F ) were added to better capture HbA1c levels. When conducting an HbA1c test in your office, submit the distinct numeric results on the HbA1c claim with the appropriate procedure code: ( Code 3045F ( HbA1c level 7.0-9.0%) has been deleted as a code and should no longer be used .)

Procedure code and most recent HbA1c level:
  • 3044F - <7%
  • 3051F - >7% and <8%
  • 3052F - >8% and <9%
  • 3046F - >9%
CDC : Retinal eye exam : New procedure codes ( 2023F and 2025F ) were added to capture negative eye exam results, which result in two years of compliance for HEDIS. The code descriptors for 2022F and 2024F were also revised to indicate their use for a positive eye exam.

Procedure code and retinal eye exam findings:
  • 2022F - Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy
  • 2023F - Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy
  • 2024F - 7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy
  • 2025F - 7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy
  • 3072F - Low risk for retinopathy (no evidence of retinopathy in the prior year)
Additional resources:
Ophthalmology-Retinopathy coding tip sheet
Diabetes CPT 11 coding updates tip sheet

Controlling High Blood Pressure
The measure has been revised to allow for administrative closure through claims. Submit blood pressure procedure codes for each office visit:

Procedure code and most recent systolic blood pressure:
  • 3074F - <130 mm Hg
  • 3075F - 130-139 mm Hg
  • 3077F - ≥ 140 mm Hg
Procedure code and most recent diastolic blood pressure:
  • 3078F - <80 mm Hg
  • 3079F - 80-89 mm Hg
  • 3080F - ≥ 90 mm Hg
 
Find more HEDIS tip sheets on TPA's Learning Institute web section .
TPA board chairman testifies at prior authorization bill hearing
Physicians are all too familiar with delays in patient care due to prior authorization requirements. The Michigan State Medical Society shares that 94 percent of Michigan physicians report prior authorization red tape causes delays in care for their patient s and 78 percent of physicians trace prescription and treatment non-adherence to prior authorization delays.

Senate Bill 612 was recently discussed at last week's Senate Health Policy committee hearing. This bill seeks to reform the prior authorization and step therapy/fail first process by introducing new transparency, fairness and clinical validity requirements. This helps ensure patients receive timely coverage decisions, and ultimately, the care and treatment they need.

Dr. Dennis Ramus, chairman of TPA's board of managers and primary care physician, testified at the committee hearing. Click here to see testimony.

Share your feedback with your state legislator by clicking here .
The latest healthcare news
Ways you can save
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Learn more about this partner.