The Illinois Department of Healthcare and Family Services (HFS) has posted a frequently asked questions page that explains how to qualify and register for the Electronic Health Records (EHR) incentive payment program.
Prior to becoming familiar with the Illinois-specific guidelines, providers should review the basics of the federal program, including maximum payment amounts, eligibility requirements and how to register at the Centers for Medicare & Medicaid Services (CMS) website.
A few of the questions answered on the HFS frequently asked questions page are:
What is the deadline for registering and attesting for the 2011 payment year?
What are the Meaningful Use requirements?
How do I calculate my Medicaid patient volume?
If providers have questions that the FAQ document does not address, you can send an email to hfs.ehrincentive@illinois.gov to get further information.
Thursday, January 19, 2012
Wednesday, January 18, 2012
Protect yourself with a flu shot
Influenza is a serious disease that can lead to hospitalization or even death. Getting a flu shot every year can protect you and your family from the flu and its complications.
It is recommended that everyone 6-months and older get a flu shot. Infants less than 6-months old cannot get a flu shot. These infants can be protected if those in contact with them get a flu shot.
Talk to your primary care provider (PCP) about when flu shots are available. The flu viruses are always changing. That is why getting a flu shot each year is important. Last year's flu shot may not protect you.
The flu can affect anyone. Certain people have a higher health risk from the flu.
Pregnant women, elderly adults and young children are more at risk to the harmful effects of flu. People who have chronic conditions such as asthma, diabetes, or heart disease also have a greater risk from flu.
Children less than 5-years-old are at higher risk of serious flu complications.
Flu shots are used to prevent illness, not treat it. It takes two weeks for the flu shot to give you protection from the flu. People who are currently sick with fever should wait to get a flu shot. Those who are allergic to eggs or who have had an allergic reaction to past flu shots should not get a flu shot.
It is best to get your flu shots from your medical home. But you could also go to a local health department or pharmacy to get a flu shot.
The flu shot cannot give you the flu. Most people do not experience side effects from flu shots. When they do, the side effects are mild. The most common side effect is redness, tenderness or swelling where the injection was given.
The nasal flu spray is an option for healthy people ages 2-49. Pregnant women, people with chronic conditions or children ages 2-4 with a history or wheezing should not get a nasal flu spray.
Source: American Academy of Family Physicians
It is recommended that everyone 6-months and older get a flu shot. Infants less than 6-months old cannot get a flu shot. These infants can be protected if those in contact with them get a flu shot.
Talk to your primary care provider (PCP) about when flu shots are available. The flu viruses are always changing. That is why getting a flu shot each year is important. Last year's flu shot may not protect you.
The flu can affect anyone. Certain people have a higher health risk from the flu.
Pregnant women, elderly adults and young children are more at risk to the harmful effects of flu. People who have chronic conditions such as asthma, diabetes, or heart disease also have a greater risk from flu.
Children less than 5-years-old are at higher risk of serious flu complications.
Flu shots are used to prevent illness, not treat it. It takes two weeks for the flu shot to give you protection from the flu. People who are currently sick with fever should wait to get a flu shot. Those who are allergic to eggs or who have had an allergic reaction to past flu shots should not get a flu shot.
It is best to get your flu shots from your medical home. But you could also go to a local health department or pharmacy to get a flu shot.
The flu shot cannot give you the flu. Most people do not experience side effects from flu shots. When they do, the side effects are mild. The most common side effect is redness, tenderness or swelling where the injection was given.
The nasal flu spray is an option for healthy people ages 2-49. Pregnant women, people with chronic conditions or children ages 2-4 with a history or wheezing should not get a nasal flu spray.
Source: American Academy of Family Physicians
Tuesday, January 17, 2012
Spotlight: DHS Division of Mental Health
The Illinois Department of Human Services (DHS) operates the Division of Mental Health (DMH), which is the state's mental health authority.
DMH provides a wide-variety of services at all levels for adults and children throughout the state. DMH partners include mental health clinics, agencies and hospitals. Services are available through 162 community mental health centers, more than 30 community hospitals with psychiatric units and nine state-owned hospitals.
DMH services include: case management, therapy and counseling, psychosocial rehabilitation, community support, crisis intervention and assertive community treatment.
A contact list of providers for crisis psychiatric and non-emergency mental health services is located at the DMH home page. There is also a DMH office locator to find the community mental health center nearest to your location.
To locate DMH services by phone, call 1-800-843-6154. Select extension 3 at the first prompt and extension 4 at the second prompt.
DMH provides a wide-variety of services at all levels for adults and children throughout the state. DMH partners include mental health clinics, agencies and hospitals. Services are available through 162 community mental health centers, more than 30 community hospitals with psychiatric units and nine state-owned hospitals.
DMH services include: case management, therapy and counseling, psychosocial rehabilitation, community support, crisis intervention and assertive community treatment.
A contact list of providers for crisis psychiatric and non-emergency mental health services is located at the DMH home page. There is also a DMH office locator to find the community mental health center nearest to your location.
To locate DMH services by phone, call 1-800-843-6154. Select extension 3 at the first prompt and extension 4 at the second prompt.
Friday, January 13, 2012
Primary Care Extension Program Summit: June 17, 2011
The primary care extension program (PCEP) is a model of care that was developed to take advantage of community networks as a means of improving quality of medical care and community health through two mechanisms, namely, local technical support or practices and linage with community resources.
PCEP is a framework of care intended to support a variety of models of practice. Optimal effectiveness is likely to come when PCEP is aligned with primary care practices based on the patient-centered medical home model (PCMH). The PCEP model provides assistance for the transformation of primary care to the medical home model.
While the medical home model represents an improvement in health care delivery and outcomes, unaddressed social determinants of health often impact a patient's ability to follow through on his or her care plan. Public health programming may be able to impact some of these barriers with the use of lay health workers who straddle the gap between the patient in the community and the medical practice.
The PCEP model incorporates Health Extension Agents (HEAs) to perform this outreach function. While the Affordable Care Act (ACA) calls for the development of a national PCEP framework, funding has not been allocated.
On June 17, 2011, Illinois Health Connect hosted a state-wide summit to explore the PCEP concept and opportunities for creating a PCEP network in Illinois.
Please review the links below for information about the summit. For additional questions, contact Margaret Kirkegaard, MD, MPH, Illinois Health Connect Medical Director at mkirkegaard@automated-health.com.
Preconference Readings
Environmental Surveys
PCEP is a framework of care intended to support a variety of models of practice. Optimal effectiveness is likely to come when PCEP is aligned with primary care practices based on the patient-centered medical home model (PCMH). The PCEP model provides assistance for the transformation of primary care to the medical home model.
While the medical home model represents an improvement in health care delivery and outcomes, unaddressed social determinants of health often impact a patient's ability to follow through on his or her care plan. Public health programming may be able to impact some of these barriers with the use of lay health workers who straddle the gap between the patient in the community and the medical practice.
The PCEP model incorporates Health Extension Agents (HEAs) to perform this outreach function. While the Affordable Care Act (ACA) calls for the development of a national PCEP framework, funding has not been allocated.
On June 17, 2011, Illinois Health Connect hosted a state-wide summit to explore the PCEP concept and opportunities for creating a PCEP network in Illinois.
Please review the links below for information about the summit. For additional questions, contact Margaret Kirkegaard, MD, MPH, Illinois Health Connect Medical Director at mkirkegaard@automated-health.com.
Preconference Readings
- Primary Care Extension Program for Illinois
- Berwick Extension Agent Interview
- HA Blueprint Article
- JAMA Extension Agent
- Annals of Family Medicine Kaufman
- New Mexico Health Extension
- Primary Care Health Extension
Environmental Surveys
- Aggressive Lipid Management and Cardiovascular Risk Reduction for Primary and Secondary Cardiovascular Prevention
- Office of the Future/PEDS CARE
- Illinois Area Health Education Centers Network Program
- Bright Smiles from Birth
- CHIPRA Quality Demonstration Project
- Enhancing Developmentally Oriented Primary Care (EDOPC)
- Building Community Based Medical Homes for Children Program
- Promoting Health
- Immunization Initiatives
Tuesday, January 10, 2012
Spotlight: HFS annual incentive program for well-child visits
The Illinois Department of Healthcare and Family Services (HFS) has since 2007 offered an annual incentive payment to providers who render all recommended well-child visits during each year of a child's life.
Due to the timing of the payment, this HFS incentive payment is sometimes confused with the Illinois Health Connect Bonus Payment for High Performance, which is also paid during the summer months. The IHC bonus has pediatric bonuses -- immunization combo-3 prior to 24 months, lead screening prior to 24 months, asthma management for ages 5-11 as well as objective developmental screenings prior to 12, 24 and 36 months. However, the IHC bonus does not offer an incentive payment for well-child visits.
The HFS well-child incentive payment is $30 per patient and the payment is sent without an explanation of benefits from HFS. The voucher that comes with the bonus check will have "MEMI" listed to help identify the source of the funds. The bonus requirements are divided into three agre groups and the bonuses are determined through HFS claims data.
For more information, read topic 202.4.1 in the HFS Healthy Kids Handbook. Providers who have further questions about this bonus should contact HFS at 217-524-7465.
Due to the timing of the payment, this HFS incentive payment is sometimes confused with the Illinois Health Connect Bonus Payment for High Performance, which is also paid during the summer months. The IHC bonus has pediatric bonuses -- immunization combo-3 prior to 24 months, lead screening prior to 24 months, asthma management for ages 5-11 as well as objective developmental screenings prior to 12, 24 and 36 months. However, the IHC bonus does not offer an incentive payment for well-child visits.
The HFS well-child incentive payment is $30 per patient and the payment is sent without an explanation of benefits from HFS. The voucher that comes with the bonus check will have "MEMI" listed to help identify the source of the funds. The bonus requirements are divided into three agre groups and the bonuses are determined through HFS claims data.
For more information, read topic 202.4.1 in the HFS Healthy Kids Handbook. Providers who have further questions about this bonus should contact HFS at 217-524-7465.
Billing for Preventive Services
The Illinois Department of Healthcare and Family Services (HFS) recently issued a provider release about billing for preventive services. The intent of the notice was to remind providers to follow the American Medical Association guidelines for the preventive evaluation and management CPT codes.
For children ages 0-20, HFS recommends that health screenings be provided on a periodicity schedule based on acceptable medical practice standards, such as those recommended by the American Academy of Pediatrics or the American Academy of Family Physicians, or the well-child visit and periodicity schedule located in the HFS Healthy Kids Handbook.
For adults ages 21 and older, providers must bill the age-appropriate preventive evaluation and management CPT codes. Payment will be limited to one preventive office visit per patient, per provider per year.
Illinois Health Connect wants to reminder providers that interperiodic health screenings -- such as administrative exams for adoption or insurance certification, as well as physicals for school, sports, camp or employment -- will continue to be covered when the correct diagnosis code is used. Providers should use the V70.3 diagnosis code with an interperiodic screening.
For children ages 0-20, HFS recommends that health screenings be provided on a periodicity schedule based on acceptable medical practice standards, such as those recommended by the American Academy of Pediatrics or the American Academy of Family Physicians, or the well-child visit and periodicity schedule located in the HFS Healthy Kids Handbook.
For adults ages 21 and older, providers must bill the age-appropriate preventive evaluation and management CPT codes. Payment will be limited to one preventive office visit per patient, per provider per year.
Illinois Health Connect wants to reminder providers that interperiodic health screenings -- such as administrative exams for adoption or insurance certification, as well as physicals for school, sports, camp or employment -- will continue to be covered when the correct diagnosis code is used. Providers should use the V70.3 diagnosis code with an interperiodic screening.
FAQ: Billing for Gardasil
Gardasil has been an HFS covered service since 2007, but providers often report having the claim rejected with the error code notes saying "more information needed."
To avoid this rejection, providers should make sure to enter the word "Gardasil" in addition to CPT code 90649 on the claims when sending to HFS. If providers are using the 2360 paper claims form, "Gardasil" should be entered in field 24C in the description area. In the 837P electronic format, "Gardasil" should be entered in the NTE segment of Loop 2400.
For providers who participate in the Vaccines For Children program, the reimbursement for CPT 90649 will be $6.40 per dose for female patients ages 9-20.
For female patients ages 21-26, all providers are eligible to bill HFS at rate of $149.33 per dose using CPT code 90649 with modifier SL.
Gardasil is also a billable HFS service for male patients ages 9-26, effective October 21, 2009. For boys ages 9-18, use CPT code 90649. The reimbursement rate is $6.40 per dose for VFC providers. For boys ages 19-26, use modifier SL along with CPT code 90649 and the rate is $149.33 per dose.
To avoid this rejection, providers should make sure to enter the word "Gardasil" in addition to CPT code 90649 on the claims when sending to HFS. If providers are using the 2360 paper claims form, "Gardasil" should be entered in field 24C in the description area. In the 837P electronic format, "Gardasil" should be entered in the NTE segment of Loop 2400.
For providers who participate in the Vaccines For Children program, the reimbursement for CPT 90649 will be $6.40 per dose for female patients ages 9-20.
For female patients ages 21-26, all providers are eligible to bill HFS at rate of $149.33 per dose using CPT code 90649 with modifier SL.
Gardasil is also a billable HFS service for male patients ages 9-26, effective October 21, 2009. For boys ages 9-18, use CPT code 90649. The reimbursement rate is $6.40 per dose for VFC providers. For boys ages 19-26, use modifier SL along with CPT code 90649 and the rate is $149.33 per dose.
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