Office Manager Newsletter

Office Talk

Important news for Samaritan Health Plan Operations' network clinic and office managers.

October 2014
  • IHN-CCO receives over $2.6 million in quality pool dollars
  • There is still time for Patient Centered Primary Care Homes to request incentive payments
  • Help IHN-CCO detect depression early on
  • Health & Wellness Tips: Celebrate chocolate day on Oct. 28
  • Health assessments are required every time a child enters DHS custody
  • Visit our new online Medicare training resource
  • It Pays to Know:
    True or False: All providers who bill IHN-CCO for physician-administered drug codes for outpatient services must report the NDC for the drugs administered on the CMS-1500 or UB-04 claim form. (Check back next month for the answer)
September 2014
  • Help your aging patients connect oral health to their overall health
  • Your patients save with referrals to in-network providers
  • Help us diagnose colorectal cancer at an early stage
  • Health & Wellness Tips: Grab some popcorn to improve mood, boost energy and satisfy cravings
  • Help take the guesswork out of Medicare coverage
  • It Pays to Know:
    Select one answer: When your patients have coverage under both Samaritan Advantage Health Plan (SAHP) and InterCommunity Health Network Coordinated Care Organization (IHN-CCO), their claims will crossover from SAHP to IHN-CCO. The benefits of crossover claims include the following:
    1. Only one claim will need to be generated instead of two, saving administrative costs.
    2. No SAHP explanation of benefits (EOB) needs to be sent to IHN-CCO.
    3. Providers will experience expedited payments due to electronic submission.
    4. SAHP payment information will be accurate.
    5. A, C, D
    6. None of the above
    7. All of the above
    Click here for the answer.
August 2014
  • A free child psychiatric consultation is just a call away
  • Care Management Plus training available for your staff
  • Help us prevent early childhood tooth decay
  • Health & Wellness Tips: Don't forget about your eyes
  • Ensure your claims get paid by reporting National Drug Codes on required claims
  • Help us encourage adolescents to get their annual well-care visits this year
  • It Pays to Know:
    Select one answer: The CMS 1500 claim form I should be using when billing Samaritan Health Plan Operations beginning April 1, 2014 is:
    1. Version 08/05
    2. Version 10/13
    3. Version 02/12
    4. None of the above
    Click here for the answer.
July 2014
  • The timeliness of prenatal care is a vital link to a healthy pregnancy
  • Know when and how to use Modifier AS
  • Are you participating in the Oregon Prescription Drug Monitoring Program?
  • Health & Wellness Tips: Try this recipe for a healthy snack
  • Use He@lthWeb to check claim status
  • Consider your patient’s perspective of electronic health records
  • It Pays to Know:
    True or False: When checking the status of claims in He@lthWeb, “Completed” means the claim has been processed and check has been printed. Click here for the answer.
June 2014
  • Take advantage of crossover claims
  • Don’t forget to use the new CMS 1500 claim form!
  • Review updates to the SBIRT Reimbursement Guidelines
  • Health & Wellness Tips: Set a calendar reminder for your H2O.
  • Home health type of bill code has changed
  • It Pays to Know:
    True or False: It is an annual requirement of Samaritan Health Plan Operations (SHPO) (for our Medicare Advantage contract) that contracted providers complete annual compliance training or sign an attestation that this training has been completed outside of SHPO. (Check back next month for the answer)
May 2014
  • Help us improve colorectal cancer prevention efforts
  • Keep us posted to avoid claims delays
  • Send claims involving hospice to the right place
  • Health & Wellness Tips: Stand up for your health
  • Let Oregon know how important your care is to this region
  • It Pays to Know:
    Select one answer: What is the new ICD-10 implementation date?
    1. September 1, 2015
    2. December 1, 2014
    3. October 1, 2015
    4. October 1, 2014
    (Click here for the answer.)
April 2014
  • ICD-10 transition postponed until Oct. 1, 2015!
  • Don't overlook two important boxes on the CMS 1500 form
  • Use updated prior authorization forms
  • Health & Wellness Tips: Dessert recipe!
  • Annual well-care visits recommended for adolescents
  •  It Pays to Know:
    Fill in the blank: There are times when your patients need to seek medical care when your office is closed. In cases where a patient’s illness or injury requires immediate treatment, but not a visit to the emergency room, remind them that                           is the best alternative. (Click here for the answer.)

March 2014

  • Thank you to all providers who completed the 2013 Health Care Professional Education Program!
  • The CCO will continue incentive payments for Patient-Centered Primary Care Homes
  • Health & Wellness Tips
  • Follow up with children prescribed with attention deficit hyperactivity disorder
  • Help take the guesswork out of Medicare coverage
  • Continue using He@lthWeb for up-to-date claims status
  • SHPO is making progress with ICD-10 preparations
  • It Pays to Know:
    True or False: Medicare patient diagnoses do not carry forward from one year to the next under the risk adjustment model. Therefore, all existing and chronic conditions must be evaluated and documented in the medical record at least once each calendar year for each patient, and the corresponding ICD-9-CM codes should be reported via the claim for services.
    (Click here for the answer)
February 2014
  • Alert! RADV Audit coming soon
  • Go online to access EFT and ERA enrollment form
  • Health & Wellness Tips for Your Practice
  • Learn how to prepare for 2014 HEDIS chart reviews
  • Review updates to the SBIRT Reimbursement Guidelines
  • Follow the proper guidelines to file an appeal
  • It Pays to Know:
    True or False: When your patient’s medical record accurately supports the diagnoses that are submitted on your medical claim to Samaritan Advantage Health Plan HMO, the plan receives the appropriate risk adjustment payment from the Centers for Medicare & Medicaid Services.
    Click here for the answer
January 2014
  • Claim holds are in effect through Jan. 20 while updates take place
  • Ensure accurate payments with proper medical record documentation
  • Health & Wellness Tips for Your Practice
  • New HCFA form coming for 2014
  • Welcome kit now available to new providers online
  • It Pays to Know:
    Fill in the blank: Samaritan Health Plan Operations follows Medicare standards for proper documentation, including record retention. All medical records must be maintained for at least ____ years after the date of medical service.
    Click here for the answer
December 2013
  • Happy Holidays from Samaritan Health Plan Operations
  • Celebrate the season with a delicious parfait dessert
  • Health & Wellness Tips for Your Practice
  • Samaritan Health Plans now offering commercial plans
  • Survey winners
  • Review upcoming benefit changes coming in 2014
November 2013
  • Is your clinic meeting requirements for "meaningful use?"
  • Remind your patients of the benefits of urgent care
  • Health & wellness tips for your practice
  • Utilizing He@lthWeb is just a click away
  • Stay informed with helpful tips on claims processing
  • It Pays to Know:
    Select one answer: Which change(s)/update(s) must be reported to your Credentialing Department at least 30 days in advance?
    1. Change in phone number
    2. Practice relocation
    3. Leaving a practice
    4. Joining a practice
    5. Ownership changes
    6. ALL of the above
      Click here for the answer.
    October 2013
    • Embrace health literacy to improve your patients' understanding
    • Ensure your health care professional is included in our PartnersUnited communication
    • Health & wellness tips for your practice
    • Remind patients that Medicare's annual open enrollment is Oct. 15 to Dec. 7
    • Does your office use flat-screen displays?
    • It Pays to Know:
      Fill in the blank: The top five reasons why claims are denied by Samaritan Health Plan Operations are:
      1. Duplicate claims
      2. No prior authorization
      3. Primary carrier's EOB not provided
      4. Claim not submitted timely
      5. ________________
      Click here for the answer.

    September 2013

    • Review the top 5 reasons why claims are denied
    • SHPO making progress toward ICD-10 transition
    • Health & wellness tips for your practice
    • It Pays to Know:
      True or false: InterCommunity Health Network Coordinated Care Organization (IHN-CCO) provides coverage for residential treatment for chemical dependency and detoxification as of July 1st.
      Click here for answer.

    August 2013

    • Free interpreter services are available to your patients
    • Risk Adjustment Chart Review Audit is underway for SAHP
    • Health & wellness tips for your practice
    • HBAI codes available for certain mental health services
    • It Pays to Know:
      True or false: Primary care centers, emergency rooms and other community health settings can now use SBIRT services to quickly assess the severity of a patient's substance use and refer him or her to the appropriate level of treatment.
      Click here for answer.

    July 2013

    • Help remind your IHN-CCO patients that a ride to the doctor is just a call away!
    • Botox only covered when medically necessary
    • Health & Wellness Tips for Your Practice
    • Guidelines now available for SBIRT services
    • IHN-CCO adds a new benefit
    • Hearing loss screenings for newborns added to preventive care services   
    • It Pays to Know:
      Select one answer: Samaritan Health Plan Operations (SHPO) is partnered with the following vendors for Electronic Claims Submission (EDI):
      A. Emdeon
      B. Gateway EDI
      C. RelayHealth
      D. ALL of the above
      E. NONE of the above
      Click here for answer. 

    June 2013

    • Samaritan Health Plan Operations follows the Oregon Health Authority billing requirements
    • It Pays to Know:
      Fill in the blank: Because prior authorization requirements occasionally change, Samaritan Health Plan Operations (SHPO) recommends that providers refer to SHPO __________________ to determine which services require prior authorization. ________________ are available for reference in the Provider section of the Samaritan Health Plan Operations website. Click here for answer.
    • Alert! EDI submitters need to include referring information
    • Health & Wellness Tips for Your Practice
    • Samaritan Health Plan’s Compliance Department adds new focus and staff
    • Electronically submitted claims are exceptionally faster!
    May 2013
    • Successful provider incentive project will be expanded
    • URGENT NEWS coming!
    • Health & Wellness Tips for Your Practice
    • Receive prior authorization determinations faster
    • It Pays To Know:
      Fill in the blank: The American Medical Association has made major changes to the Psychiatry section of the Current Procedural Terminology (CPT) codes. These code changes were effective for dates of service beginning on _______________. Click here for answer.

    April 2013

    • Receive payment faster by submitting claims electronically
    • Se habla español - We speak Spanish!
    • Keep your information up-to-date by reporting changes to your credentialing department
    • Help take the guesswork out of Medicare coverage
    • Health & Wellness Tips for Your Practice
    • It Pays to Know:
      Select one answer: What is the ICD-10 implementation date?
      A. October 1, 2013
      B. September 1, 2014
      C. October 1, 2014
      D. September 30, 2014 
      Click here for answer

    March 2013

     

    • Are you eligible for increased payments from InterCommunity Health Network CCO? Attest now!
    • Paint a more complete picture of your patients' health with the new 5010 form
    • Health and Wellness Tips for Your Practice
    • Ensure compliance by reporting National Drug Codes on CMS-1500 & UB-04 claim forms
    • February 2013 Question & Answer
    • It Pays to Know:
      Fill in the blank: InterCommunity Health Network CCO (IHN-CCO) Plus Plan members may use the ______________ medical transportation brokerage service that serves Linn, Benton and Lincoln County residents. Click here for the answer. 

     

    February 2013

    • Risk Adjustment Chart Review reports to be viewed by office managers
    • See more IHN-CCO patients when patients utilize non-emergent transportation services
    • Health and Wellness Tips for Your Practice
    • Easily access previous editions of Office Talk newsletter online
    • January 2013 Question & Answer
    • It Pays to Know:
      Fill in the blank: Samaritan Advantage Health Plan HMO members wishing to change their Primary Care Provider (PCP) may do so by completing the ________ form. The member's request will be processed within ______ business day/s. Click here for the answer.
    • Don't miss new features in each 2013 Office Talk newsletter
    • Health and Wellness Tips for Your Practice
    • New CPT codes mean changes in billing for psychiatry and psychotherapy services
    • Updated preventive care services and immunizations guidelines now available online
    • How you can help prepare for 2013 HEDIS chart reviews in your facility
    • It Pays to Know:
      True or false: As of January 1, 2013, Samaritan Health Plan Operations covers oral contraception (the pill), the shot (Depo-Provera), the ring (NuvaRing), contraceptive implants, diaphragms, cervical caps, and permanent contraceptive methods like tubal ligation at a $0.00 cost share to the member when rendered by a contracted provider. Click here for the answer.
    • While the year 2012 comes to a close, take a moment to look back on all that has changed this year
    • Celebrate the season with an easy holiday recipe

    November 2012

    • Helpful tips for billing for partial or full obstetric care
    • Is it strep throat? A sore throat may not always require antibiotics
    • Accurately using modifier 25 reduces risk of medical necessity review
    • A new resource: Your reference guide for preventive services for Medicare patients
    • It Pays to Know
      True or false: CMS defines "physically present" to mean that the teaching physician is located in the same room, (or partitioned or curtained area, if the room is subdivided to accommodate multiple patients), as the resident and patient and/or performs face-to-face service. For psychiatric services, the teaching physician will be considered "present" during each visit for which payment is sought if the teaching physician observes the key  portion of the visit through a visual device (e.g. one-way mirror, video equipment). Audio-only equipment does not satisfy the physical presence requirement. Click here for the answer.

    October 2012

    • Ensure claim payment for services performed by residents by meeting the proper criteria
    • Accessing Medicare hospice benefits for your patients
    • How to successfully report End Stage Renal Disease patient data
    • October 2012 Office Talk Addendum - Download
    • It Pays to Know
      Fill in the blank: Rather than placing time-consuming phone calls or logging into several different websites for eligibility and the status of your claims and authorizations requests, sign on once at __________ and you are set! Click here for the answer.

    August 2012

    • How does IHN-CCO affect you?
    • Receive approved claims faster with HIPAA 5010 compliance
    • What you need to know about Samaritan Health Plan Operations' Fraud, Waste and Abuse Program
    • Take advantage of our provider survey and be entered to win
    • It Pays to Know  
      True or false: For all Medicare patients, the slate is wiped clean of all diagnoses on December 31 as it relates to CMS calculations. Chronic conditions must be reevaluated, documented and billed every new calendar year. Click here for the answer.

    July 2012

    • No-cost annual preventive exams for your Samaritan Advantage Medicare patients
    • Get easy and secure access to provider sites of major local health plans, including Samaritan
    • Learn how and when you can advocate for your patients
    • Get answers quickly with your efficient provider tools
    • It Pays to Know
      What ICD-9-CM codes should be documented on a claim for an Annual Wellness Exam in order for SHPO members to receive a $0.00 cost share? Click here for the answer.

    June 2012

    • Welcome to Office Talk
    • Help to take the guesswork out of Medicare coverage
    • Reducing members' out-of-pocket expenses
    • It Pays to Know
      True or false: All Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (V01-91) (V-Codes) are acceptable in the primary position in the professional setting. Click here for the answer.