NCMGMA News is an official news resource of the North Carolina Medical Group Management Association (NCMGMA).
Articles published in NCMGMA News contains the expressed opinions and experiences of the authors and do not necessarily represent the position of NCMGMA.
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The U.S. public health emergency that was declared to respond to COVID-19 ended yesterday, May 11. North Carolina will continue to distribute the federally funded COVID-19 vaccines and tests for free to individuals who are uninsured while supplies last.
While the public health emergency has ended, COVID-19 vaccines, testing and treatment will remain free in North Carolina, regardless of insurance or immigration status, while supplies last. When supplies of federally purchased vaccines run out, they will be available like flu shots and other routine vaccinations, covered by Medicare, Medicaid, private insurance or out-of-pocket costs for the uninsured. Visit MySpot.nc.gov to learn more or NCDHHS.gov/LHD to contact your local health department.
As the public health emergency ends, people’s Medicaid, WIC and Food and Nutrition Services benefits could change. On April 1, North Carolina began the recertification process to check the status of all Medicaid recipients and work to minimize health care coverage gaps for families. Medicaid recertifications will happen on a rolling basis into 2024. The first beneficiaries will see changes July 1.
For more information about COVID-19 resources following the end of the public health emergency, visit MySpot.nc.gov or call 1-800-CDC-INFO. Read more about the massive number of vaccines administered, tests distributed, and community events and partners DHHS has worked with during the past three years in an NCDHHS news release.
By Carlos Jackson, Ph.D. and Paul Mahoney, Community Care Physician Network
2022 Alliance sponsor feature article courtesy of Community Care of North Carolina
The movement to value-based payment systems occurring simultaneously with a pandemic and, in North Carolina, sweeping changes to Medicaid, has made for an incredibly challenging environment for medical practices, particularly independent practices. This new environment requires new workflows and new approaches to managing patient panels.
The good news is that, working together, independent practices can still thrive in this new environment. In supporting the more than 900 practices in the Community Care Physician Network (CCPN), we’ve identified four critical keys to success, highlighted in the graphic below. At CCPN we work with practices where they are, share best practices pioneered by similarly-situated practices and help them find practical solutions to daily challenges.
CCPN exists to help member practices thrive financially, provide high-value care, and enable providers and patients to maximize their satisfaction with the practice of medicine. CCPN is governed by practicing, community-based physicians.
We have found that for many practices, the most challenging piece of this puzzle is making the best use of data. Practices are awash in data, but can they parse it intelligently to pull out what is actionable, and identify the information critical to hitting the metrics that drive present and future revenue?
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CCPN has made significant investments in tapping into the potential of EHR clinical data without practice staff needing to devote significant time in making sense of it all. Through new tools and innovative partnerships, we have built an infrastructure to help our network practices identify opportunities to close care gaps, improve quality and patient engagement and ultimately hit metrics that satisfy payer bonus arrangements, generating significant additional revenue critical to the long-term financial viability of the practice.
Practice PerfectSM Dashboard Designed with busy practices in mind, Practice PerfectSM is a Tableau-based business intelligence tool that distills complex information from multiple data sources, identifying actions you can take right now to boost quality and improve performance. Recommended ActionsSM are an efficient and unique way of viewing worklists taking multiple patient and practice factors into account in order to help you prioritize long lists of care gaps.
The dashboard synthesizes claims, hospital visits, and individual risk scores to prioritize patient needs, as well analyzes the cost, utilization, and disease burden of a practice’s Medicaid patient panel. The dashboard also provides monitoring of performance on contract measures to inform practices of their progress on meeting contract measures. Users can quickly create targeted patient lists to determine where to best focus resources and improve performance. Additionally, Recommended ActionsSM integrate with clinical and scheduling data, as well as ADT and immunization feeds from outside vendors, for more actionable and up-to-date guidance. The dashboards are organized in a way to not overwhelm the provider and offer just enough information to help them be successful.
VirtualHealth™ Provider Portal The VirtualHealthTM Provider Portal connects practices with their CCNC Care Management team – partners for improving patient outcomes. This provides secure access to Medicaid patient care management documentation, comprehensive needs assessments, and care plans. Through the portal, clinicians can make referrals to care management and enjoy secure communication with patient care teams. Clinicians can view patient history from claims, pharmacy, and hospital data – keeping them “in the know” regarding what care patients are receiving from outside their practices.
Value-based Informatics Program (VIPSM) CCPN has significantly upgraded technology that supports practice success under value-based contracts across all payers and populations – at no additional cost to our CIN practices. We pull clinical data from practice EHRs to measure quality more easily. This greatly helps practices generate bonus payments from insurers. Our system also gathers appointment data to help practices better capitalize on Recommended ActionsSM. We alert practices to care gaps and opportunities to improve the accuracy of RAF scoring. We do this by joining EHR data with claims data for a more comprehensive view of patient care that yields improved insights. These tools also reduce administrative burden on practice staff. We are also piloting some in-line prompting tools that will provide practices with real-time alerts at the point of care. We believe that putting information in the hands of providers at the right time is one of the keys to success in value-based contracting.
While the environment for primary care practice won’t get easier anytime soon, help is available from your peers and CCNC. Together, we can help you find a path to financial strength and greater satisfaction with the practice of medicine for you, your staff, and your patients.
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Community Care Physician Network (CCPN) CCPN is a physician-led, clinically-integrated network that helps independent primary care physicians deliver high-quality, cost-effective care. CCPN priorities are helping practices thrive financially, provide high value care, maximize provider and patient satisfaction, and take charge of their own destiny.
Tuesday, November 16, 2021 | 12:00 PM – 1:00 PM EST | Zoom
Join us as we hear from attorney Dave Horne from Smith Anderson, who will provide a year-end Legislative Update. Tune in to learn about what happened this year and what we’re anticipating for 2022!
Speaker
Dave Horne, JD Attorney, Smith Anderson Dave Horne was recently named “Lawyer of the Year” for Raleigh Government Relations by Best Lawyers®. He manages the Government Relations practice at Smith Anderson and leads a team of professionals in the firm’s Corporate Relocation and Expansion practice.
Dave has spent nearly 30 years representing private interests – including many non-profit associations, medical groups and businesses – before the North Carolina General Assembly and other state and federal government entities. For more than a decade, he has rated in the top twenty of more than 700 lobbyists registered in the State by an independent survey of his peers, the press, and legislators, conducted by the North Carolina Center for Public Policy Research Inc.
Registration
This webinar is free but you must be registered to attend. Space is limited so register early! After you register, you will receive an emailed confirmation with webinar and phone-in instructions.
Continuing education credit may be granted through your professional organization (MGMA, PAHCOM, AHIMA, etc.). Please self-submit for these organizations.
Questions
For questions or more information please contact the NC Medical Society Foundation offices at ncmsfoundation@ncmedsoc.org.
The application will close on October 26, 2021 at 11:59 p.m. ET. Applications must undergo a number of validation checks before financial information is submitted so providers are encouraged to begin their application as soon as possible to ensure they are able to meet the deadline.
In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application, and HRSA will use existing Medicaid, Children’s Health Insurance Program (CHIP), and Medicare claims data in calculating portions of these payments.
Presented by the North Carolina Medical Society Foundation in cooperation with the North Carolina Medical Group Management Association, we are trying something new this month with an open forum, virtual roundtable to address a few of the key areas challenging practices across the state:
Workforce recruiting and retention
Medicaid Transformation
Prior Authorizations
This roundtable is an opportunity for providers and administrators to network, share challenges, best practices, and help guide advocacy efforts at all levels. Please share your concerns, questions, and any other hot topic suggestions when you register here.
Registration
This webinar is free but you must be registered to attend. Space is limited so register early! After you register, you will receive an emailed confirmation with webinar and phone-in instructions.
Continuing education credit may be granted through your professional organization (MGMA, PAHCOM, AHIMA, etc.). Please self-submit for these organizations.
Questions
For questions or more information please contact the NC Medical Society Foundation offices at ncmsfoundation@ncmedsoc.org.
Please find the following NCDHHS link and review your listing if you have already contracted with the pre-paid health plans to provide services to Medicaid beneficiaries. This page provides information on how to report an error on your listing. You can still negotiate and execute contracts with health plans to have your information included for the auto-enrollment period, which begins on May 16. To be included in this, contracts need to be signed and submitted to health plans by April 12, 2021.
The North Carolina Department of Health and Human Services and North Carolina AHEC are offering two monthly evening webinar series to help prepare providers, practice managers, and quality managers for Medicaid Managed Care going live on July 1, 2021.
Hosted by Chief Medical Officer of the NC Division of Health Benefits Shannon Dowler, MD, the two series will feature changing subtopics on Medicaid Managed Care on the first Thursday of each month and clinical quality on the third Thursday of each month. The first series kicks off on October 1 with a high-level introduction to Medicaid Managed Care followed by the second series on October 15 to review pediatric immunization trends during COVID-19.
Thursday, October 1 | 5:30–6:30 PMET Better with Time: Medicaid Transformation State of Things (Series continues the first Thursday of each month)
This webinar is hosted by Shannon Dowler, MD, Chief Medical Officer, NC Division of Health Benefits, and moderated by Hugh Tilson, Director, NC AHEC Program.
Thursday, October 15 | 5:30–6:30 PM ET Immunizations and Keeping Kids Well: Trends and COVID-19 (Series continues the third Thursday of each month)
This webinar is hosted by Shannon Dowler, MD, Chief Medical Officer, NC Division of Health Benefits, and Tom Wroth, MD, CEO, Community Care of North Carolina, and moderated by Hugh Tilson, Director of the NC AHEC Program.
Originally published on September 2, 2020, by Dave Richard, Deputy Secretary of NC Medicaid Division of Health Benefits, NCDHHS.
NC Medicaid is reimbursing COVID-19 testing costs for individuals without insurance who enroll in the NC Medicaid Optional COVID-19 Testing (MCV) program. This option was made available to all states through Section 6004(a)(3) of the Families First Coronavirus Response Act (FFCRA). Enrolled MCV beneficiaries will also qualify for coverage of COVID-19 tests retroactive to June 1, 2020, provided they were uninsured at the time of the test.
To qualify, individuals must be uninsured, a resident of North Carolina, and meet the citizenship and legal immigration status requirements of the Medicaid program. NC Medicaid is required to verify citizenship and immigration status. Individuals must qualify for MCV at the time the test was obtained.
Originally published by North Carolina AHEC in July 2020.
Program Year 2020 is Open for the NC Medicaid EHR Incentive Program
Eligible professionals (EP) can return now to apply for Program Year 2020 if they have successfully participated in the Medicaid Electronic Health Record (EHR) Incentive Program at least once and have not yet received six payments.
A list of all EPs who have participated at least once, but less than six years, in the NC Medicaid EHR Incentive Program is available under the “Are You Eligible” tab on the Program website. If a practice is unsure of an EP’s past participation and that EP is not on the list, please email the EP’s National Provider Identifier (NPI) to NCMedicaid.HIT@dhhs.nc.gov and our program staff will determine if the provider previously attested in another state.
At a minimum, in Program Year 2020, all EPs must have a 2015 Edition of certified EHR technology (CEHRT) and must satisfy the CMS-issued requirements for Stage 3 meaningful use. For more details on these and additional program requirements, visit the Program’s website.
EPs can get free personalized assistance in their office from a Practice Support coach from their regional Area Health Education Center (NC AHEC). The NC Medicaid EHR Incentive Program contracts with NC AHEC to provide technical assistance on meaningful use and the attestation process, so there is no cost to the EP or practice.
Attestation assistance is also available through a detailed attestation guide, an extensive library of answers to Frequently Asked Questions, a series of short webinars explaining different aspects of the attestation process, and a dedicated help desk. Help desk hours are 8 a.m. to 4 p.m., Monday through Friday.
There are still two years left to participate the NC Medicaid EHR Incentive Program! EPs that meet eligibility requirements each year of participation may earn up to six incentive payments for a total of up to $63,750 through 2021. Participation years do not need to be consecutive.
Eligible EPs are encouraged to visit the NC Medicaid EHR Incentive Payment System (NC-MIPS) and attest for Program Year 2020 today! Please email us with any questions, we are here to help.
Originally published in the July 16, 2020 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA
July 20 is the deadline for eligible Medicaid and Children’s Health Insurance Program (CHIP) providers to apply for funding via the Enhanced Provider Relief Fund Payment Portal. The Department of Health & Human Services (HHS) expects to distribute $15 billion to eligible providers that did not previously receive a payment from the $50 billion General Distribution. The portal will allow such providers to report their annual revenue data to HHS and apply to receive a payment equal to at least two percent of reported gross revenues from patient care. For additional information on eligibility and the application process, providers can refer to the program’s application instructions.
North Carolina Medical Group Management Association Blog 