Q3 2024 newsletter

REQUIREMENTS: 1. IMMEDIATE - All Providers: Review and complete CMS-required SNP Model of Care training annually. Access 2024 training via Provider Portal. Non-compliance affects care delivery to vulnerable populations. 2. IMMEDIATE - Billing Team: Update risk adjustment documentation protocols for three high-priority conditions: - CANCER: Ensure providers document active status for known malignancy or active treatment; transition to historical once excised/eradicated. Document remission status for leukemia, lymphoma, multiple myeloma. - MORBID OBESITY: Require providers to link comorbidities to weight diagnosis and pair BMI codes with relevant weight diagnosis in billing system templates. - DIABETES: Mandate documentation of complications linked to diabetes diagnosis with clear treatment plan. Update EMR encounter templates and billing guidelines. Access updated Tips Sheets via Provider Portal. Contact RAF@devoted.com with documentation questions. 3. IMMEDIATE - All Providers: Validate and update National Provider Identifier (NPI) data in NPPES to ensure accuracy. Incorrect NPI data will impact claims processing. 4. BEFORE NOVEMBER 2024 - Clinical Staff: Actively support CMS Health Outcomes Survey (HOS) performance by addressing patient health topics during visits: balance/walking concerns, activity levels, bladder control, mental health awareness. Document interventions for survey correlation. 5. ONGOING - Providers & Billing Team: Implement processes to prevent hospital readmissions and improve Star ratings: - Schedule follow-up appointments within 7 days of discharge (or sooner if needed) - Reserve appointment slots for recently discharged patients - Track and monitor all post-discharge follow-ups - Encourage regular PCP visits for chronic condition management - Advise patients to contact PCP for condition changes - Submit claims promptly with correct diagnosis and treatment codes Reference PCR, FMC, and TRC guides for specific measure requirements. 6. ARIZONA PROVIDERS ONLY - Clinical Staff: Establish referral process to HOPCo Specialty Care Network (HSCN) for musculoskeletal care. For Devoted Health patients with back, shoulder, or knee pain: - Fax referrals to (833) 972-1640 - Patients receive personalized, evidence-based care from MSK clinicians - Track care journey updates throughout treatment - Referrals may lead to specialist care within HSCN and Devoted Health network 7. BILLING TEAM: Review and stay current with Devoted Health payment policies: - TIN Validation requirements - Radiopharmaceuticals billing rules - ABN and GY Modifier usage Access Policy Links on Devoted Health portal. 8. Questions or clinical documentation feedback: Contact RAF@devoted.com or 1-877-762-3515 (TTY 711), 8am-5pm Monday-Friday local time.