The Beacon Health Partners, CHS, Blue Cross Blue Shield Shared Savings Program Contract has been completed for attribution for our Blue Cross Medicare Population. This new program is referred to as the Freestanding Patient Centered Care (FPCC) Program.

The Gap in Care report has been sent to Beacon Physician offices quarterly from the Beacon CareNation Department.  This may have happened prior to your association.  It involves a list of patients that have missing claims (i.e. tests, screenings, medication refills, etc.). The goal is to see these patients – or refer them when appropriate – to have these tests/screenings completed.  When the event is billed, the patient Gap will close and your list will grow smaller.

Here are some additional measures, specifically targeted to the Medicare population. These measures include:

  1. Adult BMI Assessment
  2. Functional Status Assessment
  3. Pain Screening
  4. Diabetes Care-Blood Sugar Controlled
  5. Medication Review
  6. Controlling Blood Pressure

These measures are considered “enhanced” and closing these Gaps will be of great benefit in gaining “points” towards our Shared Savings. In order to close these Gaps, a CPT II code must be used when billing.

Here you will find a Billing and Coding Cheat Sheet for all of the Blue Cross Blue Shield Gaps in Care. Additionally, we have provided a standardized Functional Status Assessment called the Katz Scale, and a Pain Screening that can be used to document the completion of these measures. You do not have to use these tools if you have a mechanism built into your EMR that will record this data.

Finally, you can access your reports on demand through the use of Availity – a tool typically used in the offices to check eligibility. If you already have Availity access, you can provide Beacon us with your username and Beacon we can enhance your viewing rights to include these Blue Cross Gaps as well as other clinical information on your patient population.

If you have any questions regarding these new measures or would like additional tools to assist in the process, please do not hesitate to contact the Beacon Health Partners CareNation Department at 516-570-3580.

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