Connect Archives

October 2012

Thursday, October 18, 2012

ACO UPDATE

The Opt-out letters were sent to the ACO patients on Tuesday, October 16, 2012. If you are a PCP participating in the ACO, look for your attributed Medicare patients to start calling as early as Tuesday, October 17th.

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UPDATE ON CLINICAL INTEGRATION

As the health care delivery and financing playing field continues to shift, looking for new and more creative solutions to the issues of access, cost, and waste becomes more important. Health First Network, Inc. is responding to the challenges with a number of strategies, and central to all of them is the concept of a high performance, clinically integrated network. Since its inception in 1985, HFNI has always tried to find synergies and efficiencies within our network of physicians, and this gives us an advantage because we have been able to work together to achieve better outcomes for our patients, with more efficient, more coordinated use of resources. We are not where we want to be yet, but we are moving in the right direction. HFNI added a Clinical Integration Committee a year ago, and they are working diligently and with lively interest reviewing and adopting evidence based clinical protocols for use in all of our lines of business. HFNI is also involved in developing a pilot project with the Health Information Exchange of Florida to allow more active and secure sharing of clinically pertinent information. HFNI thinks that regardless of how the delivery and financing systems change (and they ARE changing), the best approach is a patient oriented high performance network of skilled and caring physicians.

RAPS & HCC’s

We have posted some information regarding risk adjustments on the “Health Resources” page of our website. Included in the information is a PDF file containing the hierarchical condition category (HCC) system, the ICD-9 codes that comprise each HCC, and the relative weights assigned to each HCC by CMS for determining the risk adjustment factors. We have also included a link to an article on how to use the data to determine a risk adjustment factor, and a white-paper critiquing the implementation and effectiveness of the HCC system.
We will continue to add information to this section to make the RAPS and HCC system more meaningful.

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MEDLearn Matters Article - “Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse”

For those Primary Care Physicians who provide screenings and behavioral Counseling Interventions to their Medicare Fee-for-Service beneficiaries to screen for and reduce alcohol misuse, the MEDLearn Matters CMS article “Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse” provides information on what you need to know about these services, how to bill for these services and tells where to go for additional information on these screening services.

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MEDLearn Matters Article - "Influenza Vaccine Payment Allowances - Annual Update for 2012-2013 Season"

Effective August 1, 2012, the Centers for Medicare and Medicaid Services (CMS) updated payment allowances for seasonal influenza virus vaccines. Be sure your billing staffs are aware of this update.

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OFFICE OF THE INSPECTOR GENERAL (O.I.G.) – 2013 WORK PLAN

The Health and Human Services Office of the Inspector General (OIG) has released their 2013 Work Plan. The OIG Work Plan provides us with information regarding the areas in which the OIG will focus their investigations for the coming year.

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HFNI SHAREHOLDERS MEETING NOTICE

The Annual HFNI Shareholder’s meeting will be held on Monday, November 26, 2012 at 5:30 p.m. (location to be determined). If you are a shareholder, and planning to attend, please RSVP to Michelle Hamilton at 850-438-0818 as soon as possible. Ballots will be mailed soon.

NEW PHYSICIANS JOINING THE NETWORK

Health First Network would like to welcome the most recent physician to join the Network:

Logan Porter, M.D. Hospitalist

** To determine which health plans each physician is participating in please check the “Find A Doctor” section on the HFNI website.

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