AMCNO Seminar “Solving The Third Party Payor Puzzle” A Huge Success

The Academy of Medicine of Cleveland & Northern Ohio (AMCNO) was pleased to host its twenty sixth annual “Solving the Third Party Payor Puzzle” seminar on Wednesday, November 17. The AMCNO was pleased to have the following insurance companies return including Medical Mutual of Ohio, CIGNA Healthcare of Ohio, Palmetto GBA, the Ohio Department of Job and Family Services (ODJFS), UnitedHealthcare, Anthem Blue Cross and Blue Shield and Availity, LLC. The seminar was moderated by the AMCNO EVP/CEO Ms. Biddlestone and by AMCNO President Dr. Laura J. David. 

Staying abreast of current solutions is vital for health care administrative professionals to meet the future needs of the conversion of electronic claims. Presenters encouraged guests to utilize available electronic tools to streamline practitioners’ needs.

Medical Mutual of Ohio walked through the process of utilizing the ePortal noting that the Treatment Cost Estimator (TCE), provides immediate results to automatically pay and provide the status of a “real time” claim. An update on eServices and Electronic Remittance Advice (ERA), a direct deposit system was provided by CIGNA Healthcare of Ohio. Presenters also walked the audience through their website tools. In addition, CIGNA and Surescripts have partnered to provide electronic prescriptions to the patient’s pharmacy and has established wellness programs including smoking cessation, stress management and weight loss control. Webinars are online for patients to call in with questions. 

Palmetto GBA Medicare Part B reviewed Physician Quality Reporting (PQRI) and provided an update on the Health Information Technology (HITECH) Act outlining how eligible professionals (EPs) can receive a maximum of $44,000 incentive payment through 2014.

PalmettoGBA presenters discussed the ANSI Version 5010 is essential for the use of ICD-10-CM and testing begins on January 1, 2011. Compliance is expected by January 1, 2012. Also noted - Jurisdiction 15 has been awarded to CIGNA and transition from PalmettoGBA has not yet begun, however, information should be available shortly. A presenter from the Ohio Department of Job and Family Services provided updates on the Medical Information Technology System (MITS) and registration for the Electronic Funds Transfer in lieu of paper. Ms. Caesar also noted that although MITS implementation has been delayed indefinitely the intent is for the MITS system to provide –online claim submission, new remittance advices and a clinical claims editor. Medicaid recommends that physicians and their staff begin familiarizing themselves with MITS so that they are ready to go when it is up and running. 

Annie Boynton, from UnitedHealthcare, urged providers to migrate to 5010 / ICD-10 by January 1, 2012 as it will go live by October 1, 2013. Provider interpretation consistency will result in improved practice revenue. The three main areas impacted include: medical management, contracting and fraud and abuse. UnitedHealthcare is committed to full regulatory compliance and has requested America’s Health Insurance Plan (AHIP) to take action regarding crosswalk, training, communication and implementation dates. 

Presenters from Anthem Blue Cross and Blue Shield shared how their Care Comparison pricing is bundled into one rate package. They also discussed their various lines of business for members including local and Medicare advantage (FACETS), Bluecard (WGS), national (NASCO) and coverage for federal employees. The seminar wrapped up with Availity, LLC incorporating an on line presentation of their user friendly website for providers to obtain cost and time savings with Availity’s services. Availity is strongly supported by the AMCNO. This seminar will be repeated again in 2011 – AMCNO members may obtain the handouts from the session by contacting Ms. Cindy Penton at the cpenton@amcno.org