Connect Archives

December 2015

Wednesday, December 30, 2015

HFNI LIABILITY INSURANCE PROGRAM

The Health First Network (HFN) Board of Directors is extremely pleased to announce the formation of The HFNI Liability Insurance Program, a purchasing group program designed to enhance the professional liability coverage of our members, while maintaining long and short term competitive rates through a strong A++ rated insurance partner. Think unity! With the power of strength in numbers, this program allows us to collectively bargain more effectively for our malpractice insurance.

The timing is perfect for the launch of this program. While the malpractice insurance market has been favorable to us in the years since the 2003 tort reforms in Florida, the cycle may begin to change in the near future since the caps on non-economic damages were recently overturned. Now is the time to unify to purchase our malpractice insurance together.

We are delighted to announce that MedPro Group, a Warren Buffett/Berkshire Hathaway company rated A++ (Superior) by A.M. Best, has been chosen as the program’s insurer. With MedPro, the largest healthcare liability insurer in the country, we have the ability to control our rates and coverage into the future with a financially sound and secure partner. HFNI members will benefit from:
• Competitive Pricing
- Competitive rates
- Long-term pricing stability with HFNI negotiated program
• Robust Coverage
- Professional liability and/or general liability - both occurrence and claims-made available
- Consent to settle to the first named insured
- Unlimited reporting endorsement available with reinstatement of limits
- Incident-sensitive claims trigger
- Cyber Liability ($50,000) coverage included at no additional charge
• Industry-leading Claims and Risk Management Expertise
- More than 400,000 claims handled nationally
- 90% trial win rate; 80% of claims closed without payment
- More than 130 physicians and healthcare leaders on MedPro’s Specialty Advisory Boards
- Claims Managers averaging more than 25 years of experience
- 99% Claims Service and Risk Management satisfaction

We have chosen Danna-Gracey as our group’s insurance administrator and are pleased to have them sharing their previous leadership experiences creating other very successful group purchasing arrangements.

The Board of Directors has been looking for ways to keep more money in our pockets and less in the hands of others. We unanimously agreed that this program provides both real cost savings along with a high quality product for our members.

For more information, please contact Jackie Murph at JMurph@hfni.com or Julie Danna of Danna-Gracey, our insurance facilitator at 850.995.9118 or julie@dannagracey.com.

COMPLIANCE UPDATE: BILLING COMPANY INDICTED FOR HEALTH CARE FRAUD

A medical billing company in Charlotte, NC has been indicted for allegedly falsely increasing the number of services for which it billed. The providers (mental health treatment facilities) submitted a list of beneficiaries, the services received, and the number of services to be billed. The billing company then submitted claims to Medicaid that indicated a greatly increased number of services compared to the number submitted by the providers.

The providers have already pleaded guilty to federal charges related to the false claims.

Lesson learned: Reconcile your billing records to the payors’ EOBs to identify any variances early.

CHRONIC CARE MANAGEMENT UPDATE / ENS UPDATE

Health First Network, Inc. continues working with selected provider offices on the deployment of both Chronic Care Management and Transitional Care Management services. All of the pieces are in place and we are continuing with appropriate patient identification and enrollment.

The Event Notification Service is up and running and we are expanding the providers that are included. We expect to start providing a report of Inpatient and Emergency Department activity specific to each of the participating providers on a daily basis in the near future.

HOW TO LIGHTEN PHYSICIANS' ADMINISTRATIVE LOAD

With physicians spending 20 percent of their time on nonclinical paperwork, the need to improve efficiency is becoming more acute.

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MGMA'S PQRS-VALUE MODIFIER SURVIVAL GUIDE

MGMA recently updated its popular member-benefit resource the PQRS-Value Modifier Survival Guide for the 2016 reporting year.

This interactive tool reviews criteria for eligible professionals (EPs) to successfully report for PQRS and illustrates the critical connection between PQRS and the separate Value-Based Payment Modifier (VBPM) Program, which makes potential payment adjustments based largely on PQRS quality performance and will continue to impact all physicians and now certain non-physician practitioners next year. As a reminder, EPs face a 2% automatic PQRS penalty for failing to report PQRS data, as well as additional payment adjustments under the VBPM based on performance on cost and quality metrics in 2016.

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MGMA ANALYSIS: 2016 MEDICARE PHYSICIAN FEE SCHEDULE

MGMA developed an in-depth analysis of the 2016 Medicare Physician Fee Schedule final rule, which was published in the Federal Register on Nov. 16. Among other issues, the analysis covers:
• New Medicare payment policies in 2016;
• Modifications to 2016 PQRS and Value-Based Payment Modifier requirements;
• Clarification for billing incident-to services; and
• Updates to the Physician Compare website.

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HEALTHSPRING TERMINATION NOTICE

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

If you have any questions regarding the termination, please contact Jackie Murph, HFNI Director, Network Development/Provider Relations/Credentialing at (850) 438-4487.

ANOTHER REASON TO VISIT WWW.HFNI.COM

As part of our commitment to provide value added benefits to our physician network, we have added several new services (financial services, document storage and destruction, office supplies, medical waste disposal, etc.) and will continue to add additional services as we negotiate group pricing. We invite you to explore the benefits available to you through your membership in Health First Network, Inc.

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FREE MAMMOGRAM ASSISTANCE PROGRAM

Woodlands Medical Specialists is excited to announce a partnership with the Krewe Du YaYas, Keeping Abreast Foundation. The Keeping Abreast Foundation assists individuals with funding for mammography screening, breast ultrasound and diagnostic imaging.

“Our partnership with Woodlands Medical Specialists will allow our organization to help individuals in our community receive necessary breast health related mammography services,” says Krewe Du YaYas Executive Director, Jacqui O’Connell. “Every individual deserves quality access to breast health, with or without insurance.”

You may qualify for mammogram assistance if you meet these eligibility requirements:

- Age 40 and older or, under age 40 who are at an increased risk for breast cancer
- A resident of Escambia, Santa Rosa, Okaloosa, or Walton Counties in the state of Florida
- No insurance and ineligible for Medicaid or Medicare coverage or any other form of public assistance or, if your insurance does not cover the full cost of a mammogram
- Individuals must meet income eligibility guidelines based on the size of your family

If you are interested in learning more about this program and your eligibility, please contact Woodlands Medical Specialists Breast Health Care Coordinator at 850-696-4312 or visit www.WoodlandsMed.com.

Woodlands Medical Specialists Breast Health Center is located at 4724 North Davis Hwy., in Pensacola, FL.

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NEW PHYSICIANS JOINING THE NETWORK

Health First Network would like to welcome the most recent physicians to join the Network:
Nesrin Yurttutan Engin, M.D. Pediatrics
Laura Yauch, M.D. Family Practice
Rickey Viator, M.D. Pediatrics
Mollie Smith Sowell, M.D. Pediatrics
Jesse Greer, M.D. Hospitalist
Meisha Graham, M.D. Hospitalist
Gerardo Dieguez Gomez, M.D. Internal Medicine
Emmanuel Cruz Caban, M.D. Internal Medicine
Rachel Bixler, M.D. Family Practice
Stephen Zimmermann, M.D. Internal Medicine
Kenneth Baker, M.D. Radiology

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

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