Connect Archives

November 2013

Tuesday, November 19, 2013

HCC GAP REPORTS

HFNI is currently working with our Medicare Advantage partners to identify HCC codes that have been “dropped”. “Dropped” means that the diagnosis was reported in years prior to 2013, but has not been reported in 2013. We need the primary care providers for these plans to review your HCC Gap Report and address any currently existing diagnoses that are included on the report.

We can provide your office with the report sorted by patient. PLEASE review the report and, if possible, schedule an appointment with each patient to review and document the presence or absence of these conditions. As you know, each diagnosis must be documented and reported (on a 1500 or an encounter form) every year.

PROVIDER ADD-ON SERVICES

HFNI is very pleased to announce a new relationship. We are proud to be working with athenahealth to bring you additional options for your office operations. Athenahealth offers a range of services including claims submission, lock-box, patient communications, appointment confirmation, eHR, Meaningful Use guarantees, and much more. We will be making more information available to you in the coming weeks.

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HEALTHSPRING MEDICARE ADVANTAGE HMO TRANSITION FOR CLAIM PROCESSING

Effective 1/1/14 Health First Network, Inc. (HFNI) / MED3000 will no longer be responsible for processing claims for Healthspring Medicare Advantage HMO.

Health First Network, Inc. will continue to work with Healthspring; giving support to our providers for that product.

It is very important that all claims with dates of service December 31, 2013 back are filed to HFNI / MED3000 no later than June 30, 2014 at the address below.

HealthSpring Medicare HMO
P. O. Box 11547
Pensacola, FL 32524

All claims received after June 30, 2014 will be denied timely, NO EXCEPTIONS will be made.

All claims for dates of service 1/1/14 forward should be filed to:

Healthspring Medicare Advantage HMO
P.O. Box 981804
El Paso, TX 79998
Electronic claims: Emdeon Payor ID 63092

Please contact Jenny Caillouet at 850-438-4487 if you have any questions.

PHYSICIAN INSERVICE FOLLOW-UP

On October 29, 2013, Health First Network presented a pertinent and informative Provider Education Program “Documenting in a Risk-Adjusted World”. Dr. William Whibbs, Health First Network Medical Director, was the speaker.

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.

CLARIFICATION TO BENEFIT POLICY MANUAL LANGUAGE ON "CONFINED TO THE HOME" DEFINITION

CMS has released clarification to the Home Health Care Benefit Policy Manual Language on the “Confined to the Home” definition.

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HFNI WELCOMES NEW STAFF MEMBER

Deborah Gant is HFNI’s new Director of Health Services. She received her Bachelor of Science degree from the University of Florida in Health Science/Biology, a Bachelor of Science degree in Nursing from Florida State University and a Master degree in Nursing Administration from the University of South Alabama.

Deborah is a seasoned nurse with 24 years of Clinical experience. Her clinical background consists of Pediatrics, Medical/Surgical, Orthopedics, and Operating Room Nursing.

A life-long Pensacola native, she is an avid Gator Fan. Her responsibilities will consist of Directing the daily activities of the Health Services/Medical Management Department, including review, concurrent review, prior authorization, discharge planning, care coordination, quality improvement, accreditation, case management, population management, credentialing, and disease management.

She’s excited about her new role as Director and working with a team that is committed to providing quality services to the community.


HFNI WELCOMES NEW STAFF MEMBER

Jennifer Sullivan is HFNI’s new Credentialing Coordinator. Jennifer joined the Health First Network team via Landrum in June 2013 before becoming full time in October. Jennifer has been a great asset to the HFNI’s team by being very organized and detailed oriented.

She joins Shelby Villar to ensure Health First Network 650 plus physicians are up to date on their credentials, insurance, Florida licenses and DEA’s. Jennifer enjoys learning new things and looks forward to contributing her knowledge and ideas to the growth of this organization.

She is a native of Pensacola and the mother of two girls.

HEALTH FIRST NETWORK STAFF PARTICIPATES IN UNITED WAY'S "DAY OF CARING"

On Friday, October 11, 2013, Health First Network staff members and the ACO nurse care coordinators from the Accountable Care Coalition of NW Florida joined more than 1,300 other local volunteers to participate in the United Way's "Day of Caring". The Day of Caring is a one-day, community-wide event that utilizes individuals from various businesses and military commands to administer an assortment of volunteer projects at non-profit agencies and schools in our community.

HFNI and ACO staff members spent their day at the Adult Day Care Center Facility, on Royce Street, the only facility of its kind in the Escambia County Area, for clients with Alzheimer’s disease and dementia.

When the United Way asked for a volunteer group to work with the Council on Aging Adult Day Care Center for Alzheimer’s and Dementia clients, Health First Network Staff were eager to help and volunteer for this project.

HEALTH FIRST NETWORK STAFF ASSIST WITH STAND DOWN DAY 2013

On Friday, October 25, 2013, Health First Network staff joined forces with other volunteers to partner with the VA Gulf Coast Veterans Health Care System as they hosted a Homeless Veteran Stand Down Day, at the Joint Ambulatory Care Center.

The Stand Down Event is a cooperative event between the Veterans Administration, local military and Veteran Organizations, and community organizations to provide resources, services and information to local homeless Veterans and the families of Veterans.

This year’s event provided health screenings and exams, immunizations, housing assistance, social services and ID paperwork assistance, legal assistance, clothing, supplies and a hot meal for lunch.

NEW JOB POSTINGS PAGE COMING SOON

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.

NEW PHYSICIANS JOINING THE NETWORK

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

Guillermo Patino, M.D. Urology
Robert Kincaid, M.D. Family Practice
Cheryl Jeffries, M.D. Internal Medicine
Angela Ziebarth, M.D. Gynecologic Oncology
Daniel Bambini, M.D. Pediatric Surgery
Mark Ryan, M.D. Internal Medicine
Thomas Schmelzer, M.D. Pediatric Surgery
Graham Cosper, M.D. Pediatric Surgery
Steven Donchey, M.D. Hospitalist

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