Connect Archives

February 2013

Friday, February 15, 2013


1. The Accountable Care Coalition of Northwest Florida (ACCNWFL) has launched the Care Coordination program for our ACO patients, so our physicians’ offices will be hearing from our Care Coordination nurses, Janet Blough-Black, R.N., and Pam Shelton, R.N. as they work through the patients with the most complex and difficult to manage constellations of medical problems. The ACO is identifying these patients from Personal Health Assessments (PHA’s) distributed to all of the patients by mail, and from lists of patients submitted by our PCP’s. The PHA’s are entered into the Care Coordination computer program in Houston, and the data on the PHA is meshed with the claims data from CMS to produce a profile for each of the patients that highlights opportunities to improve their care. But in addition to that, HFNI has also asked each of the PCP’s to give us a list of the patients in each of their practices that they think will need some extra help managing their medical problems for any reason; the ones that the docs are concerned about that may or may not show up on the computer profiles. We know our docs know the patients better than anybody else, and we want to make sure we are helping the patients that they identify. Janet and Pam will be contacting these patients, so we would appreciate our PCP’s and their office staffs letting their Medicare Fee For Service patients know to expect a call from one of the ACO nurses so the patients understand that they are a part of our team. These days, everybody is a little skeptical of phone calls from people they don’t really know, so a reassuring word from the doc’s office staff is really appreciated.

2. Each of the physicians will be receiving a list of their attributed patients, and their “opt-out” status (i.e. opted out of sharing data on their medical care) shortly. The opt-out rate appears to be very low, and we will continue to encourage the docs and their staffs to remind the patients how important it is for them to “opt in” so that the physician can get the data she or he will need to coordinate their care. The patients can opt back in any time they want if they initially opted out, so encourage them to opt in.

3. And speaking of data, CMS delivered the claims data file on our attributed patients (those that didn’t opt out) to the ACO just after Christmas, and the analytics team at CHS in Houston has delivered to us the first set of utilization reports based on the claims data. The reports include things like ER use, admissions by each facility, lengths of stay, readmission rates, diagnoses for admissions and for ER visits, outpatient services, rehab, and the list goes on; we also have the capability to generate custom reports for specific areas that we want to address. The quality and reliability of the data looks so far to be excellent.

4. We are also expecting to see an initial report on where we stand in terms of the quality standards soon as well. The physicians’ offices will receive a short form to check off a method for accessing medical records in their offices to verify information, and to collect additional information if necessary.

5. It has taken a while to get all of the data and the processes in place, but we are there now. We would like to plan a meeting for the PCP’s and their office staffs in the next 4-6 weeks to present the data that is available, and to get their input in terms of how they think the data can be presented and used most effectively to benefit the patients and the docs. We will structure it similar to the way we did the introduction to the ACO last summer, so be thinking about it. At any time, if you or your staff members have any questions, comments, or suggestions, please let me know. We are all building this innovative integrated health care delivery system together, and we need everybody’s help to do it the right way.

Thanks for all of the hard work that you do to take care of your patients. Believe me, it shows.

William J. Whibbs, M.D.
Medical Director


Effective 4/1/13 Health First Network (HFNI)/MED3000 will no longer be responsible for processing claims for the HealthSpring product.

It is very important that all claims for dates of service prior to April 1, 2013 are filed to HFNI/MED3000 no later than July 31, 2013.

Claims for dates of service after March 31, 2013 should be submitted directly to HealthSpring at the following address:

PO Box 981804
El Paso, TX 79998

All claims received after July 31, 2013 will be denied as not timely filed, NO EXCEPTIONS will be made.

Please contact Jenny Caillouet at 438-4487 if you have any questions.


This week Health First Network was informed, effective 3/1/13, Wellcare has contracted with Premier Eye Care of Florida for all services. Unless you are a Premier Eye Care Provider you will not be paid for seeing Wellcare members after 2/28/13. Please contact Jenny Caillouet for any additional information at 850-438-4487.


For those Providers participating in the Florida Medicaid E.H.R. Incentive Program, the following Tip Sheet contains valuable information on Program Changes for 2013, and lists Core Measures you are no longer required to report.

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On Tuesday, January 15, 2013, Florida Medicaid released details of the increased reimbursement rates to eligible Physician Providers for primary care services provided to Medicaid eligible recipients. The fee schedule increase is effective for dates of services from January 1, 2013 through December 31, 2014. Information on the implementation steps for the enhanced reimbursement can be found in the attached Medicaid bulletin. A fee schedule with the enhanced rates for Primary Care Services is expected to be posted in the next few weeks. Florida Medicaid states retroactive reimbursement back to January 1, 2013 will be given to Providers.

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In a letter to our Nation’s Health Care Providers, the Department of Health and Human Resources, Office of Civil Rights stresses to health care providers that under the HIPAA privacy rule, they may disclose necessary information about a patient to law enforcement, family members of the patient, or to other persons when they believe the patient presents a serious danger to himself or other people.

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To ensure readiness for Provider Offices for the October 1, 2014 transition to ICD-10, CMS has come out with some target dates, activities and tools to help Providers prepare. The attached article provides some information for Provider Offices to minimize the guesswork and stress as you prepare for the transition.

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CMS has released an updated educational Fact Sheet for Providers explaining Medicare Vision Services for Fee-for-Service and Medicare Advantage beneficiaries. The Fact Sheet lists the Medicare covered and non-covered vision services and provides updated correct billing and coding information for 2013.

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The AMA has released a new set of E&M Codes to be used during a patient's transition from hospital to home. Physicians now have the opportunity to bill for much of the previously unreimbursed care-coordination work they've done.

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All Health First Network members are immediately eligible for up to a 20% discount on Catalyst CRE's health care facility focused suite of services.

Catalyst CRE provides a corporate service group solution to health care providers, independent physician groups/networks, and hospital systems. Our suite of integrated deliverables allow health care organizations the ability to focus on their core competencies and outsource comprehensive facility services and real estate strategy solutions to a trusted partner. Our platform of services include: Site Selection, Leasing Services, Acquisition/Disposition Services, Transition Management, Preventative Facility Maintenance, Reactive Facility Maintenance, Special Projects such as moving services, renovations and improvements, etc..

The founders and key leaders of Catalyst CRE have experience in health care administration, health care real estate development, health care real estate brokerage, and health care facility management. We came together with the understanding that health care is facing unprecedented change and, like all other industries, must embrace the world of operating efficiencies. It is with that mindset that we set out to create a carefully selected and integrated suite of services that would allow health care administrators and providers the ability to focus on their core competencies and leave the rest to us.

We understand the importance of Physician Satisfaction, Patient Experience, and Operating Efficiencies.

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Health First Network has partnered with Senior Wellness Solutions (SWS) to provide our network with a simple, yet comprehensive Medicare Annual Wellness Visit (AWV) solution. The software enables a non-physician practitioner to efficiently deliver the AWV in 20 minutes or less and satisfies all the CMS required components of the visit. The cloud based system identifies all indicated preventive services, diagnostic tests to identify early chronic disease, and provides an extensive personalized prevention plan with long-term screen for the beneficiary. Our network receives the benefits of no up-front costs, a private login portal, free training, and significantly discounted pricing. Medicare reimburses approximately $173 for each 20 minute AWV and providers are likely to capture additional revenue from other clinically indicated preventive services identified by the SWS software.
Click the link below to create your account.

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

Nutan DeJoubner, M.D. Medical Oncology/Hematology
Megumi Maguchi, M.D. Family Practice
Jennifer Bryson, M.D. Pediatrics
Ginger Manos, M.D. General Surgery
Stephanie Slagle, M.D. Hospitalist

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