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MedNet’s most current newsletter:
March 2010 – Volume 10, Issue 1
The March 2010 issue of MedNet News includes information about the HIT federal stimulus money guaranteed by athenahealth, MedNet’s new fee schedule, major payor updates, and important info regarding HPHC’s radiology protocol changes

Quality Advance Program from HPHC

Payment systems continue to evolve in recognition that the value equation for medical services must not only include cost, but also medical necessity, effectiveness, and outcomes.

Pay-for-performance and value-based purchasing are becoming increasingly prevalent and quality performance guidelines are following suit. Many healthcare organizations, professional associations, payers, accrediting bodies, and consumer groups are now aligning reimbursement systems with the national Bridges to Excellence (BTE) and National Committee for Quality Assurance (NCQA) reporting standards.

The Quality Advance Program from Harvard Pilgrim Health Care, as well as those from other private insurers, seeks to align the intrinsic benefits of providing better quality healthcare for your patients with the potential for financial incentives for aggregate quality improvement.

Physicians can position their office for increased reimbursements by systematically collecting, managing, retrieving, and reporting quality data.

Identifying patients who are experiencing gaps in care and improving outcomes through reliable utilization of best-practices and standardized care programs can be achieved through better health information technology (HIT). However, the financial investment in HIT, such as EMR/EHR’s and chronic disease registries, can be burdensome for practices. To assist practices in this effort MedNet has strategically aligned with athenahealth, and their guaranteed compliant HIT products and services.

Action Item: Plan to report your quality data this year and take advantage of the Harvard Pilgrim Healthcare – Maine Quality Advance Program. The Harvard Pilgrim Health Care rewards are based in part on BTE and NCQA quality data, reported through the Maine Health Management Coalition. MedNet can assist you in understanding the data submission processes.

New Applicants

Go to the home page, select Applications and choose your provider type for all required forms and mailing instructions. On receipt of communication from the Council for Affordable Quality Healthcare (CAQH), go to www.caqh.org/cred and either create or update your file.

MedNet Provider Edits

Report all provider practice name, address, TIN, and other changes with the effective date in writing to MedNet Credentialing Dept. by:

Email: Carole

and to

Email: ppc@harvardpilgrim.org.

Timely reporting of changes ensures proper claims payment for services rendered and accurate practice information on MedNet’s website.

MedNet’s Fee Schedule

MedNet’s Fee Schedule update will go into effect July 1, 2010. Sample files can be made available by contacting MedNet’s Provider Relations Dept. at:

(800) 556-1144 Opt #4

Harvard Pilgrim Health Care’s (HPHC) updated Fee Schedule is in effect April 1, 2010. MedNet has sample files available for providers who are covered under the HPHC/MedNet Local Care Unit (LCU) 87 agreement. Those physicians and allied health professionals who participate in separate HPHC LCUs should receive their update directly from HPHC.

HIT federal stimulus money guaranteed by athenahealth

MedNet providers now have preferred access to the nationally recognized HIT system created by athenahealth Inc., that enables even the smallest practice to meet the definition of meaningful use.

To benefit from President Barack Obama’s 2009 American Recovery and Reinvestment Act (ARRA) and the recent enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act, providers must be able to easily report accurate data on quality measures, and potentially improve their ability to deliver higher quality care. According to the HITECH Act, physicians are eligible to receive up to $44,000 over five years in total incentives per physician from Medicare if they have adopted and are providing “meaningful use” of a certified Electronic Health Record (EHR) starting in 2011. Note: Physicians reimbursed by Medicaid can receive up to approximately $65,000 starting in 2011 based on state-defined guidelines.

MedNet providers now have preferred access to the nationally recognized services offered by athenahealth, Inc. that enables even the smallest practice to meet the definition of “meaningful use”. athenahealth is so confident in their low-investment, web-based software solutions they are offering a guarantee that clients will qualify for HITECH Act incentive payments in the first year. Their approach enables all of their client practices to access new mandates from Washington, D.C. in real time and makes updates immediately available to you and everyone in your practice. To make the process of qualifying for meaningful use even easier, the virtual back-office service team will help you enroll in the program, report on necessary clinical measures, and collect payment.

The unique collaboration between MedNet and athenahealth has a common goal of introducing technology and services that will allow Maine’s medical providers to elevate the quality of care delivered while minimizing the administrative complexity of practice operations. athenahealth’s products deliver consistent financial and clinical results with very low initial investment costs and rapid implementation. Additionally, small independent physician practices can utilize athenahealth to overcome the inherent challenges presented by emerging pay for performance and quality recognition programs. athenahealth products and services include, but are not limited to the following:

athenaCollector – a web-based physician revenue cycle management product designed to deliver faster reimbursement, increased revenue, improved practice workflow, continually updated payer knowledge, and back-office processing support.

athenaClinicals – A low-investment, high-return web-based EHR solution that combines industry-leading support, intelligence and technology to actually boost your bottom line, and integrally linked to athenaCollector.

athenaCommunicator – An on-demand, live, and automated patient communications system which streamlines workflow, supports compliance, drives more revenue and improves patient care.

Contact us for more information on athenahealth’s products and services:

• athenahealth website at: www.athenahealth.com