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.

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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.

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!

Healthcare Transformation and Value-Based Care

Harold Bischoff Healthcare Transformation Value-Added Care

From the desk of Harold Bischoff:

For each of us and all of us in the industry, healthcare transformation is top of mind and priority on our list. The goal: The delivery of value-based care. During the first week of November I had the pleasure to attend the Leadership Development Institute held by Catholic Health Partners (CHP) in Mason, OH.  At the session I got to hear presentations by the top leaders of CHP on how they are restructuring all the hospitals and organizations composing the entity.  The goals for CHP are to:

  • Develop clinically integrated networks in all markets served by the organization and to re-design the care delivery process;
  • Change the payment model from being paid for the volume of services to being paid for quality/outcomes/total costs;
  • Re-structure and align how support services within CHP, such as IT, legal services, HR, etc., are provided and attain cost efficiencies.

The message of the meeting was that we—whatever our role in the delivery process—have been called to transform with confidence, competence, and servant-hearts.  Over the next year each CHP employee will be able to make a promise to make lives better, to promise to be of service and to promise to make healthcare easier.

One week later I attended The Advisory Board Company’s  National Meeting in Washington, DC.  Over the course of two days I got to hear up-to-the-minute research on what leading-edge health delivery organizations are dealing with in healthcare transformation and doing to restructure their delivery systems.

These experiences have flooded my mind with all the changes that are happening in healthcare delivery and the financing of care.  While many believe that the Patient Protection and Accountable Care Act (the Health Reform Act) was the motivation for all the changes happening, I know that PPACA doesn’t deal directly with healthcare costs.  Many leaders within healthcare organizations have concluded that our society simply cannot afford to deliver healthcare in the manner that we have.  True leaders are attempting to change their delivery processes in order to ensure that they can continue to serve their communities.

Cornerstone Alliance Lima OHSt Ritas Medical Center Lima OHCornerstone Alliance, Inc. is working closely with St. Rita’s Medical Center in the structuring of a clinically integrated network to deliver value-based care.  Since I have been working on this effort since early 2007, I welcome the changes that are afoot within CHP and St. Rita’s and believe that our Cornerstone Member Physicians and Providers will benefit, as well as the population at large in the Lima community from this effort.

Stay with us in this adventure called healthcare transformation as we seek the best ways to deliver value-based care for the good of our people and our community.  I look forward to the journey ahead.

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

Update: Ohio’s Marketplace/Exchange Plans

October 11, 2013

Re:  Update on Ohio’s Federally-Facilitated Marketplace/Exchange

Dear Cornerstone Alliance, Inc. Providers

This note is to provide basic information about the Marketplace/Exchange plans which will be offered in our service area via the Federally-Facilitated Marketplace/Exchange effective January 1, 2014.  In addition to this letter, we are planning an Annual Meeting for later this year to bring speakers to Lima to answer your questions on this matter.  We have two slide presentations to describe the role of the Marketplaces and how they are structured: one from Mary Wachtel (HPIO) and another from Jocelyn Guyer (Manatt Health Solutions).  Once arrangements for the Annual Meeting are finalized a notice will be sent to all Member offices.

Briefly, here are the most important facts for you:

  • The entire Cornerstone primary service area (Allen, Auglaize and Putnam counties) are located in Region #2 of the Ohio Geographic Rating Areas;
  • The Health Policy Institute of Ohio estimates that 160,000 persons statewide will enroll in the Marketplace/Exchange products.  That would mean that there will probably be fewer than 10,000 covered persons in Region 2 over the entire year.
  • Member offices participating with HealthSpan and MMO through Cornerstone will be providers to patients enrolling via the Marketplace in those carrier’s plans.  No additional action by providers participating with HealthSpan and MMO via Cornerstone are needed (A letter will be posted on our website in the near future from HealthSpan informing Cornerstone participating providers that by being contracted with HealthSpan that you are also included in the HealthSpan Select network.  The HealthSpan Select network will be used for their Marketplace product).
  • Many of the bronze plans in the Exchange will have out-of-pocket maximums of $6,350 and $12,700 for individual and family coverages.  Another item to mention is that the out-of-pocket maximums in the Marketplace/Exchange products for both the individual and small group plans have ALL out-of-pocket expenses accumulating to the out-of-pocket.  This may different than what the providers may have encountered in some current PPO plans.
  • Cornerstone may offer a solicitation with at least one other carrier in order for our Members to participate in an additional Marketplace carrier.  This solicitation may be mailed to our Members within the next few weeks.
  • Finally, it is vital that Cornerstone providers understand that the Anthem Marketplace product –Community—Anthem is not contracted via Cornerstone Alliance, Inc.  Catholic Health Partners –the parent organization to St. Rita’s Medical Center—and Anthem could not agree upon mutually acceptable terms and consequently, Cornerstone Alliance is not contracted with Anthem for their Marketplace product nor is St. Rita’s Medical Center.

Please review the slides in the two presentations (first paragraph f this letter) for much more detailed information on the Marketplace offerings.  If you still have any questions on Cornerstone plans offering products on the Marketplace, please email my office at:  hlbischoff@health-partners.org

Sincerely,

Harold L. Bischoff, FACHE

Executive Director
Ohio Exchange Carriers

October 29, 2013 UPDATE

We have learned that Molina Healthcare will not be offering an “Exchange Product” in Region 2 of the State of Ohio.  Therefore, Cornerstone will not pursue an “Exchange Agreement” with Molina Healthcare.  If you have questions regarding this information, please contact Harold Bischoff, Executive Director of Cornerstone at 419-996-5317 or hlbischoff@health-partners.org