Connect Archives

December 2012

Wednesday, December 19, 2012

ACO UPDATE

The initial Personal Health Assessments (PHAs) have been mailed to ACO beneficiaries. The PHA can be completed entirely by the beneficiary without any input from the medical office. The beneficiary can then mail the PHA back to the ACO. However, it would be more beneficial if they brought the PHA to their PCP. The PCP could then fax the PHA to the ACO and place the hardcopy into the patient medical record.

If your patients have any questions about the PHA that you can’t answer, please direct your questions to Pat Ast at Past@hfni.com.

HEALTHSPRING CLAIMS TRANSITION

Effective April 1, 2013 your HealthSpring claims will no longer be processed by MED3000 but will be paid by HealthSpring. We will provide you with a billing address and contact information prior to the effective date.

SHAREHOLDER ELECTION RESULTS

The Annual HFNI Shareholder’s meeting was held on Monday, November 26, at 5:30 P.M. at the offices of Health First Network.

The HFNI Board of Directors has ratified the Shareholder Election and the results are listed below.

The Shareholders have elected to:
1) Retain O’Sullivan, Creel as HFNI’s
external auditors.
2) Approve all proposed changes to the
restatement of the Bylaws

3) Elected to the Board were:

PCP’s
D. Bruce Young, M.D.
Robert Flurry, M.D.
Randell Reese, M.D.

RCP’s
David Bernstein, M.D.
Paula Pyle, M.D.

Retired Physician
Keith Shearlock, MD

Non-Physician’s
Ed Ranelli, Ph.D.
Alice Cartee

MOLINA HEALTHCARE OF FLORIDA, INC.

HFNI has finalized a new contract with Molina Healthcare of Florida, Inc. to provide managed Medicaid products (and potentially a future Medicare product) in Escambia and Santa Rosa Counties. This contract is presented, in its current form, as a messenger model contract. Under this form, HFNI is NOT at financial risk. HFNI is delegated for credentialing. The full scope of HFNI’s involvement is still evolving.

If you wish to participate in this Agreement, you must sign and return the Participating Provider Attestation and Joinder (previously mailed) before December 31, 2012.

If you need a copy of the Participating Provider Attestation and Joinder, please contact Jenny Caillouet at JCaillouet@hfni.com.

PROVIDER SURVEY RESULTS

Thank you to all who participated in the 2012 Provider Survey. The Survey showed us that we have many areas in which we need to improve. We received many comments about how HFNI can improve its services to our Providers and we are pursuing them. We look forward to working with you as we implement all of the improvements.

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Former CEO of Health First Network retires

After many years of service to Health First Network, Charles Brewer is retiring from his position as President & CEO of HFNI at the end of 2012. The Board of HFNI and staff would like to thank Charles for his years of service. We wish Charles the best in his retirement.

Board Member Acknowledgements

Three long time Health First Network Board members have left the Board of Directors. Ron Parker, has left the Board to focus on the activities of employer, MED3000. Wayne Willis, MD & Brooks Hodnette, MD have left their Board positions but remain extremely active as members and Chairs of other HFNI and ACO committees. We thank these three Board members for their many years of service and their profound contributions to the quality of the HFNI service offerings.

HFNI WELCOMES NEW STAFF MEMBER

Amy Ates is HFNI's new Provider Relations Representative. Amy is a lifelong resident of the Pensacola area. She brings 20 years of medical office experience to Health First Network from various clinical specialties.

With the expected implementation of ICD-10 in 2014, an additional benefit to Health First Network is the fact that Amy received her coding certification in 2007 and continues to expand on her knowledge in coding. Amy’s ability to listen and communicate well with others is one of the many reasons she was chosen to fill the Provider Relations Representative position with Health First Network.

Amy will work with Jenny Caillouet to assist her in providing support and direction to Health First Network provider offices.

Importance of preparing and maintaining legible medical records

CMS has come out with a special edition MedLearn Matters (MLN) article that is intended to highlight the importance of legible documentation to avoid claims denials. The information pertains not only to Fee-For-Service Medicare members but for Medicare Advantage members as well.

For Medicare Advantage beneficiaries, accurate, legible supporting documentation in the Medical Record and correct signature authentication in the EMR system ( if an EMR system is used), validates ICD-9 diagnosis codes which are critical for accurate RAPS prospective reimbursement under the Risk Adjustment Model of reimbursement based on the health status of enrolled beneficiaries. The MLN Article is information only for Providers and does not alter existing Medicare policy. It also does not introduce new policy.

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Outpatient Therapy Cap Values for 2013

CMS has notified fiscal intermediaries of outpatient therapy caps for 2013 for Fee-for-Service Medicare beneficiaries for physical therapy and speech-language therapy combined, and occupational therapy. The CMS MedLearn Matters Bulletin contains information for Providers on these caps for rehab services. The outpatient therapy caps for physical therapy and speech-language therapy combined, and occupational therapy services have each been set at $1900 for 2013.

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NEW PHYSICIANS JOINING THE NETWORK

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

Benjamin Havard, M.D. Pathology
Ismeth Abbas, M.D. Hospitalist
Huaiyu Tan, M.D. Physical Medicine & Rehab.
Jamal Joudeh, M.D. Medical Oncology
Matthew Pauli, D.O. Physical Medicine & Rehab.
Ryan Tarantola, M.D. Ophthalmology
Ann Payne-Johnson, M.D. Family Practice
Rohit Amin, M.D. Cardiology/Cardiovascular Disease
Keith Golden, M.D. Cardiology/Cardiovascular Disease
Laura Haggett, D.O. Hospitalist
Heather Pauli, D.O. Pain Management
Brett Reichwage, M.D. Neurological Surgery