Archive for June, 2017

Medicaid Changes – Effective July 1 – Check Patient’s Insurance

Dear Providers:

 
Beginning July 1, 2017, the Georgia Families® program will provide Members a choice of four Care Management Organizations (CMOs): Amerigroup, CareSource, Peach State Health Plan, and WellCare. Georgia Families® Members were given the opportunity to select a CMO during the Open Enrollment process which took place during the month of March 2017. Some Members who did not make affirmative selections were auto-assigned to a CMO. During the choice change period of July 1, 2017 through September 30, 2017, all Members will have a one-time opportunity to change their assigned CMO without cause. The change will become effective on the first day of the month after the change is requested. In order to ensure a smooth transition and that all Members have access to care, each CMO has implemented Transition of Care processes which include the following:

Existing/Open Prior Authorizations:

 
If you are rendering services to a Member who has a newly assigned CMO effective July 1, 2017, the newly assigned CMO will honor any current/open Prior Authorizations for forty-five (45) days beginning on July 1, 2017 through August 14, 2017. This applies to in-network and out-of-network (non-par) Providers. Thus, if you are rendering services to a Member who has a newly-assigned CMO, and you are not contracted with the newly-assigned CMO, the newly-assigned CMO will honor any current/open Prior Authorizations for forty-five (45) days beginning on July I, 2017 through August 14, 2017. If the Member requires services beyond August 14, 2017, Providers must contact the Member’s new CMO to obtain authorization to continue services. Providers will be required to follow the new CMO’s prior authorization process for any continued services the Member needs.

New Requests for Prior Authorization (i.e., requests submitted on or after July 1, 2017):

Providers will be required to submit new requests for Prior Authorization based upon the applicable CMO’s guidelines. This applies to in-network and out-of-network (non-par) Providers. Prior authorization decisions for non-urgent services will be made within three (3) business days. Expedited service authorization decisions will be made within twenty-four (24) hours.

Pharmacy-Related Prior Authorizations:

Each CMO will honor prescriptions ordered/issued prior to July 1, 2017. All current prescriptions (including medication step therapy) will be transitioned and honored by the new CMO for a period of forty-five (45) days, beginning on July 1, 2017 and ending on August 14, 2017. This is part of the Transition of Care process. Claims Reimbursement for Office Visits and Sick Visits for Out-of-Network Providers (Non-Par)

Providers:

If you are rendering services to a Member who has a newly-assigned CMO effective July 1, 2017, and you are an out-of-network Provider, you may submit claims for reimbursement for office-based and sick visits rendered to Georgia Families® Members and Planning for Healthy Babies® enrollees without an authorization. Claims may be submitted to Amerigroup, CareSource, Peach State Health Plan, and WellCare by out-of-network Providers for services provided from July 1, 2017 through August 14, 2017. In all instances timely filing requirements must be met.

Please Note: Effective Friday, June 23, 2017, Providers will be able to submit CareSource PAs via the Centralized PA Portal. All PAs associated with the Centralized PA Portal will be processed for CareSource members beginning on July 1, 2017.

The following forms are currently associated with the Centralized PA Portal:
• Newborn Delivery Notification
• Pregnancy Notification
• Inpatient Hospital Admissions and Outpatient Procedures
• Hospital Outpatient Therapy
• Durable Medical Equipment
• Children ‘s Intervention Services
• Outpatient Behavioral Health

For any other CareSource PA submissions, please refer to https:/iwww.caresource.com/providers/georgia/, call 1-855-202-1058, or email gamedmgt@caresource.com.

Regards,

 

Department of Community Health

View Georgia Families® Frequently Asked Questions & Answers

Loy “Chip” Cowart, MD Named “Your Giving is Great Medicine” Capital Campaign Chair

 

The Georgia Healthy Family Alliance (GHFA) Board of Trustees is pleased announce that Loy “Chip” Cowart, III MD will serve as Chair of the “Your Giving is Great Medicine” five year capital campaign to expand the reach and funding of the Community Health Grant program and Tar Wars in communities where Georgia Academy of Family Physicians (GAFP) members live and serve.

 
With a challenge investment of $1,000,000 from the GA Academy, GHFA is seeking to raise an additional $3 million to sustain funding for essential healthcare initiatives like the 38 GAFP member sponsored community health grant projects that have been funded since 2012 for projects including obesity prevention, chronic disease management, women’s health screenings and more.

 
To date, the Alliance has awarded more than $163,000 to GAFP member sponsored community health projects. Last year, GHFA received more than 25 applications from members with available resources to fund just nine of the projects. Overall grant funding in 2016 had to be reduced to $3500 per applicant, as opposed to the $5,000 per applicant available in previous years.

 
The need and growing demand for these vital programs is real. The Kaiser Foundation ranks Georgia fifth in the nation in uninsured residents with 19 percent of the population – nearly 2 million Georgians- lacking health insurance. Charitable health initiatives supported by GHFA serve as essential providers of care to uninsured families and strengthen the state’s healthcare safety net by fostering collaborative partnerships.

 
Currently in its “quiet phase,” the five year “Your Giving is Great Medicine” capital campaign seeks to further the organizational capacity of the Alliance by securing funding from the health care community at large, foundations and businesses to increase the number of Community Health Grants and Tar Wars presentations in the years ahead.

 
More campaign details and information on how you can join us to expand the reach of these vital community health initiatives is forthcoming. We hope you will join us in our efforts to sustain the long term capacity of GHFA programs. GHFA staff will be reaching out to you in the coming weeks to share our progress and gain your support.

 
The time to prepare for the future is now. And, working together and investing together, GHFA can continue our work toward fulfilling our mission of ensuring healthy futures for thousands of underserved men women and children in Georgia.

 
Founded in 1987, the Georgia Healthy Family Alliance, formerly known as the Foundation of the Georgia Academy of Family Physicians (GAFP), is the philanthropic arm of the GAFP and a charitable public foundation recognized by the Internal Revenue Service as a 501(c)(3) tax-exempt organization.

The 2017 Summer Family Medicine Weekend Was a Beach Blast!

June 8-10, 2017 marked the GAFP’s 2017 Summer Family Medicine Weekend in Isle of Palms, SC.  This year we hosted more than 125 family physicians and other health care professionals at Wild Dunes Golf & Beach Resort.  We offered 35 CME credits to attendees and many opportunities to engage with our Industry Partners while also offering time to network with colleagues, and plenty of family fun activities.

With an expansive number of lectures, attendees were able to attain as much as 35 AAFP prescribed credits on a wide variety of topics pertinent to the broad range of practice needs of our members.  Several lectures included- Community-Acquired Bacterial Pneumonia: Is There Anything New, Burn Therapies & Pediatric Specialty Burn Care Management, Addressing HPV Vaccine Hesitancy and Myths, Treating IBS: Listen, Look, and Learn from Your Patients, Adult Inattention, and a Dementia update.

In addition to lectures and workshops, the GAFP offered three Self-Assessment Modules (KSAs) to attendees in an effort to fulfill the Maintenance of Certification, Part II – Self-Assessment and Lifelong Learning.  More than 35 attendees successfully completed the modules.

We also hosted an Alliant Quality Workshop – Designing and Implementing Your Improvement Activity to Satisfy the MIPS Requirement, which was facilitated by. Adrienne Mims MD, and included faculty from Alliant GMCF (the State’s QIO), and a representative from GA-HITEC.  The workshop was well received and participants noted that this was a great start to improving their clinical processes.

Attendees considered the meeting a success and offered the following comments on their post-meeting evaluations:

  • Excellent CME program. Thank you for having the KSA’s available!
  • Great location…
  • Great conference and topics! Thank you for your hard work and time to make it successful! Looking forward to October!
  • Overall great meeting. Sessions were interactive. Good breakfast, healthier options always a plus. Thank you for keeping coffee out the whole time. Thanks, GAFP staff, for putting on a great CME. You did it!
  • … Enjoyed all 4 presentations and the KSA on pain.
  • These have all been good and practical presentations.

The meeting’s success was based on the hard work, time, and effort of the Education Committee.  The 2017 Education Committee members are Theresa Jacobs, MD – Chair; Ken Howard, MD – Vice Chair; Karla Booker, MD; Mike Busman, MD; Clark Gillett, MD; Alice House, MD; Alison Lauber, MD; Yvonne Maduka, MD; Carl McCurdy, MD; Yuan-Xiang Meng, MD; Adrienne Mims, MD; Saida Omarova, MD; Harry Strothers, MD; Monique Merritt-Atkins, MD – resident; Blake Rudeseal – student.

Thank you to the Education Committee for all the hard work that went into making this meeting a success.

Mark your calendars now with the dates of the 2017 Annual Scientific Assembly!  This year’s Annual Meeting will be held Friday, October 27 – Sunday, October 29 at the Westin Buckhead in Atlanta, GA. We look forward to seeing you there!

Member Access to June Board Minutes and Leadership Decisions

In an effort to keep GAFP members more informed of Board decisions, members can now access the June Board minutes.
Even though major activities tend to be reported in our newsletter, members may keep track of leadership decisions and adherence to the GAFP mission and strategic plan by reviewing quarterly Board minutes via a simple request to staff. If you are interested in obtaining a copy of the GAFP Board minutes, please contact the staff by email at gafp@gafp.org. Only GAFP members have the privilege to review the GAFP’s Board of Director’s minutes.

Understanding Cost in MACRA (aka Quality Payment Program) through your personalized Quality Resource Use Report (QRUR)

For every physician that bills Medicare Part B, CMS has created a performance report called the Quality Resource Use Report (QRUR).  This report shows their interpretation of your relative cost of all care compared with your peers for the patients you see and bill Medicare Part B.  The most recently available data is the 2015 QRUR.  This report assists you in choosing quality measures and improvement activities under MACRA (aka Quality Payment Program).  It was also used to calculate the 2017 Value Modifier that is currently impacting your Medicare reimbursements this year

We are excited to announce a free web based education opportunity for you on the evening of Wednesday, August 2, 2017 from 7- 8 pm. This educational session will be a presentation on interpreting your Quality Resource Use Report (QRUR).   As the Medicare Quality Innovation Network-Quality Improvement Organization, we are contacted by CMS to provide this free technical assistance.

In preparation for the session, we suggest that you log into the CMS portal and download your report to have on hand during the call.  If you have not previously set up the specific EIDM account to access this report you can follow this guide at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2015-QRUR-Guide.pdf  This guide will walk you through how to set up and EIDM account (page 3) and how to download the report.  Please allow 2 weeks to go through this process prior to the call.   It will be very helpful for you to have your report with you when you attend the presentation as we walk you through each of the tables in the report.

Don’t wait.  Start preparing for MACRA (aka Quality Payment Program) now!

Click here to register https://attendee.gotowebinar.com/register/6824012648649498113