SCOPE | Provider Update

July 2023

Clinical Matters

Transitions of Care for Patients

The communication and follow-up between patients and their primary care physician are critical when a patient is discharged from an inpatient facility.  In 2022, Independent Health conducted a study that collected data on recently discharged members’ movement from inpatient facilities to identify opportunities to improve transitions of care. The data collected looked at the primary care rate of office visits completed following discharge.  Although the rate of office visits increased from 2021, Independent Health found areas to improve.

Effective transitions of care visits improve patient care and outcomes through discharge planning, patient education, medication management, follow-up care, care coordination, along with support services.

Importance of medication reconciliation
Medication reconciliation plays an integral role in medication management. This process is important for identifying and resolving discrepancies, such as duplicates, omissions, or incorrect dosages, that can lead to medication errors and adverse drug events. Gathering information from multiple sources, including the patient, the patient's family or caregivers, the patient's primary care physician or specialist, and any other healthcare providers involved in the patient's care, is fundamental. It is particularly important during transitions of care, such as when a patient is admitted to or discharged from a hospital or when a patient is transferred multiple times between healthcare providers or settings. By ensuring that patients are receiving the correct medications in the correct dosages, medication reconciliation can help to improve patient safety, reduce medication errors and adverse drug events, and improve health outcomes.

Billing guidelines
Administratively, when billing transitional care management CPT® codes 99495 and 99496 to Independent Health, providers must use billing guidelines from the CPT book. Supporting information is also be found within the participating provider portal; please utilize the Code Lookup tool with the portal. Of note, according to CPT guidelines, 99495 and 99496 may only be billed when the patient is discharged from an inpatient hospital setting (acute hospital, rehabilitation hospital, long-term acute care hospital), partial hospital, observation status in a hospital or from a skilled nursing facility/nursing facility.  We encourage providers to carefully review the comprehensive billing requirements found within the 2023 CPT and HCPCS books as well as the fact sheets.

Office Matters

Welcome to the new SCOPE Newsletter!

We have updated and upgraded the SCOPE newsletter to make it easier to read and share. You’ll notice these new features:

  • Cleaner format with easier-to-read fonts. We’ve made the font type larger and easier to read, with consistent formatting, which did not always occur with the previous platform.
  • Easy-to-print function. Simply click the red button on the right hand side.
  • Spotlight sidebar, giving readers another way to see what’s coming up or what they should be aware of.

Our goal is to continue to improve and deliver the content you need, so we welcome your feedback.  Please send us your comments to Scope@independenthealth.com.   Thank you!

Referrals no longer needed with Family Choice Institutional Special Needs Plan (I-SNP)

Independent Health’s Medicare Family Choice I-SNP Plan is for residents living in a participating nursing home or assisted living facility.  The plan has required referrals to specialists; however, we have determined that referrals are no longer required with Family Choice I-SNP.  Provider offices do not need to check for a referral with the patient upon the visit.

The removal of the referral requirement with Family Choice will add consistency to our Medicare products, since our other Medicare plans also do not require referrals.

Upcoming member campaigns to encourage our members to take greater control of their health

Throughout the year, the Health Care Services and Population Health Management Departments deploy various tactics to encourage members to take a more active role in their health.

During the month of July, Independent Health will be conducting one member engagement/outreach campaign.  This campaign is described below.

Colorectal Cancer Screening Reminder Campaign
This telephonic outreach campaign will engage commercial fully insured members who are overdue for a colorectal cancer screening.  The purpose of the call is to provide education around the importance of colon cancer screening, address member barriers to screening, and encourage the member to follow through on screening orders received from their provider.  Members that do not have an order for a colon cancer screening test will be encouraged to have a conversation with their provider regarding screening.

Outreach method: Outbound telephone call campaign

Target members: Commercial members ages 46-75 years who have been overdue for a colorectal cancer screening for two or more years

Timeframe: Mid-July 2023

Has your practice completed its required training modules?

We encourage you to complete these surveys sooner than later.

  • Cultural Competency Training: Staff must complete the U.S. Department of Health & Human Services  online module, “The Guide to Providing Effective Communication and Language Assistance Services,” or the comparable Think Cultural Health training that corresponds with the provider’s scope of practice, and submit the electronic attestation to confirm completion.
  • Annual Fraud, Waste & Abuse Training: Staff members of practices required to complete this training includes physicians, mid-levels, ancillary providers, registered nurses, licensed practical nurses, administrative and office staff, technicians, coders and others.

All related details, the downloadable training modules for your staff, and an attestation are available online.

Who must submit each attestation?
An authorized representative on behalf of all individuals under a practice’s Tax Identification Number (TIN) must complete the authorization. (Each individual staff member who completes each training does not need to submit the attestation).
 
Note: If your practice completes the 2023 training through another source and has a roster or spreadsheet with the dates the training was completed, you may submit the attestations through each of portal pages above.

Independent Health Medicare Advantage Plans: 5 Stars for 2023

In October, 2022, The Centers for Medicare and Medicaid Services (CMS) recognized Independent Health as a 5-Star Rated Medicare Advantage Plan for 2023. In fact, Independent Health is the only health plan in the nation to be awarded 5 stars for all of its 2023 Medicare HMO, Medicare PPO, and Medicare Prescription Drug plans.  

By using a 5-Star Quality Rating System, with 5 Stars being the highest rating, CMS measures Medicare beneficiaries' experience with their health plans and the health care system on an annual basis. Each plan is given an overall summary rating based on how it performs across five main categories:

Staying healthy: How often members got various screenings, vaccines and checkups.

  • Managing chronic conditions:  How often members got certain tests and treatments for long-term conditions.
  • Health plan responsiveness:  Overall member satisfaction with the plan.
  • Complaints and appeals:  How often members filed complaints about the health plan.
  • Telephone customer service:  How well the plan handles member calls.

This designation allows us to continuously enroll Medicare members throughout the year; no need to wait for an open enrollment period.  If you have patients that are approaching retirement, aging-in to Medicare, or dissatisfied with their current Medicare coverage - we can help!  Patients can contact us to review their options by calling  our Medicare Sales department at 716-635-4900,  via email at medicarehelp@independenthealth.com or by stopping into one of our local Medicare Information Centers.

Read more information here.

Please share this information with your teams. If  you have any questions or want to talk more about Medicare, contact your Physician Engagement Specialist or call Independent Health’s Provider Relations Department at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.
 

Pharmacy Updates

Formulary and Policy Changes

The following documents are available in PDF. We encourage you to open and download them, as they contain important information and updates:

  • Policy changes resulting from our most recent Pharmacy and Therapeutics Committee meeting.
  • Formulary changes resulting from our most recent Pharmacy and Therapeutics Committee meeting.
  • Formulary changes for Medicare Advantage individual and group members effective July 1, 2023 are accessible here.
  • Formulary changes for Pharmacy Benefit Dimensions 5-Tier formulary effective July 1, 2023.
  • Formulary changes for Pharmacy Benefit Dimensions 3-Tier formulary effective July 1, 2023.
  • View the most up to date versions of Independent Health’s policies when logged in to our provider portal.

Magellan Rx, administered by Magellan Rx Management, reviews select specialty drug prior authorization requests on Independent Health’s behalf. To view Magellan Rx policies for the drugs that they review, click here.

Independent Health's drug formulary
Access Independent Health's drug formulary here.

To obtain a hard copy, please contact Independent Health Provider Relations by calling (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.

In the News

Independent Health in the News

Check back next month for Independent Health featured articles.

Spotlight

Top Takeaways this Month

Welcome to the new SCOPE Newsletter!
We are pleased to introduce the new layout and format of Scope. Read more under the Office Matters section.  

June 2023 Policy Updates
View them here

Primary Care Physicians: Free CME-eligible webinar July 20
Michael Farrell, M.D. will present “The Pain Paradox,” an approachable deep dive into the multimodal team approach to managing chronic pain. Click here for details and to register.

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