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July 2019 Newsletter
Finalized MIPS 2018 performance feedback and scores anticipated in early July!
If you participated in MIPS in 2018, make sure you can log into the QPP website, which is where you can access your feedback report and scores. Once we know the final scores are published, we will send additional information. If you have never created a log in before, you will need to register first.
As you review your final performance feedback, here is an excellent user guide for the Cost performance category in 2018, which covers attribution, risk adjustment, and scoring.

AND... did you know that about 25% of MIPS quality performance measures are directly impacted by medication management?
Here is a one-pager that provides a sample of quality measures directly impacted and clinical practice improvement activities. 
Tips to improve your HCC (Hierarchical Condition Category) coding and help you with the Cost Category!
The Centers for Medicare & Medicaid Service (CMS) risk adjustment model uses the HCC method to calculate risk scores and distinguish high-cost Medicare beneficiaries from low-cost. This information is used to predict costs in the following year. As such, incorrect or non-specific diagnoses can affect not only patient care & outcomes, but also your future reimbursement for that care.
Here's some tips to improve:
  • Make sure any continued/chronic diagnosis and cause is documented every year and submitted on claims.
  • Pull a list of all patients who have not had their Medicare Annual Wellness Visit in the current year and get them in! Use this visit to address all of their preventive care, overdue screenings, reassessing and documenting current conditions. etc.
  • Pull a list of all unspecified conditions/diagnoses and update them with highest level of specificity if possible.
  • If you participated in MIPS 2018, review your Complex Patient Bonus points, which reflects how well the provider is doing with HCC coding.
  • May want to find out if your EHR has an add-on module/feature for HCC coding.
More information on risk adjustment and HCC coding can be found here.
Medicaid Managed Care FAQs & Resources
 
Q: What's the difference between standard and tailored plans? Both plans will:
  • Cover physical, behavioral, and pharmacy services
  • Contract with behavioral health providers
  • Have behavioral health crisis lines
Standard plans will be provided to majority of Medicaid beneficiaries including individuals with mild to moderate behavioral health needs. 

Tailored plans will be targeted to beneficiaries with significant behavioral health conditions, with additional services available, including home health care management.

LME-MCOs will continue to exist until becoming tailored plans in 2021.

Q: Will managed Medicaid patients be limited to 22 visits a year as they are now, and will the Exemption List for the Annual Office Visit Limit?  What are the covered or non-covered diagnoses?
Diagnoses that do not count towards the 22 visit limit will still be applicable to each Prepaid Health Plan (PHP). Each PHP is required to, among other things, furnish covered benefits in an amount, duration and scope no less than the amount, duration, and scope for the same services furnished to beneficiaries under the Medicaid Fee-for-Service program. 

Q: Where can I find outreach materials and enrollment information? The NC DHHS developed a "County Playbook," where general and detailed information will be stored and updated regularly.

Q: What is the timeline again for our region (5)? 
Medicaid Prepaid Health Plan (PHP) "Spotlight"
  • Carolina Complete Health is the only PHP that's a provider led entity (PLE). 
  • There is currently an active call center and, once live, a physical office location will be available in Wilmington.  
  • Engagement Representatives will work locally with providers and will visit in office. 
  • Members will have access to Connection Representatives, who will be peers in the community and “boots on the ground” to help with guidance. 
  • Carolina Complete Health recommends providers fill out an Interest Form for more information regarding contracting with them.
State Health Plan and Blue Cross NC contract
SHP is favoring and increasing their reimbursement towards independent primary care and behavioral health practices while reducing payments to hospitals and specialists.  
Contracts were to be sent in no later than July 1, 2019.
 
SHP is stating they will pay 100 + X% of Medicare rates with potential increased reimbursement to independent primary care and behavioral health practices.
More information can be found here and here is a link to the recently posted SHP fee schedule that will be effective January 1, 2020 for the providers who signed the new contract.


Community Care Physicians Network (CCPN) has contracted with SHP on behalf of independent primary care practices to accept 160% of Medicare rates.
Additional Southeastern NC Practices Receive
NCMS Disaster Relief Help!

If your practice is still struggling in the aftermath of Hurricane Florence and/or Michael, applications for relief funds from the North Carolina Medical Society Foundation Disaster Relief Program continue to be accepted. Review the guidelines and consider applying.

Congratulations most recently to The Pediatric Center in Wilmington and Whiteville Eye Associates! They were both awarded grant funds to help offset their losses after Hurricane Florence last fall. 
 
Applicants:
  • Must be a physician or physician assistant licensed and practicing in the state of North Carolina.
  • Are not required to be members of NCMS in order for the medical practice to be eligible for receipt of monies.
Learning Opportunities
                               
Online - Opioid Education: Safe Opioid Prescribing and Complimentary Therapies for Pain Management
This training meets the prescribing CME requirement from the NCMB. There are 6 video segments that comprise this online course. To receive credit, you must view all 6 segments in their entirety and complete the evaluation at the end. To learn more and to register, click here.

Tobacco Cessation online course
Northwest AHEC is offering a free online Tobacco Cessation course aimed at health professionals who provide cessation coaching. It is also available for $20 if you'd like to earn credit. Click here for more info and to take the course.

Resilience Movie Screening
July 9, 6- 8 PM, UNC-Wilmington, 601 S College Rd
This event is for Physicians, Nurse Practitioners, and Physician Assistants ONLY. Resilience is a one-hour documentary that delves into the science of Adverse Childhood Experiences (ACEs) and the birth of a new movement to treat and prevent toxic stress. To learn more about the event and register, click here.
Need to contact the Practice Support Services team? 
You can reach us at Practice.Support@seahec.net or
the Director, Jessica Williams at (910) 667-9350
Copyright © 2019  South East Area Health Education Center, All rights reserved.
Practice Support Services Newsletter

Our mailing address is:
2511 Delaney Ave., Wilmington, NC 28403

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SEAHEC · 2511 Delaney Ave · Wilmington, NC 28403-6003 · USA

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