Connect Archives

August 9, 2016

Tuesday, August 9, 2016

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HFNI Liability Insurance Program

The Health First Network, Inc. (HFNI) 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
o Competitive rates
o Long-term pricing stability with HFNI negotiated program
• Robust Coverage
o Professional liability and/or general liability - both occurrence and claims-made available
o Consent to settle to the first named insured
o Unlimited reporting endorsement available with reinstatement of limits
o Incident-sensitive claims trigger
o Cyber Liability ($50,000) coverage included at no additional charge
• Industry-leading Claims and Risk Management Expertise
o More than 400,000 claims handled nationally
o 90% trial win rate; 80% of claims closed without payment
o More than 130 physicians and healthcare leaders on MedPro’s Specialty Advisory Boards
o Claims Managers averaging more than 25 years of experience
o 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 or Julie Danna of Danna-Gracey, our insurance facilitator at 850.995.9118 or

Humana Medicaid Termination Notice

HFNI has cancelled its contract with Humana for Humana’s Medicaid product. The termination is effective as of October 22, 2016. If you have any questions regarding the termination, please contact Jackie Murph, HFNI Director, Network Development/ Provider Relations/Credentialing at (850) 438-4487.

MACRA and MIPS Webinar Follow-Up and Recording

On Tuesday, June 21, 2016, HFNI held an informational webinar on MACRA and MIPS. If you were unable to attend and would like to view the presentation, please follow the link provided below to register to view the recording.

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Compliance update: HHS/OIG Fiscal Year Work Plan, Mid-Year Update 2016

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan Mid-Year Update for fiscal year (FY) 2016 summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond.

The work plan:
• REVISED Medicare Oversight of Provider Based Status – OIG will determine the number of provider-based facilities that hospitals own and review CMS oversight of provider-based billing. Will also determine the extent to which selected provider-based facilities meet requirements. Expected to be issued in FY 2016
• Comparison of Provider-Based and Freestanding Clinics - OIG will review and compare Medicare payments for physician office visits in provider-based clinics and freestanding clinics to determine the difference in payments made to the clinics for similar procedures. Expected to be issued in FY 2016
• Review of Hospital Wage Data Used to Calculate Medicare Payments - OIG will review hospital controls over the reporting of wage data used to calculate wage indexes for Medicare payments. Expected to be issued in FY 2016
• REVISED Medical Loss Ratio - OIG will review selected States and MCOs that do not use contract provisions that require a minimum percentage of total costs to be expended for Medicaid medical services (medical loss ratio). Expected to be issued in FY 2016
• NEW Delivery System Reform Accountable Care Organizations: Beneficiary Assignment and Shared Savings Payments - Will review the CMS MSSP to determine whether beneficiary assignment to ACOs and shared savings payments for assigned beneficiaries complied with Federal requirements. Expected to be issued in FY 2017


The Centers for Medicare & Medicaid Services (CMS) released the proposed Medicare physician fee schedule (PFS) rule for 2017. The Physician Fee Schedule was released following the proposed 2017 Hospital Outpatient Rule, which was released on July 6. Highlights from both rules include:

Physician Fee Schedule
• Requires health care providers and suppliers to be screened and enrolled in Medicare in order to contract with Medicare Advantage health plans to provide Medicare-covered items and services to beneficiaries enrolled in Medicare Advantage.
• Updates to the Medicare Shared Savings Program, including alignment of measures to those proposed in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) proposed rule, and the proposal to allow eligible professionals to report Physician Quality Reporting System (PQRS) data separately when the Accountable Care Organization fails to report on behalf of the clinician.
• Proposed policies for calculating 2017 and 2018 Value-Based Modifier cost and quality tiering when data issues or other unanticipated program issues arise, which may affect the data used for scoring.
• Given the implementation of the MACRA Quality Payment Program in 2019, CMS does not propose major policy updates related to the PQRS, EHR Incentive Program and Value-Based Modifier, as these programs will be replaced by the Merit-Based Incentive Payment System and Advanced Alternative Payment Model programs.

Hospital Outpatient Rule
• Implementation of Section 603 of the Bipartisan Budget Act of 2015, which requires that certain items and services provided by certain off-campus provider-based departments (PBD) not be paid under the Hospital Outpatient Prospective Payment System (OPPS) starting Jan 1, 2017.
• Section 603 specifically eliminates the “facility fee” for off-campus PBD acquired, created, renovated, or moved after November 2, 2015. It excludes from this 1) free-standing ERs, and 2) PBDs located within 250 yards of the main or a remote inpatient campus. (Multi-hospital systems can have only one “main” campus.) The facility fee is also deleted for any services added at off-campus PBDs after November 2, 2015.
• CMS proposes to implement the 90-day EHR Incentive Program reporting period for 2016 for all eligible professionals, eligible hospitals, and critical access hospitals. The reporting period would be any continuous 90-day period between Jan 1, 2016 and Dec 31, 2016. The ACC was instrumental in getting a bipartisan, bicameral bill introduced to raise the profile of this issue and signal the need for CMS to take action.

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Are you ready for performance-based Medicare reimbursements?

Earlier this year the US Senate voted (98-2) to permanently repeal the highly criticized Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and passed the “Medical Access and CHIP Reauthorization Act of 2015” creating a new, pay-for-performance oriented Medicare reimbursements program. The program, called the Merit-Based Incentive Payment System (MIPS), will have a significant effect on reimbursement.

What will be posted when your provider performance score becomes public?

Over the next few years, healthcare consumers will be empowered to see their provider’s MIPS score and compare a provider’s score against his/her peers nationally.

What is MIPS?

Effective January 1, 2019, the “Meaningful Use” (MU) Electronic Health Record Incentive Program, Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) program will be consolidated into the new Merit-based Incentive Payment System (MIPS) program. This new program will merge and strengthen the financial impact of the various measurement and reporting tools, along with claims-based financial considerations that have become familiar since the adoption of digital health records. According to CMS, “to implement the quality category of the MIPS, CMS anticipates using the measures in the existing quality programs (PQRS, VM and EHR).”

A provider’s “MIPS score,” rated on a scale from 0 to 100, will significantly influence a Medicare reimbursement payment each year. This will translate into four areas of consideration to be scored as follows: 30% by VBM-measured resource use (claims data), 30% by VBM-measured quality (PQRS data), 25% by Meaningful Use (EHR data), and 15% by a newly introduced “clinical practice improvement” measure.

Why start now?

The 2019 payment adjustment schedule will be based on the 2017 performance metrics. In other words, provider performance in 2017 will be measured by the new MIPS scoring model and will have a direct impact on 2019 reimbursements.

In addition to the payment adjustment applied, each eligible professional’s MIPS score and individual category scores will be made publicly available on the Physician Compare website, including a comparison of the ranges of scores for EPs across the country. The sooner you can ensure your practice performance the better prepared you’ll be for 2019 MIPS implementation.

Who does this impact?

Every eligible provider with claims to Medicare. MIPS scores will result in either bonus or penalty payment adjustments. There is no score that will not affect reimbursement.

For the years 2019 and 2020, the following providers are MIPS-eligible professionals: physicians, physician assistants, nurse practitioners, clinical nurse specialists, and nurse anesthetists.

Beginning in 2021 and further, the following providers also become MIPS-eligible: physical or occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dietitians or nutrition professionals.

What does this NOT impact?

Neither Medicare nor Medicaid Meaningful Use incentives will be impacted by MIPS.

Ineligible Providers:

Providers electing to participate in an “alternative payment model” (APM) and providers who enroll in Medicare for the first time during a performance year.

Providers who do not service a minimum number of Medicare patients. (This minimum has not yet been determined.)

Bonus and Penalty Adjustment Schedule

Today through 2018: PQRS, MU, and VBM will continue to apply payment adjustments based on data received two years prior – 2015 reporting will effect 2017 payment adjustment calculations and 2016 reporting will effect 2018 payment adjustment calculations.

Beginning in 2019, a MIPS score of 0 (based on 2017 quality and cost calculations) will yield a – 4% adjustment, whereas a score of 100 would be a + 4% adjustment, along with the possibility of an up to 3.0x multiplier

The 2020 adjustment range is 5% and in 2021 it’ll move up to 7%. Beginning 2022 and thereafter providers will be subject to a 9% penalty or bonus, as well as the potential bonus multiplier.

Additionally, a bonus pool of $500M per year will reward top the 25% of MIPS scores, to incentivize further improvement among significantly improved low scores from 2019 to 2024.

Take advantage of the remaining opportunity to privately improve

Though MIPS adjustments will not begin until 2019, the performance that it will be based on will be from 2017! Now is the time to shore up your administration and performance for each of the three measurement mechanisms currently in place: Meaningful Use, PQRS, and the Value-Based Modifier.

Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services (May 5, 2015). 2015 Measures under Consideration List Program Specific Measure Priorities and Needs.

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Members get custom-discounted pricing and more with your Store Purchasing Card. When you shop at any Office Depot or Office Max store, you’ll always get the lower of the retail store price or your custom-discounted price.
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