10 TIPS ON HOW TO SURVIVE WITH SHRINKING PAYMENTS & GROWING HIGH-DEDUCTABLE HEALTH PLANS

1. 10 TIPS ON HOW TO SURVIVE WITH SHRINKING PAYMENTS & GROWING HIGH-DEDUCTABLE HEALTH PLANS Kathy Whitmire www.OPATH.net March 24, 2009

2. Why are Payments Shrinking? • Changes to Payment Requirements without proper education • Medicare Budget & Contract Reform • MIPAA, MAC - CAHABA, RAC • Large Commercial Payers following suit with Medicare • Promotion of New HDHP’s & HRA’s

3. What can you do about it? Stay Informed • http://www.cms.hhs.gov/center/physician.asp • E-Prescribing Measure Specifications • qualify for a 2% incentive payment for 2009 • 2009 PQRI • earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) • Value-Based Purchasing Program • Plan To Transition to a Medicare VBP for Physician and Other Professional Services

4. Stay Informed Cahaba GBA Georgia Part B • http://www.cahabagba.com/j10/index.htm • Cutover Date - 08/03/2009 State Health Benefit Plan • http://dch.georgia.gov/00/channel_title/0,2094,31446711_32021041,00.html

5. MEDICARE Payment Shrinkage E-Prescribing Measure Specifications • Beginning January 1, 2009, eligible professionals can participate by reporting on their adoption and use of an e-prescribing system by submitting claims information on one e-prescribing measure on their Medicare Part B claims. • The specifications for reporting the measure that will be used to determine if an (EP) eligible professional is a successful e-prescriber and qualify for a 2% incentive payment for 2009 can be found in the "Downloads" section. This document also provides the definition of a "qualified e-prescribing system." 

6. MEDICARE Payment Shrinkage 2009 PQRI.Physician Quality Reporting Initiative The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275) made the PQRI program permanent, but only authorized incentive payments through 2010. EPs who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period (the 2009 calendar year).  

7. MEDICARE Payment Shrinkage 2009 VBP.Value Based Purchasing Program Objectives • 1. Promote the practice of evidence-based medicine through • 2. Reduce fragmentation and duplication • 3. Encourage effective management of chronic disease • 4. Accelerate the adoption of effective, interoperable health information technology (HIT), • 5. Empower consumers to make value-based health care choices and encourage health professionals to improve the value of care by disseminating transparent and useful information

8. MEDICARE UPDATE January 26, 2009: The new policy allows providers to be paid by the Medicare program for services delivered up to 30 days before the date of submission of a successful Medicare enrollment application. • CY 2009 Medicare Physician Fee Schedule.Section 42 CFR 424.521(a). This provision allows a Medicare contractor to establish an effective date of billing 30 days prior to the date of filing if the practitioner meets all other program requirements (e.g., licensing). • No more retro billing further than 30 days • This policy is effective as of January 1, 2009, Enforcement of this provision and will begin actively monitoring provider compliance with this provision beginning on April 1, 2009. 

9. CAHABA UPDATE • The award of the J10 Part A/Part B Medicare Administrative Contractor (A/B MAC) contract is another step toward improved service to providers, physicians and practitioners as well as greater administrative efficiency and effectiveness for fee-for-service Medicare. • This award is indicative of the efforts underway to significantly reengineer the Medicare claims administration process and change from the “business as usual” of the past 40 years.

10. SHBP UPDATE NEW ADDRESS FOR SHBP: State Health Benefit PlanP.O. Box 1990Atlanta, Georgia 30301

11. SHBP UPDATE BIG CHANGES: ONLY 2 OPIONS FOR NEW SHBP MEMBERS: 1) HDHP 2) HRA We must know and understand these new plans!!!!

12. SHBP UPDATE Consumer Driven Health Plan Options • The Health Reimbursement Arrangement (HRA) and the High Deductible Health Plan (HDHP) are consumer driven health plan options. These options are structured to provide lower out-of-pocket expenses for many participants and are explained below.

13. HRA Health Reimbursement Arrangement (HRA) • It is similar to that of a PPO with an in-network and out-of-network benefit, except SHBP funds dollar credits to your HRA each year to provide first dollar coverage for eligible health care and pharmacy expenses. The amount in your HRA is used to reduce the deductible and maximum out-of-pocket. • After satisfying your deductible, you will pay your coinsurance amount until you reach your out-of-pocket maximum, at which time SHBP will pay 100 percent of eligible expenses for the remainder of the Plan Year. • EXAMPLE: • An HRA member with itchy eyes received a doctor’s prescription for drops that cost $82. Her pharmacist helped find $12 over-the-counter drops that did the same thing. • Savings to her HRA – $70.

14. HDHP High Deductible Health Plan with a Health Savings Account (HSA) • In return for a low monthly premium, you must satisfy a high deductible that applies to all health care expenses except preventive care. • If you have family coverage, you must meet the ENTIRE family deductible before benefits are payable for any family member. • You pay co-insurance after you have satisfied the deductible rather than set dollar co-payments for medical expenses and prescription drugs. • Also, you may qualify to start a Health Savings Account (HSA) to set aside tax-free dollars to pay for eligible health care expenses now or in the future. HSAs typically earn interest and may even offer investment options.

15. HDHP High Deductible Health Plan • This option offers 100 percent unlimited wellness benefits based on national age and gender guidelines • You must satisfy a separate in-network and out-of-network deductible and out-of-pocket maximum • You pay co-insurance after meeting the entire family deductible for all medical expenses and prescriptions

16. HSA Health Savings Account An HSA is like a personal savings account with investment options for health care, except it’s all tax-free. You may be eligible to participate in an HSA that is offered through the State of Georgia Flexible Benefits Program or by your employer. Participation through payroll deductions allows your contributions to be pre-tax.

17. COBRA UPDATE COBRA subsidy/premium assistanceIf you have involuntarily lost your job with a state agency, school system, or other SHBP-covered group from September 1, 2008 to present, and were covered under SHBP at the time of the job loss, you may be entitled to elect COBRA with a 65% COBRA premium reduction (or, if already under COBRA, receive a premium reduction) effective March 1, 2009.  COBRA Premium Assistance FAQs New Wallet Card for CIGNA HRA Members Loss of Coverage information

18. MAKE CHANGES • Write New Policy to comply with changes • Set up New Processes in your practice • Educate your staff and have them read & sign new policy • Audit Results – A/R Aging • Remittance Advices • Denials