Checkout the “extras” happening at this year’s annual convention – 10 things you won’t find anywhere else!

1. Get in Your Vote:   Scope out the scientific research exhibits on display during the convention and vote for your favorite to win the first-ever People’s Choice Award!
2. Meet and Greet:  Reconnect with your colleagues on May 16 in the Great Lakes Center from 3 – 4 p.m.
3. Visit the Exhibit Hall, learn and WIN: Make sure you visit the exhibit hall during the Convention to meet exhibitors; learn about H. pylori testing; and, you could win some great prizes!
4. Lunch and Learn with our Keynote Speaker:  May 17, Noon – 1:30 p.m., Hear an insider’s look to all things political in Lansing by Tim Skubick
5. Join us for Breakfast (more than eggs and toast):  On Thursday and Friday, start the day with our breakfast sessions and presentations on Novo Nordisk’s Product Theater (Thursday) and how to Decrease risk and increase profit (Friday) – pre-registration required.
6. Knock it out of the park: On May 16 at 7:05 p.m., join us for an evening of fun and watch the Detroit Tigers play the Minnesota Twins. To purchase tickets, contact Tessa Albright.
7. Policy and Politics:  On May 16, 4 – 7 p.m., Listen to Dr. Lawrence Abramson, Dr. Anthony Ognjan and Kris Nicholoff speak on the latest issues affecting health care today, why it’s important to support MOPAC and how term limits affect Michigan.
8. Eat Some More:  It’s not your average luncheon on May 18, Noon – 1:30 p.m. as you will be able to applaud the winners of MOA’s Scientific Research contest.
9. Get Dr. Ognjan off your back:  Visit Michigan Osteopathic Political Action Committee booth near the exhibit hall to find out how you can support health care in Michigan.   
10. Make the Rounds:  May 17, Mingle with your peers and counterparts, catch-up with old classmates and visit with students, interns and new physicians with receptions starting at 4:45 p.m.

However, more can be done.

Your MOA and MOPAC need your help to continue these successful efforts. I ask each of you to visit the MOA and MOPAC booths during the upcoming MOA Scientific Convention, learn how we can work together to strengthen your Association and Political Action Committee (PAC), find out about the hot issues at the Capitol and, of course, meet your governmental affairs team.

There is no time like the present. Please get involved. Please show support. Please join your PAC.

As of February 2012, PGIP includes 40 POs across the Michigan.  According to BCBSM, these POs represent approximately 15,500 primary care and specialty physicians who are members of the BCBSM TRUST PPO or Traditional Networks.

PGIP utilizes a wide variety of initiatives designed to incentivize practice improvement through rewards to POs and physicians for improved performance and value of health care delivered.  Per BCBSM, “program participants, including both primary care physicians and specialists, collaborate on initiatives designed to improve the health care system in the state.  Each initiative offers incentives based on clearly defined metrics to measure performance improvement and program participation.”

Interested POs apply to participate in PGIP and must meet qualifications and minimum standards established by BCBSM.  Those who are selected choose which initiatives they will be participating in.  There are currently 34 initiatives and eight pilot programs.  For example, one of the initiatives is focused on increasing generic prescribing for BCBSM members.  The goals of other initiatives include designation as a Patient-Centered Medical Home, improving chronic disease care, improving quality and decreasing variations in care transition practices, and developing organized systems of care.  Initiatives are grouped into five categories as follows:

Clinical Information Technology-focused Initiatives

• Accelerating the adoption and use of electronic prescribing
• Patient registry*
• Patient Portal*

Condition-focused Initiatives

• Cardiac Care – Phase I
• Cardiac Care – Phase II
• Cardiac Care – Phase III
• Chronic Kidney Disease
• Encouraging Evidence-Based Utilization of Hysterectomy
• Encouraging Evidence-Based Utilization of Labor Induction
• Environmental Cancer
• Michigan Oncology Quality Consortium
• Michigan Oncology Clinical Treatment Pathways
• Michigan Urological Surgery Improvement Collaborative

Service-focused Initiatives

• Advance Care Planning
• Emergency Department Utilization
• Increasing the Use of Generic Drugs
• Michigan Anticoagulation Quality Improvement Initiative
• Radiology Management

Core Clinical Process-focused Initiatives

• Evidence Based Care Tracking Initiative
• Lean for Clinical Redesign
• Michigan Transitions of Care Collaborative
• Coordination of Care*
• Extended Access*
• Individual Care Management*
• Linkage to Community Services*
• Patient Provider Partnership*
• Performance Reporting*
• Preventive Services*
• Self-Management Support*
• Specialist Referral Process*
• Test Tracking and Follow-Up*

Organized Systems of Care Initiatives

• Integrated Patient Registry
• Integrated Performance Measurement
• Processes of Care

*These initiatives relate to the PCMH program

In regards to incentive payments, POs may be eligible for both participation and performance rewards.  Participation rewards are given to POs to help cover costs associated with time, effort and investment in specified leadership and collaboration activities.  Performance rewards are given to POs that achieve measurable goals defined in the initiatives in which the PO participates during the program year.  It should be noted that improvement, not just highest performance, is rewarded.  The decision on how the earned incentive is spent (e.g., infrastructure development, reward payment, etc.) is at the discretion of the PO.  Additionally, BCBSM is implementing fee uplifts for physicians engaged in certain quality improvement efforts.

PGIP Key Information

Program Incentives: Rewards for participation and performance results; improvement, as well as overall performance is rewarded.

Physician Participation: All primary care and specialty physicians must enroll in PGIP through a participating PO.

Stakeholder Engagement: PO representatives attend

PGIP Primary Care Leadership Committee: Comprised of physician, nursing and administrative leaders of PGIP POs and some individual PGIP physicians.

PGIP Reward Pool: Currently, the PGIP PO reward component of professional fees is 4.2%; the PO component will be 4.7% as of July 1, 2012.

Receipt of Incentive: POs have discretion on how incentive payment is utilized and distributed within their organization (e.g., infrastructure development, reward payment, etc.)

Scope: As of February 2012, 34 initiatives and eight pilot programs (participation is limited for some initiatives).

Physicians interested in participating in PGIP should contact their provider consultant.  Additionally, general questions may be directed to Cyndi Earles at MOA, 734-692-5004

Employers are always looking for cost effective ways to manage employee benefit expenses.  Blue Cross® Blue Shield® of Michigan is continuing to address the specific needs of the employer by offering plans with greater affordability, more flexibility and distinct choices.  Their innovative suite of small group product options are designed to allow the employer to choose a plan that best fits their unique business needs and bottom line.

For the Cost Conscious Buyer

Plans with cost-sharing features keep premiums affordable and offer all the protection employees need.

Simply Blue PPO^SM

This PPO plan is competitively priced and provides employees with the benefits they want.

• Multiple deductible and copay plan options
• Preventive care covered at 100%
• 20% in-network coinsurance
• 40% out-of-network coinsurance
• Cost-sharing feature supports cost-effective use of services

Consumer Directed Health Plans

These plans reward employees for living healthy and spending health care dollars wisely.

Simply Blue HRA^SM

The Simply Blue deductible PPO plans can be paired with a health reimbursement account (HRA) providing the flexibility to help employees to cover out-of-pocket health expenses.

• Multiple deductible and copay plan options
• Preventive care provided at 100%
• Can also be paired with a Flexible Spending Account (FSA)
• Fund through the Blues HRA or FSA partner or other administrator
• The account is funded and owned by the employer
• The employer chooses which qualified medical expenses are covered

Simply Blue HSA^SM

The Simply Blue PPO plans are IRS-compliant to be paired with a health savings account (HSA) offering employees a tax advantage and encouraging them to take responsibility of their health care dollars

• Multiple high-deductible and coinsurance plan options
• Pharmacy is integrated with medical deductible
• Preventive care covered at 100%
• Fund through Healthy Blue Choices HSA with no start-up or administrative fees or use another financial institution’s HSA
• Employees are able to save for current or future health care expenses
• Employer or employee can contribute pre-tax dollars
• The employee owns the account

For the Traditional buyer ^SM

Community Blue PPO plans are designed with low deductible and higher out-of-network cost sharing to keep employees in-network and maximize savings.

• Multiple deductible and copay plan options
• Preventive care covered at 100%
• 20% in-network coinsurance
• 40% out-of-network coinsurance
• Cost-sharing feature supports cost-effective use of services

BCN Basic, BCN 5 and BCN10

HMO plans that offer comprehensive coverage and low out-of pocket costs employees.

• Multiple deductible  and non-deductible plan options
• Flexible coinsurance and copay options combine cost sharing features

Blue Elect Plus ^SM

Our self referral option HMO has all the benefits of managed care coupled with the option of giving employees the choice to self-refer.

More Access

All the plans feature industry-leading provider network so your employees have unmatched access to doctors and hospitals throughout the state, nation and world. That way they reap the benefits from better:

• Coordinated care
• Relationships with doctors and specialists
• Health outcomes

BlueHealthConnection®

Employees are provided with comprehensive wellness and care management through BlueHealthConnect. This unique program includes an online health assessment and coaching programs, 24/7 nurse line and health improvement programs including Quit the Nic, chronic condition management and case management.

Valuable Web resources

Employees have the convenience of viewing their account, benefit and claims information online anytime. They also can find and compare the cost and quality of doctors, hospitals and drug treatment options based on the criteria that is important to them with Healthcare Advisor, which is powered by WebMD.

Member Discounts

Employees can save money on healthy products and services with Healthy Blue Xtras^SM and Blue365® savings programs. This includes healthy products and services they use every day from companies across Michigan and the United States.

Association Benefits Company-the MOA Insurance Team.

Association Benefits Company has provided MOA members and their staff benefits consulting services for more than 20 years. When you enroll your practice in a MOA/BCBSM Small Group plan, not only do you support your association, your association supports you by providing an experienced benefits team that handles all aspects of administering your BCBSM group health benefits including providing exclusive plan designs, premium billing, customized renewal packages, and direct  assistance with claims and benefits issues . . . all with no administrative fees. In addition, you always receive first quarter base rates! Lastly, we reimburse one year’s MOA membership dues when you join the MOA/BCBSM Small Group Program!

Are you already in a BCBSM small group plan but not with the MOA? Give us a call today for a no obligation benefit analysis to see if you could be saving money with the MOA Insurance Team.

For additional information, call Devona at the MOA at (800) 657.1556 or call Julie Watson of  Association Benefits (800) 782.0712. You can also visit Julie at booth #11 and the 2012 Scientific Convention

On November 17, 2011, the Centers for Medicare & Medicaid Services (CMS) announced it will implement a 90-day period of enforcement discretion for compliance with HIPAA Version 5010. While the compliance date of January 1, 2012 has not changed, CMS has decided it will not initiate enforcement until June 30, 2012.

What is “5010”?
5010 is the next version of the HIPAA electronic transaction standards. “5010” is the abbreviated way to refer to Version 005010 of the Accredited Standards Committee (ASC) X12 Technical Reports Type 3 (TR3s). The TR3s are the implementation guides for the ASC X12 administrative transactions, some of which are named in HIPAA and are required to be used when conducting the transaction electronically.

Who will need to upgrade to HIPAA 5010?

All covered entities (listed below) who transact business electronically are required to upgrade to HIPAA 5010 standards; covered entities may use a clearinghouse to assist with compliance:

• Physicians
• Hospitals
• Ancillary and behavioral health providers, including nurse practitioners and nurse practitioner primary care providers
• Payers
• Clearinghouses
• Pharmacies
• Dentists

Software vendors are not included in the list of covered entities, but they must upgrade their products to support HIPAA 5010 as a business imperative and to support their customers.

How does the 5010 implementation affect me?

If you do not convert to version 5010 by the compliance date, your claims and other transactions will be rejected, and reimbursement delays and resubmission costs could occur.

If you haven’t already started planning for the move to 5010, start now. Discuss the following steps with your vendor or clearinghouse to ensure you can meet the compliance deadline:

• Confirm that your vendors, clearinghouses and other partners can support the 5010 and ICD-10 requirements. Ask the following questions:
• Will they upgrade your current system? Is there a charge?
• Will the upgrade include transaction acknowledgements (for example, 999 and 277CA)?
• Will they support both 4010A1 and version 5010 concurrently?
• When can you begin testing?
• Will they complete their transition prior to the Jan. 1, 2012, compliance date?
• Review your contracts for terms related to honoring federal mandates and amend contracts as needed.
• Make sure you and your trading partners have the same understanding of the changes.
• Obtain timelines and project plans.

Paper claim submitters are not required to switch, but are encouraged to consider adopting an electronic approach for efficiencies in claims filing, inquiries and turnaround time.

Why the change?

The upgrade to HIPAA 5010 is required by federal law. In January 2009, the U.S. Department of Health and Human Services (HHS) announced a rule that mandates updated standards for electronic health care and pharmacy transactions. The upgrade to 5010 is important because the new version will be able to accommodate the forthcoming and mandatory ICD-10-CM and ICD-10-PCS code sets.

This is the first major version change since HIPAA implementation. The new version enhances business functionality, clarifies some ambiguities and better defines situational and required data elements.

Changes include:

National provider identifier reporting is fully supported.

• New ICD-10 codes will be fully supported, effective Oct. 1, 2013.
• Use of a post office box as the billing provider address is prohibited.
• A nine-digit ZIP code is required at the billing and service provider loops.
• Assignment or Plan Participation Code (Loop 2300 CLM07) can now be used for providers to accept assignment with payers. Previously, this segment was used to indicate Medicare participation status only.
• Approved and allowed amounts are deleted from AMT segments for COB claims.
• The number of diagnosis codes expands to 12.
• The date-of-service range will only be required when the “from” and “to” dates are different.
• The pay-to-provider address is required when different than that of the billing provider.

You can also find a wealth of information online. You are encouraged to review the Provider Action Checklist for a Smooth Transition (PDF)* created by the federal Centers for Medicare & Medicaid Services.

To learn more, visit http://bcbsm.com. You’ll find up-to-date information and resources related to the 5010 and ICD-10 migrations.

How does upgrading to 5010 relate to ICD-10?
ICD-10 is the upgraded version of ICD-9. The ICD-10 codes have a different format and length than the ICD-9 codes. The new format of the ICD-10 codes cannot be reported in the current version of the HIPAA transactions. So, the upgrade to 5010 needs to be completed before the ICD-10 codes can be reported in the HIPAA transactions. Additionally, ICD-10 codes cannot be used in HIPAA transactions prior to the October 1, 2013 compliance date.

BCBSM Update on 5010 acceptance

It is also important to note BCBSM has implemented 5010 and is in a position to accept all claims in this version; 85% of the Medicare claims BCBSM receives from providers are in the 5010 file format and are routed to the Part B carrier (WPS).  However, providers are still submitting 15% of their Medicare claims to us in the 4010 claim version and these are also routed to the Part B carrier for processing.

* BCBSM, MDCH and CMS are contributors to this information.

Despite the economic challenges both in Michigan and across the country, health care continues to serve as an economic engine and remains Michigan’s largest private-sector employer. Michigan’s community hospitals account for a significant portion of the state’s health care employment, in addition to playing a major role in training new physicians, nurses and other health care professionals. MORE>

• Reminder: File claims for payment for Healthy Blue Living qualification forms – Page 3
• BCN participates in the Michigan Primary Care Transformation Project – Page 5
• Criteria clarified for member transfer requests – Page 9
• Best Practices: Waterford practice uses spirometry to diagnose COPD and asthma – Page 25
• And more

Their work is evident through their strong and committed partnerships among community-based organizations, health departments, health advocacy groups, health service providers, and academic institutions.

The PRC/MI is one of 37 Prevention Research Centers funded by the Centers for Disease Control and Prevention. The Prevention Research Centers work as an interdependent network of community, academic, and public health partners to conduct prevention research and promote the wide use of practices proven to promote good health.

Kris T. Nicholoff, CEO/Executive Director of the Michigan Osteopathic Association (MOA) has been named to their State Board.

That agenda included a presentation on SIP: Potential for Cancer Screening Interventions for Cancer Survivors Delivered through Central Cancer Registries. Other project and proposal updates included:

-          Injury Center proposal

-          Bullying proposal

-          Current SIPS FOA topics include: Cancer Prevention and Care, Managing Epilepsy Well, Fall Prevention among Older Adults, Mobility of Older Adult Populations, and Evidence-Based Tobacco-Control Policies

-          UM Future Public Health Leaders program

-          UM Substance Abuse Research Center

Genesee County Arab American survey