Connect Archives

April 2014

Monday, April 21, 2014

URAC ACCREDITATION QUALITY IMPROVEMENT PROJECTS

HFNI continues to move ahead with the elements necessary for URAC accreditation, and the two Quality Improvement Projects (QIP’s) required have been identified in Phase 1 of the process, and are built around Fall Risk, and Depression Risk in the traditional Medicare population. To date we have collected the data that has been generated by the Personal Health Assessment completed by the ACO patient population, which yielded a statistically significant sample size to work with, and has allowed us to identify those patients at risk. This number is 964 for both QIP’s; of these, there are 318 at risk in both categories, and these will be our highest priority. Phase 1 is essentially complete.

Phase 2 involves completing the analysis of the data, and developing training materials and programs to be used by our Care Coordination Nurses and Provider Offices to help in following up with the patients at risk, and developing appropriate care plans to improve/mitigate each particular patient’s risk. This may involve educational materials, further testing, and/or treatment of underlying problems identified. With the Falls Prevention project, we will be providing training resources for the TUG test (Timed Up and Go), which is a fast and easy way to document Fall Risk in the office setting. With the Depression Screening project, we will be working with a 9 element questionnaire (PHQ-9) to refine those indicated at risk for depression based on the initial Health Assessment. Because both projects are based on ACO and PQRS Quality Measures, the performance data collected by the ACO for PQRS reporting will be used as a standard of comparison to measure the progress achieved on our own patient population, and the baseline performance will be documented during this Phase, and we are slated to complete this Phase by mid-May.

Phase 3 is the execution phase during which the planned interventions are completed, and comparative data assembled. Because these risks are ongoing in this population, we will be making sure that we have available for our providers a simple Health Assessment that can be included in the Introduction to Medicare Exam, and the Annual or Semi-annual Exams to assure that areas of high risk are addressed on a periodic basis. This Phase should be fully functional by mid-August. As a part of Phase 3, we will be working with the Providers’ Offices to arrange appropriate follow up visits for the patients who need them.

Phase 4 is the ongoing evaluation of both our results, and our ongoing process. This allows regular monitoring and updating of our progress against the standards, as well as making sure that what we are doing allows us to touch all of the patients who are at risk, especially those new to the system. Phases 2, 3, and 4 actually overlap extensively.

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WEBINARS

HFNI will be starting a series of webinars for our providers in late April that will cover multiple topics of current interest including our progress towards URAC accreditation. Stay tuned for details.

REQUEST FOR PHYSICIAN FEE SCHEDULES

The terms of your contract with Health First Network, Inc. (Health First) anticipate that you will provide Health First with a written expression of your minimum acceptable fees. We need to update our files with your current acceptable contract fee schedules and any special considerations you may want us to incorporate into our payor contracts. Please print the attached Fee Schedule Request form, complete it and fax to Stephanie Allen at 850-434-8253.

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CAQH UNIVERSAL PROVIDER DATASOURCE (UPD) REMINDER

The CAQH Universal Provider Datasource (UPD) is the trusted source and industry standard for collecting provider data used in credentialing, claims processing, quality assurance, member service and more. By streamlining data collection electronically, UPD is reducing duplicative paperwork and millions of dollars of annual administrative cost. HFNI supports CAQH as the national resource for provider self-reported data.

To better serve you, if you are currently submitting your credentialing data though CAQH, please submit your CAQH I.D.# to Deborah Gant, Director of Health Services at DGant@hfni.com. If you are interested in obtaining Information or how to sign-up for CAQH, log-on to the CAQH website .

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“Remaining Independent Through Turbulent Times”

athenahealth and Health First Network, Inc. will be hosting a free private dinner on Tuesday, April 22nd at 6:00 p.m. at The Fish House, located at 600 South Barracks Street, Pensacola, FL. The topic of discussion will be “Remaining Independent Through Turbulent Times”.

*This event is intended for Physicians, Office Managers/Practice Administrators and Practice Owners Only.*

To register to attend, please complete the registration form below and fax to 888.864.4427. Seating is limited.

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ICD-10 READINESS ASSESSMENT TOOLS

Along with the one year delay in the implementation of the SGR payment reductions, Congress handed us another gift (I guess to appease us for them not permanently doing away with the SGR cuts.) We were given another year before we must begin submitting claims with ICD-10 coding. CMS has not yet decided if we will be able to submit claims with both ICD-9 and ICD-10 codes to test our readiness.

There are some tools that can help assess how prepared you are for ICD-10. Here are two:
• The official CMS ICD-10 Implementation Guide for Small and Medium Practices
• Tools and instructional videos from the Healthcare Information and Management Systems Society

Several professional associations are preparing seminars on ICD-10 topics. In addition, Health First Network, Inc. will be presenting webinars and live seminars on a range of ICD-10 (and other regulatory) topics.

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FLORIDA MALPRACTICE CAPS THROWN OUT

The Florida Supreme Court has made the decision to throw out the medical malpractice limits on “pain and suffering”.

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OBAMA SIGNS SGR PATCH, DELAY OF TWO-MIDNIGHT RULE INTO LAW

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. The new law protects physicians until the end of March 2015 from a 24 percent reimbursement reduction due to take effect under the SGR. And the law delays the implementation of ICD-10 to Oct. 1, 2015.

The law also delays enforcement of the controversial two-midnight rule by six months. On April 14, 2014 the American Hospital Association filed a lawsuit challenging the two-midnight rule.

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HEALTHSPRING MEDICARE ADVANTAGE HMO TRANSITION FOR CLAIM PROCESSING

Effective 1/1/14 Health First Network, Inc. (HFNI) / MED3000 is no longer 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 prior to January 1, 2014 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 for dates of service prior to January 1, 2014 will be denied timely, NO EXCEPTIONS will be made.

All claims for dates of service after December 31, 2013 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.

HFNI SHAREHOLDER MEETING ANNOUNCEMENT

The Annual HFNI Shareholder’s meeting will be held on Monday, April 28, 2014 at 5:30 p.m. at Hyatt Place Airport located at 161 Airport Lane, Pensacola, FL.

If you are planning to attend, please RSVP to Michelle Hamilton at MHamilton@hfni.com.

PAHCOM PENSACOLA CHAPTER

PAHCOM stands for Professional Association of Health Care Office Management.

Being the Office Manager or Practice Administrator of any size
practice is a very challenging position. All the members of the team look to the Manager for the support and information they need to properly fulfill their roles.

The Managers seek out information wherever they can to properly manage their practice. The PAHCOM Chapter in Pensacola is a very active, information sharing and networking organization that consistently looks to help each other. It is run and operated by active Office Managers, Administrators and CEO's of larger groups that volunteer for the good of others. We provide professional education from experts in their field on all issues affecting Medical Practices.

Sharing of information is key to the success for all of us. Join us for our next meeting and connect with other members in the area. Your jobs are tough enough. Let PAHCOM help. It is truly worth your time.

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NEW JOB POSTINGS PAGE

HFNI has created 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.

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NEW PHYSICIANS JOINING THE NETWORK

Health First Network would like to welcome the most recent physicians to join the Network:
Lilly Marshall, M.D. General Practice
Frank Scott, M.D. Nephrology
Lloyd Sloan, M.D. Family Practice

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

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