Connect Archives

May 2011

Friday, May 27, 2011

HUMANA CONTRACT TERMINATION

Please be advised that as of December 31, 2011, Health First Network and Humana will terminate their agreement for the Medicare Advantage HMO product in Escambia and Santa Rosa Counties.

For the remainder of the year it will be business as usual. Please continue what you do in providing care to any Humana member that may be assigned to your panel or that you may be providing specialty care.

It is Humana’s intention to remain in Escambia and Santa Rosa Counties for Medicare Advantage HMO in 2012. Please expect a call or visit from a Humana representative. They will look to continue your participation with them through another contractual arrangement.

Health First Network will also post a question and answer document on our website to assist you and your staff with questions that may arise.

NO INPATIENT STAY REQUIRED FOR SNF ADMIT FOR MEDICARE ADVANTAGE MEMBERS

Fee-for-Service Medicare requires a qualifying 3-day inpatient stay prior to a Skilled Nursing Facility Admission. This 3-day acute inpatient stay is not required for Medicare Advantage members. In the appropriate circumstances, Medicare Advantage members can be directly admitted to a SNF (Skilled Nursing Facility). Most physician offices do these direct admissions to SNF so infrequently, there is often confusion, hesitation, and inappropriate selection of members (and/or services requested) during the direct admission to SNF process.

If the PCP wishes for the member to go to SNF directly from home, documentation of a skill for SNF services will need to be provided. If the skill will be therapy, a therapy evaluation needs to be obtained and provided. For WellCare members, Case Management Nurses at MED3000 will gladly assist any office with information and an authorization for a Home Health Care Physical Therapy evaluation for placement purposes. The typical procedure is that they send a Home Health Care MSW to the home to assist with placement in SNF as well. The PCP office will need to fill out nursing home orders on a 3008 form. The 3008 is the only acceptable form of orders for SNF admission. This completed form must accompany the member to the facility. If the member arrives at the facility without the completed 3008 they will not be allowed to stay. Medicare Advantage members and their families occasionally have to wait an unacceptable amount of time for SNF admission from home because this process is not followed.

Since direct admissions to SNF from home or Provider Office on fragile seniors are not an everyday occurrence, a knowledge deficit can exist on the process. Health First Network Providers can contact the Case Management Department at MED3000 for any assistance needed, for questions or for more information on the SNF Auth and admission process. The MED3000 Case Management Department can be reached at 478-6060, ext 3231.

The 3008 Medical Certification Form for Skilled Nursing Admission can be found at the following link along with other pertinent information.

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HEALTHSPRING PARTNERSHIP FOR QUALITY PROGRAM

HealthSpring Healthplan is introducing a Partnership for Quality Initiative for contracted Physician Providers in this area. The Program, called Partnership for Quality (P4Q), is aimed to improve the health and quality of life for HealthSpring members. HealthSpring will partner with Providers by providing the resources needed for quality measures in the office. It is based on the documentation and reporting of quality measures for covered Medicare Services. In addition to the assistance of a local in-office nurse coordinator and HealthSpring Certified Coder, HealthSpring will provide additional financial incentives for high quality performance. Those offices with HealthSpring Membership Panels of 25 members or greater will qualify for these resources and incentives.

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HEALTHSPRING 360 CODING INITIATIVE

HealthSpring Healthplan has partnered with Health First Network to develop new goals for completion of the 360 and HMR Forms on their members in the Pensacola area. HealthSpring is willing to provide additional resources to Physician offices that serve as HealthSpring providers to assist in completion of these forms. The contact person at HealthSpring for this initiative is Dawn Hicks. She can be reached at 251-470-8513 or dawn.hicks@healthspring.com. HealthSpring will provide a Certified Coder to your office to pre-populate forms in preparation for a patient visit. If your office would consider dedicating a morning or afternoon for a “HealthSpring Day” HealthSpring has agreed to send a certified coder and a nurse to assist. HealthSpring realizes that these visits take extra time to complete and has attached additional financial incentives that will stream directly into the Provider’s office.

HEALTH FIRST NETWORK SPONSORS BLOOD DRIVE

On March 4th, Health First Network sponsored a blood drive for the businesses located near our office on South Palafox Street. Participating companies besides HFNI included Smith Barney, Stifel Nicolaus & Co., Inc., Merrill Lynch, and EmCare. The bloodmobile collected 16 pints of blood which can help save up to 48 lives in our community hospitals.


HEALTH FIRST NETWORK HAS MOVED

Health First Network has moved to its new location at 705 S. Palafox Street.