Thanks to all who spent the afternoon with us yesterday at the annual Lakeland Care Network Payor Conference. We hope it was a valuable day for you and your office or department. Attached are presentations for your reference.
(Aetna's presentation and handouts will be attached in a separate news article as we are limited to 10 attachments per article.)
Meridian Health and McLaren Health Plan have also confirmed with Lakeland Care that physicans who see any Medicaid, or even simply refer Medicaid patients to Lakeland for any services, MUST ENROLL and ATTEST to their information within the CHAMPS System. Please note that enrolling in CHAMPS does not require you to be a Medicaid FFS Provider.
Here's how you enroll in CHAMPS:
1. Go to www.michigan.gov/mdhhs
2. Click on “Doing Business with MDHHS” Icon (top of page)
The letters from ASR that were sent to all of the Lakeland Care Network physicians, were sent in error. Unfortunately, it’s created confusion, so here's a little clarity on the whole thing.
HAP is a network in the Detroit area and is expanding in the east and into northern Michigan. HAP bought ASR about 5 years ago and they are currently marketing their expansion into Northern Michigan. These letters were intended for the physicians in the eastern and northern Michigan expansion areas.
United Healthcare has announced that they will no longer be participating in the individual insurance marketplace for 2017 for both Michigan and Indiana, as well as 24 other states. This will leave only Blue Cross Blue Shield and Priority Heath as options for Michigan residents looking to sign up for insurance on the exchange. For Indiana residents, PHP of Northern Indiana has also opted to exit the Indiana individual marketplace as well as its Individual Product line for 2017.
In case you haven't heard, UnitedHealthcare Community Plan (Medicaid) is now requiring all new providers to be enrolled in CHAMPS, due to State policy changes. They warn that failure to enroll could cause unnecessary delays in payment. This applies to both rendering and ordering/referring providers that are servicing Medicaid members. As they receive rosters from Lakeland Care, they will validate each new provider to ensure they are enrolled in CHAMPS. If the provider is not found in CHAMPS, Lakeland Care will notify your office.
There will be an information session and breakfast for the Office/Practice managers, nurses, and staff of any surgery offices in Niles, Watervliet, and St. Joseph regarding the new surgical optimization clinic called "Presurgery Planning." The presentation will be on Thursday, September 22, from 0700 - 0800 in the Upton Conference room 5 (SJ) and will be videoconferenced to the the Small Dining Room in Niles. Breakfast will be served in both locations.
The Lakeland Medical Office Association (LMOA) invites you to attend our September season kick-off luncheon and seminar. **Please note this is a half-day seminar**
Program: Documentation - The Key to Preventing Medicare Recoupments
The New Gateway to UnitedHealthcare’s Online Tools. It’s here! Click here to learn more about Link and view answers to frequently asked questions. If you have questions, please call the Link Support at 866-842-3278 option 3, 8 a.m. to 10 p.m. Monday through Friday. Thank you.
Here's a sneak peek at the first program that the Lakeland Medical Office Association will bring to you for our 2016-2017 season!
Come and learn from Medicare what they want in your documentation, because we all know if the documentation isn't there, you can risk losing a lot of money.
We encourage you to bring your physician(s) for this presentation, so block their calendars—and yours—and we'll see you at our season kickoff meeting on Wednesday, September 28th!
Cigna's newest edition of Network News for July 2016 includes these topics:
A New Look. Better Service at CignaforHCP.com on page 3
Introducing the new Care Allies on page 7
Cigna ranks #1 on 2016 PayerView Report on page 8
Taking action to fight the opioid epidemic on page 19
These highlights and more are found in the attached newsletter.
As of October 1, Priority Health will require the inclusion of National Drug Codes (NDC) on claims for services that include drugs. This aligns Priority Health’s billing requirements with many national payers.
Claims submitted on or after Oct. 1, 2016 without the NDC codes will be rejected. This applies to all Priority Health plans, and applies to all drugs on the claim (even if the drug is not a covered benefit).
More information:
Complete Network Bulletin Available Here
FRONT AND CENTER (P 3)
Communication Effectiveness Survey (P 3)
“Speak for Yourself - Plan Your Care” is an advance care planning initiative through, Lakeland Health, Caring Circle, and the Southwestern Michigan Community. It involves a systematic approach to advance care planning. We are encouraging people, at any age, to have a designated decision maker, and identify their end-of-life wishes. The focus of the “Speak for Yourself - Plan Your Care” pilot is to have meaningful discussions with patients who are seriously ill and frail. Certified facilitators are located within the following pilot sites:
Care Coordination and Collaboration is an opportunity to maximize the Triple Aim goals while improving patient outcomes. We currently have several initiatives underway:
The 2016 Spring Edition of MPIE’s FACETS Newsletter is attached for your reference. This issue contains the following articles:
Looking to change or add professional liability coverage?
Approximately two-thirds of the Lakeland Care Network physicians are insured by our long-time partner, the Michigan Professional Insurance Exchange (MPIE). MPIE recently received an AM Best Rating of A- and continues to provide great rates to west Michigan physicians.
You may have noticed a couple of surveys from Lakeland Care in your email over the past few weeks, or you might have been contacted by the Advisory Board via phone. THANK YOU to those of you who took the time to reply online and/or agreed to speak to the Advisory Board. We value your feedback!
Quick Summary: Complete Network Bulletin Available Here
FRONT AND CENTER (P 3)
The UnitedHealthcare Community Plan "COMPASS" newsletter contains a variety of news and information of interest to Michigan patients, parents, and providers. The March issue includes new information about lead screening, MQIC updates, HPV vaccination, reports from the Michigan Cancer Consortium and more. Click on the following attachment to download the newsletter.
Quick Summary: Complete Network Bulletin Available Here
FRONT AND CENTER (P 3)
Quality Improvement Programs Make Great Strides (P 3)
AM Best recently upgraded MPIE’s financial strength rating from to B++ stable (Good) to A- (Excellent) positive. The rating actions reflect MPIE’s strong risk-adjusted capitalization, historically profitable operating results, stable loss reserving trends and its expertise in Michigan’s medical professional liability market. Additionally, supportive rating factors include an expansion of MPIE’s enterprise risk management programs and underwriting performance that compares favorably with its peer companies.
The Lakeland Medical Office Association (LMOA) invites you to attend our May luncheon and meeting.
PROGRAM: Michigan State Medical Society presents: ICD-10 Aftermath, Payer Issues, CPT Coding, and MSMS Alerts
This presentation will focus on four main topics:
Lakeland Care has added a new employer group, Kruger Plastics Products, as an employer direct contract who uses Heritage Consultants as their payor. Kruger Plastics employees’ access to the Lakeland Care Network began January 1, 2016. Please verify they are presenting their new ID card showing Heritage Consultants, since this group has used United Health Care and Preferred Benefit Administrators over the past couple of years.
It's that time of year when allergy sufferers start to experience increased sneezing, a runny nose, itchy eyes, or a scratchy throat, due to high grass and tree pollen counts. Seasonal allergies, also sometimes called "hay fever," affect millions of people each year. Symptoms can be minor, or they can be more disruptive such as chronic sinus infections, or breathing difficulty associated with asthma.
If you suffer from seasonal allergies, lifestyle interventions and medications can provide relief. Here's what you need to know about living with seasonal allergies.
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.
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.
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.
