Connect Archives

May 31, 2016

Tuesday, May 31, 2016

Coventry Florida Healthy Kids Termination Notice

Effective 5/31/2016, Health First Network and Coventry Florida Healthy Kids terminated their contractual agreement. Please 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 05/31/2016 will be considered for the Coventry Florida Healthy Kids Product is 08/31/16. All claims received after that time will be denied for failure to file timely. If you have any questions regarding the termination, please contact Jackie Murph, Director, Network Development/ Provider Relations/Credentialing at 850-438-4487.

Coventry Health Care of Florida Termination Notice

Effective 5/15/16, HFNI's contract with Coventry Health Care of Florida terminated, affecting all commercial Aetna and Coventry product lines. If you have any questions regarding the termination, please contact Jackie Murph, Director, Network Development/ Provider Relations/Credentialing at 850-438-4487.

CMS Releases NPRM on the Medicare Access and CHIP Reauthorization Act of 2015

In April 2015, CMS released a Notice of Proposed Rulemaking for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Supported by a bipartisan majority and stakeholders, such as patient and medical associations, the MACRA legislation ended more than a decade of last-minute fixes and potential payment cliffs for Medicare doctors and clinicians. It also made numerous improvements to America’s health care system.

Proposed MACRA Requirements:

Currently, Medicare measures the value and quality that physicians and other clinicians provide through a patchwork of programs. In the MACRA legislation, Congress streamlined these programs into a single framework to help clinicians transition to payments based on value from payments based on volume. The proposed rule would implement changes through this unified framework known as the Quality Payment Program, which includes two paths:

The Merit-based Incentive Payment System (MIPS): Most Medicare clinicians will initially participate in the Quality Payment Program through MIPS. MIPS allows Medicare clinicians to be paid for providing high value care through success in four performance categories:

• Quality (50 percent of total score in year 1)
• Advancing Care Information (25 percent of total score in year 1)
• Clinical Practice Improvement Activities (15 percent of total score in year 1)
• Resource Use (10 percent of total score in year 1)

Advanced Alternative Payment Models (APMs): Clinicians who take a further step toward care transformation would be exempt from MIPS reporting requirements and qualify for financial bonuses. These models include:

• Comprehensive ESRD Care Model (Large Dialysis Organization arrangement)
• Comprehensive Primary Care Plus (CPC+)
• Medicare Shared Savings Program – Track 2
• Medicare Shared Savings Program – Track 3
• Next Generation Accountable Care Organization Model
• Oncology Care Model Two-Sided Risk Arrangement (available in 2018)

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Practice Transformation Network (PTN)

Health First Network, Inc. (HFNI) is dedicated to identifying opportunities that will assure the flourishing of the independent practice of medicine well into the future. With the passage of the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, the transition from volume based payment to value based payment got a huge push, and all Physician (and non-Physician) providers will need to be aware of what is required, and how to make it happen.

The Centers for Medicare and Medicaid Services (CMS) has funded an initiative named the Practice Transformation Network (PTN) which is designed to help practices position themselves to take maximum advantage of what is coming with payment reform.

As a member of HFNI, your practice has been enrolled in QualityImpact, a CMS recognized PTN.

This initiative will help prepare you for the new 2019 CMS quality-based payment models for which performance reporting begins January of 2017.

The PTN Program Coordinator, Harshini Parvatha, will be reaching out to your offices to schedule a welcome webinar to explore next steps.

We have attached an overview of the PTN, and the resources and support that you will have available.

If you have any questions, please contact Jackie Murph, Director, Network Development/ Provider Relations/Credentialing.

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Financial Focus for Young Physicians: “First, Build Your Foundation”

As advisors to young physicians across the country, we are often asked the question: “What is the most important thing I should be doing financially in the first years of practice?” Our answer is simple: “You need to build a solid foundation” – yet, the application of this concept (Foundation) is different for each physician. As with patients, we often see very common symptoms and can make some generalizations about what is involved in creating a ”financial foundation” for many young doctors. We will do that here in this article.

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Featured Advisor

Brian Cape

Brian is an internationally recognized leader in business with extensive experience leading multi-national business enterprises and expertise in medically minded video conferencing.

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Member Benefit Portal

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.

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