Connect Archives

September 2013

Wednesday, September 18, 2013


Most of us are reasonably sure that amputated limbs don’t usually grow back unless you are a newt; and that diabetes, hypertension, and congestive heart failure, even if well controlled, don’t usually disappear. So it’s a little bit difficult to understand why we are being asked to come back and re-document these types of problems at least once a year. Since the advent of managed care, the importance of maintaining records of currently active problems has moved to the front of concerns because of the necessity of being able to anticipate expected/potential problems. Managed care reimbursement should be determined on the basis of how sick the population of patients is, and how sick each individual patient is within that population. And for practical purposes, a year seems to be the unit of time that works the best for determining changes.

What that means practically for physicians, patients, and payers dealing specifically with Medicare Advantage plans is that the slate is wiped clean at midnight on December 31st. On January 1st all of the Medicare Advantage beneficiaries emerge into the New Year essentially as a male or female of a given age…that’s it. It is then up to the patient and her/his physician to complete the picture, to fill in all of the details…ALL of the details…that will impact that patient’s health and healthcare for the rest of the year. Hierarchical Condition Categories (HCCs) are groupings of diagnosis codes (ICD-9, soon to be ICD-10) that CMS uses to project the cost of care of an individual patient, and the level of prospective payment to the health plans accountable for delivering that care. Any diagnosis that IS documented during the year IS included in the calculation and any diagnosis that IS NOT documented IS NOT included. CMS does the calculation twice a year, and makes an appropriate adjustment in the amount paid. That’s why it is critically important to document all conditions at least yearly.

With all of the emphasis on Continuity of Care, this may seem like it introduces an element of DIS (or DYS?)- Continuity of care, but on the other hand, it gives us an opportunity to take a thoughtful and comprehensive look at where that person is now, and where that individual is going over the coming year; to make sure we have captured the things that will drive their health and our care; to have a chance to positively drop out the things that are no longer an issue; and to reacquaint ourselves with who we each are, and who we have become over the last year.

Looking ahead, that approach will work regardless of what the delivery system looks like, or who the payers are, and the sooner we are able to embrace this for ALL of our patients, the further we will be ahead.


Health First Network will be presenting a CME-Approved Program on Tuesday evening, October 29, 2013 at 5:45 P.M. in the Baptist Medical Meeting Room, located at 1717 N. E St., Pensacola, FL for Physicians only. The two-part program will feature a presentation by Dr. William Whibbs on “Documenting In A Risk Adjusted World”, and a second topic covering “ACO Updates”.

Baptist Hospital has approved this educational activity for a maximum of 1.5 hours AMA PRA Category 1 creditTM. A Buffet Dinner will be served. Doors will open at 5:30 PM. The program will begin promptly at 5:45 PM.

To RSVP, please contact Jenny Caillouet at 850-438-4487.

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The Annual HFNI Shareholder’s meeting will be held on Monday, September 30, 2013 at 5:30 p.m. at Health First Network located at 2929 Langley Avenue, Ste. 103, Pensacola, FL.

If you are planning to attend, please RSVP to Michelle Hamilton at 850-438-0818.


As part of our continuous commitment to provide access to important information, Health First Network has added a new “HFNI Shareholder’s page” to the website. From this page you can access such things as, HFNI By-Laws, Stock Restriction Agreement, and Audited Financials.

If you are an HFNI Shareholder, please follow the link below to register.

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For WellCare contact information, claims information, pharmacy information and Pre-Auth. requirements, click on the link below for the WellCare quick reference guide.

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HFNI is in the process of creating a new “Job Postings page” in an effort to help our physician offices fill job vacancies.

If you would like to advertise open employment opportunities on the HFNI website, please contact Jenny Caillouet at 850-438-4487 or


This edition includes information on new and updated frequently asked questions on the Medicare and Medicaid Electronic Health Record Incentive Programs. Also included are steps to avoid the negative payment adjustments under the Physician Quality Reporting System and the value-based payment modifier.

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

Please note the new secure fax numbers listed below.

General Faxes 850-438-0298
Credentialing Dept. 850-438-0298
Medical Dept. 850-290-4822
Provider Relations Dept. 850-434-8253