quarter 3 provider forum - maryland physicians. care, inc. · 2019-09-26 · agenda dawn marszal,...
TRANSCRIPT
Quarter 3 Provider Forum
September 26, 2019
AGENDA
Dawn Marszal, Senior Director, Provider Relations/Network
and Contracting
• Maryland Department of Health- ePREP update
• Provider electronic payment option- Payspan
Sammi Turner, Manager, Quality Improvement
• Quality Improvement Initiatives
MDH EPREP UPDATE
• Maryland Department of Health (MDH) requires all providers delivering
services to Maryland Medicaid members to have an active enrollment status
in the electronic Provider Revalidation and Enrollment Portal (ePREP) every
5 years.
• Beginning November 1, 2019 claims system will validate billing and
rendering NPI against weekly MDH file.
• If billing or rendering NPI is not found on most recent file or does not have
an active status, claim will deny with specific denial reason.
MDH EPREP UPDATE
• Professional license verification in ePREP
– Providers are responsible for updating professional license information prior to
license expiration in the ePREP portal.
– If a provider fails to update her professional license expiration date in ePREP, the
provider’s enrollment status will “suspend” and claims submitted by the provider
will deny until the provider corrects the issue in ePREP.
– Explanation of payment will reflect the reason for claim denial specific to ePREP
– The provider can resubmit claims for adjudication within timely filing guidelines
(180 days from date of service) once her status has been updated.
MDH EPREP UPDATE
• MDH Website: mmcp.health.Maryland.gov/pages/ePREP.aspx
• ePREP Portal: https://eprep.health.maryland.gov
• ePREP Call Center 1-844-463-7768
PROVIDER PAYMENT- PAYSPAN
Maryland Physicians Care offers electronic funds transfer via Payspan.
Benefits of EFT:
• Improved cash flow: Electronic payments mean getting paid faster
• Maintain control over bank accounts: Control over the destination claim
payments
• Payment notification: Email notification when payments are received with
easy search and presentation of EOB’s online
• Security and efficiency: EFT payments are secure- you do not have to
worry about a lost check in the mail. EFT payment are also efficient by
reducing trips to the bank.
PROVIDER PAYMENT- PAYSPAN
Link to PaySpan can be accessed from Maryland Physicians Care secure
Provider Web Portal.
Instructions for registration are available on the MPC website:
www.marylandphysicianscare.com/providers
Quality Improvement
VALUE-BASED PURCHASING
Value-based purchasing is a Pay for Performance Model of care. The state of Maryland uses HEDIS measures as well a
custom measure to monitor the performances of the Maryland Medicaid MCO’s
9
2019 VBP Measure
2018 Benchmarks 2019 Benchmarks Variance from 2018 to 2019
Neutral Incentive Neutral Incentive Neutral Incentive
Adolescent Well Care 69% 74% 68% 73% ↓1% ↓1%
SSI Adult 84% 87% 84% 87% No change No Change
SSI Child 83% 86% 84% 87% ↑1% ↑1%
Asthma Medication Ratio > 50% 68% 73% 66% 72% ↓2% ↓1%
Breast Cancer Screening 71% 75% 70% 75% ↓1% No change
CDC - HbA1c Control (<8%)- New Measure N/A N/A 57% 64% New New
Controlling High Blood Pressure 65% 71% 63% 69% ↓2% ↓2%
Lead Screening 64% 70% 66% 71% ↑2% ↑1%
Well Child Visits- 1st 15 months of life (6+ visits)- New
MeasureN/A N/A 71% 76% New New
VALUE-BASED PURCHASING
1
Information is a reflection of NCQA HEDIS 2019 Technical Specification and is used only as a
reference to assist in improving your practice’s HEDIS/VBP rates
Measure Requirement CPT
Adolescent Well-Care ages 12-21 (AWC) Members must complete one comprehensive visit per
year.
99384, 99385, 99394, 99395
Well-child visit first 15 months of life (W15) Members must have 6+ well visits by age 15 months 99381, 99382, 99391, 99392, 99461
Breast Cancer Screening (BCS) Women 50-74 need to complete one mammogram in
the past 27 months. Exclusion: Bilateral Mastectomy
7705-77057, 77061-77063, 77065-77067
Lead Screening All members born in 2018 (not based on risk), must
complete a lead test before the end of 2019. Testing
can occur as early as 9 months of age
Only one code will meet compliance
83655
SSI Child- Birth to age 20
SSI Adult- 21-64
All members receiving Social Security Income should
complete at least one Ambulatory Care Visit with
PCP. This can be sick or well. No urgent care,
substance abuse, ED visits count
Any Ambulatory Care visit code or well visit code.
Asthma Medication Ratio Members must fill maintenance medication at least .05 to rescue inhalers
Pharmacy claim based
HbA1c Control The last reading in the measurement year must have value of <8
Lab based
Controlling High Blood Pressure Based on last blood pressure reading of the year. Reading must be less than can not equal 140/90
PROVIDER ASSISTANCE-BI-DIRECTIONAL DATA SHARING
EMR- Electronic Medical Record Access
• Network Agreement/ Data Sharing Agreement
• Allows Plan to provide Prospective reviews to improve rates throughout
the year
• Provider can request measure specific reviews
• Decrease resources to Provider/Plan during HEDIS season- no faxing of
records
Contact for EMR Access:
QI HEDIS Manager: Denise Redding at
11
PROVIDER ASSISTANCE-BI-DIRECTIONAL DATA SHARING
Supplemental Data
• Targets high volume providers (30+members in a specified measure)
• Providers provide a flat file extraction from EMR based on the
measurement requirements
• Flat files are submitted to plan by provider on a monthly basis
• Benefits:
Provides real time data
Encounter data: claim info not submitted to plan, FFS information
Supplemental Data Extraction Contact: QI Manager: Sammi Turner @
12
PLAN INTERVENTIONS: MEMBER ENGAGEMENT
• Clinic Days/Events: Plan works with specialty providers to host clinic days
for MPC members for: Breast Cancer Screening, HbA1c testing, Lead
testing, and SSI assessments. Members offered round trip transportation
and a VISA incentive
• SBHC: Plan collaborates with SCBH to promote healthy well visits. Plan
attends community based meetings as well as back to school events
• Member only incentives: Select measures may market members to
complete service with PCP to receive a VISA gift card
• Alegis: Home visits providing HbA1c, Lead , SSI assessments
13
PLAN INTERVENTIONS: MEMBER ENGAGEMENT
14
Measure Definition Planned Activities
AWC Adolescent Well Care Visits promote annual visit- Social platform: text, e-mail, robo-call
SSI – Adult Ambulatory Care Visits (MD Custom) Alegis Home Visits- Launch April Clinic days- Launch May
SSI – Child Ambulatory Care Visits (MD custom) Clinic days- Launch May
AMR Asthma Medication Ratio Pharmacy collaboration- Outreach to members not filling prescriptions
BCS Breast Cancer Screening Clinic days- Launch May
CDC- HbA1C Control Comprehensive Diabetes Care – HbA1c <8 Alegis Home Visits- Launch April Clinic Days- Launch May Provider engagement- for follow-up care for member values <8
Launch April
CBP Controlling High Blood Pressure Create custom measure pending Inovalon capabilities
LSC-MD Lead Screenings for Children – Ages 12-23 Months (MD custom)- Any member born in 2018 must have lead testing completed in 2019
Clinic days- Launch April
W15 Well-child Visits for Children – First 15 months (6+ visits) Promote Healthy Infant Visit-6+ Marketing, Telephonic outreach
PLAN INTERVENTIONS FOR MEMBERS
October
BCS Community Radiology (Frederick) Wednesday 10/02 1p – 4p
BCS Diagnostic Imaging Services (Washington Co) Tuesday 10/8 3:30p-7:30p
BCS Peninsula Imaging – Salisbury Thursday 10/17 1p – 3p
Lead/HbA1c Urbana Regional Library (Frederick) Friday 10/18 10a – 2p
BCS Seton Imaging Saturday 10/19 9a-1p
BCS Advanced Radiology (G B) Wednesday 10/23 3p – 6p
November
BCS Diagnostic Imaging Services (Washington Co) Tuesday 11/5 3:30p-7:30p
LEAD Adventure Dental Pratt St Thursday 11/07 9a – 1p
BCS Seton Imaging Saturday 11/09 9a-1p
BCS Advanced Radiology (Dundalk) Thursday 11/14 1p – 4p
LEAD Adventure Dental Essex Wednesday 11/20 9a – 1p
December
BCS Diagnostic Imaging Services (Washington Co) Tuesday 12/3 3:30p-7:30p
Lead/HbA1c/SSI Eastpoint Mall Friday 12/06 10a-4p
BCS Seton Imaging Saturday 12/7 9a-1p
LEAD Adventure Dental Landover Tuesday 12/12 9a – 1p
BCS American Radiology (Fleet St.) Saturday 12/21 9a – 1p
15
All members who attend a clinic day receive round trip transportation
HbA1c/Lead/SSI receive a $75.00 Visa card BCS receive $100 Visa cards provided day of clinic
Contact for Clinic days:
Mary Sisson-Collier 443-713-4906 Amanda Hart – 443-713-4759 Barb Koonz – 443-713-4624
EPSTD
16
Assessments
• Lead Risk Assessment- Every Well Child Visit age 6 months-6years
• Tuberculosis Risk Assessment- Annual starting at age 1 month
• Cholesterol/Heart Disease Risk- Annual starting age 2
• STI/HIV Risk Assessment- Annually starting at age 11
Screenings
• Anemia Screening: Annual starting at age 11
• Lead Testing: Can start as early as 9 months of age and should be completed for 12 month and 24 month
• Hereditary/Metabolic Screening: Newborn screening with second completed 2-4 weeks of age
• Hemoglobinopathy Screening: 12 months and 24 months of age
• Critical Congenital Heart Disease: Newborns with rescreening at 24-48 hours of age
Q & A