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Annual Chart Data Collection for Medicare Advantage Patients

Each year, Blue Cross and Blue Shield of North Carolina (BCBSNC) is required to conduct retrospective chart reviews with providers in order to comply with CMS requirements to submit all diagnoses for Medicare Advantage members each year, as well as to validate accurate reimbursement and reporting.  We are again working with Outcomes Health Information Solutions (OHIS) for this annual data collection and abstraction.  Beginning in August and through December, we will be collecting diagnostic data for dates of service from July 1, 2012, through June 30, 2013. 

Your medical records team will soon receive a call from either OHIS or BCBSNC to schedule chart retrieval or on-site abstraction for your office or facility.  In order to minimize impact to your staff, OHIS will accept the requested charts by mail, secure fax, secure file transfer, or B2B data exchange.

New for 2013: Prospective Risk Assessments

New for 2013, BCBSNC will be introducing prospective risk assessments, which involve outreach to targeted members and their primary care physician (PCP) to schedule an appointment for an in-office assessment.  For targeted members with acute and/or chronic conditions who are unable to go to their PCP office, we will also offer an in-home assessment. 

To assist with this new risk assessment, we have selected Inovalon, Inc. to provide leadership and analytics through their Prospective Advantage® program.  Providers will receive more information about this program in September from Inovalon.  

With Inovalon’s Web-based provider decision-support portal, ePASS, providers will be able to enter patient-specific data during the in-office or in-home assessment.  With ePASS, we’ll be able to aggregate patient profiles from multiple-source data and enable significant improvements in areas such as gap closure, documentation, care coordination and risk score accuracy (  Data entered using ePass update monthly and are available to access by providers at any time.

Your Participation Can Pay Off

If you complete and submit a prospective risk assessment to Inovalon (either electronically via ePass or print copy) before November 30 for conducting an in-office Medicare Advantage patient risk assessment, BCBSNC will pay you $100 per completed assessment.  This is our thank you for your work in ensuring that the level of care our members have always experienced with our Medicare Advantage provider network is fully documented to comply with CMS’ annual requirements.