Oct 012014

A reminder that HNE is proud to announce that we will be co-sponsoring and subsidizing a Continuing Medical Education (CME) event on behavioral health integration in the primary care setting. CMEs will be provided in the area of risk management. Please see the attached brochure for information and how to register for this event. The cost of the event, if you register before October 6th is $25.00. The cost of the event after October 6 is $35.00.

 Practical Strategies flyer 2014

Sep 302014

Two different patient satisfaction surveys impact CMS Star ratings:

  1. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, typically mailed to the Plan members from March–June.
  2. The Health Outcomes Survey (HOS), typically mailed to members April–July.

HNE has compiled a list of some of the questions from both surveys. You can see exactly the questions your patients are answering. We’ve also included recommendations to efficiently address these metrics. These guidelines have been compiled from various organizations including the Centers for Disease Control and Prevention (CDC), The Mayo Clinic, and Medscape Medical News.

5-Star Metric: Care Coordination

Recommendations for Physicians:

  • You probably know all relevant information about your patient’s medical history—but does your patient know you know? Make sure they do — it’s a quick way to improve patient satisfaction with doctor-patient communication.
  • Ask if the patient has seen any other providers—and if you are aware specialty care has occurred, mention it and discuss as needed.
  • Tell your patients when they should expect test results (“by the end of next week”) and who will give them the results – a staff member, your medical assistant, you?
  • Do you let patients know when test results are normal? If not, be sure they know that—but that they can call your office if they still want to check results.

5-Star Metric: Getting Care Quickly:

Recommendations for Your Staff:

  • Ensure a few appointments each day are available to accommodate urgent visits.
  • Maintain an effective triage system to ensure that frail and/or very sick patients are seen right away.
  • Offer appointments with a nurse practitioner or physician’s assistant to patients who want to be seen on short notice but cannot be seen by their doctor.
  • Encourage patients to make their routine appointments for checkups or follow-up visits as soon as they can—weeks or even months in advance.
  • Be proactive and call patients months before their tests, screenings, or physicals are due and get them scheduled. Don’t wait for the patient to call.

5-Star Metric: Monitoring Physical Activity


• Have medical assistants assess patient’s physical activity level.

• Review and address the assessment results as needed.

• Utilize appropriate educational materials and suggest community resources, such as gyms or fitness programs.

• Consider referral to physical therapy so patients with limited mobility can learn safe and effective exercise.

5-Star Metric: Urinary Incontinence

Recommendations for Physicians:

  • Encourage nursing staff and medical assistants to ask patients about any incidents of urinary incontinence in the last 6 months. Patients are often too embarrassed to initiate the discussion.
  • Educate patients about noninvasive behavioral interventions for UI; when necessary, refer for appropriate treatment.

5-Star Metric: Reducing Risk of Falling

Recommendations for Physicians:

  • Conduct a Medication Review with patients. Some medications or combinations of medications can have side effects like dizziness or drowsiness, increasing fall risk.
  • Consider gradually withdrawing psychotropic medication and modifying other prescriptions, as appropriate, to reduce fall risk.
  • Encourage annual eye exams and regular prescription updates for glasses/contact lenses.
  • Consider referral to an occupational therapist for home safety evaluation* and modification.
  • Encourage exercise, specifically those that increase leg strength and balance.

And, General Tips for Providers:

  • Encourage patients to obtain preventive screenings annually or when recommended.
  • Create office practices to identify noncompliant patients at the time of their appointment.
  • Submit complete and correct encounters/claims with appropriate codes.
  • Submit clinical data such as lab results to HNE.
  • Communicate clearly and thoroughly; ask, “Do you have any questions?”
  • Understand each measure you impact.
  • Incorporate Health Outcomes Survey (HOS) questions into each visit. Find out more about HOS at http://www.hosonline.org/Content/SurveyInstruments.aspx .
  • Review the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey to identify opportunities for you or your office to have an impact: http://ma-pdpcahps.org/content/surveyinstruments.aspx.


Sep 242014

CPT Category II codes are supplemental tracking codes that can be used for performance measurement.The codes are intended to facilitate the collection of information about the quality of care delivered by coding services or tests that support performance measures.


The use of the tracking codes will not only ease the administrative burden of record abstraction and chart review for performance measurement, it will also enable providers to monitor internal performance for key measures throughout the year. By identifying areas of opportunity, interventions can be initiated to improve performance throughout the year.


CPT II codes are comprised of four digits followed by the letter F. They are billed in the procedure code field, just as CPT Category I codes are billed. CPT II codes are not associated with relative value because they describe clinical components that are usually associated with evaluation and management or clinical services. Therefore, they are billed with a $0 billable charge amount.


Tracking codes for performance measurement are released three times yearly following approval of panel minutes after each editorial panel meeting (March, July and November) on the AMA CPT Category II website, www.ama-assn.org/go/cpt-cat2, and published annually in the CPT book as part of the general CPT code set.

If your office would like more information on the use of Category II codes, please contact your Provider Relations representative.

Source: www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-ii-codes.page


Jul 092014

Mass Health has updated their list of Approved Standardized Behavioral Health Screening Tools for Children Under the Age of 21 by adding several tools. Please click on the links below for more information.

MassHealth-Approved Standardized Behavioral Health Screening Tools For Children Under the Age of 21_July_2014





Jul 012014

HEDIS Corner:  Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET)

This HEDIS measure looks at the percentage of adolescent and adult enrollees with a new episode of alcohol or other drug (AOD) dependence who receive the following:

  • Initiation of Treatment: The percentage of enrollees who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient visit or partial hospitalization within 14 days of the diagnosis.
  • Engagement of AOD Treatment: The percentage of enrollees who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit.

Early identification of substance abuse issues can help enrollees avoid future drug-related illnesses and deaths as well as improve enrollee quality of life. It can also help curb the overuse of health care services related to substance dependence.


HNE recommends the following best practices for substance abuse:

  • Screen for it! Make sure to incorporate substance use questions or tools upon intake and upon yearly treatment plan review, at a minimum. Many times substance abuse goes undetected simply due to not asking the question! You can be part of the solution by assessing substance use. Patients may want to minimize their substance abuse, so persistence is required in raising the topic and keeping it at the forefront of a patient’s treatment.
  • Document it! If a substance abuse concern is identified, be sure to document it and code it on any claims submitted. Often, practitioners are reluctant to use a substance abuse diagnosis for fear of stigmatizing a patient who has discussed his or her struggles with substances. The lack of labeling a diagnosis, however, prevents other clinicians from working with a patient in a coordinated manner, ultimately resulting in less effective care for the patient.
  • Follow-up! When a substance abuse concern is identified, it’s very important to schedule appropriate follow-up treatment. For newly diagnosed patients, in particular, we recommend making a point of scheduling 3 follow-up appointments within the first 30 days. Increased intensity of contact in early stages of treatment, will help to address the concerns as timely as possible and help to keep the patient connected and motivated for treatment.
  • Educate! It’s important to educate patients on the effects of substance abuse and educate them on the treatment options that exist for them in their community. Additionally, substance abuse often co-occurs with other behavioral health problems, like: major depression, or anxiety disorders, which can make treating substance abuse or diagnosing a behavioral health disorder more difficult. In instances like these, you may want refer your patient to a behavioral health provider. If you need assistance, call our care management department at  1-800-842-4464. 


Jun 052014

The attached explains a notice of formulary changes that was recently mailed to providers on 5/20/2014. This mailing was sent to providers who currently have patients that are utilizing fluoxetine 40mg capsules and fluoxetine 20mg tablets. HNE will no longer cover fluoxetine 40mg capsules and fluoxetine 20mg tablets. The fluoxetine changes are effective 7/1/14.

 *We will still cover all other strengths and all quantity limits remain in place at this time. Members and pharmacies have already been made aware of this change.

 •          In place of the 20mg tablets pharmacies will be asked to switch to 20 mg capsules.

•          In place of the 40mg capsules pharmacies will be asked to switch to two 20 mg capsules.

 For ease of transition we are asking HNE providers to proactively apply the above changes when prescribing fluoxetine.

 The reject messaging on the claim at POS will reflect the bullets above. Pharmacies will be asked to contact the prescribing physician for verbal authorization to switch. 

 The reason for this change is the current net pricing for the 40mg capsules and the 20mg tablets, after all discounting, is much more expensive than the net pricing for the 20mg capsules. If you have any questions, please contact Provider Relations at 413.233.3313 or 800.842.4464, extension 5000.

 Fluoxetine Provider LTR