Connect Archives

April 13, 2016

Wednesday, April 13, 2016

Heath First Network Member Benefits

Health First Network, Inc. is pleased to announce the launch of its Exclusive Member Resource Center. Through the “Members Benefit Portal (website)”, you will be able to access your exclusive Health First Network membership benefits; such as negotiated savings on products and services, competitive pricing on Medical Malpractice, Education Center - offering web-based CME, Advisors Panel, Connect Newsletters and much more.

There is NO COST associated with accessing the website as it was simply created to house all of the benefits available to you in one convenient location. Because benefits are exclusive to Health First Network, Inc. members ONLY, you will need to complete the short registration form and set up your own unique User ID and Password. Once registered, you can schedule your FREE Benefit Review through the online portal. Please contact Jackie Murph with any questions at 850-438-4487.

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How To Avoid Quality Reporting Penalties

This reporting year for 2016 PQRS will be very critical for group practices according to the Centers for Medicare & Medicaid Services (CMS) in order to avoid penalties under the Value Based Payment Modifier (VBPM) in 2018.

Penalties will be based on quality outcomes and cost measures from the previous 2 years’ performance.

How does this relate to you? CMS will consider a group practice’s size to calculate payment adjustment. Group practices with fewer than 9 eligible professionals (EPs) and solo practitioners could see payment adjustments ranging from +2.0X to -2.0%. Groups with 10 or more EPs could see an adjustment of +4.0X to -4.0% with “X” representing the adjustment factor calculated to redistribute the total VBPM (Value-Based Payment Model) penalties collected. The “X” can vary annually so that CMS can ensure that the program remains budget neutral.

Also, groups that earn bonus payments will be eligible for an additional one-time payment increase if they provide care to high-risk Medicare patients. Note: The “X” in the VBPM adjustment factor is separate from the added one-time bonus payment for providers who care for high-risk patients.

CMS expanded the Value-Based Payment Model to affect not only the Practitioners but their extenders as well. That includes, the physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists based on the 2016 cost and quality data.

This will become a reality during the 2018 calendar year. Remember, participation in PQRS this year is critical for avoiding payment penalties under the Value-Based Modifier Program in 2018.

For more information concerning this topic, you may contact Health First Network Medical Management Department at 850-438-0818.

Reference: MGMA Connection: March 2016

ENS Update

The Event Notification Service (ENS), that HFNI initiated last Fall, is now providing a list to each of our ACO practices on a daily basis that details their Traditional Medicare patients discharged from either an inpatient or Emergency Department encounter at one of our regional hospital providers within the past 24 hours. This allows for timelier download of critical clinical information, and more efficient and effective scheduling of follow up visits and transition of care services. Health First Network, Inc. is in the process of refining the presentation of the lists, and expanding the number of practices and patients represented. The data has been well received by the doctors’ offices, and is filling a gap in admission, discharge, and transfer (ADT) information that has made it more difficult to provide the highest quality care for the patients with the most critical needs. We are approaching this as an opportunity to improve the care of all of our patients, and we welcome any feedback.

Coventry Florida Healthy Kids

Effective 5/15/2016 Health First Network and Coventry Florida Healthy Kids will terminate their contractual agreement.

Continue to send your claims to Coventry FHK at 1340 Concord Terrace Sunrise, Fl 33323. HFNI will be working with them in processing timely claims.

It is very important that all claims for Coventry Healthy Kids be filed in a timely manner. HFNI has a 90 day timely filing deadline. There will be NO EXCEPTIONS to this deadline. The final date that claims with service dates prior to 05/16/2016 will be considered for the Coventry Florida Healthy Kids Product is August 15, 2016.

All claims received after that time will be denied for failure to file timely.

Please contact Jackie at 438-4487 or if you have any questions.

Featured Advisor

We are proud to present your elite team of Meridian Certified Business Advisors. Each Advisor has been selected for their renown expertise in their respective field, and their willingness to provide business education to our Physician members.

Stephen D. Bittinger
Healthcare Audit Defense/Compliance Attorney at Nee | Bittinger LLC

Stephen is honored to have been able to develop a national reputation for his work in healthcare audit defense, payer appeals, and compliance.

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Featured Partners

Follow the link below and select an HFNI Financial Partner to view their available programs.

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Featured Educational Content

We are continually gathering new and cutting edge content to ensure you have full access to the most relevant education, from marketing and new technology to breakthroughs in patient care and HR strategies. Your new benefit portal provides access to articles, video, recorded webinars and podcasts, all available as part of your HFNI Membership.

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