Connect Archives

January 2015

Monday, January 19, 2015

URAC UPDATE

HFNI has successfully completed our URAC onsite review on 40 Core (basic), approximately 40 Credential and Network Standards not to mention all elements related. Specific details are pending URAC’s Committee final review of the surveyor’s report submitted.

The on-site review lasted 2 days and was a thorough review of all policies and detailed interviewing process of management and staff.

The exit conference was very positive and indicated HFNI as a quality organization with quality built into our culture.

The next step in the process is that the URAC Surveyor will produce an Executive Summary that will go to the Executive Committee for the final report. More details to come.

REGULATORY CHANGES/UPDATES

Compliance Insights

• CMS Administrator Marilyn Tavenner resigned effective at the end of February.

• On January 20, the US Supreme Court will hear a case out of Idaho (Armstrong v. Exceptional Child Center Inc.) that will decide if individual providers can sue the state Medicaid agency over low re-imbursement rates. HFNI will monitor this case closely.

• On January 21, the US House Energy and Commerce Committee will begin hearings on a permanent SGR fix which could remove the threatened 21.2% Medicare rate cut that is to take effect at the end of March.

THE ROLE OF CARE COORDINATORS IN IMPROVING CARE COORDINATION:

The prevalence of chronic illness and increasing life expectancy is forcing all nations to consider models of care delivery that achieve desired outcomes at affordable costs. Nearly half of all Americans live with chronic conditions. One in 4 patients with a chronic condition will see at least 3 physicians. People with chronic conditions are at high risk of poor care coordination, leading to test duplications, medical errors, and adverse health outcomes.

Promising solutions to improve care coordination include providing easy access to care when patients need it, establishing a stable relationship and effective communication between patients and their primary care practice, and using multidisciplinary care teams that include care coordinators to manage the care plan.

Using data from a 2010 survey (Commonwealth Fund International Health Policy Survey) they reported on what effects having a care coordinator, better access to primary care, and strong health care provider-patient communication have on care coordination. They found that having a care coordinator reduces the risk for all non-acute and post-acute coordination problems independent of accessible care and a strong health care provider-patient relationship. Patients with a care coordinator were less likely than patients without one to say their care was poorly organized and coordinated, their test results or medical records were not available at their scheduled appointment, they received conflicting information from different providers, someone failed to follow up about their tests results, and that information was not being shared among providers about their care.

Among hospitalized patients, those lacking a care coordinator were more likely to report that no one made arrangements for a follow-up visit with a physician after discharge and that their regular physician was not informed about the care they received while they were hospitalized or had an ER visit.

Having accessible care was also associated with lower rates of experiencing coordination gaps. At the same time, patients with a strong health care provider-patient relationship had about half the odds of experiencing coordination gaps related to medical records or repeated tests and the lack of follow-up after a hospital and or ER discharge.

The practice of medicine is changing rapidly. As the United States considers delivery and payment reforms made possible by the Affordable Care Act, it’s noticed that having care coordinators as part of the care team has drastically reduced the overuse of services, medical errors, and poor outcomes for their most complex patients.


Sited Reference: JAMA Internal Medicine.2012;172(7):587-588.

MLN Connects™ Article: Holding of 2015 Date-of-Service Claims for Services Paid Under the 2015 Medicare Physician Fee

On November 13, 2014, the CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015 (i.e., Thursday January 1 through Wednesday January 14). The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

MPFS claims for services rendered on or before Wednesday Dec. 31, 2014 are unaffected by the 2015 claims hold and will be processed and paid under normal procedures and time frames.

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PHYSICIAN & PRACTICE RESOURCES

The Practice Resources page of the HFNI website provides information on a variety of products and services aimed at assisting our physician practices. There you will find information on things such as Certified E.H.R. products, office supply vendor information, and information on insurance products and services. We invite you to explore.

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PROVIDER FEEDBACK

Health First Network, Inc. is committed to providing the best support possible to our network physicians. We want to support our physicians' success by creating exceptional value by identifying issues and offering solutions. We would like your feedback regarding areas where we can offer our assistance. Please submit your feedback to Jenny Caillouet at 850-438-4487.

STRATEGIC PARTNERSHIP WITH THE SIGMA GROUP AT MORGAN STANLEY

As part of our commitment to value added benefits for our physician network, Health First Network, Inc. is pleased to announce a strategic partnership for financial services with The Sigma Group at Morgan Stanley. They will provide the following complimentary services for our physicians:

• Asset Allocation Study - This is an institutional quality analysis that evaluates the correlations and risk characteristics of your investment portfolio.

• Financial Planning - Using a personalized wealth management process, they can help you gain a better understanding of how to align and achieve your financial goals.

• Estate Plan Review – Drawing on their years of experience with trust departments, they will review your estate plan, and discuss the use of various trusts and estate planning techniques. They can help you better understand generational planning, asset protection and ownership structures.

• Periodic Market and Economic Updates – The Sigma Group will provide you with access to timely market observations and thoughts from Morgan Stanley’s Global Investment Committee.

As part of Morgan Stanley’s financial platform, The Sigma Group at Morgan Stanley will make the following products and services available at highly competitive pricing:

• Mortgage and Lines of Credit – Morgan Stanley is one of the largest banks in America and has the lending capacity and flexibility to meet your borrowing needs.

• Custom managed portfolio solutions – a disciplined portfolio management process using the resources of Morgan Stanley’s Consulting Group, the leader in the managed account industry.

The Sigma Group at Morgan Stanley is a team of wealth management professionals structured to meet the needs of families and institutional clients. The team partners are Stephen Harrod, Financial Advisor, Senior Institutional Consultant and Family Wealth Director, Don W. Bryant, Financial Advisor, CFA®, CAIA®, Portfolio Manager, Stephen Timberlake, Financial Advisor, Financial Planning Specialist, Michele Fielder, Financial Advisor, and two support staff members.

They can be reached at 850-470-8023, or by email, at thesigmagroup@morganstanley.com, or their web site at www.morganstanleyfa.com/thesigmagroup, and their office is located at Morgan Stanley, 850 S. Palafox St., Suite 200, Pensacola, FL 32502.

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25% DISCOUNT ON ALL GILMORE SERVICES FOR NETWORK PROVIDERS

As previously announced, we have a strategic relationship with Gilmore Services. As a valued Health First Network, Inc. member, you are immediately eligible for 25% savings on:

• Document Shredding
• Secure Document Storage
• Retention Management
• Records Compliance
• Document Imaging
• Commercial Moving

To find out more about this offer follow the link below and find out how professional document management can help you save time, money and resources, while elevating your compliance processes.

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NEW PHYSICIANS JOINING THE NETWORK

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

Lisa Currier, M.D. Pediatrics
Rita Pabby, M.D. Allergy/Immunology
Melanie Thomas, M.D. Endocrinology, Diabetes and Metabolism
Jason Nydick, D.O. Orthopaedic Surgery
Donald Herip, M.D. Family Practice
Kacey Gibson, D.O. Family Practice
Jennifer Dulin, M.D. Palliative Care
Jennifer Payne, M.D. OB/GYN
Alan Beal, M.D. Surgical Critical Care
Gary Person, M.D. OB/GYN
John Riehl, M.D. Orthopaedic Surgery
Douglas Ross, M.D. Otolaryngology
David Wartenberg, M.D. Family Practice
Douglas Ross, M.D Otolaryngology (Oncology)

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

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