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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.

http://www.helendevoschildrens.org/lakeland

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 “admin@lakelandcare.com” with instructions on how to access COMET and set their password.

Our Lakeland Care physicians that currently see Care Source patients will continue to be considered participating under McLaren Health Plan.

Effective 8/1/12, those Care Source patients should be presenting in your office with a new McLaren ID card. You can continue to see these Care Source/McLaren patients as a participating physician.

For claim payments from United Health Care, please be advised that this new contract's fee schedule is based off of the 2010 Medicare base rates, so they may not match the 2011 base rates used for the current Lakeland Care fee schedule.

For claim payments from Priority Health, please be advised that this new contract's fee schedule is based off of the current year Medicare base rate, per the contract language.  This means their fees are based on the 2012 rates.

The longstanding contract that Lakeland Hospital has held with CIGNA has recently been renegotiated.  There will be no disruption in the continuity of care for CIGNA patients.

CIGNA will be sending their participating physicians and members a notification letter to inform them of the renegotiation.

Please be advised that as a participating Lakeland Care provider, you DO participate with this insurance, through our agreement with Cofinity.

The ID card will show MiHIP, the Cofinity logo, but no Lakeland Care logo.  You ARE PARTICIPATING and will be paid at the Lakeland Care fee schedule when you care for MiHIP patients.

 The plan is administered by PHP of Lansing.

Please be advised that there was no change to their access to the Lakeland Care network. The ID cards were printed in error without our logo. ASR will be reprinting the ID cards for the Berrien RESA employees that will once again include the Lakeland Care logo.

This year United Health Care Community Plan will be offering grant opportunities in the following categories:

*Women's Care
*Patient Centered Medical Home (PCMH)
*Non-emergent ER reduction

UHC Community Plan encourages you to start thiking of methods to utilize additional funding to improve the delivery of care in these categories for their Medicaid members.

Lakeland Care has executed a contract with United Health Care (UHC) to provide access to all Lakeland Care physicians, and all Lakeland facilities and affiliates. The effective date of this contract is 3/15/12, therefore all Lakeland Care physicians will be participating with UHC starting on 3/15/12 and going forward. 

Lakeland Care has executed a contract with the Pokagon Band of Potawatomi Indians to provide access to our specialists.  The agreement does not meet our minimum contract terms as they are looking to access only our specialists, OB/GYNs, and pediatricians. The Pokagon’s have a primary care health clinic located in Dowagiac that acts much like a Patient Centered Medical Home that will coordinate referrals and authorize treatment by our specialists. 

Lakeland Care issued a new fee schedule that went into effect for all Lakeland Care payors on 1/1/12.  However, Aetna/Cofinity was unable to meet that deadline so they have been allowed to load the new Lakeland Care fee schedule for dates of service beginning 2/1/12 and going forward.

If you are seeing January claims being paid at the old fee schedule rates, that is correct and has been approved by Lakeland Care.  For February dates of service, however, those claims should be paid according to the new Lakeland Care fee schedule.

Their mailing address, phone & fax numbers will stay the same but their website will change to www.mhplan.com.

The Claims Dept moved next door on Woodward Avenue, so the claims address may change for billers submitting paper claims. They will send out notices when that takes effect. Their payer ID did not change so the process is the same for electronic billers.

All Great Lakes Health Plan patients will be reissued new ID cards.  The top of the new card will read "UNITED HEALTH CARE" and in the lower right hand corner of the card you will MEDICAID written in small font.

The change is part of a national branding campaign that United Health Care medicaid groups are undergoing to simplify their name from state to state. 

What will change? Their logo, the ID card, and their website.  Please update your Great Lakes Health Plan website address to be www.uhccommunityplan.com.