Fall 2012 - Intermountain Physician
Transcription
Fall 2012 - Intermountain Physician
provider i n s i g h t inside this issue CLINICS HONORED FOR CARE. . . . . . . 2 PATIENT PERCEPTION OF QUALITY SCORES. . . . . . . . . . . . . . . 4 NEW STAFF . . . . . . . . . . . . . . . . . . . . . . . 5 M-TECH . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 HCPC CODES. . . . . . . . . . . . . . . . . . . . . . 7 If you have questions, suggestions, or success stories you would like to share, e-mail provider.relations@selecthealth.org. TM fall 2012 Clinics Honored For Care SelectHealth® and Intermountain Healthcare® are presenting the Excellence in Healthcare Award to 122 healthcare clinics for their work in 2011. This annual award recognizes independent physician offices as well as those within the Intermountain system for demonstrating exemplary care in managing chronic illnesses. These clinics have achieved high service marks from patients in preventive programs. Honored clinics have rates in the top 10 percent of the scored offices. The award notes achievement in the following areas: asthma care, diabetes care, breast cancer screenings, cervical cancer screenings, colon cancer screenings, childhood immunizations, adolescent immunizations, and customer service. Many clinics received more than one award for outstanding work in multiple areas. “Congratulations to the clinics recognized this year,” said Stephen Barlow, MD, SelectHealth chief medical officer. “Our physicians consistently provide excellent care for their patients, but these awards represent outcomes that exceed local and national standards.” Measurements include how well patients control chronic illnesses, test results meeting recommended levels, percentage of patients who received screenings, and percentage of patients who received immunizations. CLINIC SPOTLIGHT Clinics Honored For Care Intermountain Bountiful Clinic Front Row: Dr. David Horsley, IM; Dr. Douglas Nielsen, Ped; Sun Yong Kim, MA; Dr. Celia Blackburn, FP; Cindy Kaufusi, MA; Terrie Luk, MA; Dr. Tyler Williams, IM Back Row: Dr. Randy Reese, Ped; Dr. Douglas Kasteler, FP; Julie Christensen, MA; Dr. Nedda Hendler, IM; Kris Ericksen, MA; Dr. Scott Beckstead, FP Alpine Medical Group Adolescent Immunization Park City Healthcare Asthma Management Ogden Clinic Skyline Breast Cancer Screening Sandy Family Practice Cervical Cancer Screening Coombs Private Practice Adolescent Immunization Tri City Medical Clinic Pleasant Grove Asthma Management Ogden Women’s Clinic, PC Breast Cancer Screening Taylor Family Practice Cervical Cancer Screening Cottonwood Pediatrics Adolescent Immunization Alta Internal Medicine Breast Cancer Screening River View Medical Clinic Breast Cancer Screening Wade Family Medicine Cervical Cancer Screening Grow Up Great Pediatrics Adolescent Immunization Central Utah Clinic - Provo Breast Cancer Screening Salisbury Internal Medicine Breast Cancer Screening Cottonwood Pediatrics Childhood Immunization Intermountain Holladay Pediatrics Adolescent Immunization City Creek Internal Medicine Breast Cancer Screening Tod L. Berg, MD Breast Cancer Screening Intermountain Memorial Clinic Adolescent Immunization Cope Family Medicine Breast Cancer Screening Grandview Family Medicine Childhood Immunization City Creek Internal Medicine Cervical Cancer Screening Granger Medical Clinic Childhood Immunization Intermountain North Valley Pediatrics Adolescent Immunization Intermountain Avenues Internal Medicine Breast Cancer Screening Grandview Family Medicine Cervical Cancer Screening Granger Medical Clinic - Riverton Childhood Immunization Intermountain Southridge Pediatrics Adolescent Immunization Pediatric Care of Ogden Adolescent Immunization Southpoint Pediatrics Adolescent Immunization Granger Medical Clinic Pediatric Asthma Mangement Intermountain Avenues Internal Medicine Asthma Management Intermountain Holladay Pediatrics Asthma Management Intermountain Medical Tower Family Practice Asthma Management Intermountain South Ogden Clinic Asthma Management 2 Intermountain Budge Clinic Breast Cancer Screening Intermountain Gorang Family Practice Breast Cancer Screening Intermountain Obstetrics & Gynecology Specialists Breast Cancer Screening Herriman Family Practice Cervical Cancer Screening Intermountain Bountiful Clinic Cervical Cancer Screening Intermountain Canyon View Family Practice Cervical Cancer Screening Intermountain Bountiful Clinic Childhood Immunization Intermountain Bryner Clinic Childhood Immunization Intermountain Layton Clinic Childhood Immunization Intermountain Syracuse Clinic Cervical Cancer Screening Intermountain Sandy Clinic Childhood Immunization Jordan Family Health Cervical Cancer Screening Intermountain Southridge Pediatrics Childhood Immunization Jordan River Family Medicine Cervical Cancer Screening Ogden Clinic Canyon View Childhood Immunization Ogden Clinic Mountain View Cervical Cancer Screening Ogden Clinic Harrison Blvd. Childhood Immunization Jordan Family Health Breast Cancer Screening Ogden Clinic Skyline Cervical Cancer Screening Pediatric Care of Provo Childhood Immunization McKay-Dee Porter Family Practice Breast Cancer Screening Olympus Clinic Cervical Cancer Screening Southpoint Pediatrics Childhood Immunization Intermountain River Road Internal Medicine Breast Cancer Screening Intermountain Salt Lake Clinic OB Breast Cancer Screening Intermountain Utah Valley Internal Medicine Clinic Breast Cancer Screening provider INSIGHT FA L L 2 0 1 2 Southwest Children’s Clinic Childhood Immunization Mountain Utah Family Medicine Customer Service Family Practice Treehouse Pediatrics and Family Care Childhood Immunization Sandy Family Practice Customer Service Family Practice Utah Valley Pediatrics American Fork Childhood Immunization Wade Family Medicine Customer Service Family Practice Intermountain Central Orem Clinic OB Chlamydia Screening Dixie Primary Care Customer Service Internal Medicine Intermountain Wasatch OB/GYN - McKay-Dee Chlamydia Screening Intermountain Wasatch OB/GYN - North Ogden Chlamydia Screening Valley OB/GYN - Provo Chlamydia Screening Alta Internal Medicine Colon Cancer Screening Christian Private Practice Colon Cancer Screening City Creek Internal Medicine Colon Cancer Screening Intermountain Avenues Internal Medicine Colon Cancer Screening Intermountain Bryner Clinic Colon Cancer Screening Intermountain Budge Clinic Colon Cancer Screening Intermountain Canyon View Family Practice Colon Cancer Screening Intermountain Cottonwood Internal Medicine Colon Cancer Screening Intermountain Gorang Family Practice Colon Cancer Screening Intermountain McKay-Dee Internal Medicine Clinic Colon Cancer Screening Intermountain American Fork Internal Medicine Customer Service Internal Medicine Intermountain Bountiful Clinic - Internal Medicine Customer Service Internal Medicine Intermountain Women’s Health Specialists Customer Service OB/GYN Robert W. Later, MD Customer Service OB/GYN Russell A. Smith, MD Customer Service OB/GYN Intermountain Holladay Pediatrics North Customer Service Pediatrics Intermountain Holladay Pediatrics Customer Service Pediatrics John Shakula Pediatrics Customer Service Pediatrics Kelly Pediatrics Customer Service Pediatrics Lofgren Pediatrics Customer Service Pediatrics Parkway Pediatrics Customer Service Pediatrics Pediatric Care of Ogden Customer Service Pediatrics Rose Pediatrics Customer Service Pediatrics Central Utah Clinic - Provo Diabetes Management Intermountain Utah Valley Internal Medicine Clinic Colon Cancer Screening Intermountain Avenues Internal Medicine Diabetes Management Jordan Family Health Colon Cancer Screening Intermountain Bountiful Clinic Diabetes Management Ogden Clinic Skyline Colon Cancer Screening Intermountain Budge Clinic Diabetes Management Olympus Clinic Colon Cancer Screening Intermountain Central Orem Clinic Diabetes Management Sandy Family Practice Colon Cancer Screening Intermountain Cottonwood Family Practice Diabetes Management Valley Family Medicine Colon Cancer Screening Alpine Family Medicine Customer Service Family Practice Intermountain Cottonwood Internal Medicine Diabetes Management Coalville Health Clinic Customer Service Family Practice Intermountain Holladay Clinic Diabetes Management Intermountain Bear River Clinic Customer Service Family Practice Intermountain North Canyon Family Practice Diabetes Management Intermountain Gorang Family Practice Customer Service Family Practice SelectHealth has formed a unique strategic alliance with St. Luke’s Health System, Idaho’s largest and only locally governed healthcare system, to offer a new approach to health insurance benefits to residents of Idaho. This new alliance is committed to exceptional health care and exceptional health insurance for Idahoans. The alliance will be supported by BrightPath, an extensive network of physicians and healthcare facilities that has been developed over a number of years by St. Luke’s and other leading providers to provide a comprehensive healthcare delivery system in Idaho. Like SelectHealth, St. Luke’s is a nonprofit organization that gives back to the community. Both organizations share a community pledge for improving healthcare, providing superior service, and actively supporting health and wellness education initiatives. To provide local service to members, providers, and the community, SelectHealth will establish a local office in Boise. Intermountain North Ogden Clinic Diabetes Management Intermountain Springville Clinic Customer Service Family Practice Intermountain South Ogden Clinic Diabetes Management Intermountain Syracuse Clinic Customer Service Family Practice Jordan Family Health Diabetes Management Isaacson Family Practice Customer Service Family Practice Olympus Clinic Diabetes Management s e le c th ealt h .org SelectHealth Announces New Affiliation with Idaho-based St. Luke’s Health SyStem 3 Patient Perception of Quality Scores The annual Patient Perception of Quality was completed in 2011. SelectHealth attempted to collect surveys on more than 250 primary care, OB/GYN, and endocrinology clinics. Questions on the survey focused on the patient’s experience with physicians, nursing staff, reception staff, cleanliness, waiting time, and availability of appointments. Results for clinics with a sufficient number of completed surveys are available at selecthealthphysician.org. Copies were delivered to clinc managers as well. Log in to selecthealthphysician.org to review your clinc’s results. Click on “Clinical Reports,” “SelectHealth,” “Primary Care” or “Women and Newborn,” and “SelectHealth Satisfaction and Performance Rating Reports.” After choosing your clinic and a reporting period in 2011, click on “satisfaction” at the top of the page to access the results of these surveys. Members can review results for primary care and OB/GYN clinics with more than 30 completed surveys on selecthealth.org. Scores for primary care physicians have generally improved over the past three years. Overall, internal medicine practices have shown improvement for patient interaction and nursing staff for the past four years. Scores for family practice clinics have increased in the categories “waiting time” and “experience calling the clinc.” Pediatric clinics have improved in all categories. Patient scores for OB/GYN clinics were slightly lower in 2010, but improvements were made in all categories in 2011. We hope that these positive trends continue and recognize that it takes effort. SelectHealth offers a one-day class called “Science of Superior Service.” If you are interested in learning more or enrolling, call Staci Dearden at 801-442-7158. There is a $30.00 fee for each attendee. We appreciate all that you do at your clinics to ensure an excellent experience for our members. National Drug Codes As of June 1, 2012, claims submitted without a valid National Drug Code (NDC) are rejected by our claims processing system. The NDC is useful because it is a universal identifier for human drugs and biologics. The Healthcare Common Procedure Coding System (HCPCS) only specifies the chemical name of a drug and can be used to represent multiple NDCs for several drug therapies. Many healthcare providers have already made changes to their procedures to collect and submit NDC data to meet billing requirements of some federal and/or state-funded programs. This data helps manage injectable and specialty drug benefits for SelectHealth. This requirement does not apply to immunizations or services provided as part of an inpatient stay. In 2007, we asked providers to begin submitting NDCs for injectable and specialty medications (in addition to the HCPCS code). We appreciate your efforts to provide this information. Currently, approximately 70 percent of all claims submitted for injectable and specialty medications include an NDC number. If you need assistance to meet these requirements, please call the SelectHealth EDI department at 801-442-5442. If you have general questions related to this requirement, contact your Provider Relations representative. 4 provider INSIGHT FA L L 2 0 1 2 Tom Wahlen has recently joined SelectHealth as the director of Provider Relations. Previously, Tom served as senior manager and negotiation lead in the Payer Contracting department at Intermountain Healthcare. Tom holds a Master of Business Administration degree from Westminster College and earned a Bachelor’s degree in Business/Public Relations from the University of Utah. Health Services Management Team The update to the 5010 versions of EDI transactions is now complete. If your office is having any difficulties with this transition, please contact our EDI Team at (801) 442-5442 or edi@selecthealth.org. Get Involved! There are many standards being created at a national and state level that may have an impact to your office. The Utah Health Information Network (UHIN) provides a way for these community-based standards to be created and maintained. We share feedback to UHIN to share with national organizations that create standards. For Christine Lake, Chris Chytraus, Lynanne Gibbons, Robbie Morris more information, visit UHIN.org. Christine Lake has held clinical positions in hospital and outpatient surgery. She has worked as a region nurse consultant within the Intermountain Medical Group and most recently headed up the implementation of the SelectHealth physician/clinic public reporting and the Primary Care Physician Incentive program. Chris Chytraus joined SelectHealth in 2011 to oversee care management for the Medicaid program. Chris was a manager for the Utah Department of Health Fostering Healthy Children Program, where she oversaw administrative care management for children in Utah’s foster care system. Chris received her nursing degree from Westminster College and her Certified Public Manager certification from the state of Utah. Lynanne Gibbons held nursing positions with Intermountain Healthcare for 24 years and has been at SelectHealth for seven years. Lynanne graduated from Brigham Young University with a bachelors degree in nursing. Robbie Morris has held positions at SelectHealth for 11 years. She currently oversees the coordination of care management services for new product lines. Robbie received a bachelors degree in nursing from Brigham Young University. She has over 38 years of nursing and management experience. s e le c th ealt h .org 5 EDI UPDATES New Staff at SelectHealth m -t E C H medical technology assessment (M-Tech) M-Tech is SelectHealth’s formal process for reviewing emerging healthcare technologies (procedures, devices, tests, and biologics) for the purpose of establishing covered benefits. Existing technologies are, at times, also examined through this process. Following is a list of recently reviewed technologies and committee recommendations: Technology Date Reviewed* Committee Recommendations Continuous Glucose Monitoring Systems (CGMS) 01/24/12 Continue to cover in limited circumstances. Criteria for coverage have been modified. See Medical Policy #223. Intraoperative Stereotactic Image Guidance for Lumbar Spinal Arthrodesis 01/24/12 Cover. Current evidence, though limited, supports that stereotactic intraoperative image guidance in lumbar spine surgery improves health outcomes. See Medical Policy #502. Percutaneous and Endobronchial Brachytherapy for Lung Tumors 01/24/12 Cover in limited circumstances. Current evidence supports percutaneous endobronchial brachytherapy for the treatment of lung cancer to be safe and effective. See Medical Policy #501. Bicompartmental Partial Knee Replacement/Resurfacing 01/24/12 Deny as unproven and not medically necessary. Current evidence remains limited as to the efficacy, safety, and durability related to bicompartmental knee replacement/resurfacing. See Medical Policy #431. Total Hip Resurfacing Age Limit Restriction 01/24/12 Raise upper age limit to 60 in men, continue age limit of 55 for women. Current evidence supports total hip resurfacing for men up to age 60 to have equivalent health outcomes to standard total hip arthroplasty. Evidence beyond age 60 in men is insufficient to draw conclusions. Evidence in women older than age 55 demonstrates inferior outcomes to total hip arthroplasty. See Medical Policy #254. Heart Transplant Age Limit Restrictions 01/24/12 Cover in limited circumstances. Current evidence demonstrates no statistically significant difference in survival or complications for patients undergoing heart transplantation between age 60 and 70. Beyond age 70 the current evidence is insufficient to reach any firm conclusions as to the equivalence of outcomes in this population. See Medical Policy #125. Transcutaneous Electrical Modulation Pain Reprocessing (Calmare®/Calmar™) 03/13/12 Deny as investigational. Current evidence is inadequate to determine the efficacy, safety, durability, or appropriate therapeutic protocols for transcutaneous electrical modulation pain reprocessing therapy. See Medical Policy #503. John Cunningham Virus (JCV) Testing for The Assessment of Progressive Multifocal Leukoencephalopathy (PML) Risk 03/13/12 Cover in limited circumstances. Current literature supports use of the STRATIFY JCV Assay in patients receiving immunosuppressive therapies to stratify risk of PML. See Medical Policy #504. Shoulder Resurfacing 03/13/12 Deny as investigational. Current evidence suggests shoulder resurfacing has a greater number of complications and higher revision rate than the current standard of total shoulder arthroplasty for the same indications. See Medical Policy #505.1. Axial Lumbar Interbody Fusion (AxiaLIF®) 04/24/12 Deny as experimental/investigational. Evidence on the safety, efficacy, and durability beyond two years has not been published for review. See Medical Policy #450. Endometrial Cryoablation for Menorrhagia 04/24/12 Cover. Current evidence, though limited, demonstrates endometrial cryoablation to be a safe and effective technique in the treatment of menorrhagia equal to alternative therapies. See Medical Policy #329. Intravascular Ultrasound (IVUS) for Peripheral Vascular Disease (PVD) 04/24/12 Cover. Current literature demonstrates improved stent placement and fewer restenoses with IVUS in PVD. See Medical Policy #447. Magnetic Resonance (MR) Neurography 04/24/12 Deny as investigational. Current evidence is limited and has not yet proven clinical validity for many conditions, and the clinical utility has not been defined. See Medical Policy #491. MAKOplasty® Hip Replacement for Osteoarthritis 06/12/12 Deny as investigational and not medically necessary. Current evidence has not demonstrated clinical utility of this method of total hip arthroplasty as it compares to standard hip arthroplasty. See Medical Policy #236. Cooling Garments for the Management of Multiple Sclerosis (MS) 06/12/12 Deny as investigational. Current evidence has not demonstrated significant impact of these garments on the health outcomes in individuals with MS compared to nonmedical items. See Medical Policy #345. Transcatheter Aortic Valve Replacement (TAVR)/Implant (TAVI) for Aortic Stenosis 06/12/12 Cover in limited circumstances consistent with FDA-approved indications and at designated facilities only. See Medical Policy #444. *“Date reviewed” does not necessarily reflect the policy implementation date. See Medical Policies for details. If you have questions regarding coverage of these or any other technologies or procedures, or if you would like SelectHealth to consider coverage for an emerging technology, please e-mail mtech@selecthealth.org or call Ken Schaecher, MD, FACP, M-Tech committee chairman, at 801-442-7927. All SelectHealth medical policies and technology assessments can be viewed on selecthealth.org. Click on the “Provider” tab (upper right corner), enter your login information, and then click on “Policies and Procedures” (left side of page). 6 provider INSIGHT FA L L 2 0 1 2 The HCPC level I and II codes became effective January 1, 2012. Please refer to the latest edition of your coding reference books or software updates for current information regarding these code changes. If you have purchased books, be aware that there are already corrections being made. Please refer to the following websites to get the lastest information and corrections*: ama-assn.org/ama/pub/category/3896.html cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_ summarytables.asp#TopOfPage cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list. asp#TopOfPage Preventive Care Tips As a result of the Affordable Care Act (ACA), the majority of plans offered by SelectHealth offer preventive care services covered at 100 percent. SelectHealth defines preventive care as routine healthcare that includes screenings, checkups, and patient counseling to prevent illness, disease, or other health problems not currently known to exist in the person, or in the case of immunizations, to prevent the development of disease. As members continue to use this benefit, there are a few points that can make claims submission easier. 2.365 Days. Prior to January 1, 2011, preventive services were covered once per calendar year. However, effective the beginning of this year, members are only eligible for preventive services every 365 days. 3. Lab Work. Laboratory work billed in conjunction with a routine exam may be billed as preventive if the patient has not been diagnosed with a related condition in the past. In these situations, it is important that the correct diagnosis is sent to the lab. If the lab work is not billed with a preventive diagnosis, it will apply to a different benefit and may be subject to a copay, deductible, and/or coinsurance. For example, it is common to see CPT 80050 billed with an existing diagnosis, which triggers the outpatient minor diagnostic testing benefit instead of the preventive benefit. For additional information regarding preventive coding polices and services, please visit selecthealthphysician.org. 1.Existing Conditions. If the purpose of the patient’s visit is to evaluate and manage an existing condition (i.e., treating high blood pressure to prevent a heart attack or stroke), it is not considered a preventive service. However, if a member has an existing condition, they are still eligible for a preventive visit for their general well-being. In these situations, it is appropriate to bill using a preventive diagnosis code instead of a code for an existing diagnosis. *SelectHealth may link to other websites for your convenience. SelectHealth does not expressly or implicitly recommend or endorse the views, opinions, specific services, or products referenced at other websites linked to the SelectHealth site, unless explicitly stated. SelectHealth disclaims any responsibility for the content, information or the privacy and security policies contained on other websites, and does not exert any editorial or other control over those sites. s e le c th ealt h .org 7 Coding Corner 2012 Code Changes P.O. Box 30192 • Salt Lake City, Utah 84130 Nonprofit Org. U.S. Postage PAID Salt Lake City, UT Permit No. 4547 The information that is contained in this newsletter does indicate whether a treatment is subject to insurance benefits. If a member has questions about benefit coverage, please refer him or her to Member Services at 801-442-5038 (Salt Lake area) or 800-538-5038. © 2009-2012 SelectHealth. All rights reserved. 1844 09/12 Provider Insight is a trademark of SelectHealth. Tamara Sheffield, MD, MPA, MPH, and Shannon Seymour, RN will present current information about immunizations and influenza. The summit is free, but seating is limited. Visit selecthealthphysician.org to register today! Immunization Summits