CommercialAdministrativeMedium impact
Follow up care after an emergency visit – A new quality incentive program measure
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, General Practice +5 more·Physician
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
BCBSRI has implemented a new quality incentive program measure (FMC) requiring follow-up care within 7 days of emergency department visits for patients with high-risk chronic conditions. This measure is part of the BCBSRI PCP Quality Incentive Program and affects provider quality scores and potential incentive payments.
Action Required
By April 1, 2026: Billing team and providers must establish workflow to ensure follow-up appointments are scheduled within 7 days for patients with chronic conditions (COPD, chronic kidney disease, Alzheimer's, depression, heart failure, atrial fibrillation, stroke, MI) after ED visits. Update scheduling system to maintain open appointment slots for post-ED patients. Train staff to conduct proactive outreach calls and schedule visits before patients leave ED when possible. Document all qualifying follow-up encounters (office visits, telehealth, virtual check-ins, care management) to ensure proper quality measure reporting for BCBSRI incentive program.