The Point Issue 1 2022
Posted 03/03/22
For more of The Point Provider Newsletter
IN THIS EDITION:
2022 Plan Benefit Updates Available
Please remember to confirm member benefits at the start of each plan year, as benefits can change annually. Updated 2022 plan year benefits for Martin’s Point Generations Advantage plan are available through the Provider Portal as of 1/1/2022.
We have added and/or enhanced several benefits for 2022 (see member’s individual plan for potential coverage), including:
- OTC Benefits through OTCHS/CVS (added over fifty new eligible products)
- Removed frequency limits to benefits designed to address food insecurity among members with specific chronic conditions.
- Reduced member’s Maximum Out-of-Pocket amounts on several plans.
- Lowered monthly premiums on our most popular plan, Prime (HMO-POS), as well as Value Plus (HMO) in Northern Maine counties.
We will continue offering coverage in 2022 for existing benefits (see member’s individual plan for potential coverage), including:
- Hearing Aids (through Amplifon)
- Fitness Benefit (includes coverage for gym equipment, fitness trackers and more)
- Nutrition & Dietary Services
- Weight Management Programs
- Smoking Cessation
- Personal Emergency Response Systems (benefit fully funded for Alliance (HMO) plan members)
- Fall Prevention
- Bathroom Safety
- Reimbursement for masks through the Wellness Wallet continues to be offered.
- Registered Dietitian counseling services through Foodsmart—covered at no cost to members.
- Meals (fully funded for Alliance plan members post-surgery or discharge). All other members have the option to purchase meals directly from the vendor through the private pay program.
HEDIS Medical Records Requests
Martin's Point will be faxing HEDIS-related medical record requests to network providers from January through early May 2022. We ask for your support in responding to the request as quickly as possible to allow a timely audit by our reviewers.We will include a phone number for your use should you have any questions and a secure fax number and physical mailing address to expedite delivery of your records to Martin's Point.
The HEDIS fax number is 207-828-7853 and is only monitored January 1 to May 9. Please remember that medical records should never be faxed to the Provider Inquiry department.
Thank you for your assistance with this effort and for the excellent care you give our health plan members.
Colorectal Cancer Screening
March is Colorectal Cancer Awareness Month.
Did you know?
- Colorectal cancer is the 2nd leading cancer killer.
- Martin’s Point Health Plan Quality team periodically sends out fecal immunochemical tests (FITs) to our health plan members.
Four types of Colorectal Cancer Screenings are generally covered by Martin’s Point health plans (please check the benefits for coverage details) for people between 50 and 75 years of age. If your patient is over 75 years old the decision to screen for colorectal cancer screening should be determined by you, taking into account their prior screening history and overall health. Talk to your patients about what schedule works best for them.
- A colonoscopy every 10 years.
- A flexible sigmoidoscopy exam every 5 years.
- A DNA-based test, such as Cologuard®, every 3 years.
- A guaiac-based, fecal occult blood test (gFOBT) and the fecal immunochemical test (FIT) every year.
Cervical Cancer Screening
NEW: Martin’s Point has added a Cervical Cancer Screening quality measure to our 2022 Primary Care Performance Payment Model.
Did you know?
- Cervical cancer screenings save lives.
- Of all gynecological cancers, only cervical cancer has screening tests that can find this cancer early, when treatment can be most effective.
- Over the past 40 years the number of deaths from cervical cancer has decreased significantly. However, the American Cancer Society estimates for cervical cancer in the United States for 2020 are:
- About 14,100 new cases of invasive cervical cancer will be diagnosed.
- About 4, 280 women will die from cervical cancer.
This important preventive screening identifies patients in early stages of cervical cancer or those who are at significant risk. We ask that providers be vigilant to assure our health plan members get their necessary cancer screening.
Patients can be excluded from this screening if there is clear documentation in the records that states they had any of the following in their medical history – with month and year noted:
- Hysterectomy with no residual cervix—a complete, total, or radical abdominal or vaginal hysterectomy.
- Cervical agenesis.
- Acquired absence of cervix.
NEW for 2022: Providers who participate in our Primary Care Performance Payment Model are eligible for a $25 payment during the 2022 calendar year for screenings using the following criteria:
- Aged 21-64 years with cervical cytology performed within last 3 years
- Aged 30-64 years with cervical high-risk human papillomavirus (hrHPV) test performed within last 5 years
Hypertension: Obtaining an Accurate Blood Pressure Reading
Obtaining accurate blood pressure readings in the office can be challenging. Improper technique and the so-called “white coat effect” result in unusable data and wasted time for staff. Some simple suggestions for obtaining accurate readings are listed below:
Prepare the patient
- Ask patient to empty his or her bladder, if needed.
- Confirm patient has not had nicotine, caffeine, alcohol, or vigorous exercise in previous hour.
- Position patient comfortably with legs uncrossed in chair with back and arm support.
- Place the cuff on bare arm one inch above the antecubital fossa with the midline of the bladder over the brachial artery.
- Support the arm so that the cuff is at the level of the mid-sternum.
- Ask the patient not to speak or move while the cuff is being inflated and deflated.
Employ best practices for blood pressure measurement
- Wait 5 minutes after applying the cuff before taking the initial reading.
- Wait 5 minutes and recheck if the initial reading is elevated; document the 2nd reading.
- Size matters—confirm your office has cuffs that will fit all your patients.
- Consider impact of terminal digit preference, random error, and bias when recording values.
- Advise patients to avoid wrist and finger monitors for home readings.
Comprehensive Visit Program Continues in 2022!
We are pleased to announce the continuation of our Comprehensive Visit Program for 2022. This program provides additional payments to PCPs for submission of updated documentation of diagnoses for qualifying Martin’s Point Generations Advantage members gathered during Annual Wellness Visits and/or annual physical exams. This effort supports the annual assessment of the health status of our qualifying members—promoting their health while ensuring compliance with CMS documentation requirements for Medicare Advantage plans. For added flexibility due to COVID-19, we expanded our qualifying visit types. To learn more about the program and these changes, visit https://martinspoint.org/for-providers/resources/clinical-documentation/comprehensive-visit-program.
Chlamydia Screening in Women
NEW: Martin’s Point has added a Chlamydia Screening quality measure to our 2022 Primary Care Performance Payment Model.
Did you know?
- Chlamydia is one of the most prevalent sexually transmitted infections (STIs) in the United States.
- Chlamydia is most common in persons in the 15-24 year age group.
Testing for this infection is generally not completed because most people who have chlamydia are asymptomatic.
The CDC recommendations for screening are below:
- Sexually active persons with a cervix age 25 or younger: Yearly testing. Retest when patient has new sex partner regardless of timing.
- Pregnant persons: Test at first prenatal exam. If at high risk of infection—from changing sex partners or regular partner who might be infected—test again later in the pregnancy.
- All persons at high risk: People with multiple sex partners, who don't always use a condom; and/or who have anal/oral sex should receive frequent chlamydia screening. Other markers of high risk are current infection with another STI and possible exposure to an STI through an infected partner.
NEW for 2022: Providers who participate in our Primary Care Performance Payment Model are eligible for a $25 payment during the 2022 calendar year for each screening performed on girls/women between the ages of 16-24 years who are identified as sexually active.
As you schedule wellness visits for the year, please look closely at this age group and consider doing a chlamydia test in office. Prevention, discussion, and treatment will help decrease the spread and limit the damage that can be caused by untreated chlamydia.
New Exclusions: Medicare Statin Use in Persons with Diabetes (SUPD) Quality Measure
The Pharmacy Quality Alliance has updated the exclusions for the Medicare SUPD quality measure. Measure description: The percentage of individuals ages 40 to 75 years who were dispensed at least two diabetes medication fills and received a statin medication during the measurement year (January 1 – December 31 of a given year).
Previously, only members enrolled in hospice or who have end-stage renal disease (ESRD) were excluded. The new exclusions include: rhabdomyolysis and myopathy, liver disease, pre-diabetes, pregnancy, lactation or fertility and/or polycystic ovary syndrome (PCOS).
If your patient meets any of the criteria listed, adding the appropriate ICD-10 code to claims for a visit for a diabetes, cardiovascular, or annual wellness visit, or via annual code recapture, can help Martin’s Point Generations Advantage maintain accurate information and properly exclude them from this measure calculation. It should also reduce false alerts to providers and members.
| Excluded Condition |
ICD-10 Code Examples |
| Pre-diabetes |
R73.03, R73.09 |
| PCOS | E28.2 |
| Pregnancy, lactation, or fertility |
Z33.1, O92.70, Z34.00 |
| Liver disease |
K74.69, K74.5 |
| Myopathy, rhabdomyolysis |
T46.6X5A, M62.82, G72.9 |
| ESRD | N18.5, N18.6, Z99.2 |
Want Timely Claim Payments and New Patient Growth?
CMS requires us to regularly contact our network providers to confirm the accuracy of our directory information. Up-to-date directory information helps our members find new providers when they need care and ensures more timely and accurate claims processing.
There are two convenient, online tools you can use to keep your NPI-related practice/provider information accurate:
1. Provider DataPoint: Please use our web-based provider data management tool to submit real-time changes:
- Change your practice information, including name, phone/fax, address, billing information, NPI, etc.
- Add/delete a location to your already-contracted practice/group
- Change provider information, including name, specialty, panel status, add a language, etc.
- Add a provider who requires credentialing to your practice
- Terminate a provider from your practice/group
- Check the status of a previously submitted data change request
Visit: https://www.martinspoint.org/For-Providers/Tools/Update-Your-Info. If you have any questions, please see the instructions on our website or speak to a Provider Representative.
2. National Plan and Provider Enumeration System (NPPES): CMS now allows providers to use the NPPES to certify their NPI data. Information and FAQs about using NPPES as a reliable source for provider directory data are available at https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/index. Please direct questions about the NPPES to Jeremy Willard at [email protected].
Tips for Practice Administrators
- Create a monthly tickler reminder to check the accuracy of your provider/practice information in Provider DataPoint.
- We no longer accept NPI-related updates/changes and credentialing applications via email or fax. They must be submitted online via Provider DataPoint.
- Radiologists, anesthesiologists, and midlevel providers (NP, PA) who do not practice as PCPs do not require credentialing.
- Please provide 30 days advance notice of changes to your provider/practice information when possible.
Just For Kids - Pediatric Behavioral Health HEDIS Measures
Did you know?
- Each year, one in six children aged 6-17 in the US experiences a mental health disorder¹ and an estimated 8.8% of children aged 4-17 have ADHD.
- Psychosocial care, which includes behavioral interventions, psychological therapies and skills training, among others, is the recommended first-line treatment option for children and adolescents diagnosed with nonpsychotic conditions such as attention-deficit disorder and disruptive behaviors.
- Prescribing antipsychotic medications should be part of a comprehensive, multi-modal plan for coordinated treatment that includes psychosocial care.
Martin’s Point annually monitors the quality of our pediatric members’ behavioral health by claims submission. We use the following HEDIS quality measures in our monitoring process:
Use of First-Line Psychosocial Care for Youth on Antipsychotic Medication: Measures the percentage of children and adolescents 1–17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment.
Antipsychotic Prescriptions and Metabolic Testing*: Measures the percentage of children and adolescents 1–17 years of age who had two or more antipsychotic prescriptions and had metabolic testing. The measure includes the percentage of children or adolescents that received the following testing yearly:
- Blood glucose testing
- Cholesterol testing
Newly Prescribed ADHD Medication and Follow-Up Visits*: Measures the percentage of children ages 6-12 newly prescribed ADHD medication who had at least:
- Three follow-up care visits within a 10-month period:
- One within 30 days of when the first ADHD medication was dispensed.
- At least two more within 9 months for those who remain on the medication at least 6 months.
*Our Behavioral Health Care Managers work to close gaps in care related to antipsychotic prescription and metabolic testing and newly prescribed ADHD medication and follow-up visits. We may send a letter to you and your patient if there are not claims showing your patient has received any indicated testing and/or follow-up visits as described above.
1 https://www.nami.org/mhstats
