It’s Happening One Delivery System at a Time

In my initial blog on December 2, 2013 I told about the hospital delivery systems trying to change their delivery systems from focusing upon the quantity of services they provide to changing the delivery system to better coordinate care and provide higher quality of care at a lower cost. It is important to understand that these efforts are not mandated in the Patient Protection and Affordability Care Act-PPACA-the health reform law. The law did authorize several demonstration projects in Accountable Care plans but the Act didn’t directly address the cost-side of healthcare delivery.

Most of the leaders of the healthcare systems involved in these efforts are doing so because they believe that the current mode of healthcare delivery is unsustainable. There are many facts and statistics that note that the US cannot continue to spend the current 17% of our Gross Domestic Product (GDP) on healthcare and be competitive with other countries.

Last week I attended a seminar put on by the Midwest Healthcare Executives Group and Associates—the Midwest affiliate of the American College of Healthcare Executives. At the session I had the pleasure of hearing two leaders of physician-led delivery systems in Michigan detail their journeys. Their stories verified that lasting changes in health care delivery are not made possible by government regulation or Congressional legislation but by physicians and hospital leaders working together over time to restructure their delivery processes by being focused on quality metrics.

Having been involved in healthcare delivery in both payer and provider organizations, I can say that the time and expense in technology and personnel to monitor and restructure the delivery process doesn’t happen quickly and comes at a great cost. Not all organization’s which start on this journey will succeed. Some organizations will fail.

Leaders in all healthcare delivery systems must be open and accountable to their organization’s and the communities that they serve. The changes that they seek to implement will be sustainable only if they can work effectively with consumers and patients. The commitment of patient’s to live healthier lives and to make improvements in their health are additional changes that cannot be mandated by a governmental entity. Having observed St. Rita’s Medical Center and Catholic Health Partners initiate the clinical integration process, the real test will be if patient’s can be engaged.

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ICD-10: It’s time to test with Anthem

ICD-10: It’s time to test with Anthem

Anthem has started acceptance testing for providers who are EDI direct-submitters. We have chosen TIBCO Validator® as our primary testing tool that offers unlimited testing of your EDI HIPAA transactions. This self-guided, web-based processing application is equipped to test file formats and edits as they pertain to ICD-10. If you are not a direct submitter, you will need to partner with your claims submission vendor (clearinghouse, billing company, etc.) to test with us.

To get started, visit the “Free On-Line HIPAA Validation Testing” section on our Anthem EDI webpage, where you can find links to registration information and the guidelines for using the tool.

For more updates on ICD-10, visit the ICD-10 Updates webpage at www.anthem.com>Providers (enter state)>ICD-10 Updates.

 

IN, KY, OH: Changes to EFT 

Within the next few months, providers will see enhancements to EFT, including a new ability to search online by Nasco check, Nasco EFT remittance, and Nasco EFT number. In addition, there will be a change in search parameters: You will be able to hunt for remittances within a new 7 day range for remittances issued up to 2 years prior to current date.

As a result of the new functionality, there also will be minor screen display changes:

  • The page title for ‘Check Date Range:’ will be changed to ‘Check/EFT Date Range:’
  • The column title for ‘Check Date’ changed to ‘Check/EFT Date’.
  • The column title for ‘Check Number’ changed to ‘Check/EFT Number’.
  • The column title for ‘Check Amount’ changed to ‘Check/EFT Amount’.

Note: If you are not set up for EFT and would like to be, you may sign up utilizing the CAQH EFT enrollment tool, which simplifies EFT registration and allows providers to enroll and update practice information electronically. A link is available via the Availity® Web Portal and the Anthem EDI website. After completing the online EFT enrollment forms, enrollees will receive a confirmation that the enrollment request has been submitted. The CAQH website and CAQH EFT enrollment tool provide additional information about the benefits of EFT and the registration process.

ICD-10: The facts you need to know

health care 2014 icd-10

2014: A year of health care transformation.

With new initiatives in the areas of Meaningful Use, claims reporting, and ICD-10The Ohio Department of Medicaid is doing its utmost to support medical providers with information they need to know. This year brings the implementation of ICD-10, which is a tremendous undertaking for our industry.

The ODM website shares that International Classification of Disease (ICD) codes are used in virtually every healthcare setting, including inpatient and outpatient hospital settings and physician offices as well as in professional, medical services.  As the 10th edition, ICD-10 will replace the current ICD-9 code set.  All HIPAA covered entities are required to comply with the new code set regulations.

Claims for all health care services on or after October 1, 2014 and inpatient hospital with date of discharge on or after October 1, 2014 must use ICD-10 diagnosis & inpatient procedure codes.

ICD-10 offers a number of benefits to Ohio Medicaid, some of which include:

    • Enhanced code specificity,
    • Improved ability to measure the quality of health care services.
    • Enhanced accuracy of data analytics and reporting.
    • Improved processes to identify fraud and abuse.
    • Improved ability to identify populations and members for targeted outreach and case management.

Ohio Medicaid continues to work toward implementation of ICD-10 by the compliance date of October 1, 2014.  They are actively engaged with sister state agencies, managed care plans trading partners, and many provider associations to ensure that all Ohio medical providers will be ready for the transition.

CLICK HERE for the ICD-10 Ohio Medicaid Provider Q&A, which provides information you need to know. Cornerstone Alliance continues to support our provider partners as the health care industry prepares for monumental changes and the transition toward implementing ICD-10.

ICD-10 QA

To further support our members, Cornerstone will be sponsoring an educational seminar on February 11th:

2014 Coding & Government 

Update Regulations

presented by: B.J. Hohenstein RN, CCS, CCS-P, FCS, PCS

Our goal is to enable our members and provide needed tools to implement coding updates. We hope you can join us! Don’t hesitate to contact us if we can support your medical office in any way.

The Transformation of Health Care in 2014

Laptop And Stethoscope Health Care in 2014Did 2013 leave you wondering about health care in 2014? There’s no doubt about it: the health care industry is being transformed even as I type. While I don’t have a crystal ball, there are trends we can see – and much of what is happening is because of technology. Cornerstone Alliance exists to ensure that current and future residents in our Primary Service Area are able to receive health care locally, with good access, competence and affordability.

As we look forward to what lies ahead, we want to share some of the transformation in health care that we see unfolding before us.

The Transformation Consumers Will See

Mitch Rothschild, CEO of Vitals, shared in a recent blog post, “Over the past decade, the internet has transferred power from the buyer to the seller in several different consumer sectors. We’re helping shape that transition in health care. Other patients’ feedback on doctors has become a critical part of the process of selecting a doctor.” He outlined five key changes he predicts health care consumers will see in the coming year:

        1. Wait Times Will Go Up- Over a million new people enrolled in the health care system in 2013, and many millions more are estimated to begin participating in 2014
        2. Patients Will Continue to Love Their Doctors- Health care consumers are becoming more savvy about choosing a doctor with whom they can build a lasting relationship
        3. Urgent Care and Alternate Care Center Use Will Continue To Grow- Consumers have more options to choose from than just their primary care physician when they want or need to receive care
        4. More Online Appointments- In 2013, about 20 percent of practices allowed online appointment requests either through patient portals or online scheduling services
        5. Increase in the Power of Online Patient Reviews- In 2014, more will turn to online reviews for comparing doctors, just like we do for other purchase decisions

The Transformation Technology is Creating

Forbes magazine outlined 5 ways technology is transforming the health care industry to help keep people healthy. Because of this, venture capitalists are pouring funds into Health IT, simply because technology will enable health care to be more efficient and effective through:

        1. Crunching data to offer a better diagnosis and treatment
        2. Helping doctors communicate with patients
        3. Linking doctors with other doctors
        4. Connecting doctors and patients
        5. Helping patients stay healthy

The Transformation We Need to Know About

The transformation of health care has far-reaching effects. Because of this, insurance providers must stay on top of the changing health care landscape. Consumer needs and the opportunities offered by technology are transforming health care in a variety of ways, including these 6 outlined in a recent article by Mark Roberts:

        1. Guaranteed issue- In 2014, health insurance companies cannot deny health insurance coverage to an individual based on a pre-existing condition. They must give coverage to anyone who applies
        2. Taxation, with representation- The penalty is $95 per uninsured adult, in 2014 there’s a $325 cap for a family or 1 percent of taxable household income, whichever is greater
        3. Boomer sooner- The 50+ population is the fastest growing segment worldwide and predicted life expectancies are at a historical high
        4. Designer teeth and eyes- More people are retiring earlier than ever before, these men and women have been used to keeping up appearances and having access to aesthetic benefits like dental and vision
        5. Clinical review- Americans are seeking access to less expensive health care options including clinics and urgent care centers rather than going to typical private physician offices
        6. Doc talk- There’s a huge opportunity for mobile applications and customized, purpose-built devices. There are already roughly 100,000 health applications available in major app stores

What lies ahead for health care in 2014?

Cornerstone Alliance Lima OH Transformation of Health Care in 2014

New opportunities.

The transformation of health care in 2014 will bring new ways of providing access, competence, and affordability to support healthier communities. Contact us for more information about how Cornerstone Alliance can support your organization through our network of providers.

New Associate Member Program from Cornerstone Alliance, Inc.

Cornerstone Alliance Inc Lima Ohio PHO healthcare reformSPECIAL ANNOUNCEMENT!!

Cornerstone Alliance PHO is pleased to announce that we have contracted with Provider Services of America to develop a range of services that are private labeled for Cornerstone member practices.

Provider Services of America (PSA) has successfully launched similar programs with other physician networks throughout the United States.

The New Associate Member Program will offer programs, products and services to our member practices that are designed to do the following:

      • Increase Practice Profitability
      • Lower Costs
      • Increase Practice Efficiencies
      • Develop New Revenue Streams For The Practice
      • Improve Patient Relations

PSA will be sending out information to you via fax or email each month that will highlight the value proposition associated with these offerings.

These programs are offered to you on an ala carte basis and the decision to use these programs, products and services is strictly voluntary.  Again, these offerings are designed to increase your revenues and, in some cases, substantially lower your costs. If you feel that any one of these offerings may be of benefit to your practice, you can simply fill out the contact section found at the bottom of the fliers to be faxed or emailed to your practice. Then send these forms back to PSA who will follow up with your practice and answer any questions you might have about the program(s) of which you have an interest.  There is no cost to your practice to enroll in this program.

Please make sure that you review the information in these faxes and /or emails as these offerings could make a significant contribution to your practice goals in 2014.

Please call Jim Skognes at: (770) 390-9183 if you should have any questions about this new program.

Harold L. Bischoff, FACHE
Executive Director
Cornerstone Alliance, Inc.

Keeping up with the NEW this Happy New Year

Should old acquaintance be forgot,
and never brought to mind?
Should old acquaintance be forgot,
and old lang syne?

For auld lang syne, my dear,
for auld lang syne,
we’ll take a cup of kindness yet,
For auld lang syne!

 Out with the old… in with the new! Even as the last words to the traditional Auld Lang Syne were sung, cheers and tinsel were flying through the air. Let the celebration begin – the new year is here!

Happy New Year from all of us at Cornerstone Alliance. This promises to be a very exciting year in the healthcare industry as we move forward with ICD-10, Value-Based Care, and many new opportunities to serve the ones we exist for: our patients.

Cornerstonepho.com website happy new year

The past year was one of moving forward in many ways for Cornerstone. We moved into the realm of social media and updated our website to make it more user-friendly and consistently up-to-date. Our goal is to provide our members with a value-added service and a portal for information. We know you are busy, so we hope to save you time by having information you need readily available at your fingertips.

new this month cornerstonepho.com Our new “New This Month” tab will be the place where we will provide information as we receive it to keep everyone “in the know” as we receive updates. Instead of providing information quarterly or even monthly, we’ll add documents that we know you’ll need as soon as possible. Bookmark this tab – and make it a favorite!

credentialing cornerstonepho.com newAnother tab you’ll want to check is our “Credentialing” tab. Not only do we offer information about what credentialing is and why it’s important, we’ll provide our list of new providers in an easy-to-follow format. At the bottom of our “New Providers” page is a link where you can access full contact information for each new provider so you’ll have it available to use anytime.

cornerstonepho.com about us newBe sure and check out our “About Us” tab. Of course it gives you information about us and what we do, along with our history and mission statement. We also share a couple of testimonials that you can click on to view, along with resources to keep you updated with recall news, recent FDA updates, drug interactions, and current developments in the medical field.

Each of our staff members is ready to support you as we bring on 2014 with anticipation and excitement. Don’t hesitate to contact us, and be sure to let us know if there’s something we can add to our website that will be of help to you. Happy New Year!

happy new year

Exploring your practice’s health insurance options for 2014?

healthcare optionsWondering what to do about your medical practice’s health insurance for the new year? Confused about what to look for and how to get the coverage you need for your team? Exploring healthcare choices for the new year for your medical office staff and need some expert insights?

Cornerstone Alliance is here to help.

We want to share an exciting idea for our members that could be a valuable opportunity and to gauge your interest in pursuing it. And there’s more! We’re here to provide information you can use from an expert who can help you understand your options.

New for Cornerstone PHO members

As you know, Cornerstone PHO is contracted with HealthSpan, an experienced healthcare company affiliated with Catholic Health Partners, which is now offering insurance plans in the greater Lima area. These insurance plans feature Cornerstone health providers in a focused, high-value provider panel.

Cornerstone and HealthSpan are evaluating offering an association plan exclusively for members of the Cornerstone PHO, effective July 1, 2014. This large group program could be open to you, your staff and their families.  If this association plan is of interest to you, please fax this letter to Cornerstone by January 15th.  

Exploring your health insurance options?

Consider HealthSpan. You’ll find exceptional benefits at some of the most competitive prices in the area for individuals and groups, both on and off the Federal marketplace. Cornerstone PHO contracted providers serve as the network for HealthSpan’s HMO plans. You can rely on Cornerstone to work hard to represent our Member practices to provide and arrange the services that you need. You can get more details on this HealthSpan offering from your broker or the HealthSpan representatives at the meeting on  December 30.th 

Learn more about HealthSpan healthcare options

You’re invited to an informational meeting at the Auxiliary Conference Center at St. Rita’s Medical Center on December 30, 2013, from 2pm to 4pm to meet with HealthSpan representatives. Plan to attend for:

  • An introduction to HealthSpan, Inc.
  • A review of HealthSpan plans for individuals and small groups
  • What to expect when seeing HealthSpan members
  • What to expect when seeing employees of St. Rita’s Regional Medical Center and Catholic Health Partners
    We hope to see you there!

Healthcare options

Navigating healthcare as a medical provider can be overwhelming. Cornerstone Alliance serves Allen, Auglaize, Hancock, Hardin, Logan, Mercer, Paulding, Putnam, Shelby and Van Wert counties in Ohio. Please contact us if we can be of service to you!