Mercy Care Provider Newsletter: Spring 2018
|
Cover Story
Complete Care Awards
We are happy to announce that AHCCCS has awarded an AHCCCS Complete Care (ACC) contract to Mercy Care. Below please find important information to assist you in with questions you may have:
- The contract award includes the Central GSA (Maricopa, Pinal and Gila counties). This allows us to retain our existing business in Maricopa County and expand to Gila and Pinal Counties.
- While we are retaining our business in Maricopa County, we will no longer be serving ACC members in Pima County. It is important to note that we will continue to serve our ALTCS, MCA, and DDD members in Pima County for whom we are still responsible.
- The new contract begins October 1, 2018 and will run for three years with two optional two-year contract extensions.
- We will continue to provide outstanding service to providers to ensure a successful transition to this new contract. Our Contracting Department may issue contract amendments beginning in April. If a provider receives a contract amendment, the amendments must be signed and returned no later than May 22, 2018.
- Before the October 1, 2018 effective date of this contract, we will be assisting in the transition of members in Pima County to other healthcare providers.
- As part of the requirements of the ACC contract, Mercy Care Plan and Mercy Maricopa Integrated Care are continuing our work to merge into one health plan, which will be one entity. Our new name will be Mercy Care. We will have a new logo, a new website URL (www.mercycareaz.org) and some other minor changes. These changes are anticipated to take effect July 1, 2018 and we'll have more communication to share with providers as we move toward that date.
As we move closer to contract implementation, we will provide you with further detailed communication regarding this transition through provider forums, notifications, etc. As always, thanks for all you do!
All Plans Corner
Common EPSDT Questions Answered
Question 1:
Where do I send EPSDT forms?
Answer:
Please sent forms by mail to 4350 E. Cotton Center Blvd., Bldg. D, Phoenix, AZ 85040, Attention: Quality Management or fax the forms to 602-431-7157.
Question 2:
Does the AHCCCS ID number for members need to be on the electronic well-visit note sent to the health plan for an EPSDT well-visit?
Answer:
Providers must use the EPSDT Tracking Forms provided by AHCCCS Contractors (or electronic equivalent that includes all components found in the hard copy form) at every EPSDT visit; this includes the AHCCCS ID number.
Question 3:
What is required on EPSDT forms regarding BMI reporting?
Answer:
PCPs are required to calculate the child's BMI and percentile and report the percentile on the EPSDT tracking form. The BMI percentile is used for children and teens 2-20 years of age.
Developmental Screening
Developmental screening is an important component of regular EPSDT (well-child) visits. AHCCCS policy allows for an enhanced payment for specific developmental screening tools at EPSDT visits. The developmental screening should be completed for EPSDT members from birth through three years of age during the nine month, 18 month and 24 month EPSDT visits.
The developmental screening tools that may be used and reimbursed by AHCCCS include:
For proper payment for the enhanced developmental screening rate, 96110-EP should be billed.
Mercy Care Plan will reimburse providers for developmental screening on members up to 8 years of age.
Human Service Campus (HSC)
As many as 2300 people are served on the Human Service Campus (HSC) in a 30 day period, many of which are living with an untreated mental illness and addiction which remains one of leading underlying causes why people become homeless.
Mercy Care is excited to announce that we are partnering with the HSC and Community Bridges, Inc. to collaboratively deliver a new fully integrated behavioral health model on the HSC. This patient centered, home health model will consist of streamlined processes that timely connect individuals to physical health services, mental health services, substance abuse services and the necessary psychosocial supports such as housing, employment, and food supports.
Ongoing outreach within and around the HSC will be integrated into this model. These efforts will be focused at engaging those who have either not accessed services at HSC, or who have disengaged from services. This approach will reduce the number of crimes committed in the surrounding neighborhood and enhance opportunities for engagement.
The establishment of this model is yet another example of our community partners ongoing commitment to addressing the complex issue of homelessness in a manner that balances the needs of those experiencing homeless and the concerns of the neighborhoods they impact.
Provider Relations Network Assignments
Our Provider Relations Network Assignments have recently changed. These assignments have been updated to our website but are contained here for your convenience:
Self-service coming soon
Soon you'll be able to get the information you need - anytime you need it.
Interactive voice technology (IVR) is coming soon. With IVR self-service, you'll have 24/7 access to information you need for your patients with Mercy Care Plan and Mercy Maricopa Integrated Care, like:
- Eligibility
- Claim status
- Benefit information
No limits to eligibility inquiries
In the past, you may have had limits to a certain number of eligibility inquiries. Now you will have no limits, so it will be faster and easier to get the information you need.
No need to wait in queue
In a hurry? No need to speak with a representative or wait in queue. You can do it all with self-service.
No trouble connecting with a real person
Now you will have the information you need at your fingertips, faster and easier than before. And don't worry. You can still talk with a real person when you need to. Questions? We're here to help. Just call your Mercy Care provider relations representative at 1-800-263-3000 or your Mercy Maricopa provider relations representative at 1-800-564-5465 to learn more. You'll have access to IVR soon.
Take action to lower your patient's breast cancer risk
We are dedicated to serve our members and appreciate your partnership in ensuring your patients receive important preventive screenings. It is our goal to increase the percentage of women, age 50-74 years of age, who had a mammogram to screen for breast cancer. Mammograms are a covered benefit for members aged 40 and over. With your help, we can make sure our goals are met and more importantly, your member is screened annually for her breast health.
In May, we will reach out to all providers by mail to obtain a mammogram order for members that need their breast cancer screening. The letter and order form makes it simple for your office to fill out and return by fax. Once we have a current mammogram order, our outreach specialists will call the member to schedule her mammogram and the results will be sent directly to your office for review. It's that easy.
Let's work together to keep your patient's breast health a priority this year. It just might save a life!
Provider notifications
Provider notifications contain updates that contain important information. Please click on the link to view the most recent provider notifications in greater detail:
News and Events
Our News and Events section provides information regarding current news and event, including training opportunities. Please click on the below links to view the most recent news and events in greater detail:
Reference Material and Guides
Reference Materials and Guides contain valuable information you may refer to at any time. Please click on below links to view the most recent Reference Material and Guides updates in greater detail:
Mercy Maricopa Integrated Care Corner
Mercy Maricopa
Integrated Care's Grievance and Appeals Department
As a reminder, Mercy Maricopa Integrated Care's Grievance and Appeals Department receives and processes all Member Grievances (complaints), SMI Appeals, TXIX Appeals and SMI Grievances.
Our
processes are defined as follows:
- Member Grievance is a member's expression of dissatisfaction with any matter, other than an adverse benefit determination.
- TXIX Appeal is a review of an adverse benefit determination.
- SMI Appeal is a request for review of a decision regarding an SMI member.
- SMI Grievance is an allegation, made by Seriously Mentally Ill (SMI) member or other concerned person, of a violation of the rights of a Seriously Mentally Ill (SMI) member or a condition requiring investigation.
In order to ensure all issues are addressed and tracked appropriately, please remember to route ALL Member Grievances (complaints), SMI Appeals, TXIX Appeals and SMI Grievances directly to Mercy Maricopa Integrated Care's Grievance and Appeals Department and do not try to work through them internally. Please forward ALL Member Grievances (complaints), SMI Appeals, TXIX Appeals and SMI Grievances via phone to 602-586-1719, 866-386-5794, via fax to 844-251-3524 or via email to
[email protected].
Mercy Care Advantage Corner
Alcohol and other drug dependency
Alcohol and other drug dependency is one of the most preventable health conditions.
The National Institute on Drug Abuse found that alcohol and other drug dependency:
- Affects many age groups
- Contributes to the death of more than 90,000 Americans each year*
- Exceeds $700 billion annually for items such as to crime, lost work and health care*
In a 2012 study, an estimated 23.1 million Americans (8.9 percent) needed treatment for a problem related to drugs or alcohol, but only about 2.5 million people (1 percent) received treatment.**
There is strong evidence that treatment for alcohol and other drug dependency can improve health, productivity and social outcomes, and can save millions of dollars on health care and related costs.*
At Mercy Care Advantage HMO SNP we are committed to maintaining and improving our member's health and lives. Please partner with us in helping your patients, our members, in receiving these important services.
Our goal is to increase the percentage of members with a new episode of alcohol or other drug (AOD) dependence who receive both of the following:
- Initiation of AOD Treatment: initiation of treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.
- Engagement of AOD Treatment: initiation of treatment and receipt of two or more additional services with a diagnosis of AOD within 30 days of the initiation visit.
See more at:
Medicare has neither reviewed nor endorsed this information.
Annual Wellness Visit
CMS is encouraging providers to regularly review their patients' wellness and develop plans to keep them healthy.
The Affordable Care Act provides for an Annual Wellness Visit (AWV), including Personalized Prevention Plan Services (PPPS) for Medicare beneficiaries.
The Annual Wellness Visit is a covered benefit for Mercy Care Advantage members and is a preventive wellness visit - NOT a "routine physical checkup."
Initial Preventive Physical Exam (IPPE) (during first 12 months of Medicare enrollment)
Initial preventive physical examination; face-to-face visit G0402.
The IPPE consists of the following:
- Acquire Beneficiary Information
- Begin Exam and Discussion
- Counsel Beneficiary
OR
Initial Annual Wellness Visit (AWV)
Annual Wellness Visit including a personalized prevention plan of service G0438.
The AWV consists of the following:
- Acquire Beneficiary Information
- Begin Exam and Discussion
- Counsel Beneficiary
OR
Subsequent Visit
Subsequent annual wellness visit including a personalized prevention plan of service G0439.
The Subsequent visit consists of the following:
- Acquire Update of Beneficiary Information
- Begin Assessment
- Counsel Beneficiary
Tips:
The Annual Wellness visit provides an excellent opportunity to address additional preventive measures such as:
- Flu / Pneumococcal and other Adult Immunizations
- Fall risks assessment
- Bone Mass Measurements
- Cancer Screenings
- Cardiovascular Screenings
- Diabetic Screenings
- Screening and Behavioral Counseling Interventions
- Screening for Depression
- Tobacco-Use Cessation Counseling Services
Antidepressant medication management
At Mercy Care Advantage HMO SNP, we are committed to maintaining and improving our member's health and lives. Our goal is to increase the percentage of members 18 years of age and older with a diagnosis of major depression, who were newly treated with antidepressant medication AND who remained on an antidepressant medication treatment for 6 months.
Please help us reach our goals by partnering with us in helping our members, your patients in receiving these important services.
Mercy Care Advantage Model of Care Training for 2018
The
2018 Mercy Care Advantage Model of Care Training is now available for your use. The training course incorporates an attestation statement in it so that you will no longer have to fax in a separate attestation after you complete the course. As you know, this is an annually required course for any provider treating Mercy Care Advantage patients.
Pharmacotherapy Management of COPD Exacerbation (PCE)
Mercy Care Advantage (HMO SNP) sends a daily fax to providers, for members that have been identified as being discharged from the hospital following an acute COPD exacerbation.
For members experiencing an acute exacerbation of their COPD, MCA tracks two separate indicators:
- Members being dispensed a systemic corticosteroid (or evidence there was an active prescription) within 14 days of the event.
- Members being dispensed a bronchodilator (or evidence there was an active prescription) within 30 days of the event.
MCA would like to partner with our primary care providers to improve the rates of members being dispensed a systemic corticosteroid and bronchodilator after an acute inpatient discharge or ED visit, due to a COPD exacerbation.
Prevention is key!
Tips to help with COPD exacerbations, admission and readmission prevention:
- COPD puts members at risk for contracting Pneumonia. Help prevent serious complications from Pneumonia by considering for those members diagnosed with COPD, the PPSV23.
- Review each patient's COPD action plan with them, ensuring proper understanding of what to do when symptoms worsen or if they experience a flare up.
- Have patients with COPD demonstrate for you how they use their inhalers.
- Provide education on appropriate follow up if an inpatient discharge or ED visit has occurred.
- If appropriate, consider a systemic corticosteroid and bronchodilator after an acute inpatient discharge or ED visit due to a COPD exacerbation, to prevent recurrence of an exacerbation.
Reducing the Risk of Fall
According to the CDC, research has identified many risk factors that contribute to falling. The more risk factors a person has the greater their chances are of falling.
At Mercy Care Advantage HMO SNP we want to improve and maintain the health of our members. Our goal is to reduce the risk of falls in our members 65 years of age and older, particularly those who have had problems with balance, walking or a fall in the past. We would like to you to partner with us to accomplish this goal.
You can help to lower your patient's risk of falling with a two part approach - Discussing Fall Risks and Managing Fall Risks.
- use a fall risk assessment checklist
- focus on those risks that can be changed, such as poor vision or problems with shoes
- assess your patient's readiness to act on your advice
- take action steps to decrease those risks you can influence
For more information and tools available please visit the CDC website at:
Understanding the use of medication reconciliation post discharge (MRP)
Measurement requirements
It is recommended that members 18 years of age and older who were discharged from the hospital, have their discharge medications reconciled with the most recent medication list in the outpatient medical record.
- The appropriate providers conducting the reconciliation include: A prescribing practitioner, clinical pharmacist, or registered nurse.
- The appropriate intake period: On the date of discharge through 30 days after discharge (31 days total).
- The appropriate setting includes: Only documentation in the outpatient medical record meets the intent of the measure, but an outpatient visit is not required.
- The appropriate documentation in the outpatient medical record: Documentation of the current medications with evidence of medication reconciliation and the date when it was performed.
|
Codes to Identify Medication Reconciliation
|
|
Description
|
CPT
|
|
Medication Reconciliation
|
1111F, 99495, 99496
|
Mercy Care is proud to introduce...
Jessica Clemens
Provider Relations Manager
Mercy Care Plan and Mercy Maricopa Integrated Care
Jessica began her career in the behavioral health field in 2003. Since that time, she has acquired experience in direct care, customer service, auditing, provider relations, management, and administration. Throughout her career, Jessica worked with a variety of populations that include: persons with developmental disabilities; general mental health and substance abuse disorders; and the seriously mentally ill before transitioning into the
Provider Relations and Network Administrator roles.
Jessica has been with Mercy Care Plan and Mercy Maricopa since February 2017. Jessica manages all behavioral health groups and the following specialties: Durable Medical Equipment, Infusion, Pain Management, Dermatology and non-participating providers.
Jessica genuinely enjoys the work she does, both with providers and subsequently with members. She is very much looking forward to seeing the benefits our members receive through the integration of healthcare services.
|
|
