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.
If you have patients who are currently enrolled in HIP Michigan, please read this important notice!
When you click on the link below, look down toward the middle of the page for "Schedule". Here they have posted their April - June schedule as well as their August - October schedule.
Please note that Pediatric Neurology is currently not able to rotate through the St. Joseph clinic. They are in the process of recruiting another physician. Once they are fully staffed, they will again be able to have office hours in the St. Joseph clinic.
Each month the Patient Centered Medical Home (PCMH) project will update our physicians on what we have accomplished to date, our efforts currently underway, our NCQA point standing, and our future goals. For the month of May 2013, we are pleased to report the following:
You can receive Marty's weekly VISION emails simply by contacting him and asking to be put on his "weeklies" list. Also, you could join his LinkedIN group and see the weeklies that way also. His most recent 'weekly' is below.
Easy is NOT equal to Simple
“I have never in my life envied a human being who led an easy life. I have envied a great many people who led difficult lives and led them well.” ― Theodore Roosevelt
OK, it’s time to remind you that there isn’t any easy way to do the right things, the right way. When you come to the fork in the road and one sign says EASY and the other says HARD. Rarely is the EASY path the right one. It’s just the way it is. Sorry.
Currently, all Lakeland Care providers participate with NGS Coresource only for the Lewis Cass ISD employees. Effective March 1, 2012, Lakeland Care providers will also be the preferred providers for Niles Community Schools covered members as well.
Their new ID cards for 2013 were inadvertantly printed with an "LCI" rather than the full rectangular Lakeland Care logo. Our logo, as you are aware, indicates that you, as participating Lakeland Care physician offices, participate with the patient's insurance and would be considered IN NETWORK for claims processing.
So, in summary, you are a participating physician for Vail Rubber employees, even if the ID card they bring in shows "LCI". They will have the corrected cards shortly.
If you have any questions, please feel free to call Monica Roney at 269-927-5207.
On a national level, Whirlpool announced that for 2013 they have signed a contract with Quest to provide labs at discounted rates for their members. Locally, however, you may continue to send labs to Lakeland for your Whirlpool patients at no additional cost.
The Lakeland Care PHO expects to have the contract with CIGNA completed by the end of March or early April. The contract that the committee is working on would, for the first time, include the physicians along with the hospital.
If the proposed Lakeland Care PHO contract is accepted, the new contract would supercede any existing contracts that our physicians may currently hold with CIGNA.
Priority Health is actively informing our physician practices about various incentives that they offer physicians, especially primary care. You can choose to participate in these, or not. It's up to you. There is some money there to be had, however, Priority Health doesn't have very many members yet in Southwest Michigan, so the volume of patients that you could potentially receive incentive monies on, is low.
The surveys are optional as well. You can choose to complete them or ignore them, it's up to you.
Reimbursement Advocate Alert for November 15, 2012 from the Michigan State Medical Society
Lakeland Hospital has a long standing contract with CIGNA. This is a hospital-only contract and does NOT include all of the Lakeland Care physicians underneath it. This contract was renegotiated in the spring of 2012 to be effective until December 31, 2012. This deadline has recently been extended until March 31, 2013 in order to give the Lakeland Care PHO time to work with CIGNA on a PHO contract. A PHO contract with CIGNA would be inclusive of both the Lakeland Hospitals as well as the Lakeland Care physicians.
Announcing Lakeland Care COMET — Continuing Online Medical Education and Training. Your online source for obtaining CME credit and tracking your CME credits.
Physicians have access to videos from the 2012 Weekly CME Program and lectures from Graduate Medical Education. New videos are added weekly. Physicians have received a personalized email from “firstname.lastname@example.org” with instructions on how to access COMET and set their password.