Connect Archives

April 2015

Thursday, April 16, 2015


On April 14, 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly. This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule. In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1st have been extended. CMS will immediately begin work to implement these provisions.

In an effort to minimize financial effects on providers, CMS previously instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later. While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.

No action is necessary from providers who have already submitted claims for the impacted dates of service.


• In a 5 to 4 decision on Tuesday, March 31, the US Supreme Court ruled against the providers in Armstrong v. Exceptional Child Care Inc. (the Idaho case that HFNI has been following.) The decision means that private health care providers cannot sue state Medicaid agencies over low reimbursement rates.

• On March 25, 2015, the HHS Office of Inspector General (OIG) posted OIG Advisory Opinion No. 15-04. In AO 15-04, the OIG considered a clinical lab’s proposal to waive all patient fees for patients in practices who come to that clinical lab instead of the clinical lab as directed by the patients’ insurance plans. The OIG stated that the “Proposed Arrangement could potentially generate prohibited remuneration under the anti-kickback statute and that the Office of Inspector General (“OIG”) could potentially impose administrative sanctions on the clinical lab.”


Care coordination is an approach to healthcare in which all of a patient's needs are coordinated with the assistance of a primary point of contact. The point of contact provides information to the patient and the patient's caregivers, and works with them to make sure that they get the most appropriate treatment, while ensuring that health care is not accidentally duplicated. This process saves money on health care costs, as demonstrated by a number of care coordination pilot studies and organizations, and it improves the quality of care as well as patient satisfaction.

Some of the functions performed by our Care Coordinators on a daily basis to assist our patient population in care coordination are:
• facilitating PCP and specialists follow up after ER or IP admits
• performing med rec’s and encouraging medication compliance
• sending patient diagnosis related educational materials
• contacting patients to complete DSA’s, PHA’s, and care plan development
• providing patients with wallet size cards identifying their primary care physician. It is to be presented if patients are seen at any other facility other than their primary care provider’s office. It instructs the reader to notify patient’s PCP of any ER or hospital admission. This can be done by fax or secure e-mail listed on the card. By performing these activities, the ER and IP admissions have decreased tremendously.

We continue to educate our patients on the importance of living a healthy life style, communicating with their providers on any health changes, and keeping their appointments as scheduled. The patients and their families in this community are very important to us. Keeping them healthy is our number one priority.


Amy Ates will be leaving HFNI on Tuesday, April 21st to pursue her career in the Health Care Field. Amy has grown into a valuable member of our team over the past two years; she is very conscientious, professional and a hard-worker. HFNI wishes her the very best of luck and the greatest success in all future endeavors.


The Annual HFNI Shareholder’s meeting will be held on Monday, April 27, 2015 at 5:30 p.m. at Health First Network located at 3001 Langley Avenue, Pensacola, FL.

If you are planning to attend, please RSVP to Michelle Hamilton at 850-434-6192.

MODERN HEALTHCARE™ARTICLE: Medicare Advantage plans nab 1.25% raise for 2016

CMS announced that the benchmark payment rates for Medicare Advantage health plans will go up by 1.25% on average in 2016, a significant departure from the slight decrease the agency proposed in February.

When factoring in the expected growth of risk scores coded by insurers, payments will go up 3.25% on average, CMS officials said.

Related Links


Health First Network, Inc. is pleased to announce another added benefit to your membership. We have partnered with GROUPSOURCE Purchasing and Henry Schein Medical to offer discounts on medical products and services such as 35% or more off of your medical waste disposal or 15-20% average savings through Office Depot.

Related Links


Is your business outgrowing your current space? Hancock Bank has a special offer for long-term, fixed rate financing that can meet your commercial real estate needs.

Their Extended Fixed Rate Term Owner-Occupied Commercial Real Estate Loan can help you better forecast your real estate expenses. You can capitalize on this opportunity to lock in your loan at today’s low rates.

• Available for owner-occupied commercial real estate loans
• Minimum individual loan size of $100,000
• Maximum individual loan size of $5,000,000
• Competitive fixed rate
• Interest may be tax deductible*
*Consult your tax advisor regarding your individual tax situation.

4.09% / 5 year / 20 year / Up to 1% / paid
4.09% / 10 year / 10 year / Up to 1% / paid
4.29% / 15 year / 15 year / Up to 1% / paid

Contact Monica Sherman at 850-435-6739 for more information.

A Hancock Bank or Whitney Bank Business/Commercial Checking account is required with this offer.


As a value added proposition, Health First Network, Inc. has arranged a strategic partnership with The Sigma Group at Morgan Stanley. As agreed, we will provide educational information and certain levels of planning services for the physicians at no charge. We are excited to be able to work with Health First Network, Inc. and offer the first class investment services of Morgan Stanley and capitalize on the local expertise of The Sigma Group team. This month we want to highlight our financial planning services.

As a high income earner, you are faced with many challenges as you plan your financial future. How can I manage debt, maximize my practice, save for my life goals. Do you look forward to spending your retirement as you’ve dreamed, purchasing a vacation home, or putting your children or grandchildren through college or all of the above?

The Sigma Group at Morgan Stanley, using a suite of tools that includes goal-specific analysis, can work with you to create a realistic, holistic strategy that integrates the various aspects of your financial life, including your investments and cash management needs— making sure they align with your goals and wealth management plan. Chances are, of course, that the goals you set today will evolve over time. Ongoing and adaptable, the Morgan Stanley wealth management process is designed to evolve with them and with the changing circumstances of your life.

Creating a Road Map for Your Future
• Establishing Goals - The process begins with an in-depth conversation focused on your current situation and what you hope to accomplish. During the initial meeting, we will establish the parameters for our review and the information needed.
• Financial Analysis – Utilizing Morgan Stanley’s state of the art planning tools, we will assess the probability of financially achieving your goals. The analysis will include a risk assessment of your portfolio allocation to determine potential downside risk in periods of extreme volatility.
• Proposed Solutions – Once we are satisfied that we understand your goals and risk tolerance we will be well positioned to discuss possible portfolio solutions. There will be no obligation on your behalf to utilize our investment advisory services.
• Implementation – Should you decide to utilize our advisory services you will gain access to Morgan Stanley’s world class intellectual capital, award winning analyst research and the largest open architecture manager platform in the industry. The Sigma Group would become your family’s wealth advisors and oversee the implementation and monitoring of your investment program.
• Ongoing monitoring – Your financial plan is automatically updated with Morgan Stanley account information to allow monitoring of your plan a regular occurrence.

The Sigma Group at Morgan Stanley has worked together as a team for over 15 years and earned advanced industry credentials. As members of Morgan Stanley’s Family Wealth Director program (extended to less than 250 advisors company- wide) the team has access to a collection of resources tailored for high net worth 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, CFP® Financial Advisor, Financial Planning Specialist, Michele Fielder, Financial Advisor, and two support staff members.

They can be reached at 850 470-8023. Their office is at Morgan Stanley, 850 S. Palafox St., Suite 200, Pensacola, FL 32502.