Dear Alabama Chapter-AAP Practice Management Association Member:
"A business has to be involving, it has to be fun, and it has to exercise your creative instincts."
--Richard Branson, businessman, investor and philanthropist
Happy Summer! Wow, where has the time gone? The last quarter has certainly been a time of frustration and uncertainly for Alabama pediatric practices, especially those that take Medicaid. With the uncertainty of state funding, which could affect payment starting in the fall, and the delay of the Regional Care Organizations (RCOs), practices are scratching their heads regarding next steps. Below are some updates and considerations to help you along the way.
What You Need to Know Now
Alabama Medicaid funding crisis
The Alabama Chapter-AAP and many member pediatricians have worked hard and long hours over the last several months with other advocates to make a case to Alabama legislators on the importance of keeping Medicaid funding whole for Fiscal Year 2017. Unfortunately, the Regular Session passed with a $85 million hole. Unless a special session is held and additional funding appropriated, Alabama Medicaid budget cuts are likely, including cuts to physician reimbursement! Our advocacy work is far from over, however. Throughout June and July, please help your physicians advocate to their legislators and their governor on this issue. Tell your physicians to respond when the Chapter sends out our calls for action this summer and continue to use social media for this cause! There is still a chance and the fight is not over!
Budget shortfall prompts Agency to seek delay for RCO start date
Citing the current lack of funding for the 2017 fiscal year, the Alabama Medicaid Agency announced May 9 that it is seeking to delay the October 1, 2016 start date for Regional Care Organizations. A revised start date has not been determined, according to Medicaid Commissioner Stephanie Azar. With the delay, contract deadlines have also been indefinitely extended.
RCO Contracts: What you need to know
In late April, Medicaid providers were sent communications from several of the RCOs with a tight deadline to return contracts. Since then, the RCOs have been delayed, allowing everyone more time to address contracts. Bear in mind that there are many similarities and standard language in the contracts across RCO organizations, but pediatricians are strongly encouraged to have an attorney review all contracts prior to signing. The Medical Association of the State of Alabama offers this guidance for Alabama Medicaid physicians.
Medicaid Now and Then (Post-RCO implementation)
For more details on what changes will be made once the RCOs do get off the ground, see the Chapter's Medicaid Now and Then document. In addition, please visit the Medicaid RCO web page (pictured at left)
ICYMI: Important clarifying information about Blue Cross Blue Shield Exchange Plan Policies
Recently, practices across the state have been having issues with the new healthcare reform policies purchased on the exchange. For clarification, please see this set of Frequently Asked Questions.
Don't miss PMA's July 13 webinar: Risk Management and Custody Issues
Don't miss out on our next PMA webinar, "Risk Management and Custody Issues," set for Wednesday, July 13 at 12:15 p.m. Mallory Earley, Risk Resource Advisor with ProAssurance, will address this important topic of risk management issues associated with custody arrangements for pediatric practices. Registration coming soon! See below under "Other Important Links" for our other on-demand webinar recordings.
PMA Executive Committee positions open October 1
Are you interested in getting more involved in the Practice Management Association? Elections will be held at the PMA Annual Meeting on Friday morning, September 30 at The Hyatt Birmingham-The Wynfrey Hotel. Positions up for election include:
1st Vice Chair
2nd Vice Chair
If interested in serving, contact Rosalyn Rowley at firstname.lastname@example.org.
Avoid "Minor" Issues Becoming Major Problems
Note: This article is provided to you courtesy of ProAssurance, Alabama’s leading medical professional liability insurer.
Unless your practice routinely treats minor children, you may not be familiar with the rules governing the ability of minors to give consent in Alabama. In this comment, we address some of the more frequent issues surrounding a minor’s ability to consent. Read more>>
Pediatric Practice Management Briefs
Did you know? You can be a member of the National AAP, Pediatric Practice Manager Alliance (PPMA), which includes access to the Section on Practice Management group email list. For more details, click here.
Best practices for transitioning to value-based care
Hospitals and health care systems making the transition from a fee-for-service model to outcomes-based care must collaborate early with key stakeholders, including employed and affiliated health care providers, to set strategic objectives, experts say. Other best practices include using data to identify the right physician-partners, developing a variety of care strategies, empowering health care professionals and updating incentives. Hospitals & Health Networks Magazine (5/16)
Pediatrician looks at requirements for interpreter services for LEP patients
Pediatricians can determine the need to provide an interpreter for patients with low English proficiency by considering guidelines from the HHS Office for Civil Rights, which looks at four factors to ensure reasonable steps have been taken to provide meaningful access, writes Steven Bondi, member of the AAP Committee on Medical Liability and Risk Management. Practitioners should also look into state or local laws for such patients, which may have higher requirements than federal law, Bondi writes. AAP News (5/18)
Bright Futures -- coverage and payment resources
The Bright Futures Payment Information Page contains resources to help AAP chapters, pediatric councils and pediatricians obtain coverage of -- and payment for -- all Bright Futures screenings, assessments and services. For more practice-related information, visit the AAP Practice Transformation Page.
CPSC recalls several children's products over health hazard risks
The Consumer Product Safety Commission announced that 121,000 pairs of Rainbow playset rings, 34,000 Fisher-Price cradle swings, 11,000 IKEA bat cape costumes, 2,000 Miniland Moogy plush toys and 500 Rollerblade Maxxum helmets are being recalled due to safety hazards to children. AAP News (5/24)
AAP coding hotline offers reviews by certified coders
The AAP offers a member benefit where members or their staff can submit coding and payment issues for review by certified coders. AAP staff works to assist not only with correct coding, but help with payer denials where they can. The AAP encourages all members to utilize this free resource, as this is the only official source for answers for your coding questions from the AAP. The coding hotline also is the hub for all payer issues as well. Contact the hotline at email@example.com.
HPV champion toolkit
The HPV Champion Toolkit has been developed to provide practices with easy access to the best resources available regarding HPV vaccination including sample PDSA cycles that can be used in your office, power point presentations, FAQs and more. This toolkit is intended to help members of the pediatric office team protect children from HPV infections and future HPV-related cancers.
National Center for Medical Home Implementation: Technical Assistance and Support for Pediatric Clinicians
The National Center for Medical Home Implementation in the AAP is available to all pediatric clinicians and practices as the premier source for tools, resources, literature, and state-based initiatives focusing on pediatric medical home implementation. Contact the NCMHI for technical assistance and support.
Survey looks at parents' trust in online doctor reviews
More than two-thirds of parents were doubtful of doctor ratings available online, while more than half were suspicious that doctors may have influenced their own ratings, according to the C.S. Mott Children's Hospital National Poll on Children's Health. The survey also showed that more than 70% of parents over the age of 30 worried about fake reviews, compared with 59% of parents under age 30. HealthDay News (3/22)
Some parents see flu shot as less important than other vaccines
Fifty-nine percent of parents whose children did not receive flu shots this season said they viewed the vaccine as less important than other childhood vaccines, compared with 14% of those whose children did receive the flu shot, according to the C.S. Mott Children's Hospital National Poll on Children's Health. Researchers surveyed 1,367 parents and found those whose children did not get the flu vaccine were three times as likely as those who did to say their doctor recommended the flu vaccine less strongly than others. Medical News Today (2/23)
Zika resources for physicians and parents
The AAP is monitoring the situation surrounding the Zika virus and is working closely with CDC leaders to determine how best to evaluate infants who may have been exposed to the Zika virus. Visit the AAP website to access many resources including a CDC algorithm that was developed in partnership with the AAP, as well as information for physicians and parents.
AAP introduces online motor delay tool
AAP recently launched "Physical Developmental Delays: What to Look For," an interactive online tool for parents of children ages 5 and under to use when they are concerned about their child’s motor development. Pediatricians addressing these concerns can refer to the AAP clinical report "Motor Delays: Early Identification and Evaluation," which includes an algorithm to guide developmental surveillance and screening, red flags signaling a need for prompt referral, and recommendations, including appropriate testing.
ICYMI: AAP practice transformation pearl
Let the AAP help your practice complete and organize the 2014 NCQA Standards. The Digital Navigator provides step-by-step guidance through practice transformation into the Patient-Centered Medical Home model of care utilizing over 400 forms, templates, sample policies, reports, and other resources. Contact DNSales@aap.org to set up a demo of the tool. For more practice-related information, visit the AAP Practice Transformation Page.
Other Alabama Medicaid/ALL Kids Updates
Medicaid PMP Portal
Still have questions regarding the RMEDE PMP Portal for Medicaid? Contact Tonya Hollingshead at firstname.lastname@example.org or 251-461-1801.
Follow these links for more information from Medicaid about pharmacy, RCOs, alerts and more:
- News Articles
Other Blue Cross Blue Shield Updates
2016 Blue Advantage® Primary Care Incentive (PCI) Program - Quick Facts
Territory Map for Network Services Representatives
Meet your PMA leadership!
Please contact us and let us know how we can serve you and your practice.
Rosalyn Rowley, Chair
Reggie Hope, 1st Vice Chair
Pediatrics East, Pinson
(205) 681-5377 x 62249
Linda Waldrop, 2nd Vice Chair
Children's of Alabama
Robert Troy, Secretary-Treasurer
Partners in Pediatrics, Montgomery
Lynn Brown, Communications Chair
Children's of Alabama
Byron Clark, Immediate Past Chair
Birmingham Pediatric Associates
Other Important Links
Rosalyn Rowley, 2015-2016 Chair
AL-AAP Practice Management Association