Through Gateway Health Plan® (Gateway)’s model of Prospective Care Management (PCM®), we emphasize the importance of extensive member outreach, community involvement and physician practice engagement. We support the efforts of physician practices in delivering the highest quality of care to members. Recent enhancements to our physician practice engagement initiatives include the Gateway to Physician ExcellenceSM PCP Pay-for-Performance Program, Primary Care Practice Dashboard Reports and educational training sessions carried out by Gateway’s Provider Relations department and medical directors.
These tips can help practices continue to deliver quality care:
Reporting
Primary care practices can take advantage of information provided in the following reports:
· Primary Care Practice Dashboard Reports (quarterly)
· GPESM Report Cards (annual)
· Medicaid Primary Care Practice Portfolio Reports (biannual)
· Medicare Assured® Primary Care Practice Portfolio Reports (annual)
These reports can be used to assess practice performance, plan future patient visits or perform outreach to patients in need of care. Although Gateway conducts reminder outreach to members, hearing directly from their doctor’s office helps.
Prospective Care Management (PCM®)
Refer medically complex cases to Gateway’s Care Management department. The referral phone numbers are:
· Medicaid 1-800-642-3550
· Medicare Assured® 1-800-685-5212
Coding and Claims Submission
· Always submit claims, even when Gateway is a secondary payer. Claims submissions keep us aware of the quality-related services provided.
· Bill EPSDTs. Billing not only demonstrates that the service has been performed but also results in increased practice reimbursement.
· Code thoroughly and completely by listing all diagnoses, which makes us aware of a member’s total health condition when conducting outreach.
Streamlining
· Schedule patients for annual physicals to review all of their needs.
· Schedule follow-up appointments before patients leave the office.
· Have a reminder system. Let patients know by mail or telephone of an upcoming appointment to help minimize “no shows.”
· Arrange for patients with chronic conditions to have blood work drawn a week before their next appointment. This allows practitioners to have more information at the time of the visit and reduces the amount of required follow-up communication.
· Make use of in-office testing (e.g., HbA1c), a reimbursed service by Gateway. (CPT codes 83036 for Medicaid and 83037 for Medicare).