Connect Archives

October 2015

Friday, October 23, 2015


HealthSpring has notified Health First Network, Inc. that they are terminating their agreement with us effective midnight 12/31/2015.

HealthSpring will be contacting your office to contract directly with them. If you have any questions regarding the termination, please contact Jackie Murph, HFNI Director, Network Development/ Provider Relations/Credentialing at (850) 438-4487.


On October 16th the Department of Justice released a notice regarding a $237M False Claims act judgement against a hospital system in South Carolina. (United States ex rel. Drakeford v. Tuomey Healthcare System, Inc., Case No. 3:05-cv-02858 (MBS) (D.S.C.)). The Department of Justice settled for $72.4M. (Plus, the two hospital system will be sold to another multi-hospital system.)

The hospital was accused by the government of “fearing that it could lose lucrative outpatient procedure referrals to a new freestanding surgery center, entered into contracts with 19 specialist physicians that required the physicians to refer their outpatient procedures to Tuomey and, in exchange, paid them compensation that far exceeded fair market value…” even though one of the hospital’s attorneys warned against these contracts.

The case was brought as a whistleblower suit filed by an orthopedic surgeon who was offered (but did not accept) one of these illegal contracts. He will receive $18.1M under the settlement.

What we find interesting is that the government used the Stark Law to underpin the false claims accusation, rather than using the anti-kickback statute.


The (HFNI) Chronic Care Management Program is moving along steadily; our staff is scheduled for final launch training on the Mirth data handling programs the week of October 26, and the process of introducing the program for patient consent has started in the first two offices. There are the expected minor glitches, and progress will be slow by design to allow for modification and correction.

The Event Notification System (ENS) is up and running and we are working with correcting a few of the data fields to allow full functionality. We are excited about what these programs will be able to do in terms of helping both the docs and the patients to improve outcomes.


The Centers for Medicare & Medicaid Services (CMS) released a long-awaited final regulation that includes modifications to Stage 2 of the EHR Incentive (meaningful use) Program and outlines the requirements for Stage 3 of the program. The rule also specifies EHR certification standards and finalizes the government's "interoperability roadmap." For meaningful use in 2015 through 2017, major provisions include:

• Shortened 2015 reporting period (from all year to any 90 consecutive days in 2015);
• Ten objectives for eligible professionals including one public health reporting objective, down from 18 total objectives;
• Reduced number of measures that are required to be reported;
• Reduced measure threshold for View, Download or Transmit (from 5% to just one patient in 2015); and
• Reduced measure threshold for Secure Messaging (from 5% to simply having the capability in 2015).

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On September 28, 2015, CMS made available the 2014 Supplemental Quality and Resource Use Reports (QRURs) to every medical group practice and solo practitioner nationwide. Medical group practices and solo practitioners are identified in the Supplemental QRURs by their Taxpayer Identification Number (TIN). The Supplemental QRURs are also available for medical group practices and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer ACO Model, or the Comprehensive Primary Care initiative in 2014, in addition to those consisting of non-physician eligible professional (EPs).

The 2014 Supplemental QRURs provide information to TINs on the management of their Medicare fee-for-service (FFS) patients based on episodes of care (“episodes”). An episode is a resource use measure that includes the set of services provided to treat, manage, diagnose, and follow-up on a clinical condition or treatment. The 2014 Supplemental QRURs are for informational purposes only and complement the per capita cost and quality information provided in the 2014 Annual QRURs.

Authorized representatives of group and solo practitioners can access the 2014 Supplemental QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. Only TINs with at least one attributed episode will receive a full 2014 Supplemental QRUR. For more information on how to access the 2014 Supplemental QRURs, please see the “Instructions for Medical Group Practices and Solo Practices to Access Their 2014 Supplemental QRURs”, available for download on the CMS webpage.

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In 2016, CMS will apply a negative payment adjustment to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment.

EPs, CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit an informal review between September 9, 2015 and November 9, 2015 requesting CMS investigate incentive eligibility and/or payment adjustment determination. All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.

All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available September 9, 2015 through November 9, 2015 at 11:59 p.m. Eastern Time.

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As a physician, you are likely looking for opportunities to reduce your taxable income and build your retirement savings. To address both, you may want to consider a Cash Balance plan, which is a type of tax-qualified, defined benefit pension plan regulated by the Internal Revenue Service (IRS). Cash Balance plans offer a number of great features, and can potentially have the following characteristics:

• Generally, larger business tax deductions for contributions to the Plan than a typical 401(k) plan;
• More flexibility to weight benefits in favor of owner(s) and/or key employees than a typical defined contribution/401(k) plan (all within IRS guidelines);
• Like other defined benefit plans, significantly higher contribution limits than participant and employer-matching contributions to a 401(k) plan;
• Like other tax-qualified retirement plans, creditor protection of assets in the event of a lawsuit; and
• Ability to roll assets into an IRA or other qualified plan.

As Morgan Stanley Financial Advisors, the Sigma Group can help you evaluate your current plan and suggest strategies to better align your retirement plan with your overall objectives. We would welcome the opportunity to meet with you to discuss how a Cash Balance Plan might benefit you and your practice and to work with you and your legal and tax advisers on how these strategies might be implemented.

If you are interested in discussing your plan, please call us at 850 470-8023. You can also visit our web site at for additional information.

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The Association of Medical Practice Management held a Lunch and Learn seminar on Thursday, September 17, 2015. Dr. William Whibbs, Health First Network, Medical Director served as the guest speaker and gave a presentation on Annual Wellness Visits and Chronic Care Management

To review the presentation, click below.

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In an effort to reduce the time in processing authorization requests for DME Ancillary Services and Home Health Services, WellCare has requested that we use the following forms.

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Sunshine Health 2015 Provider Training Webinars

Sunshine Health’s Provider Partnership Management team is hosting provider training webinars for participating providers.

For more information and a list of available dates please click on the links below.

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Founded in 1976, EvolvTec is focused on the areas of computer equipment, service, data protection, technology efficiency, visualization, and document management. EvolvTec utilizes a team of engineers, service technicians, and efficiency experts that work with organizations of all sizes, including: government agencies, financial institutions, healthcare, public & private companies and education entities throughout the USA.

EvolvTec offers a full suite of services such as:
• Managed IT Services
• Managed Print Services
• Back up and Disaster Recovery
• Maintenance and Repair
• Recovery and Disposal
• Document Management
• Network Solutions
• Virtualization
• Cybersecurity
• VoIP services

Contact Allan German with EvolvTec at 954-587-5521 ext. 206 to schedule your FREE IT ASSESSMENT.

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Health First Network would like to welcome the most recent physicians to join the Network:
Jeremiah Dreisbach, M.D. Sports Medicine
Charles Wyatt, M.D. Thoracic/Cardiac Surgery
Todd Minga, M.D. Hospitalist
Mikael MacKinney, M.D. Family Practice
Richard Hilliard, Jr. , D.O. Hospitalist
Andrew Henson, D.O. Family Practice
Ann Gwinnup, M.D. Family Practice
Shohrat Annaberdyev, M.D. Colorectal Surgery
Matthew Fowler, D.O. Hospitalist
Katia Dieguez-Otero, M.D. Internal Medicine
Christina Morelock , M.D. Hospitalist
Barry Palizzi, D.O. Family Practice
Eric Roberts, D.O. General Surgery
Horacio Rodriguez-Jimenez, M.D. Internal Medicine
Saurabh Sanon, M.D. Cardiology/Interventional
Kevin Schopmeyer, M.D. Family Practice
Hilliary White, M.D. Otolaryngology
Luke Williams, M.D. Hospitalist
William Woolery, D.O. Hospitalist

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

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