Connect Archives

July 2013

Thursday, July 18, 2013

ACO QUALITY CHANGES FOR REPORTING MEASUREMENT YEAR 2013

The ACCNWFL successfully reported the quality measures for our first year, performance year 2012; but things will get a little more complicated for year two. The measures themselves will remain the same, but of the 33, 27 will be scored on actual performance rather than just the ability to report, which was the standard for year one. The performance standards are expected to be released by CMS anytime now, and that is the next big hurdle. Just being able to report the measures was a chore…now it will be a chore with a score. In year three, all 33 measures will be scored on performance. We are working with our partners at CHS to extract some performance estimates on what was reported for the first performance year, and will get that out as soon as practical.

Initially, CMS had targeted 65 measures for quality review, but reduced that number to 33 after a lot of concern was expressed over such a large number. As ACO experience moves beyond the first 3 year cycle, it’s a good bet that the other 32 will resurface. As reimbursement methodologies move to a more and more heavily quality performance based approach in all payer sectors, that trend is expected to continue.

One other heads-up that involves both Medicare FFS and Medicare Advantage, the number of HCC’s (Health Condition Categories) for determining RAPS (Risk Adjusted Payment System) scores will expand from 70 to 79, and it will involve some additions, deletions, and recombinations based on experience and changing technologies. We’ll keep you posted as it unfolds.

RE-CAP ON HFNI’S PHYSICIAN EDUCATION PROGRAM “DOCUMENTING IN A RISK-ADJUSTED WORLD”

On Thursday evening, July 11, 2013, Health First Network presented a pertinent and informative Provider Education Program to ACO Physicians titled “Documenting in a Risk-Adjusted World”.

The successful CME Program consisted of two separate components, “Documenting in a Risk-Adjusted World”, and a second segment on “ACO Updates” to inform ACO Physicians of the progress of the ACC of NW Florida (Accountable Care Coalition of NW Florida). Dr. William Whibbs, Health First Network Medical Director, was the speaker.

The first portion of the program was a comprehensive session covering essential elements of the methodology used by CMS to calculate payments for Medicare beneficiaries based on a patient’s overall health status. The program was geared to being a practical approach in assisting physicians to understand and meet documentation requirements of CMS’s Hierarchical Condition Coding (HCC) Risk Adjustment Coding. Dr. Whibbs’ description of each Physician creating an “avatar” image of the patient and using the medical record to paint a complete and accurate picture of his/her findings, observations and clinical thinking of the patient’s condition at the time of the encounter visit was well received. Dr. Whibbs went on to describe how creating this image could also incorporate the provider’s plan to evaluate, treat and monitor the patient’s condition, further demonstrating the high quality healthcare services being provided to the patient.

The second portion of the program covered important updates and information for ACO Physicians regarding the ACO. Dr. Whibbs discussed the ACO population, data and reporting issues, Quality Improvement measures, results of the ACO’s recent G-Pro review to report quality data to CMS, Care Coordination, and steps toward clinical integration through the Health Information Exchange.

Health First Network plans to present a similar CME Program to all Network Physicians in the future.

HFNI SURVEY

HFNI would like your feedback. Please take a moment to answer the following survey question:

Has your office submitted your Physician(s)’ Credentialing Information to the CAQH Provider Database for both initial and re-credentialing admin functions?

Please submit your answers to Pat Ast, Director Health Services at PAst@hfni.com. Please include the Practice Name in the response email.


NEW CLIA WAIVED TESTS

CMS has released a list of new waived tests, effective October 1, 2013, for clinical laboratories submitting claims to Medicare Claims administrators for services to Medicare beneficiaries. CLIA requires that for each test it performs, a lab facility must be appropriately certified. For tests listed in the graph on the CMS bulletin, please note that the Current Procedural Terminology (CPT) Codes for the new tests must have the modifier QW to be recognized as a waived test.

Related Links


NEW HFNI DEPARTMENTAL FAX NUMBERS

Please be advised that HFNI has added additional departmental fax numbers.

Please note the new fax numbers listed below.
General Faxes 850-438-0298
Credentialing Dept. 850-438-0298
Medical Dept. (secure faxes) 850-290-4822
Provider Relations Dept. 850-434-8253

2013 – 2014 ESCAMBIA COUNTY SCHOOL HEALTH FORMS

Annually, the Escambia County School Health Department provides Health First Network with the most updated school health forms available. Attached is an index which contains links to all of the forms for the upcoming 2013 – 2014 school year. Whether you need a form to authorize the administration of a medication to a child during the course of a school day, or to request a procedure to be done during a school day, or need a form for an athletic screening, the information is available on the HFNI website.

Related Links


NEW PHYSICIANS JOINING THE NETWORK

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

Peter Bercz, M.D. Pulmonary Disease
Garen Steele, M.D. Orthopaedic Surgery
Clinton Waggoner, M.D. Radiology
Nicole Briley, M.D. Hospitalist
Bryan Smith, M.D. Hospitalist

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