Measure of the Month – Are Your Adolescent Patients Up to Date with Immunizations?

The NCQA Immunization for Adolescents measure is defined as the percentage of adolescents 13 years of age who had one dose of meningococcal conjugate vaccine; had one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine; and completed the human papillomavirus (HPV) vaccine series by their 13th birthday. The specifics for this measure, and others, can be found in North Carolina's Medicaid Quality Measurement Technical Specifications Manual (page 102). 

Additional resources include:

• Child and Adolescent Immunization Schedule by Age from the CDC
• Fact Sheets to Promote Vaccination of Preteens and Teens | CDC which includes printable flyers

Ideas that can help your practice improve this quality measure:

• Display the printable flyers at the front desk and exam rooms
• Monthly run a list of your patients who are twelve that have not received the following:
  – One dose of meningococcal conjugate vaccine
  – One tetanus, diphtheria toxoids and acellular pertussis (Tdap vaccine)
  – Completion of the human papillomavirus (HPV) vaccine series
• Consider starting the HPV series at 9 years of age
• Contact the patients with a phone call or patient portal reminder. Script example:
  – “We are contacting you to schedule your adolescent child for immunization(s) to keep them up to date and remain healthy. I have XX day/time available; will that work for you?”
• Combine the reminder with an upcoming appointment, such as a well-care visit, or a follow up for asthma and/or ADHD medication.
• Work with a South Piedmont Practice Support Coach!

Regulatory Reminders – Importance of Documentation

CMS has developed a series of fact sheets to help providers stay compliant. The Documentation Matters Toolkit covers multiple aspects of a practice to help ensure accurate documentation that supports compliance with federal and state laws and reduces fraud, waste and abuse. Here are some key takeaways:

• Have and use a medical record documentation policy. Ensure staff are knowledgeable about expectations within the policy and ensure it is assessable.
• Audit yourself. Do a monthly review of records to ensure the policies of your practice are being followed. Pay close attention to plans of care, time stamps and documentation of patient education. Ophthalmic Mutual Insurance Company, OMIC, has a medical record audit form to use as you develop a practice specific tool. Magellan also has great audit tools.
• Turn off auto-fill and don't copy/paste care notes. Documentation that is, or seems to be, too similar can cause issues if a payor or governmental agency does an external audit. Documentation short cuts may not reflect the individualization of an encounter and could even cause incorrect diagnosis.

Community and Partner Engagement Initiative

NC Department of Health and Human Services (NCDHHS) is launching a new Community and Partner Engagement initiative to strengthen health equity and community partnerships across North Carolina. This website details their commitment to working with community members, healthcare professionals, and various partners to shape policies, services, and operations that ultimately improve health and well-being for all North Carolinians. To learn more, review NC DHHS Community and Partner Engagement and Community and Partner Engagement Resource Tools.

MIPS Submission Window and EUC Exception Applicaiton Extended

For performance year 2023, CMS has extended the submission period and reopened the Extreme and Uncontrollable Exception (EUC) Application to provide relief to clinicians impacted by the Change Healthcare Cyberattack. You can submit data or a MIPS EUC Application for 2023 performance year until 8 AM ET on April 15th, 2024. QPP has additional details.

Aetna State Health Plan – May 31st Deadline

The State Health Plan is transitioning its third-party administrator from Blue Cross NC to Aetna® beginning Jan. 1, 2025. Current Clear Pricing Project (CPP) providers, who want to accept the State Health Plan rates (currently 160% of Medicare) will need to re-sign to remain a CPP provider when the State Health Plan transitions to Aetna. Otherwise, your Choice POS II Aetna contract rates will apply. Click here to start that process. You only join CPP once for your TIN. All providers practicing under that TIN will be part of CPP. 

The online process is the most efficient way to re-sign; for specific provider situations related to the State Health Plan, Aetna can be reached at 800-353-1232 using prompt 3.

Additional information can be found on Aetna's website and the North Carolina State Health Plan website.

New CPT Coding for RSV Monoclonal Antibodies

Two new monoclonal antibodies, nirsevimab (Beyfortus) and palivizumab (Synagis) are now available to protect infants and toddlers from severe disease caused by respiratory syncytial virus (RSV) infection. 

CPT codes have been approved for the product administration of nirsevimab (Beyfortus), a monoclonal antibody designed to protect infants and toddlers. Report the following product codes for nirsevimab based on the dose administered: 

• 90380 Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use
• 90381 Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use

CPT codes have also been approved for the product and administration of palivizumab (Synagis), another monoclonal antibody indicated for eligible high-risk infants and children up to 24 months. Report the following CPT product code for palivizumab based on the dose administered:

• 90378 Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each
• 99392 Periodic comprehensive preventive medicine reevaluation and management of an established patient; early childhood (age 1 through 4 years)
• 96372 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or IM

*NOTE that these products are not vaccines and are not for the treatment of RSV 

To learn more about coding for nisevimab and palivizumab, review this resource from the American Academy of Pediatrics.

Additional Provider Flexibilities to Support Providers during Change Healthcare Disruption

To support providers during this transition, NCTracks will implement the following flexibilities which align with guidance from the Centers for Medicare & Medicaid Services (CMS):

• Details on how to update the billing agent in NCTracks
• Extension of timely filing requirements
• Process for hardship payments

For more information on the additional flexibilities, please review the Medicaid blog.

Annual HIPAA Privacy and Security Training

As you work through your list of annual trainings, AHEC offers free HIPAA Privacy and Security Training online. The free training also offers 0.50 contact hours. You and your staff can register on the Piedmont AHEC website.  

South Piedmont AHEC Practice Support – Helping you meet the challenges!

In this time of great transition in health care practices need to position themselves for new payment models, incentive programs, and other health care reforms while refocusing on patient-centered care. South Piedmont AHEC is currently able to provide these direct, individualized services at no cost.

Additional Resources: