Partnership HealthPlan of California

Transcription

1 Partnership HealthPlan of California Provider Advisory Group Lunch: 12:00 Meeting 12:30 Mission Statement: The Provider Advisory Group of the Partnership HealthPlan of California will act as a liaison between the Health Care Services providers and the HealthPlan. The Group will make recommendations and provide a forum for providers to have ongoing input into the activities of the HealthPlan. January 22, 2016 Meeting Agenda 1. Standing Agenda Items 1.1. Welcome and Introductions Chairperson Jacqueline Wood, Physician Relations Specialist, St. Joseph 1.2. Approval of Minutes 1.3. Review of Agenda 2. Presentations 2.1. Cervical Cancer Presentation Presenter: Dr. Bob G. Field, Annadel Medical Group Keypoints: PAP smear changes and how to manage HPV 3. Old Business 3.1 None 4. New Business PHC Update & Report from Physician's Advisory Committee Robert Moore, MD, MPH, Medical Director 4.2. Report from the Claims Department Rebecca Mannella, Claims Resolution Manager 4.3. Report from the Consumer Advisory Committee Maria Cabrera, Member Services Supervisor 4.4. Report from Provider Relations PR Staff 4.5. echdp and BHT for Autism Update Gwen Bassett, Provider Education Specialist 4.6. Provider Topics of Interest: All Attendees 4.7. Upcoming Events, Health Fairs and Trainings: All Attendees Next PAG Meeting: Friday, March 18, 2016 in Solano County Meeting Adjourned

2 Committee: Provider Advisory Group (PAG) PARTNERSHIP HEALTHPLAN OF CALIFORNIA MEETING MINUTES Date/Time: November 20, :30 p.m. 1:30p.m. Members Present: PHC Staff Present: Fairfield: Bill Byrnes, Kathy DeMaggio, Jacqueline Wood, Katie Ash, Aimee Stacey, Tracy Bowers, Nalah Yip, Irene Jimenez, Martha Arenal, Jeff Taylor, DC, Tara Sharifzadeh, Amye Wirth, Maggie Galacia-Mendoza, Elizabeth Diaz, Katrina Nguyen, Grace Salud, Jana Ralston, Bridget Oduni, Santa Rosa: Claudia Nola, Anita Lopez, Sally Giovinco Redding: David Canton, Jeff Bosworth, Susie Foster, Candy Stockton, Elaine Flores, Eureka: Sarah Foster, Amber Bowlds, Velina Godoy Fairfield: Liz Gibboney, Mark Netherda, MD, Kevin Spencer, Heather Brandeburg, Joan Russell, Rebecca Mannella, Teresa Duch, Necole Montgomery, Ledra Guillory, Carol Parker Santa Rosa: Stephanie Phipps, Judy Paul, Melissa Perez Redding: Michael Vovakes, MD, Kelley Sewell, Sharon McFarlin, Tara Brumley, Kim Bergeron, Nai Chadderdon, Andrew Sager, Jane Lyon, Megan Shelton Eureka: Jeff Ribordy, MD, Jennifer Chancellor, Michelle Swift AGENDA ITEM DISCUSSION/CONCLUSIONS RECOMMENDATIONS / ACTION 1. Standing Agenda Items 1.1. Welcome and Introductions 1.2. Approval of Minutes 1.3. Review of Agenda 1. None Meeting called to order by Chairperson Bill Byrnes, Clinic Manager, Community Medical Centers. Bill welcomed participants from Santa Rosa, Redding, and Eureka via video conference Minutes from 9/18/2015 reviewed and approved Agenda was reviewed and approved. 2. Presentations 2. Kathy DeMaggio, Registered Dietician and Diabetes Educator gave a presentation to the group on Diabetes Intervention. The presentation illustrated how obesity, as well as poor eating habits and lack of exercise contribute to Type II Diabetes. Losing weight, eating healthy, and increasing activity level can have a huge impact on reducing the risk of Type II Diabetes. Providers are encouraged to create systems in clinic to screen patients, and talk to Approved Approved. 2. Presented as information only DATE RESOLVED

3 at-risk patients about diet, exercise, and other options. 3. Old Business 3.1. None. 3. Presented as information only. 4. New Business 4.1. PHC Updates 4.1. Liz Gibboney, Chief Executive Officer at Partnership HealthPlan of California presented updates on recent activities at PHC. There may be cuts to Medi-Cal in the proposed State budget because Managed Care Organization Tax issues have not been resolved. The DHCS/DMHC Joint Medical Audit in January includes visits to provider offices. PHC has opened a second office in Redding, making a total of six offices. We have a Provider Recruitment Fund which can help get new providers on board by providing incentives. Strategic Use of Resources projects include medical equipment grants to assist providers in caring for Seniors & Persons with Disabilities (SPD), and funds to improve access to both medical and mental healthcare for our members. 4. Presented as information only Report from Physicians Advisory Committee 4.2. Mark Netherda, MD, Regional Medical Director updated the group on current events from the Physicians Advisory Committee (PAC). PHC is currently sponsoring a pilot program in four counties to increase member access to palliative care. The Partners in Palliative Care program will help us implement upcoming legislation which extends palliative care to Medi-Cal beneficiaries. Beginning January 1, 2016, PHC will offer financial incentives to support and improve quality of long-term care to our members. The Social Determinants of Health Program at PHC works with key partners in the community to improve social determinants of health. PHC's Diabetic Retinopathy Screening Quality Initiative seeks to reduce diabetesassociated vision loss through expanded Primary Care retinopathy screening by providing equipment and training to sites with high populations of at-risk members News from Claims 4.3. Teresa Duch, Claims Coder presented Tips for Billing in ICD-10. Resources include and the Medi-Cal Manual under ICD10 at Report from Provider Relations Necole Montgomery, Provider Relations Lead Senior Rep II informed the group that PR conducts quarterly surveys, and to expect survey calls in the near future.

4 5. Provider Questions, Topics of Interest, Announcements, and Upcoming Events Joan Russell, Manager of Provider Education presented information on the new Online Services Platform Phase I of the site redesign was implemented on July 1, New enhancements include increased ability for staff at provider sites to create and administer their user accounts, as well as improved search capabilities. Provider staff are encouraged to attend ongoing training webinars designed to assist with the transition. 5. None 5. Presented as information only. Meeting Adjourned Next Scheduled meeting: January 22, 2016 in Sonoma County. 1/22/2016 PHC Provider Advisory Group November 20, 2015 in Solano County Minutes prepared and submitted by: Carol Parker 1/8/2016 Bill Byrnes Chairperson Bill Byrnes, Clinic Manager, Community Medical Centers Date

5 ICD-10 Frequently Asked Questions The purpose of this FAQ is to provide answers to commonly asked questions in regards to the implementation of ICD-10. When will the use of ICD-10 Diagnosis Codes be implemented? * Implementation of the use of ICD-10 diagnosis codes is October 1, Will there be a grace period for providers that are not ready? * No, PHC will not have a grace period for this implementation. 10/1/15 is the final date. Is PHC ready to start accepting ICD-10 diagnosis codes? * Yes, PHC s ICD-10 workgroup has tested this thoroughly and are ready to start accepting ICD-10 s. Will PHC be training providers on how to use ICD-10 s? * No ICD-10 was mandated by the Federal Government, so PHC will not be training on ICD-10 s.

6 My DOS is 9/25/15, but I am sending my claim in on 11/30/15. Which set of diagnosis codes do I use? * DOS prior to 10/1/15 must be billed with the ICD-9 code set. DOS on or after 10/1/15 must be billed with the ICD-10 code set. Hospital Inpatient stay with DOS 9/25 10/5/15. How should we bill? * Providers that get paid on a per diem basis may split bill a claim that crosses over the months with the correct DX set. * If a provider that gets paid on a per diem basis does not split bill, and the start date is in September, the provider needs to bill with ICD-9 diagnosis codes. * If the provider is non-contracted with PHC and is using DRG billing rules, then the provider does not need to split their claim. The discharge diagnosis will determine the entire payment for stay. If discharge is after 10/1/15, then ICD-10 will be required. If a provider sends in a TAR with ICD-9 codes and it runs through 10/1/15, is there a need to change the DX codes to ICD-10? * No, there is no need to change the DX code to ICD-10 or to send a new TAR. TAR s are not DX specific.

7 PROVIDER BULLETIN Behavior Health Treatment: Children with Autism Spectrum Disorder Volume 16-3 February 2016 WHAT S NEW Effective 2/1/2016, PHC assumes responsibility for the provision of Behavior Health Treatment (BHT) services for children ages 3-21 diagnosed with Autism Spectrum Disorder (ASD). We worked collaboratively with DHCS, DDs and the RCs on this transition. We estimate more than 600 children will transition from the Regional Centers. An eraf is not required for BHT services. WHAT S NEXT Contact PHC Care Coordination Department if your patient receives treatment for BHT services, or you suspect your patient meets the diagnostic criteria for ASD. Family members can also call us. Our phone is (800) PHC requires a Diagnostic Evaluation; and Behavior Assessment and Treatment Plan Development. We are actively reaching out to the BHT Provider Network regarding authorization and billing requirements. DHCS supplies us with member information. We are reaching out to each identified child to assist with the transition of care. NOTES Reference policy MPUP3126 in our Provider Manual on our website for more informaiton. Refer children under the age of three to the Regional Center for services. Many children will continue to receive services from the Regional Center. PHC is responsible for BHT services that the State defines as medically necessary. Eureka Fairfield Redding Santa Rosa (707)