A Reminder for You...When Calling Member Services

Having the member's ID Number readily available when calling Member Services can significantly enhance the efficiency of addressing your inquiry. This helps our representatives access the account details swiftly, ensuring that they have the most accurate and relevant information at their fingertips. With the member's ID number in hand, you actively contribute to a seamless and effective customer service experience, ultimately leading to a quicker and more satisfactory resolution of your inquiry.

Medicare Coverage for Mental Health Counselors and Marriage Family Therapists, Effective 1/1/24

Per section 4121 of the Consolidated Appropriations Act, 2023, services furnished and directly billed by Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) will be covered by Part B of the Medicare program, effective January 1, 2024. This expanded focus on mental and behavioral health care includes coverage under our MAHP Medicare Cost Plan.

The FAQs recently released by Centers for Medicare & Medicaid Services (CMS), which outline the definitions, requirements, and important enrollment details as well as instructions for this new Medicare coverage can be found here. According to CMS, MFTs and MHCs can submit enrollment applications to Medicare after the 2024 Physician Fee Schedule Final Rule is published, usually around November 1, 2023.

In order to start covering these services for Medicare members, MAHP will need:

• The MHC/MFT’s Medicare Provider number
• Effective date with Medicare
• Confirmation that the provider has opted into Medicare

This information may be sent via email to mahpcredentialing@mahealthcare.com or call 563-584-4861.

Making a Strong Flu Vaccine Recommendation

As fall meets winter, the importance of flu vaccination remains a priority for all ages within the patient population. Many patients do not visit their primary care provider during the months of September-March, when flu shots are typically administered. Often, patients overlook flu vaccines when appointments have not been previously established during this timeframe. Whenever possible, these individuals should be contacted during specialty care visits and directed to facilities that are most convenient for them, thus increasing the chances of compliance. Creating an opportunity for vaccination administration is essential to promoting optimal health during the cold and flu season while also preventing unnecessary illnesses. Provider education can help patients understand why vaccination is important. Centers for Disease Control and Prevention recommends using the SHARE method to make a strong vaccine recommendation and provide important information to help patients make informed decisions:

SHARE the reasons why an influenza vaccine is right for the patient given his or her age, health status, lifestyle, occupation, or other risk factors.

HIGHLIGHT positive experiences with influenza vaccines (personal or in your practice), as appropriate, to reinforce the benefits and strengthen confidence in influenza vaccination.

ADDRESS patient questions and any concerns about influenza vaccines, including side effects, safety, and vaccine effectiveness in plain and understandable language. Acknowledge that while people who get an influenza vaccine may still get sick, there are studies that show that illness may be less severe.

REMIND patients that influenza vaccines help protect them and their loved ones from serious influenza illness and complications that can result in hospitalization or even death for some people.

EXPLAIN the potential costs of getting influenza, including potential serious health effects for the patient, time lost (such as missing work or family obligations), financial costs, and potentially spreading influenza to more vulnerable family or friends.

Provider to patient contact and education remains two of the most important influences on flu vaccine compliance this season.

To build a healthier America for all, we must confront the systems and policies that have resulted in the generational injustice that has given rise to health inequities. Achieving health equity requires focused and ongoing societal efforts to address historical and contemporary injustices; overcoming economic, social, and other obstacles to best health and healthcare; and eliminating preventable health disparities.

These closely-related concepts play a significant role in determining an individual's overall health and well-being.

Health Equity

Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences. These consequences include powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care. Achieving health equity is a fundamental goal of public health and healthcare systems worldwide.

Social Determinants of Health (SDOH)

SDOH are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems. These determinants encompass a wide range of factors, including:

• Economic Factors: Income, employment, and socioeconomic status
• Physical Environment: Housing, access to clean air and water, and neighborhood safety
• Education: Literacy, access to quality education, and knowledge about healthy behaviors
• Social Support Networks: Family, friends, and community relationships
• Healthcare Access: Access to medical care, preventive services, and health insurance
• Culture and Beliefs: Cultural norms, beliefs, and practices that influence health behaviors
• Health Behaviors: Diet, exercise, substance use, and other lifestyle choices

Health Disparity

Health disparity is a health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

The interplay of the above social determinants can significantly impact health outcomes. Disparities in social determinants often lead to health inequalities and inequities. People with limited access to resources and opportunities are more likely to face health challenges and poorer outcomes. Additionally, SDOH factors are approximately 80% of an individual’s healthcare outcomes, leaving 20% of healthcare outcomes attributed to the actual medical care from health systems.

Efforts to address health equity and SDOH involve a combination of public policies, healthcare interventions, and community-based initiatives. Some strategies include:

• Poverty Reduction: Efforts to alleviate poverty can directly impact several factors, such as income, education, and access to quality housing.
• Healthcare Access: Ensuring access to affordable healthcare and preventive services is crucial for improving health equity.
• Education and Health Literacy: Promoting education and health literacy can empower individuals to make informed choices about their health.
• Community-Based Interventions: Community programs that address issues like housing, food security, and social support can have a significant impact on SDOH.
• Cultural Awareness and Humility: Healthcare providers need to have an awareness of, query, and respect the cultural beliefs and practices of their patients to provide equitable care.

Addressing health equity and SDOH is essential for achieving better overall health outcomes for all individuals, reducing healthcare disparities, and creating a more just and equitable society. Many public health initiatives and healthcare policies now focus on these concepts to improve the health and well-being of communities. The Social Determinants of Health Screening Survey that can be referenced and queried with patients to help address those areas.

References:

• Health Equity Guiding Principles for Inclusive Communication
• Cultural Humility: treating the patient, not the illness

Chronic Kidney Disease: Documentation and Coding 

Chronic Kidney Disease (CKD) is a condition characterized by a gradual loss of kidney function over time, as defined by the National Kidney Foundation. Medically, this condition is identified by various clinical indicators including lab and other diagnostic testing.

The ICD-10-CM Official Guidelines for Coding and Reporting classifies CKD based on severity. The severity of CKD is designated by stages 1-5. Stage 2, code N18.2, equates to mild CKD; stage 3, codes N18.30-N18.32, equate to moderate CKD; and stage 4, code N18.4, equates to severe CKD. Code N18.6, End Stage Renal Disease (ESRD), is assigned when the provider has documented ESRD.

If both a stage of CKD and ESRD are present, code N18.6 for ESRD should be assigned. If the patient is dependent on dialysis for ESRD, code Z99.2, Dependence on Dialysis, should also be assigned in addition to code N18.6.

Documentation to support CKD should include specific lab values (such as a Glomerular Filtration Rate or GFR) and presence of current symptoms related to CKD, such as changes in urine output and edema. Be sure to document the specific STAGE of CKD. Be sure to also document any causal relationship that may exist between CKD and other chronic conditions such as Diabetes Mellitus, Hypertension, Anemia, and Heart Disease. Last but not least, be certain to document a current treatment plan to include medications, dietary recommendations, and/or referrals made.

Reference:

• ICD-10-CM Official Guidelines for Coding and Reporting FY2024-Updated 10/1/23, Chapter 14: Diseases of the Genitourinary System (N00-N99), pages 60-61.

Online Information and Resources

Medical Associates Health Plans participating providers, click here.

Health Choices participating providers, click here.

Live360 Health Plan participating providers, click here.

Be Sure to Utilize our Online Portal!

Our secure health portals are wonderful online tools that will save you time! Plus, you can access them 24/7. You have the option to ask questions, review eligibility, review claims that you have submitted, review authorization requests that you have submitted, look at the member subscriber agreement and schedule of benefits to verify coverage. You can also enter CPT/HCPCS codes to see if authorization is needed. 

If you have not yet signed up for this time-saving service, you will need your federal tax ID number to create an account. If you have any questions, please e-mail Member Services.

For Your Reference:

Information related to MAHP's quality improvement plan, case management services, disease management services, member rights, communications, appeals process, after-hours assistance, accreditation/awards, and privacy/confidentiality may be viewed at www.mahealthplans.com. Persons without access to the internet may request paper copies by contacting MAHP at 1-800-747-8900 or 563-556-8070. Please ask to speak with a member of the QI team for assistance.