Connect Archives

July 2012

Monday, July 16, 2012

ACCOUNTABLE CARE COALITION OF NORTHWEST FLORIDA, LLC TO PARTICIPATE AS A MEDICARE SHARED SAVINGS PROGRAM ACCOUNTABLE CARE ORGANIZATION

Voluntary, New Care Coordination Program Created to Offer High Quality Service and Care to Beneficiaries Through Partnership with Medicare


Accountable Care Coalition of Northwest Florida, LLC today announced it has been selected to participate in the Medicare Shared Savings Program Accountable Care Organization (ACO), a multifaceted new program sponsored by the Centers for Medicare and Medicaid Services (CMS).

Through the Shared Savings Program, Accountable Care Coalition of Northwest Florida, LLC will work with CMS to provide Medicare fee-for-service beneficiaries with high quality service and care, while reducing the growth in Medicare expenditures through enhanced care coordination.

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HFNI WELCOMES NEW CEO

Richard Tuten, HFNI President & CEO On June 4, 2012, Health First Network welcomed Richard M. Tuten as the company’s new President & Chief Executive Officer. Richard is replacing the former President & CEO Charles Brewer who is retiring from Health First Network after 12 years with the company.

Richard has over 30 years experience in health care. Beginning his career as a Respiratory Therapist, he spent several years as an instructor of Respiratory Therapy at Columbus State University in Georgia. After earning his masters degree in health service administration, he served as vice president of a large teaching hospital with responsibility for fourteen clinical departments. During that time he completed his Juris Doctor degree at Georgia State University, College of Law. Richard has specialized in health care regulatory affairs, transactions, and operations.

Prior to becoming the CEO of Health First Network, Richard worked in the capacity of Chief Operating Officer of a regional Medicare Advantage HMO and Primary Care Physician organization. As a Consulting CEO, Richard guided the early creation of Florida's Health Insurance Exchange. In addition, he has advised numerous Medicare and Medicaid insurers on improving operational efficiencies and implementing health care regulatory reform.

Richard is excited to bring his level of expertise to Health First Network, where he will be responsible for operations and long-range strategic planning that will benefit patients, physicians and the communities of Northwest Florida.


NEW HEALTH RESOURCES AVAILABLE ON THE WEBSITE

As part of our continuous commitment to improve your website experience and provide helpful resources, we've added two HealthCare pricing links. These independent websites are intended to be used as a guide to help consumers determine fair prices of healthcare services in their area.

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NEW MAPPING FUNCTIONALITY ON THE WEBSITE

HFNI has added a new mapping functionality to its website. On the Find a Doctor page, a search for a physician by specialty or health plan will now include a Google Map that includes the physician’s office location and directions to the office.

We hope this will assist you in providing your patients with concise directions to the referred physician’s office location.

ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAMS

The Medicare and Medicaid EHR Incentive Programs will provide financial incentive payments to eligible professionals and eligible hospitals as they adopt, implement, upgrade or demonstrate meaningful uses of certified EHR technology. For all HFNI Providers who want to gain the full impact of the Medicare EHR Incentive Program and take maximum advantage of the financial incentives, the deadline to get registered, enrolled, and begin reporting is October 3, 2012.

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WELLCARE SELECTED DRUG LISTS

Twice a year, the WellCare Clinical Pharmacy Staff update their list of Selected Drug Costs for Health First Network Physicians. This list provides helpful information on selected categories of drugs where cost or selection of the most appropriate medication for the patient’s needs may be a concern. It also serves as a tool for hints to keep Pharmacy PMPM Expenses down. Health First Network Physicians are leaders within the WellCare Pharmacy Community in their high rate of generic usage. Among Medicare Advantage members, the average generic rate is greater than 83%. For Medicaid HMO members (HealthEase) the generic usage rate is greater than 86%.

The most current Selected Drug Cost List has been updated for Spring of 2012 and is attached below for use by Health First Network Physicians who see WellCare members.

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COVENTRY CLAIMS SUBMISSIONS

Effective 1/1/12 Health First Network (HFNI)/MED3000 is no longer responsible for processing claims for the Coventry (Vista) HMO / Open access products.

It is very important that all claims for dates of service December 31, 2011 back are filed to HFNI/MED3000 no later than June 30, 2012.

Coventry (Vista) Healthplan
P. O. Box 10948
Pensacola, FL 32524

All claims received after June 30, 2012 will be denied timely, NO EXCEPTIONS will be made.

WELLCARE CLAIMS SUBMISSIONS

Effective 8/1/11 Health First Network (HFNI) / MED3000 is no longer responsible for processing claims for the Wellcare Medicare HMO.

It is very important that all claims for dates of service July 31, 2011 back are filed to HFNI / MED3000 no later than July 31, 2012.

Wellcare Medicare HMO
P. O. Box 11279
Pensacola, FL 32524

All claims received after July 31, 2012 will be denied timely, NO EXCEPTIONS will be made.