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Claims & Billing - Policy, Billing, or Coverage Update - 2021
Policy for Medical Record Documentation Standards

Effective February 1, 2021, consistent with Centers for Medicare & Medicaid Services (CMS) guidelines and the Healthfirst Provider Manual, Healthfirst will require the medical record documentation standards outlined within this document.

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Medical Record Reviews
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2021
Foster Care and Initial Health Assessments

Effective July 1, 2021, children/youth placed in foster care, including those in direct placement foster care and those in the care of Voluntary Foster Care Agencies statewide, will be mandatorily enrolled in Medicaid Managed Care unless they are otherwise exempt or excluded from enrollment. As such, these individuals may present Healthfirst insurance.

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Foster Care
  
Behavioral Health and Foster Care - Practice Guidelines and Tips - 2021
Initial Health Assessments for Kids in Foster Care

Effective July 1, 2021, children/youth placed in foster care, including those in direct placement foster care and those in the care of Voluntary Foster Care Agencies statewide, will be mandatorily enrolled into Medicaid Managed Care unless they are otherwise exempt or excluded from enrollment. This presentation was created to educate Primary Care Providers who may treat children placed in foster care on the initial health activities that must be completed within 60 days of foster care placement.

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Foster Care
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2021
Fourth Annual World Health Continuing Medical Education Conference

June 3-5, 2021 Virtual Conference This Continuing Medical Education activity is designed to update primary care and specialty practices on the evolving strategies for implementing evidence-based medicine to meet the needs of local, regional, and global communities. The intent is to inform the attendees on innovations in treating special patient populations, with a focus on Caribbean communities. Using evidence-based prevention, chronic-disease management, pharmacotherapy, and cutting-edge treatment options, participants will be able to integrate approaches to improve patient care outcomes.

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Provider Events
  
Coding - Practice Guidelines and Tips - 2021
Documentation and Coding: Prostate Cancer

This tip sheet will offer guidance on how to submit diagnosis codes with greater specificity for coding Prostate Cancer. Cancer is a chronic condition that is often coded inaccurately. The prevalence and complexity of cancer and neoplasm coding requires a solid understanding of the ICD-10-CM codes and coding guidelines to ensure accurate code assignment.

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Clinical Documentation Improvement
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2021
Best Practices and Innovation: Facing the Reality of Post-COVID Symptoms

May 14, 2021 Virtual Conference Healthfirst’s semi-annual Provider Symposium features the innovative work of practices, health care organizations and industry leaders who care for and serve our members. Providers, administrators, and leaders from a variety of ambulatory, community based, and independent health and social service settings look forward to attending and learning from colleagues and health leaders. This theme for symposium is Best Practices and Innovation: Facing the Reality of Post-COVID Symptoms.

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Provider Events
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2021
0421 21 Pediatric CME Conference Program Booklet

May 6-7, 2021 Virtual Conference This CME activity is designed to help improve the skill level of primary care providers who care for overweight or obese children in their evaluation, treatment and referral for obesity-related illness. Obesity rates have increased rapidly in the pediatric populations, especially in minorities and children living in poverty. Recent studies suggest that abnormal weight gain and poor eating practices begin in infancy and young childhood and continue through early school years and adolescence, leading to obesity.

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Provider Events
  
Coding - Policy, Billing, or Coverage Update - 2021
Documentation and Coding: Cerebrovascular Disease

Codes in this category describe the type of stroke and the sequelae (late effects) caused by the stroke. Documentation should clearly state whether a neurological deficit is directly related to cerebrovascular disease or a cerebrovascular accident. Ensure that all diagnoses reported are supported by the MEAT (Monitoring, Evaluating, Assessing, Treating) concept.

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Clinical Documentation Improvement
  
Pharmacy Resources & Formularies - Quality and Compliance - 2023
Pharmacy Carve Out Delay Announcement

The Pharmacy carve-out has been delayed by two years, until April 1, 2023. Review this DOH announcement to learn more.

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Medicaid
  
Quality Program Resources - Practice Guidelines and Tips - 2021
Checklist for HARP CAHPS Success

This document outlines ways you can improve your patients’ experience and help with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey that your Health and Recovery Plan (HARP) patients may receive this year. For your reference, the HARP CAHPS survey questions are also available in this document.

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HARP Health And Recovery Plan
  
Education Events & Patient Care Resources - Practice Guidelines and Tips - 2021
Building the Future We Wish to See: Partnerships for Optimal Medical Outcomes in 2021 and Beyond

Healthfirst’s semi-annual Provider Symposium features the innovative work of practices, health care organizations and industry leaders who care for and serve our members. Providers, administrators, and leaders from a variety of ambulatory, community based, and independent health and social service settings look forward to attending and learning from colleagues and health leaders.

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Mental Health
  
Coding - Practice Guidelines and Tips - 2021
Documentation and Coding: Chronic Kidney Disease

This tip sheet will offer guidance on how to submit diagnosis codes with greater specificity for coding Chronic Kidney Disease classified based on severity, by stages 1–5 and End Stage Renal Disease.

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Clinical Documentation Improvement
  
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