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Quality Program Resources - Practice Guidelines and Tips - 2024
Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States

Each year CDC estimates the burden of influenza in the U.S. CDC uses modeling to estimate the number of flu illnesses, medical visits, hospitalizations, and deaths related to flu that occurred in a given season.

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Annual Flu Vaccine
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-110 Preventive Care Services (Commercial Plans)

Healthfirst recognizes the importances of preventive care in promoting overall health and well-being. To support our members in maintaining good health and preventing illnesses, we provide coverage for a range of preventive services in accordance with this policy.

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Reimbursement Policy
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Social Determinants of Health

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection of services submitted to Healthfirst—specifically for Social Determinants of Health.

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Clinical Documentation Improvement
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Coma, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for Coma.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2020
Institute for Healthcare Improvement
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Documentation
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-105 Removal of Impacted Cerumen

The removal of impacted cerumen (earwax) is the extraction of hardened or accumulated cerumen from the external auditory canal by mechanical methods (irrigation or debridement).

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Reimbursement Policy
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Coagulation Disorders, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for common types of Coagulation Disorders.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Malignant Neoplasm

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst —specifically for Malignant Neoplasm.

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Clinical Documentation Improvement
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Unstable Angina

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection on services submitted to Healthfirst—specifically for common types of Unstable Angina.

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Clinical Documentation Improvement
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-088v1 National Drug Code Billing Requirements

This policy describes the National Drug Code (NDC) information that is required on professional and outpatient facility drug claims that are reported for reimbursement.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-089v1 Radiopharmaceuticals

Healthfirst has updated its reimbursement policy for radiopharmaceuticals commonly used for myocardial perfusion imaging studies.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-092v1 Ultrasound Diagnostic Procedures

Healthfirst will no longer provide reimbursement for CPT 76856 (Ultrasound, pelvic [non-obstetric], real time with image documentation; complete) or CPT 76857 Ultrasound, pelvic [non-obstetric], real time with image documentation; limited or follow-up) when billed with CPT 76830 (Transvaginal ultrasound) unless extenuating circumstances are present to validate the necessity of both studies.

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Reimbursement Policy
  
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