Connect Archives

November 2015

Tuesday, November 17, 2015

COMPLIANCE UPDATES - OIG 2016 WORK PLAN

The HHS Office of Inspector General (OIG) released their 2016 Work Plan recently. Here are a few of the investigations they plan on undertaking in 2016:

• Costs associated with replacement of defective medical devices.
• Provider-based status. The OIG will evaluate the number of provider-based facilities that hospitals own and how they comply with federal requirements for billing. (Think “facility fee”.)
• Comparison of the cost differences at hospital-based and freestanding clinics.
• Update of ESRD payment bundles and dialysis utilization.

The OIG re-iterates that “The Medicare Payment Advisory Commission (MedPAC) has expressed concerns about the financial incentives presented by provider-based status and stated that Medicare should seek to pay similar amounts for similar services.”

This should be an interesting year.

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CHRONIC CARE MANAGEMENT UPDATE / ENS UPDATE

The (HFNI) Chronic Care Management Program is still in the early stages, and we are tailoring the application for each of the offices to coordinate with their established workflows. We are anticipating our first billing cycle to be in December, which will complete the loop on the process. We will be offering the service to a wider audience once that is complete.

The Event Notification Service is beginning to produce more consistent results, and we are in the process of a second data load into the system. We will be receiving real-time notification of both Inpatient and E.R. encounters on over 14,000 of our physicians’ patients that will allow all of us to provide improved care.

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FINAL 2016 MEDICARE PHYSICIAN FEE SCHEDULE RELEASED

The Centers for Medicare & Medicaid Services (CMS) finalized the Medicare physician fee schedule (PFS) for 2016.

The final rule:
• Sets 2016 Medicare payment rates for physician services, including a 0.5% payment increase as a result of SGR repeal under the Medicare Access and CHIP Reauthorization Act (MACRA).
• Establishes criteria for the 2016 performance year for the value-based payment modifier (VBPM), which could result in penalties of 4% in 2018 for high cost/low quality providers;
• Details criteria for 2016 performance in PQRS to avoid a 2% penalty in 2018;
• Increases the amount of information about physicians and practices on the Physician Compare website, including information pertaining to quality measure performance; and
• Clarifies billing guidance for incident-to services without any major changes.
In a separate rule, CMS finalized changes to policies and payments regarding hospital outpatient and ambulatory surgical centers.

Visit the Federal Register to view the full final 2016 Medicare PFS. CMS also released a fact sheet on the final PFS.

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2016 PQRS NEGATIVE PAYMENT ADJUSTMENT AND THE INFORMAL REVIEW PROCESS

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 23, 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 23, 2015 at 11:59 p.m. Eastern Time.

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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.

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

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

On Friday, October 16, 2015, Health First Network staff members 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 staff members spent their day at Montclair Elementary School assisting the librarian adhering barcode labels to approximately 400 books. The school was extremely grateful for the support noting that without the additional assistance this task might have taken the entire school year to accomplish.

HEALTHSPRING TERMINATION NOTICE

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.

NEW PHYSICIANS JOINING THE NETWORK

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

Darin Dinelli, M.D. - Family Practice
Erica Peart, D.O. - Rheumatology
Florentina Litra, M.D. - Hospitalist
Craig Larson, M.D. - Radiology
Meredith Knofsky, D.O. - Surgical Critical Care
Chad Edwards, M.D. - General Surgery
Vinay Wayal, M.D. - 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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