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Complete Diagnosis Submission Improves Quality and Care


Have you shot eight out of ten free throws in a row and yet no one was there to witness your accomplishment? Ever made that incredible putt (alright, maybe it was just mini golf) and no one in your group was paying attention? That’s what happens when a physician completes a thorough evaluation but does not document all of the patient’s diagnoses in the medical record – there is no witness to the thoroughness of your efforts.

“Big deal”, you may say. Think again. Proper charting is essential to managing patients, documenting quality and enhancing your effectiveness.

Are you aware that diagnosis codes are used to measure quality (e.g., Primary Care Practice Portfolio Reports, Primary Care Practice Dashboards, HEDIS, etc.)? Diagnosis codes also impact quality-related revenue such as Gateway to Physician Excellence?, which varies by practice. More than ever, Gateway Health Plan® (Gateway) needs you to care for your patients, our members, and to ensure that your medical records and claims are thorough and complete. The more thoroughly you document a patient’s diagnoses, the better these measurements and data will be.

With accurate data from you, Gateway is able to proactively outreach to your Gateway patients and thus enhance the effectiveness of your practice. Gateway’s outreach efforts help your patients overcome barriers to care, which is part of our Prospective Care Management model of care. Diagnosis codes on medical claims and pharmacy claims data enable our staff to identify members in need of services and then contact them to address care gaps and non-medical needs. We educate and empower patients to follow your instructions and learn about their condition in order to become better patients and healthier citizens. The more thoroughly you list patients’ diagnoses, the better Gateway can outreach and enhance your efforts.

Paradigm shift? Yes. Help maximize quality measurements, quality-related revenue and Gateway’s member outreach activities by thoroughly listing your patients’ diagnoses in the patient’s chart at every visit and when you submit a claim/encounter for every visit.