Practice Support Newsletter

December 2023

Regulatory Reminders – Policies and Checklists

Provider offices have a host of regulatory requirements that come from government agencies to insurance companies. Often these requirements overlap but it can be hard to keep track of it all. It is best practice to have policies to reference, annual staff training to review and importantly a checklist that is reviewed on a monthly/weekly basis to ensure everything is in order. 

South Piedmont AHEC can help practices organize regulatory policies and prioritize what is the most important for the practice based on risk into a checklist/s. 

Additional resources can be found online at: 

OSHA – Occupational Safety 

CMS Life Safety Code – National Fire Protection Agency – Fire and Emergency Preparedness 

SPICE – NCPH Epidemiology – Infection Control 

NC Environmental Quality – Laboratory 

Office of Civil Rights – HHS.gov – ONC Security Risk Assessment – HIPAA 

NC DHHS State Policies and Manuals

Measure of the Month

Are Your Patients Up to Date?

December 4th – 8th is National Influenza Vaccination Week. Getting a vaccine every year is the best way to prevent flu. Every year there are thousands of hospitalizations because of influenza. Getting vaccinated against flu is particularly important for young children and older adults who are at higher risk of developing serious complications. 

The CDC has a Digital Media Toolkit to help you reach out to patients. 

Check out the current Influenza Activity Map. 

If you are participating in MIPS (Merit-based Incentive System) the Adult and Childhood Immunization Status measures include influenza vaccine. 

Adult Immunization Status 

Childhood Immunization Status

Diversity Moment: Why is it Important to Reduce Implicit Bias

A few months back we talked about minimizing Implicit Bias in the primary care practice setting. We did not discuss WHY it is important to do so. What are the benefits? Why should practices care? Here are a few reasons:

• Improves patient experience & satisfaction. Satisfied patients tend to return for additional treatment (reducing no-show rates) AND recommend your practice to others.
• Supports an environment of inclusion and builds patient trust. Practices can tap into community resources and foster networks that help impact the communities in which they practice. This, in turn, may decrease disparities in care among different groups.
• Improves patient compliance with care and treatment goals. Patients that are satisfied and feel included may feel more involved in decision making and can be more compliant with meeting goals set by the care team. These steps tend to create better health outcomes for patients.

For additional reading on Implicit Bias, please refer to the Joint Commission Quick Safety Issue 23: Implicit Bias in Healthcare (April 2016).

South Piedmont AHEC Continuing Education Suggestion

Safety Stuff That Matters! A Compliance Webinar Series

This FREE series is a monthly, 1-hour session which will educate clinical and leadership staff about clinical compliance concerns at the practices that could affect patient safety. This monthly series will be held on the third Wednesday of each month starting January 17, 2024, from 12 PM – 1 PM. Topics include:  

• OSHA is Here! No Need to Fear
• Who’s on First: The Role of the Infection Control Coordinator
• TIME OUT!! Management of a Blood Exposure
• No Wet Packages: Instrument Processing Done Correctly and Efficiently
• One Needle, One Syringe: Safe Injection Practices

Register now with South Piedmont AHEC

NC Medicaid's New Innovations Waiver Dashboard

NC Medicaid has introduced an Innovations Waiver Waitlist dashboard to improve service delivery to individuals in need. This dashboard provides valuable insights into the individuals on the waitlist, categorized by county and LME/MCO. Its purpose is to ensure timely and appropriate services in appropriate settings. 

NC Medicaid is continuously improving the dashboard and plans to expand its information to enhance our understanding of the population awaiting NC Innovations Waiver services. 

For more details, please visit the following link: New NC Medicaid Dashboard - Innovations Waiver Waitlist. 

Is Your Provider Directory Information Correct?

It’s important to make sure that your patients and potential patients have the information they need about your practice. Checking the “Find a Provider” on the insurer's website is a great way to see if the information about your facility is correct. Providing accurate information is essential for patients to be able to choose to receive care at your practice.

Information may include:

✓  Address 
✓  Hours 
✓  Star Rating (Medicare Plans) 
✓  Accepting New Patients 
✓  Services Offered 

Steps to take if information is missing or incorrect:

1. Wellcare and Healthy Blue have information on their websites about updating provider directory information.
2. For Medicaid plans make sure provider and practice information are correct in NC Tracks.
   a. If information is correct in NC Tracks reach out to the Plan to verify they have correct information.
3. NC Medicaid has a “report an error” option for providers to communicate errors.

Wellcare – Updating Provider Directory Information | Wellcare 

Healthy Blue – Reminder for Providers to Attest Every 90 Days to Confirm Accuracy of Directory Information | Blue Cross NC 

Carolina Complete Health – Find a Provider: Search Options (carolinacompletehealth.com) 

United Healthcare Community Plan – United Healthcare Community Plan

AmeriHealth Caritas – Find Care – AmeriHealth Caritas North Carolina (healthsparq.com) 

NC Medicaid – Find a primary care provider (PCP) | NC Medicaid Managed Care (ncmedicaidplans.gov)

MIPS Data Validation Audits Have Begun!

The Centers for Medicare & Medicaid Services (CMS) has contracted with Guidehouse to conduct MIPS Data validation Audits. The notification of selection and requests for information began in November and will continue through March 2024 with ad hoc requests through the end of 2024. 

 How do I know if my group or provider was selected?

• Be on the lookout for an email that will come from MIPS_DVA_Request@guidehouse.com
• The email will be sent to the person named as the Security Official in your HARP account.

What should I do to prepare?

• Ensure contact information is correct in the HARP platform.
• Review the “MIPS Data Validation and Audit (DVA) Factsheet PY 2022” by navigating to QPP Resource Library, completing a quick search and downloading the PDF.

2023 MIPS Extreme and Uncontrollable Circumstances Exception and MIPS Promoting Interoperability Performance Category Hardship Exception Applications

The MIPS EUC Exception application for the 2023 performance year is now available and will close at 8 p.m. ET on January 2, 2024. If you believe you’ve been affected by an extreme and uncontrollable circumstance, you can apply for this exception whether reporting traditional MIPS, MVPs, or the APM Performance Pathway (APP)

For more information and to apply for an exception, visit QPP.

Coding Corner

Don't Miss Out on Coding 99401 for Counseling Families on the new RSV Monoclonal Antibody!

Are you counseling families about the new RSV monoclonal antibody, Beyfortus? While Beyfortus may currently be in short supply there is probably no shortage of questions about it! 

CPT 99401 may be used for counseling for children 0-19 months and may be billed once per day for providing education and counseling about the new RSV monoclonal antibody. There are no limits on the number of times the education may be provided to an eligible beneficiary's family. For more information see NC Medicaid Respiratory Syncytial Virus (RSV) Guidelines for 2023-2024.

Upcoming ICD-10 Update Includes New Codes for Parkinson's and Other Conditions

The diagnosis codes on your claims sometimes play as big a role in determining whether you get paid as the service or procedure codes, so it’s important to prepare for the upcoming update to the ICD-10-CM. The update is effective for patient encounters on or after Oct. 1, 2023, and includes additions, deletions, and revisions to diagnosis codes common in family medicine. 

For example, the current single code for Parkinson’s disease (G20) is expanding into these five codes:

• G20.A1 (Parkinson's disease without dyskinesia, without mention of fluctuations),
• G20.A2 (Parkinson’s disease without dyskinesia, with fluctuations),
• G20.B1 (Parkinson's disease with dyskinesia, without mention of fluctuations),
• G20.B2 (Parkinson’s disease with dyskinesia, with fluctuations),
• G20.C (Parkinsonism, unspecified).

ICD-10-CM is similarly expanding Z83.71 (“Family history of colonic polyps”) into four more specific codes:

• Z83.710 (Family history of adenomatous and serrated polyps),
• Z83.711 (Family history of hyperplastic colon polyps),
• Z83.718 (Other family history of colon polyps),
• Z83.719 (Family history of colon polyps, unspecified).

There will also be a new family of codes for chronic migraine with aura (G43.E-) and a new code for “Resistant hypertension” (I1A.0). A complete set of the ICD-10-CM code changes that are effective Oct. 1 is available in the “Downloads” section of the 2024 ICD-10-CM webpage on the Centers for Medicare & Medicaid Services’ website.

South Piedmont AHEC Practice Support – Helping you meet the challenges!

In this time of great transition in health care practices need to position themselves for new payment models, incentive programs, and other health care reforms while refocusing on patient-centered care. South Piedmont AHEC is currently able to provide these direct, individualized services at no cost.

Additional Resources: