Enrollment, Forms, Etc.
Will this be an ongoing program and will it be mandatory? Are there any caps on payments to providers with this new program?
- The program contract currently extends to June of 2009. It is possible it may be continued after that. It is NOT mandatory, but there is no risk to providers to participation. If a provider provides no feedback or information, and does not complete any paperwork (except a W-9 required by federal law to be allowed to receive payment from the contractor) they can benefit from payment in this program for care already delivered in 2007.
- There are no caps on total payment.
How do I enroll? How much paperwork is required? Have enrollment forms been sent to providers?
- Enrollment information is available through the Provider Outreach Coordinator (POC) for your office. If you don't know who that is, call the Provider Support Group at 1-800-892-1028 Option 3.
- Information can also be obtained at the ACCESS Plus website www.accessplus.org
- Mailings will occur in the new year for the new program, but primary care providers are encouraged to contact their POC prior to the end of this year to be eligible for 2007 payments. Dentists and Ob-Gyn's will receive enrollment packets after the new year.
Do medical records have to be mailed along with the CCA forms?
- No, we require a signature of the provider on the Chronic Care Assessment Tool (CCAT) attesting that the information is correct, and no records are required.
Does the group practice sign up for this or will it need to be each individual physician?
- There are both individual and group practice agreements depending on your employment and tax structure. Signatures and a survey are required from each provider to participate in the program, and if in a group, a W-9 needs to be sent with the TIN for the group, or W-9's for each provider if not.
Will there be a detailed Bulletin on this? If so, when is it expected to be published?
- No bulletin will be published, but detailed information will be available through the website www.accessplus.org , and local ACCESS Plus representatives, as well as from the Provider Support Group at 1-800-892-1028 Option 3.
Will there be a standard form for the physician to fill out for all of these measures?
- The data to pay each measure is different. Some are claims based, some are derived from reports, and some information will require the completion of the Chronic Care Assessment Tool. The program is designed to minimize the paperwork required, and for the most part, completion of any paperwork will yield payment for the effort to do so.
Women's Health
Do the Women's Health incentives apply to Family Planning Clinics?
- The ACCESS Plus program is designed around a Medical Home concept, with a designated Primary Care Provider (PCP) for each recipient. As such, incentives are designed to reward the PCP for ensuring their patients receive appropriate care, in or out of their office.
Will there be a standard form for the OB measures that will result in incentives?
- OBNA forms are already used in the program and these will not be replaced. At this time, no standard form has been established for Depression Screening, so any of the standard validated Screening Tools can be used.
We operate a Healthy Beginnings program within our hospital setting. The majority of our patients do not have a Primary Care Physician. How do we fit into the P4P program?
- You would be able to participate fully in the measures related to Obstetric and peri-natal care.
May midwives enroll?
- If you provide obstetric and peri-natal care to ACCESS Plus recipients, your practice would be eligible for the Obstetric and peri-natal incentives.
Do you consider obstetricians to be PCPs?
- Not automatically. Obstetricians can be designated as Primary Care Physicians if they request to do so and meet the requirements of a PCP under the guidelines issued in the program.
Is there a designated amount of time that the practice has to submit (fax) the OBNA form each trimester (ie., how many days after the trimester ends or the woman delivers do we have to submit the form to be in compliance for the incentive?)?
- The OBNA form should be faxed within 20 business days of the date of service.
Is there a specific depression questionaire or is it already on the access plus OB assessment form we currently use?
- There is no specified standard depression tool. The department will accept any of the many standard validated questionnaires available.
Can an OB/GYN office be a smoking cessation counselor or just a PCP office?
Smoking Cessation
Where do we send our smoking cessation forms?
- To be registered as a smoking cessation counselor go to http://www.dsf.health.state.pa.us/health/lib/health/tobacco/CessationProviderApplication.pdf and follow the instructions there. At this time, it is anticipated that providers who register will be rewarded for doing so with the data source being the Department of Health.
Can the smoking cessation counseling be in conjunction with another visit?
Pediatrics
Lead screenings are done at EPSDT visits for 9mo and 2yr olds. Is there a form that should be submitted for them?
- No additional submission is necessary as the data to pay these will be obtained from claims.
Has there been any consideration to reward improvements in immunization rates and/or EPSDT screening rates within a practice?
- Improvement in well child visits for ages 3 through 6 and adolescents are included in the program. A great number of measures were considered and rejected for consideration. The decisions to include or exclude measures suggested were based on budget, ease of implementation and other factors.
Will pediatricians who complete a PPD screen on the mother be recognized for payment even though their patient is the child?
- Assuming this is referring to a depression screen (not a TB test) the answer is yes. Maternal depression screening is considered to be an integral part of the well child visit since detection of depression is helpful in improving the safety and well being of the child.
For the care plans for children, will the $40 be reimbursed for the initial development and updates? ie $40 twice per year for development and oversight.
- Complex care plans will be reimbursed $40 for the initial and subsequent updates, with payment up to twice a year, for children with the appropriate diagnoses.
General
If I have a diabetic with CAD who is at goal LDL will I be reimbursed under both quality indicators?
- There will be payment for each measure once for each patient, sorry, no double payment for one patient.
Does FQHC status preclude participation in the Incentive Program? Do these incentives also apply to FQHCs?
- FQHC's who serve as medical homes and provide PCP services are encouraged to participate. All incentives available apply to all FQHC's who provide the services.
Are the MA HMOs (Amerihealth Mercy, Gateway) included in the P4P incentives?
- This is an ACCESS Plus program. The MA HMO's may have their own incentive programs, but this program applies to ACCESS Plus.