NC MGMA Advocacy Day | Audience Questions

On March 13, 2019, the North Carolina Medical Group Management Association (NCMGMA) held our Advocacy Day at the Raleigh Marriott City Center.  Our record-setting group of attendees listened to, and interacted with, legislative experts as they presented updates and opinions on North Carolina’s “hot list” of topics.

The following is the transcript of answers provide to questions asked during the session with Dr. Mandy Cohen, secretary of the North Carolina Department of Health and Human Services:

To what entity should providers report PHPs that are late on payment?
Providers will report issues such as late payment to the Provider Ombudsman. These positions are still being developed. However, DHHS plans to have several staff available to assist providers.

Will PHPs be able to delay payment by asking for superfluous claims revisions? How will we track this behavior?
In 2018 the General Assembly passed House Bill 156 which requires prompt payment of claims. DHHS subsequently integrated applicable parts of the statute into the PHP RFP/Contract. The prompt pay standards in the PHP RFP/Contract provide that a PHP must pay a penalty of 18% interest (annual interest rate) on a claim when the PHP has not paid the claim pursuant to the time frames in the PHP RFP/Contract. It also requires that a PHP who has failed to promptly pay a claim must pay the provider a penalty of 1% of the claim for each calendar day a claim is delayed beyond the date it should have been paid. Therefore, there are financial incentives for the PHP to implement a claim payment process that complies with the required time frames.

Through the Provider Ombudsman, DHHS will monitor PHP compliance with the contract, including claim payments and processing, respond to inquiries from providers, and address performance issues with PHPs should they exist. Spurious claims revisions will be tracked (and providers are encouraged to report them), although we anticipate PHPs will be motivated to pay in a timely manner because they will want to keep providers in their network.

How quickly will LME-MCOs be added to the new centralized credentialing system?
Tailored Plan design is currently underway in anticipation of Tailored Plan implementation in July 2021. The current plan is that providers credentialed by LME-MCOs will transition into the centralized credentialing system with the implementation of Tailored Plans. Additional details will follow as finalized.

How quickly will new CPT codes be added to the fee schedule?
New CPT codes published in October of each year must be in the system and ready for use by the following January 1. Clinical Policy staff work with Provider Reimbursement staff to have the rates on file as soon as possible after the 1/1 date. Approved new CPT codes and their respective rates can be added to fee schedules within a week as long as they are covered services that can be folded in under the existing state plan.

New CPT codes and rates for services that are not within the state plan must follow the State Plan Amendment process for CMS approval before they can be added to the fee schedule.

When will the reimbursement increases for PCPs hit providers?
The reimbursement increases for PCP are effective January 1st, but not yet approved.  The increased rates will be implemented after CMS has approved the State Plan Amendment. The SPA has been submitted, however, CMS has not approved it.  Unfortunately, there is no target date for CMS approval at this time. Once CMS has approved and NCTracks is programmed, the rates will be implemented.  There will be a retroactive payment back to January 1, 2019, but that will most likely not take place until after July 1, 2019.

Could NC HealthConnex be used to help integrate the NCCARE360 resource platform into the EHR?
Yes. We are working with the Department of Information Technology on the integration between NCCARE360 and NC HealthConnex (HIE) for this purpose. We know that large health systems can pay the integration fee that their EHR vendor charges for each integration, but independent providers might not be able to front this cost. We hope that NC HealthConnex is the solution for that. There will be some delay in implementation, so providers who don’t integrate NCCARE360 into their EHR can still access NCCARE360 through the web directly.

NCMGMA Boasts Largest Advocacy Days Ever!

With over 115 attendees in-house on Wednesday, NCMGMA celebrated our largest-ever Advocacy Days event. Our speaker lineup this year included Attorney General Josh Stein; Chip Baggett, NCMS; Cody Hand, NCHS; NC State Treasurer Dale Folwell; Dr. Mandy Cohen, DHHS; and a panel that include four of the newest Medicaid Managed Care payors. Our speakers and panelists brought our attendees up-to-date on everything from the State Health Plan to the latest happenings with Medicaid Managed Care.

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And just this morning, over 40 members set out to meet with their representatives at the North Carolina General Assembly to discuss important healthcare issues including:

  • Joint HHS Appropriations Committee for Medicaid Managed Care and the importance of awareness of the additional requirements now shifting to the providers due to multiple types of Insurance Carriers. Additionally, changes to the Fee for Service contracts moving to value-based care contracts and the administrative burden shifting to providers.
  • The Save Act asking providers not to vote for this bill as supervision from physicians is necessary to maintain the highest quality of care for our NC residents.
  • HB184 – Study of State Health Plan Design, asking to keep the bill as it currently is until more definite options are in place for quality and cost savings for the members and tax payers.
  • S886 – In favor of the Small Business Healthcare Act reducing employees from 26 to 12.

Thank you to all who came out for this year’s Advocacy Days, and a big thank you to Melissa White and Cam Cox, NCMGMA’s Advocacy Days co-chairs, for all their hard work in putting this event together for our members!

2019 NCMGMA Annual Conference

ac19-themepic300aDon’t forget to join us in Wilmington, May 8-10, 2019, for NCMGMA’s Annual Conference to network and receive additional advocacy updates, including:

  • A session on the Blue Premier Update from BCBSNC’s Mark Werner
  • “The Health of Healthcare Politics in NC” from Representative Dr. Murphy and Representative Josh Dobson
  • The “State of Change” with Nathan Babcock of Parker Poe
  • And More!

Click here to view the complete list of conference sessions and to start making plans to join your colleagues in Wilmington in May.

Send Us Your Advocacy Day Questions!

Have Questions for Our Advocacy Day
Panelists and Speakers?

Send in your questions early to info@ncmgm.org to ensure they are asked of our speakers and panelists. Topics and areas of interest include:

    • Medicaid Transformation
    • State Health Plan Changes
    • State Legislature Issues – General

If you have not already registered for Advocacy Days, sign up today. Early registration discounts end today, February 27th. Complete event details, including registration, can be found below or on our website here.

Schedule of Events

Wednesday
March 13, 2019
11:00 AM – 5:30 PM
Legislative Program Sessions:
Josh Stein 125 Image
11:00 AM – 12:00 PM
Josh Stein, North Carolina Attorney General
Join us for a candid discussion as the NC Attorney General, Josh Stein, updates NCMGMA membership on how the Department of Justice is working to protect the business of North Carolina’s healthcare industry including updates on medical marijuana and the current opioid crisis.
Chip Baggett 125 Image
12:00 PM – 1:00 PM
Bowtie Briefing LIVE
Chip Baggett, North Carolina Medical Society
Always a fan favorite, hear about the many hot topics affecting medical practices in North Carolina. Chip Baggett will provide the group with insight into all that is happening in downtown Raleigh during the current session.
Cody Hand 125 Image
1:00 PM – 2:00 PM
Cody Hand
Senior VP, Advocacy & Policy; Deputy General Counsel
North Carolina Healthcare Association
Dale Folwell 125 Image
2:00 PM – 3:00 PM
Dale Folwell, State Treasurer of North Carolina
Mr. Folwell will present on high-priority items including reimbursement changes for State Health Plan patients, the state’s relationship with Blue Cross, and the cost-saving measures the treasury department has demanded. Don’t miss this opportunity to talk to the Treasurer face-to-face about how the proposed fee schedule will impact your practice!
Mandy Cohen 125 Image
3:00 PM – 4:00 PM
Dr. Mandy Cohen, NC Department of Health & Human Services
Hear the latest updates on Medicaid transformation and the critical timelines you need to know as the program moves forward. DHHS has announced their selections for PHP insurers, and we will be prepared to answer questions onsite about the carriers that will administer Medicaid benefits and claims adjudication, and the state’s role in overseeing the contracting and credentialing process and ensuring carrier compliance.
4:00 PM – 5:30 PM
Medicaid Managed Care Panel

  • Chris Paterson, Carolina Complete Health
  • Jesse Thomas, BCBS
  • Candice Bowen, WellCare
  • Anita Bachmann, United Healthcare
5:30 PM – 7:00 PM
Medical Mutual Logo ImageNetworking Reception
Sponsored by Medical Mutual

Join fellow Advocacy Days attendees, speakers and sponsors for an evening of fellowship and networking before we gear up for Thursday’s assembly meetings and legislative visits.
Thursday
March 14, 2019
9:00 AM – 12:00 PM
Organized Legislative Visits and General Assembly Meetings

Registration

Registration
Advocacy Days registration includes educational sessions, lunch and Medical Mutual reception on Wednesday, March 13th, and organized legislative visits on March 14th. The cost to register is $95 for NCMGMA members, $125 for non-members and $45 for students. The early registration cutoff is February 27th. After 2/27, the cost of registration increases $20 per-person for members and non-members, and $10 per-person for students.

Click here for online registration!

General Information

Hotel Accommodations
Reserve your room now at the Raleigh Marriott City Center. Limited standard rooms are available at the discounted rate of $189/night for single/double occupancy plus tax. To reserve your hotel room, please call the hotel directly at 1 (888) 236-2427. Guests making such reservations must identify themselves as members of the NCMGMA. All reservations must be accompanied by a first-night room deposit or guaranteed with a major credit card. If a guest does not cancel a reservation within 48 hours before 6:00 PM of the guest’s check-in date, then Hotel may charge the credit card one night’s room fee plus any applicable taxes.

Registration Cancellation Policy
Registration cancellations must be received in writing. Cancellations received on or before 5:00 PM on March 5th are entitled to a full refund less a $25 processing fee. No refunds will be awarded for cancellations after 3/5 or for no-shows.

Questions?
If you have any questions about the NCMGMA Advocacy Days, please contact the NCMGMA offices at 800-753-MGMA (6462) or by email at info@ncmgm.org.

10th Annual Advocacy Days a Success

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10th Annual Advocacy Days a Success

The NCMGMA Advocacy Days event had a very positive response from the members who were able to attend. Some of the feedback describing the experience:

“Pertinent and timely issues impacting the practice due to legislation passed, Medicaid, and State Health Plan.”

“Excellent. Speakers were great and relative to all that is happening in NC right now. Well worth the time and money. Dinner was delicious!”

“I wanted to learn more about Medicaid and was extremely pleased. I wish I had planned to stay for the Legislative day, next year – I will!”

Attendees learned about the future of many different healthcare issues that will affect our state both now and in the future, including Medicaid Managed care, new legislation impacting our provider networks, and updates on hot healthcare topics currently being debated in Raleigh. In addition to the education sessions, attendees enjoyed the opportunity to engage with peers from other practices; they were able to proactively share challenges and solutions.

Finally, several attendees of the legislative visits also learned a great deal about what actually happens at the legislative level when concerns are raised by the public (when visiting the legislature, that’s US!). Attendees were able to witness and talk to the people who establish the criteria for what is heard by our lawmakers and also HOW it is being heard from different constituencies. They saw the true impact of what it means to make sure your voice is represented.

The Advocacy committee and NCMGMA Board would like to thank all the attendees for participating. Though our positions are sometimes varied, we do many times speak with a singular voice on many of the issues facing our practices. Your active participation in both education and advocating for our practices is invaluable; we thank you for making our organization a success!

Make Your Voice Heard in Raleigh: Join us for Advocacy Days in June

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Meet with North Carolina Legislators
Make a Difference in Healthcare in our State

June 6-7, 2018
Holiday Inn Raleigh Downtown
North Carolina State Capitol

This year, join us June 6th and 7th in Raleigh as we host our 10th annual Advocacy Days which we promise to be packed full of information you do not want to miss! There is no shortage of issues at hand in North Carolina and NOW is the time to make our voices heard!

Schedule of Events

Wednesday
June 6, 2018
1:00 pm – 2:00 pm
Medicaid Managed Care Payor Panel: What’s Next for North Carolina?
A diverse panel of payors competing for contracts to administer Medicaid managed care in NC will present information about their programs, next steps, and what providers need to know about the upcoming transition.
• Lisa Farrell, North Carolina Owned Provider Plans (Bio)
• Steve Keene, Carolina Complete Health Network, Inc. (Bio)
• Anita Bachmann, United Healthcare Community Plans (Bio)
• Gregg MacDonald, WellCare (Bio)
2:00 pm – 3:00 pm
BCBSNC, Legislative Affairs Update
Hear directly from Blue Cross about legislative efforts in North Carolina. This will be an excellent opportunity to learn more and ask questions face-to-face about Blue Cross’s plans to address the recent direction from State Treasurer Dale Folwell to cut State Health Plan reimbursement rates by 15%.
• Chris Evans
3:00 pm – 4:00 pm
NCDOI Seniors’ Health Insurance Information Program (SHIIP)
Learn about how SHIIP can help your practice and your patients navigate the complexities of Medicare, Medicare supplements, Medicare Advantage, Medicare Part D, and long-term care insurance. Since the program’s creation in 1986, SHIIP has become a role model for other states and has received two national awards for “innovative” and “exemplary” service.
• Melinda Munden, Communication Specialist
4:00 pm – 5:00 pm
DHHS
Learn what role the DHHS will play in helping to structure the Medicaid Managed Care plans. Take the opportunity to validate with DHHS some of the information learned in the prior session with the potential Medicaid Managed Care companies.
• Dave Richards, Deputy Secretary for Medical Assistance
Bowtie: Live and Unedited
Always a fan favorite, hear about the many hot topics affecting medical practices in North Carolina. Chip Baggett will provide the group with insight into the current “sausage making” that is happening in downtown Raleigh during the current session.
• Chip Baggett, NCMS
6:00 pm – 9:00 pm
Dinner at Taverna Agora
Sponsored by Medical Mutual
Thursday
June 7, 2018
9:00 am – 12:00 pm
Legislative Visits with NCMGMA and General Assembly Meetings

General Information

Registration
Register and join fellow NCMGMA members in Raleigh on Wednesday, June 6th for a half-day of education sessions and a dinner program sponsored by Medical Mutual. Stay on Thursday, June 7th and meet with our legislators, along with other North Carolina administrators. For members of NCMGMA, the cost is $55 per person. For non-members, the cost is $75 per person. Registration cost covers education and dinner. After May 21st, the cost of registrations increases by $10.

Hotel Accommodations
Reserve your room now at the Holiday Inn Raleigh Downtown. Limited standard rooms available at the discounted rate of $109/night for single/double occupancy plus tax. To reserve your hotel room, please call the hotel directly at 919-832-0501. Reservations will be accepted until rooms are sold out or until Monday, May 21st. Self-parking is available for $7.00.

Questions?
If you have any questions about the NCMGMA Advocacy Days, please contact the NCMGMA offices at 800-753-MGMA (6462) or by email at info@ncmgm.org.

NCMGMA Advocacy Days are June 6-7 in Raleigh

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Meet with North Carolina Legislators
Make a Difference in Healthcare in our State

June 6-7, 2018
Holiday Inn Raleigh Downtown
North Carolina State Capitol

This year, join us June 6th and 7th in Raleigh as we host our 10th annual Advocacy Days which we promise to be packed full of information you do not want to miss! There is no shortage of issues at hand in North Carolina and NOW is the time to make our voices heard!

Schedule of Events

 

Wednesday
June 6, 2018
1:00 pm – 2:00 pm
Medicaid Managed Care Payor Panel: What’s Next for North Carolina?
A diverse panel of payors competing for contracts to administer Medicaid managed care in NC will present information about their programs, next steps, and what providers need to know about the upcoming transition.
• Lisa Farrell, North Carolina Owned Provider Plans (Bio)
• Steve Keene, Carolina Complete Health Network, Inc. (Bio)
• Anita Bachmann, United Healthcare Community Plans (Bio)
• Gregg MacDonald, WellCare (Bio)
2:00 pm – 3:00 pm
BCBSNC, Legislative Affairs Update
Hear directly from Blue Cross about legislative efforts in North Carolina. This will be an excellent opportunity to learn more and ask questions face-to-face about Blue Cross’s plans to address the recent direction from State Treasurer Dale Folwell to cut State Health Plan reimbursement rates by 15%.
• Chris Evans
3:00 pm – 4:00 pm
NCDOI Seniors’ Health Insurance Information Program (SHIIP)
Learn about how SHIIP can help your practice and your patients navigate the complexities of Medicare, Medicare supplements, Medicare Advantage, Medicare Part D, and long-term care insurance. Since the program’s creation in 1986, SHIIP has become a role model for other states and has received two national awards for “innovative” and “exemplary” service.
• Melinda Munden, Communication Specialist
4:00 pm – 5:00 pm
DHHS
Learn what role the DHHS will play in helping to structure the Medicaid Managed Care plans. Take the opportunity to validate with DHHS some of the information learned in the prior session with the potential Medicaid Managed Care companies.
• Dave Richards, Deputy Secretary for Medical Assistance
Bowtie: Live and Unedited
Always a fan favorite, hear about the many hot topics affecting medical practices in North Carolina. Chip Baggett will provide the group with insight into the current “sausage making” that is happening in downtown Raleigh during the current session.
• Chip Baggett, NCMS
6:00 pm – 9:00 pm
Dinner at Taverna Agora
Sponsored by Medical Mutual
Thursday
June 7, 2018
9:00 am – 12:00 pm
Legislative Visits with NCMGMA and General Assembly Meetings

General Information

Registration
Register and join fellow NCMGMA members in Raleigh on Wednesday, June 6th for a half-day of education sessions and a dinner program sponsored by Medical Mutual. Stay on Thursday, June 7th and meet with our legislators, along with other North Carolina administrators. For members of NCMGMA, the cost is $55 per person. For non-members, the cost is $75 per person. Registration cost covers education and dinner. After May 21st, the cost of registrations increases by $10.

Hotel Accommodations
Reserve your room now at the Holiday Inn Raleigh Downtown. Limited standard rooms available at the discounted rate of $109/night for single/double occupancy plus tax. To reserve your hotel room, please call the hotel directly at 919-832-0501. Reservations will be accepted until rooms are sold out or until Monday, May 21st. Self-parking is available for $7.00.

Questions?
If you have any questions about the NCMGMA Advocacy Days, please contact the NCMGMA offices at 800-753-MGMA (6462) or by email at info@ncmgm.org.

NCMGMA Advocacy Days are May 31st – June 1st in Raleigh

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Make Your Voice Heard in Raleigh with NCMGMA!
Meet with Legislators | Make a Difference in Healthcare

Join us as we host our 9th annual pre-legislative meeting which we promise to be packed full of information you won’t want to miss! It’s a short session, so the time is NOW to be heard!

This year’s pre-legislative meeting’s tentative schedule includes:

  • Blue Cross Blue Shield’s Chief Medical Officer Brian Caveney, MD, JD, MPH, and Director of Strategic Provider Relations Susan Menendez will discuss:
  • Benefit and network design trends from our self-funded employer groups and state health plan
    • Timing and factors of our ACA “play or stray” decision
    • Consumerism
    • Telehealth
    • What our members and customers are asking of providers
  • The North Carolina Medical Society will present updates on current state regulatory issues.
  • Former NC Lieutenant Governor Dennis Wicker and Partner with Nelson Mullins Riley & Scarborough will share with us some of the legislative issues that face both healthcare systems and insurers in NC.

Schedule of Events

Wednesday
May 31, 2017
1:00pm – 5:00pm
Legislative Updates & Presentations
at the Holiday Inn

Sponsored by SunTrust Bank and LabCorp
6:00pm – 9:00pm
Dinner for Advocacy Day Participants at Taverna Agora
Sponsored by Medical Mutual
Thursday
June 1, 2017
9:00 am – 12:00 pm
Legislative Visits with NCMGMA
and General Assembly Meetings

General Information

Registration
Register and join fellow NCMGMA members in Raleigh on Wednesday, May 31st. Stay on Thursday, June 1st to meet with our legislators, along with other North Carolina administrators. For members of NCMGMA, there is no cost to participate in Advocacy Days. For non-members, the cost is $50 per person and covers education and dinner.

Click here to register

Accommodations
Reserve your room now at the Holiday Inn Raleigh Downtown. Limited standard rooms available at the discounted rate of $109. To reserve your hotel room, please call the hotel directly at 919-832-0501. Reservations will be accepted until rooms are sold out or until Friday, May 12th. Self-parking is available for $7.00.

Questions?
If you have any questions about the NCMGMA Advocacy Days, please contact the NCMGMA offices at 800-753-MGMA (6462) or by email at info@ncmgm.org.