HNS Policy
HNS providers shall ensure the delivery of cost-efficient care, as defined by HNS Comparative Practice Program parameters, to members of healthcare plans that contract with HNS.
HNS Comparative Practice Patterns Review (CPR) Program & Policies
Introduction
The objective of the HNS Comparative Practice Patterns Review (CPR) Program is to ensure the consistent delivery of cost-efficient care. The program promotes the delivery of cost-efficient healthcare by regularly sharing objective and actionable data regarding a provider’s individual practice patterns, the practice patterns of their peers, and the costs of the care provided.
Through the use of performance-based tiers, recognition programs, and administrative withholds, the program aligns incentives and rewards the delivery of cost-efficient care.
Scope
The HNS CPR Program is based on the core tenet that physicians should be able to make treatment decisions based upon their own clinical judgments.
The program does not mandate the number or type of services physicians may provide nor the length of time care may be provided. CPRs are statistical reviews of the individual physician’s performance relative to costs and practice patterns and compare the physician’s data to the collective costs and practice patterns of his/her peers in the HNS Network.
The program does not include medical necessity determinations nor the approval or denial of the provision of, or payment for, services provided by network physicians.
CPR Quick Links:
To learn more about HNS’ CPR Program, please review the information in each of the links below.
Philosophy of Care
CPR Decisions
CPR Probationary Status
Appeals & Hearings
CPR Process
HNS Code Audit Program
Introduction
The HNS Code Audit Program helps achieve the two Clinical Integration (CI) objectives of improving quality of care and helping to control the cost of care.
Consistent with our responsibility to promote quality and cost-efficient healthcare and educate providers, on a semiannual basis, HNS conducts reviews of Network Physicians’ individual utilization of certain services (i.e., CPT/HCPCS codes) that may:
- Indicate quality of care issues;
- Indicate sub-optimal utilization; and
- Subject the physician to close scrutiny of the physician’s practice patterns by contracted healthcare plans.
Click here for a summary of the HNS Comparative Practice Patterns Review & Code Audit Programs