The State of Illinois has not passed a 2015/2016 budget and therefore has stopped funding claims payment specifically for the Quality Care Health Plan/ State of Illinois retirees membership, account #3181456. Their ID cards are attached (front and back):
by Richard Stolz, Employee Benefit News
April 23, 2015
In a sign of increasing employer urgency for results, the percentage of wellness program sponsors offering incentives for various forms of employee engagement with those efforts rose to 87% last year, up from 77% two years ago.
The Lakeland Medical Office Association (LMOA) invites you to attend our March luncheon and meeting.
Program: “Do No Harm”: Best Practices for the Integral Roles of Medical Assistants and Administrative Personnel in the Physician Office
As of 12/1/15, Niles Community Schools has changed their insurance payor. The school system has switched from Preferred Benefit Administrators to BCBS. Please check for new ID cards from your patients.
Why should you think twice before opting for a lunchtime cheeseburger?
What you eat can significantly affect your work performance, but we rarely give our digestive decisions any thought, consultant Ron Friedman writes in the Harvard Business Review.
Many of us intuitively know that high-carb meals can lead to a "sugar high" (and then crash), and that high-fat diets can cause us to become tired quickly after eating. But Friedman notes that we do not always make smart decisions when it comes to how we refuel our bodies at lunch.
The Lakeland Medical Office Association (LMOA) invites you to attend our February luncheon and meeting.
PROGRAM: How to Measure Success
We all want measures. We all want to make data-informed decisions and grow our organization. But, how do we measure success? How do we know where to start? We should start at the beginning. Mission, Vision and Values define our organization and how we measure success.
TigerText is widely used as a secure health care messaging app which allows users to safely exchange non-emergent PHI with colleagues. TigerText messages are encryped and set to self-destruct after a preset period of time, which ensures maximum corporate data security. The app also complies with HIPAA, SOX, and other regulations. Visit the app store on your mobile device to download. For questions, contact the help desk at Lakeland.
For ALL after-hour surgeries, please us the dedicated surgery line to call in a surgery team.
- Calling from outside Lakeland, dial (269) 982-2566
- Calling from in-house, dial extension 2566
By using this dedicated line, you bypass the automated greeting and avoid being placed in a queue where your call is answered in the order it was received. The dedicated surgery line is answered immediately by an operator who will assist you by calling in the surgery on-call team.
A written attestation of CME completion (as required by the State of Michigan for licensure) will be required by the Medical Staff Office 60-90 days prior to your physician license renewal. Upon re-credentialing, documentation of completed CMEs required by Lakeland will be reviewed, in addition to the written attestation.
April 24, 2015
Researchers have developed a new diet that could reduce a person's risk of developing Alzheimer's, the Wall Street Journal's Sumathi Reddy reports.The diet was developed by researchers at Rush University Medical Center and combines features of two other heart-healthy diets: The Mediterranean diet and the DASH diet. Called the MIND diet, it is low in high-fat foods, high in leafy vegetables, and encourages the consumption of blueberries—among other recommendations.
- Remember to keep collecting patient emails for the patient satisfaction surveys that are now through Sullivan Luallin
- Specialty offices: Be on the look-out for an email regarding the Physician Group Incentive Program (PGIP) in the next month or two
- December’s PHO Report will be sent out this week to Epic practices
- Remember the deadline for PQRS submission is the end of February
The Lakeland Medical Office Association (LMOA) invites you to attend our January luncheon and meeting.
PROGRAM: Epic Insights
Join us for a FUN, interactive presentation of some of the most common misconceptions and insights into how EPIC works! Audience participation and discussion on how to help get patients engaged with their healthcare and help staff know more about the system they use every day.
IT Topics to be discussed:
As a reminder, the co-pay for Lakeland Health's covered plan participants did not change for 2016. It remains at $30.
As a reminder, the Lakeland Care has two payors for the MI Health Link program which serves the Dual Eligible population: Meridian Complete and Aetna Better Health Premier. Please note that "Aetna Better Health" is a Medicaid plan that Lakeland Care physicians do not participate with.
Aetna Better Health Premier, one of our two payors for the dual-eligible population, has updated their EOB, after the feedback they received from physician practices during the October Lakeland Care payor conference. The newly designed EOB will now show patient pay responsibility! They are working to add sequestration soon.
If your physician has been fully credentialed for all of the Lakeland Care payors, but is still in process for McLaren's Medicaid credentialing, you must obtain an authorization for services rendered to any McLaren patient during that interim period. When your office calls McLaren's customer service, ask the service representative for "MEDICAL MANAGEMENT' to get the authorization -- don't just ask the customer service rep. who answered the phone. If you have the authorization, your claims will be processed as participating.
The Patient Experience surveys that are currently being performed by Arbor Associates, will be done by Sullivan & Luallin beginning January 1, 2016. This new survey will be done via email, instead of phone calls to patients' homes. It is important to make sure your office is gathering email addresses on each patient.
•EPIC OFFICES: the file which is currently being sent to Arbor, will automatically be updated with the new criteria and sent to Sullivan & Luallin weekly
The Lakeland Medical Office Association (LMOA) invites you to attend our November luncheon and meeting.
PROGRAM: Staff Harmony
Is “drama” in the workplace affecting your work environment? This presentation will identify why drama may be occurring. It also will discuss ways to address workplace issues that may be creating the drama.
The Michigan Professional Insurance Exchange (MPIE) is pleased to announce the relocation of their office to Bridgewater Place in downtown Grand Rapids. If your physician(s) are insured by MPIE for their professional liability coverage, please update your records with the following new address and phone and fax numbers, effective immediately.
Michigan Professional Insurance Exchange
333 Bridge St. NW, Suite 810
Grand Rapids, MI 49504
NEW PHONE & FAX NUMBERS:
While many worried that the U.S. transition to ICD-10 was going to be the coding world’s equivalent to the apocalypse, I am happy to report that the transition has been about as “apocalyptic” as the Y2K panic was back in 2000.
On Wednesday, October 21, 2015, LMOA will host the Lakeland Care Network's Annual Payor Conference from 11:45 - 4:30 at the Hilton Garden Inn, in Benton Harbor. Invitations will be coming to your inbox soon! Please save the date so you can join us for this half day event.
Are you looking for some help with the conversion of ICD-9 to ICD-10 codes and vice versa?
The American Association of Professional Coders (AAPC), the nation's largest medical coding training and certification association for medical coders, has created this link to help you.
On Thursday, October 1, 2015, the United States’ code set will change from ICD-9 to ICD-10 after a 3 year delay. Lakeland has been clinically live with ICD-10 in Epic since October 1, 2014. There will be limited impact to the current views within Epic due to this code set change.
ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. Health care providers, payers, clearinghouses, and billing services must be prepared to comply with the transition to ICD-10 by October 1, 2015.Lakeland has been preparing for the October 1, 2015 deadline and we are confident that this will be a smooth transition. All orders submitted to Lakeland for processing wil
Effective 7/1/15, Medicaid expansion was approved for Priority Health to provide care to Medicaid patients in our Southwest Michigan service area. Because of this, Priority Health will be allowed to offer their Medicaid product to members in our area beginning 1/1/16. All Lakeland Care participating Primary Care providers are automatically a part of this plan. All Lakeland Care participating specialists can be considered participating for these new members if you choose to accept new patients.
Effective 8/15/15, Commercial Travelers will be the new claims payor for any Andrews University student that has the school-sponsored student insurance. The previous payor, ASRM, will process claims with dates of service up to and including 8/14/15. Only a handful of ID cards have been printed since Commercial Travelers is waiting for the final download of participating students from Andrews. Until then, here is some information to help you to provide care and send in claims for those students:
Lakeland Health has joined five other leading Michigan health systems to form a Clinically Integrated Network (CIN). This network includes Allegiance Health (Jackson), Bronson Healthcare (Kalamazoo), Covenant HealthCare (Saginaw), Lakeland Health (St. Joseph), MidMichigan Health (Midland) and Sparrow Health System (Lansing). Each of the organizations will continue to operate independently.
The Lakeland Care Contracting Committee announced this week that, despite rumors to the contrary, the Lakeland Care network will continue to contract with United HealthCare for their COMMUNITY PLAN Medicaid product. There has been no interruption in this contract and those patients who have Community Plan will be able to continue to see those Lakeland Care providers that have chosen to accept this plan.
EMR Risks and New Technology
Priority Health, Humana, Blue Cross Blue Shield of Michigan, United HealthCare and Health Alliance Plan (HAP) have combined resources as a consortium of payers offering ICD-10 information to the provider community. Their goal is to show that transitioning to ICD-10 does not have to be overly costly or burdensome. They will use one voice and work together to aid physicians and other health care providers in the transition to ICD-10.
The Payers Collaboration is planning a series of hour-long webinars by specialty on Thursdays at noon Eastern time.
The Dual Eligible (Medicaid/Medicare) program named "MI Health Link" begins on March 1, 2015. Representatives from Aetna Better Health and Meridian will be in St. Joseph on Wednesday, April 8, 2015 to present an overview of the program. Time and place will be communicated once they are finalized.
President Obama made the ICD-10 delay official on April 1, 2014. ICD-10 implementation was scheduled to take place October 1, 2014, however that date has been delayed for at least one year. CMS has yet to make an official statement on the issue.
Stay tuned to lakelandcare.com for updates.
The following is a memo directly from ASR which explains a Medicare Secondary Payor reporting issue they are currently experiencing and what is being done to resolve it.
ASR sent a file to the Centers for Medicare & Medicaid Services (CMS) in February identifying persons with active coverage, as required by the Medicare Secondary Payer reporting mandate. On account of a software error, this file incorrectly included not only active employees but also Medicare primary retirees. The error has been identified by our software partner, and together we are working on a solution.
Today, ASR is sending to CMS a file that will reverse the erroneous information. Unfortunately, we are unable to provide an exact date on which CMS will load that file; CMS has confirmed only that it could take one to two weeks.
Michigan will be expanding the Medicaid program in 2014. The new program, called the Healthy Michigan Plan, is part of the Affordable Care Act and will extend health care benefits to over 320,000 Michigan residents this spring.
The Berrien Health Plan estimates that 100% of their current Plan A members and 90% of the Plan B members will be eligible for the new Healthy Michigan Plan.
These letters were sent by Humana in Error!
There have been absolutely no changes to our contract with Humana and therefore all of the Lakeland hospitals and facilities, as well as all of the Lakeland Care physicians continue to participate in both Humana (commercial) plans as well as Humana Medicare Advantage plans.
In case you have only heard about the letter through your patients, here's what it actually said:
Lakeland Care has signed a contract with Cigna effective January 1, 2014. This PHO agreement includes both the Lakeland HealthCare system facilities as well as all of the Lakeland Care physicians. If your office currently holds a contract with Cigna, this new PHO contract will automatically super cede your existing contract.
On Wednesday, December 18, 2013, Lakeland Care is hosting a breakfast meeting at the Vineland Center from 8:00 – 10:00 a.m. for practice managers and staff to attend a presentation by Cigna on this new contract.
Lakeland Care has expanded their contract with Priority Health to include their Medicare Advantage Plan.
This contract was signed on 10/1/13, with the new Priority Health Medicare enrollees becoming eligible on January 1, 2014. On Wednesday, December 18, 2013, Lakeland Care is hosting a breakfast meeting at the Vineland Center from 8:00 – 10:00 a.m. for practice managers and staff to attend a presentation by Priority Health Medicare on this new contract.
Effective 8/15/12, the Andrews University Student Insurance Plan that used to be through Bollinger has changed. Currently, their plan is being underwritten by American Fidelity Assurance Company and their claims administrator is John T. Riley Insurance Agency, PO Box 356, West Boylston, MA 01583.
For online claims and EOB information, please visit www.johntriley.com.
I was recently addressing a group of health care providers to overview the impending transition from ICD-9 to ICD-10 from an operational perspective, and to speak about the various processes, staff resources and impact areas affected by the changeover within the physician practice setting. It occurred to me that even though the audience was familiar with ICD-9, they couldn’t quite “wrap their arms around” the anticipated impact of ICD-10.
Those MI-HIP patients who have rolled over to the new federal Pre-existing Condition Insurance Plan, have a new address for their claims.