Loading...Loading...To improve our members’ outcomes and reduce or avoid readmissions, it is important that patients see a behavioral health clinician within seven days of discharge.
Timely follow-up visits:
- Can occur any time between days one and seven
- May be held in person, via telehealth or through billable phone visits
Note: Discharge appointments or appointments occurring on the day of discharge do not count as follow-up appointments.
Care coordination and telehealth can help ensure members receive timely post-discharge care.
Your facility should:
- Begin follow-up planning at admission
- Schedule follow-up appointments, including one within seven days of discharge
- Consider choosing telehealth to help meet the Healthcare Effectiveness Data and Information Set (HEDIS®) standard for timely follow-up care and/or for ongoing care
- Discuss the importance of follow-up visits with patients and families
- Ensure accurate post-discharge contact information
- Call patients with appointment reminders
- Obtain necessary authorization forms when required
Information sharing
- Most behavioral health information can be shared among treating providers without a release of information (ROI).
- ROI is specifically required for coordinating with substance use disorder (SUD) providers or facilities. Download our Authorization to Disclose Protected Health Information form.
- Requesting unnecessary ROIs can delay appropriate care.
Care coordination is vital to good treatment planning and plays a critical role in improving outcomes. By working with us, the member and their family and/or support system, we collectively ensure members have successful discharge plans and can function at their highest ability when they leave the hospital setting.
Our care management team will:
- Determine a follow-up plan during the inpatient review process
- Help secure follow-up appointments, including finding new providers, if needed
- Contact members post-discharge to discuss follow-up
- Educate members on the importance of follow-up care with a licensed behavioral health provider
Connect with case management
Email our case management team or call:
- 1 (866) 543-5765 or
- The Customer Service number on the back of the member’s card
Telehealth enables members to receive timely follow-up care via computer, phone or tablet.
To learn more about our members’ telehealth options, access these toolkits from the homepage of our provider website:
- The Telehealth section of Behavioral Health Toolkit includes an up-to-date list of virtual providers.
- The Care Options Toolkit includes additional national behavioral health vendors available to some members.
The HEDIS measure Follow-Up After Hospitalization for Mental Illness (FUH) tracks post-discharge behavioral health care to ensure members transition safely from an acute hospital setting back to their home environments.
Qualifying clinician types
- Psychiatrist
- Licensed clinical social worker (LCSW)
- Licensed marriage and family therapist (LMFT)
- Licensed professional counselor (LPC)
- Psychiatric nurse
- Psychologist
- Providers rendering services via incident-to billing criteria—See our Incident to Services reimbursement policy
Qualifying services
- Intensive outpatient (IOP)
- Partial hospitalization program (PHP)
- Residential treatment center (RTC)
Health Outcomes Survey (HOS) season is starting soon. CMS administers the HOS survey every year. This year’s survey is expected to be live from July 21 to November 3.
The HOS survey has a significant impact on plans’ Medicare Star Ratings, and our providers have the best opportunity to influence positive survey results for Medicare members who receive the survey. We also use survey data to evaluate how we can support our members through innovative benefits and programs that enhance their experience with us.
It’s important for providers to focus on meaningful and measurable conversations and interactions, especially for key HOS measures that affect the member’s experience with providers and staff in the health care setting. These topics include:
- Improving bladder control
- Reducing the risk of falling
- Monitoring physical activity
- Improving or maintaining mental health
- Improving or maintaining physical health
Having frequent conversations about these topics during in-office or virtual visits can have a significant impact on your patients’ health. For example, discussing physical activity with patients opens the door to addressing all five quality measures simultaneously. Research shows that targeted physical activity, particularly core-strengthening exercises, delivers multiple benefits including:
- Reducing fall risk through improved balance and strength
- Decreasing urinary incontinence symptoms by strengthening pelvic floor muscles
Enhancing overall physical health through improved cardiovascular function
Regular physical activity also helps to boost mental health by reducing anxiety and depression symptoms and helps support better sleep quality and cognitive function.
For help with workflows, best practices, screening tools and educational content to share during provider-patient conversations, see our Quality Improvement Toolkit.
Regular appointments are essential for patient health, particularly for immunizations, screenings, preventive care and chronic disease management. Patients should also take all medications as prescribed.
We promote these health maintenance practices on our website and our social media channels, providing members with tips for scheduling and preparing for medical appointments. Members can also explore behavioral health options by logging into their accounts.
Preventive vs. diagnostic care
Please remind patients that diagnostic care addressing new symptoms or existing problems during a preventive visit will incur standard cost sharing (copays, coinsurance or deductibles), just as additional services during non-preventive visits would.
Medicare annual wellness visits (AWVs)
Medicare AWVs and preventive care visits are crucial for documenting patient health status for chronic conditions and are recommended at least annually. Providers participating in our Medicare Advantage incentive programs can earn incentives when billing with:
- Annual wellness visit: HCPCS G0438 or G0439
- Initial preventive physical examination: HCPCS G0402
- Annual physical exam: CPT 99381-99387, 99391-99397
Preventive care resources
- Commercial members (English/Spanish)
- Medicare Advantage members
- BCBS FEP members
We use survey results, like the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to evaluate our members’ experiences with receiving their test results in a timely manner.
Studies show:
- Delayed test results can trigger unnecessary repeat testing, increasing health care waste
- Unscheduled or skipped follow-up appointments often lead to missed or delayed diagnoses
- Poor communication can result in medication errors and serious patient safety issues
- Patient trust and satisfaction often depend on timely results
Transform your test result process with these proven strategies:
- All results matter: Follow up on every test result, normal or abnormal
- Meet patients where they are: Let patients choose their preferred communication method (mail, phone, email or patient portal) to ensure they are notified of their results
- Maximize your electronic medical record (EMR): Use it to track test results automatically, flag abnormal results, enable team communication and communicate with patients through your patient portal
- Set clear expectations: Create a simple promise to your patients: “We’ll contact you within two or three business days with your results.” This small commitment can reduce anxiety, prevent unnecessary calls and improve staff efficiency.
Consider timely test result follow-up a quality improvement project for your 2025 program year. Here are some resources that can help:
- Review best practices in the Care Coordination section of our Quality Improvement Toolkit
- Download the Institute for Health Improvement’s Plan-Do-Study-Act (PDSA) Worksheet for structured improvement
- Implement the Agency for Healthcare Research and Quality’s Step-by-Step Guide for Rapid-Cycle Patient Safety and Quality Improvement to improve processes and workflows within your practice
Small changes in test result management can lead to big improvements in patient satisfaction, safety and practice efficiency.