Medical Provider Network: Expansion Discussion Karen Jost, Health Services Analysis Program Manager January 2015.

Slides:



Advertisements
Similar presentations
Medicare and Medicaid EHR Incentive Programs Next Flow Chart to Help Eligible Professionals (EPs) Determine Eligibility for the Medicare and Medicaid Electronic.
Advertisements

SE ALARM One Day Seminar Medical Malpractice 24 th January 2007 Mike Thane AIG.
WHAT IS K-SERV A web-based volunteer management system.
Copyright © 2010, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 Medical Office Administration 2nd edition Brenda A. Potter, CPC.
Idaho HCBS Medicaid Provider Orientation Guide General Information: Part I Division of Medicaid An Introduction to Medicaid Guidelines, Rules, and Programs.
Florida’s Health Information Exchange and Electronic Health Record Incentive Program CHIPRA Part C Meeting January 18 and 24, 2012 Carolyn Turner and Pam.
HIPAA Privacy Rule Training
National Health Information Privacy and Security Week Understanding the HIPAA Privacy and Security Rule.
GRETCHEN SCHROEDER HEALTHREACH FOR CCHI HealthReach 2012 Medi-Cal Administrative Activities (MAA)
House Bill 2437 Health Carrier Access Payment Commissioner Kim Holland Oklahoma Insurance Department.
Instructor’s Name Semester, 200_
Medicare & Medicaid EHR Incentive Programs HIT Policy Committee February 10, 2015.
Nebraska’s Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Nebraska’s Emergency System for Advance Registration.
1 Centers for Medicare & Medicaid Services 2007 Physician Quality Reporting Initiative (PQRI) Module One.
Chapter 10: Strategies to Reduce Liability. Managing Physicians Facilities may have liability when a physician is involved in malpractice –Respondeat.
Telemedicine Melissa M. Starry Compliance Bootcamp (5/15)
Adapted from CMS guidelines Aug 2013 for Ambercare Corporation Education Department 2014.
Protecting and promoting the health and safety of the people of Wisconsin Volunteer Health Care Program Bejack Lor Provider Recruitment Coordinator June.
Nic Dibble, Consultant School Social Work (608) Department of Public Instruction
Introduction to US Healthcare. History Patients paid directly Help from religious and charitable organizations Technology Advances in healthcare made.
State & Local Government Roles & Responsibilities
New Jersey Medicaid EHR Incentive Program Professionals Overview.
Overview of CISI Benefits & Procedures For the Participants of Rotary International 2012.
Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or use of this presentation should occur.
Medicare & Medicaid EHR Incentive Programs HIT Policy Committee March 11, 2014.
Reducing Compliance Risk- Strategies for Medicare Consultation Billing 2010 AAHAM Keystone Educational Meeting February 18, 2010.
DSDS Quality Assurance Unit State of Alaska, Dept. of Health and Social Services Division of Senior and Disabilities Services (DSDS) Quality Assurance.
HR 676 THE EXPANDED AND IMPROVED MEDICARE FOR ALL ACT  Introduced February 15, 2011  Author: US Rep John Conyers March 26, 2011Physicians for a National.
HP Provider Relations October 2011 Electronic Health Records (EHR) Incentive Program.
2015 HFAP Standards CMS Final Rule – Burden Reduction II May 2014 Karen Beem, MS, RN HFAP Standards Interpretation 2015 National Credentialing Forum1.
Health Delivery Fundamentals
Component 2: The Culture of Health Care Unit 2: Health Professionals – the people in health care Lecture 2 This material was developed by Oregon Health.
SCOPE OF PRACTICE: NURSING IN OHIO Pamela S. Dickerson, PhD, RN-BC, FAAN
David G. Schoolcraft Ogden Murphy Wallace, PLLC
Overview of CISI Benefits & Procedures For the Participants of Rotary International 2011.
Exploratory Analysis of Observation Stay Pamela Owens, Ph.D. Ryan Mutter, Ph.D. September, 2009 AHRQ Annual Meeting.
“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment.
RAC Legal Defenses Renee M. Jordan, Esq. Bacen & Jordan, P.A Stirling Road, Suite 206 Fort Lauderdale, FL (954) (800)
Medical Provider Network: Provider Re-credentialing Karen Jost Health Services Analysis Program Manager October 23, 2014.
IEP Health Related Services: Nursing
IEP Health Related Services Children’s Therapeutic Services and Supports (CTSS): Mental Health Identifying ICD-10-CM Codes May, 2015.
HIT FINAL EXAM REVIEW HI120.
DIRECT NURSING SERVICES 1. WHAT ARE DIRECT NURSING SERVICES? Direct Nursing Services are a direct shift nursing service provided by an RN or LPN for an.
Emily Freeman, David Laber, Josh Calvelage, Nadezhda Neganov, & Katie Bachus.
Minimum Standards for Health Professions’ Mandated Suicide Training Stakeholder Briefing December 17, 2015.
Understanding Policy Regulations and Reimbursement Practices Impacting Telehealth Programs Rena Brewer, RN, MA CEO, Global Partnership for Telehealth Lloyd.
Physiotherapy registration: what you need to know Physiotherapy March 2016.
Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or use of this presentation should occur.
Career Opportunities in Health Care Department of Human Resources (HR) at Stronger Memorial Hospital.
HCS 430 Week 4 Individual Professional Regulation and Criminal Liability Paper To purchase this material click below link
HIPAA Privacy Rule Training
TRANSITIONAL CARE MANAGEMENT Codes 99495; CMMI September 2015
Physician assistants and Advanced practice Nurses who are they?
Arkansas State Board of Nursing
Health Insurance Key Definitions & Frequently Asked Questions
Establishing and Understanding a CVO
Medicare and Medicaid EHR Incentive Programs
Chapter 15: Consumerism and Environmental Health
Patient Medical Records
Florida Medicaid Draft Rule 59G School Based Services Policy
ALLEGATIONS OF ABUSE Internal Occurrence Reporting and Investigation.
Health Care Providers and Professionals
Medicare & Medicaid EHR Incentive Programs
Meaningful use Financial Incentives for Eligible Professionals and Hospitals.
Event & Disclosure Reporting
Concurrent Care For Children Who Are Enrolled In Hospice
MACRA/MIPS – CME and Improvement Activities
Volunteer Health Care Program
Chapter 8The Health Care Team
Presentation transcript:

Medical Provider Network: Expansion Discussion Karen Jost, Health Services Analysis Program Manager January 2015

2 Objectives  Review MPN purpose, criteria, previous expansion discussion  Introduce data regarding AP provider types, claimants, quality of care in border states (Oregon, Idaho)  Input from ACHIEV

3 MPN Eligible Providers Beginning January 1, 2013, the following Washington State providers can treat for the initial visit only unless they are in the network or submitted a complete application by December 31, 2012: Physicians (medical and osteopathic) Chiropractic Physicians Naturopathic Physicians Podiatric Physicians Advanced Registered Nurse Practitioners Physician Assistants Dentists Optometrists

4 Currently excluded providers  Pathologists  Consulting radiologists working within a hospital radiology department  Anesthesiologists or certified registered nurse anesthetists (CRNAs) except anesthesiologists and CRNAs with pain management practices in either hospital- based or ambulatory care settings  Emergency room providers  Hospitalists

5 Expansion  Department may expand to include –Additional providers not already listed (slide 3) –Those excluded (slide 4) –Out-of-state providers  Previous discussions –Out-of-state –PT/OT –Psychologists

6

7 Network criteria summary Minimum QualificationsFurther Review/Potential Denial Complete application, signed contract, no material misstatements or omission Pending licensure disciplinary action, informal license actions, noncompliance with restriction, history of licensure actions Professional liability coverageMalpractice claims history Current professional license without restrictions Termination or surrender privileges from a health plan, public program, clinic, or facility No exclusion from public program Medicare or Medicaid for quality care Material noncompliance with department rules, guidelines, and policies, risk of harm No felonyBilling fraud or significant billing irregularities No denial of hospital privileges for quality of care Criminal history, sexual misconduct, alcohol or chemical dependency, fraud Current Drug Enforcement Administration (DEA) registration without restrictions Invasive procedures without admitting privileges or use of unlicensed staff Pattern of material complaints or allegations Negligence, inadequate treatment, misconduct

8 Providers, Claimants, and Paid Amount 2012 # Providers (NPI) # Claimants Paid Amount Idaho 482 1,052 $ 854, Oregon 1,440 2,357 $ 2,329, Total * 1,921 3,405 $ 3,183, # Providers (NPI) # Claimants Paid Amount Idaho 465 1,022 $ 799, Oregon 1,450 2,474 $ 2,262, Total * 1,913 3,481 $ 3,061, # Providers (NPI) # Claimants Paid Amount Idaho 647 1,757 $ 1,653, Oregon 2,050 4,093 $ 4,592, Total * 2,694 5,827 $ 6,245, * (Across provider types, across states) See provider type detail in handout

9 Provider Distribution: Oregon ( )

10 Provider Distribution: Idaho ( )

11 Discussion / Input from ACHIEV  Meets purpose of MPN  Impact on access  Provider ease  Yield – balance work vs. actionable findings  Staff impact / resource needs / Cost  Coordination with related processes  Appropriate provider expectations / responsibility