Dear Alabama Chapter-AAP Practice Management Association Member:
"The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires."--William Arthur Ward, writer
Happy February! Wow, where has the time gone? It does not seem that long ago that we were all freaking out about ICD-10 implementation. We were anxious, it arrived, and we all conquered. Now we can all stress regarding the transition to RCO's. I am so grateful to have all of you to network with through all of the transitions that we endure in the healthcare field. I encourage you all to continue to stay connected on the listserv, this tool is so effective and relevant for us all.!
Here are some important payor updates, webinar dates and other pediatric practice management briefs:
What You Need to Know Now
Medicaid RCOs plan approved by CMS; sign up for Provider Forums being held now across state
On Tuesday, Governor Robert Bentley and Medicaid Commissioner Stephanie Azar announced the Alabama Medicaid Agency’s regional care organization (RCO) plan to provide medical care to most Alabamians on Medicaid has been approved by the Centers for Medicare and Medicaid Services (CMS). The next day, Medicaid announced a series of open forums for providers in February and March. If your practice is a Medicaid provider, please see the schedule and make plans to attend to learn as much as possible!
Medicaid RCOs: how patients will be assigned
If all moves forward as planned, Medicaid will move to RCOs beginning October 1, 2016, replacing Patient 1st. It's important to begin to educate your practice physicians and staff on the coming changes. The Alabama Chapter-AAP has been meeting with Medicaid and RCO representatives as part of a PMP workgroup to explore how patients will be assigned and other issues. Look for more details on this and all of the changes soon, but for now, please review this visual of how patients will be assigned to RCOs. You can direct questions on the assignment process to Linda Lee.
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.
Chapter response to direct-to-consumer telehealth
As most of you are aware, Blue Cross Blue Shield of Alabama (BCBS) partners with an out-of-state company by providing many of its plans with a resource for Blue Cross-covered members to call and receive telephone care outside of the medical home. The Alabama Chapter-AAP vehemently opposes this practice and met with the Blue Cross Medical Director (along with the Medical Association and the Academy of Family Physicians) on February 1 to address this directly. We also sent this letter to BCBS senior management. In addition, we are drafting materials for your practices to use to reach out directly to your patients on the importance of having care provided in the medical home. Stay tuned for this information soon.
Don't miss PMA's March 9 webinar: Cash Flow Optimization
Don't miss out on our next PMA webinar, "8 Keys for Practice Cash Flow Optimization," set for Wednesday, March 9 at 12:15 p.m. Cash flow is one area where the most successful practices set themselves apart from the average pediatric office. This presentation by Gene Rodriguez with Transworld Systems, Inc., is an aggregation of those best practices, along with some important recommendations. Register now! See below under "Other Important Links" for our other on-demand webinar recordings.
Pediatric Practice Management Briefs
Obama administration modifies HIPAA to strengthen the firearm background check system
Understanding Individuals’ Right under HIPAA to Access their Health Information
Online tool helps pediatric offices create obesity prevention and treatment plans
The Pediatric e-Practice: Optimizing Your Obesity Care is an online tool to help prepare pediatric offices to deliver effective prevention, assessment and treatment of childhood overweight and obesity. Each room contains a variety tools and resources for the context of that portion of a patient visit. These tools and resources have been developed and/or curated by AAP to support the practice and help integrate obesity screening, guidance, and counseling into a busy practice setting.
CMS wants Meaningful Use to put providers back in charge
CMS Acting Administrator Andy Slavitt confirmed the agency's plan to replace the EHR meaningful use program with a new program to support the alternative payment models of the Medicare Access & CHIP Reauthorization Act of 2015. At the recent J.P. Morgan Healthcare Conference, Slavitt said the CMS has lost the support of physicians as they encounter problems with MU. The new approach will prioritize patient outcomes, provider perspectives and interoperability, Slavitt said. EHR Intelligence (1/12)
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.
Value-based reimbursement models continue to evolve
The US health care system is moving inexorably away from a fee-for-service model and toward a value-based reimbursement model, and experts say health care providers should prepare for the change now. A variety of reimbursement plans is evolving that requires providers to assume increasing financial risk. Emerging payment models include population-based, physician-focused, merit-based and outcomes-based. RevCycle Intelligence (12/2)
More cyber attacks coming for health care in 2016, report projects
The high value of patient data and the growing use of EHRs mean health care will be among the most attractive targets for cybercriminals in 2016, according to Experian's 2016 Data Breach Industry Forecast. Large hospital networks and insurers will continue to be a focus of attacks because of the large payoff they represent, but smaller breaches due to negligence could be just as damaging. The report recommends use of up-to-date security tools and regular training for staff who handle data. Healthcare Informatics online (12/18)
Addressing frequently asked ICD-10-CM questions
The AAP is regularly updating an online FAQs page related to coding encounters in ICD-10-CM, such as coding for well-child visits; vaccine encounters; coding for injuries and coding for tobacco exposure. Refer to the resource “FAQ for Coding Encounters in ICD-10-CM” to see the latest updates. To learn more about ICD-10-CM, visit Coding at the AAP at 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