Hello all!
I haven't posted much here, but I'm hoping there is someone here who could help me discern this. My administrator and nurse manager (who does the quality payment related things) looped me in on a meeting with our BCBS quality rep. They stated that the quality payments are happening per claims now (since 1/1/24) and we will need to have certain codes on the claim to denote some quality measures are happening.
The main question I have is regarding the quality measure for well child checks with regards to BMI, nutrition, and physical activity. The BCBS rep said that we need to code the childs BMI, no problem, I'll get the ICD code on there. However, she mentioned that we should use codes, 97802, 97803, 97804, G0270, G0271, G0447, S9449, S9452 and S9470 for when the provider speaks to the child/parent about nutrition. We were also told to use codes G0447, and S9451 for when the provider speaks to the child/parent about physical activity.
From her perspective she is saying we should use these codes to denote that the quality measure is being met. However, most of the nutrition codes require the conversation to be at least 15 min or longer and the physical activity codes are for excerise classes! We would not be charging for these codes on the claim, BCBS just wants to know if the provider is discussing nutrition and physical activity with kids/parents. From my perspective it would not be appropriate to put these codes on the claim even if we are not charging with these codes as the code description is most likely not being fully met.
So, my questions are:
-Can you put codes on a claim, with a $0 charge, for data purposes only when the code description is not met? It just smells of fruad to me, even though we would not be charging for it...
-Does anyone here deal with these quality payments who could maybe explain the process to me more? I'm not sure if I'm confused because I'm ignorant of the process...
Thank you so much for your help!!!
I haven't posted much here, but I'm hoping there is someone here who could help me discern this. My administrator and nurse manager (who does the quality payment related things) looped me in on a meeting with our BCBS quality rep. They stated that the quality payments are happening per claims now (since 1/1/24) and we will need to have certain codes on the claim to denote some quality measures are happening.
The main question I have is regarding the quality measure for well child checks with regards to BMI, nutrition, and physical activity. The BCBS rep said that we need to code the childs BMI, no problem, I'll get the ICD code on there. However, she mentioned that we should use codes, 97802, 97803, 97804, G0270, G0271, G0447, S9449, S9452 and S9470 for when the provider speaks to the child/parent about nutrition. We were also told to use codes G0447, and S9451 for when the provider speaks to the child/parent about physical activity.
From her perspective she is saying we should use these codes to denote that the quality measure is being met. However, most of the nutrition codes require the conversation to be at least 15 min or longer and the physical activity codes are for excerise classes! We would not be charging for these codes on the claim, BCBS just wants to know if the provider is discussing nutrition and physical activity with kids/parents. From my perspective it would not be appropriate to put these codes on the claim even if we are not charging with these codes as the code description is most likely not being fully met.
So, my questions are:
-Can you put codes on a claim, with a $0 charge, for data purposes only when the code description is not met? It just smells of fruad to me, even though we would not be charging for it...
-Does anyone here deal with these quality payments who could maybe explain the process to me more? I'm not sure if I'm confused because I'm ignorant of the process...
Thank you so much for your help!!!