Anthem & Hartford HealthCare Continue To Negotiate Terms

As of this afternoon, the state’s largest health insurer, Anthem Blue Cross Blue Shield and a network of five major Connecticut hospitals, Hartford HealthCare, have yet to reach an agreement. Anthem and Hartford are continuing to negotiate contract terms; the existing contract expires at midnight tonight.  If the contract expires, Anthem’s network will no longer include Hartford Hospital, The Hospital of Central Connecticut in New Britain, MidState Medical Center, William W. Backus Hospital, and Windham Hospital. Many similar disputes have been resolved near the contract deadline.

Stay tuned to the HMS blog for the latest information regarding this negotiation.

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Study: Understanding Home Healthcare May Lead To More Effective Partnerships

According to a new study by the University of Pennsylvania School of Nursing, home health agencies can help hospitals reduce readmissions and control healthcare costs. However, the effectiveness of these agencies in meeting such goals depends on the quality of organizational support given to healthcare field workers. Researchers note that home health care nurses are so frequently overburdened with non-care responsibilities that it affects their ability to provide patients with the level of services they need. Additionally, reduced reimbursement from Medicare, such as the 14 percent cut from 2014 through 2017, makes it harder for high-performing agencies to continue their success. In determining which agencies to work with, hospitals should be aware of the work environment pressures agencies are under and how these pressures may impact their ability to be an effective partner.

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Tiptastic Tuesday: Update On Requests For Reconsideration/Non-Compliance With HQRP Reporting Requirements

CMS recently posted the following notice to the Spotlight and Announcements section of the HQRP website. If your hospice applied for a request for reconsideration for a determination that it was out of compliance with HQRP reporting requirements, please take note:

Attention Hospice Providers!

On June 30, 2014 CMS mailed notifications to all Hospices that were determined to be out of compliance with the CMS Hospice Quality Reporting Program requirements.    Any Hospice that received a notice of non-compliance had the opportunity to submit a request for reconsideration of the initial CMS determination of non-compliance, with respect to quality data submissions affecting the FY 2015 market basket update.  We have completed our review of all Hospice requests for reconsideration.  All notifications will be mailed by Tuesday, September 23, 2014.  If your Hospice has applied for reconsideration and is expecting to receive a letter of notification, we kindly ask that you allow at least 7 days, beginning with September 23, 2014, before submitting inquiries to our help desk regarding the status of your notification.  If your Hospice has applied for reconsideration and does not receive a letter of notification by Tuesday, September 30, 2014, you may contact our reconsiderations help desk for assistance.  Please send your inquiries to:

2014 NGSConnex Recertification Process

NGS will be conducting a mandatory recertification for all NGSConnex Local Security Officers (LSOs) and users. This process is required by CMS to maintain security of data and failure to comply in the recertification process will result in access cancellation.

Process Details

  1. LSOs will receive an email asking them to enter their supervisor’s information in NGSConnex.
  2. National Government Services will send the supervisor an email with a recertification code(s) asking them to verify that LSO is still the correct individual and forward the email to them.
  3. The LSO will enter the code for themselves and for their users.

Key Dates

  1. Recertification period is October – November 2014
  2. LSOs will receive the email requesting the supervisor submission early October
  3. Supervisor emails with codes sent 10/15/2014 – 11/30/2014

Monday Morning Recap

The HMS Healthcare Management Solutions Monday Morning Recap reviews some of the top stories and healthcare highlights you may have missed last week.

Completion & Submission Timeframes For Hospice Item Set Records

As part of the Hospice Quality Reporting Program (HQRP), all Medicare-certified hospices are required to complete and submit a Hospice Item Set (HIS)-Admission record and a HIS-Discharge record for patient admissions on or after July 1, 2014. Hospices should complete and submit each record according to the timeliness criteria outlined below:

  • HIS Record Completion: The Completion Date is defined as the date all required information has been collected and recorded and staff have signed and dated that the record is complete. Hospices have 14 days from admission to complete HIS-Admission records and 7 days from discharge to complete HIS-Discharge records.
  • HIS Record Submission: The Submission Date is defined as the date on which the completed record is submitted and accepted to the QIES ASAP System. Hospices have 30 days from a patient admission or discharge to submit the appropriate HIS record for that patient to the QIES ASAP System.

If you have questions about completing and submitting the HIS, there are several resources available on the HIS web page. Providers should review the updated version of the HIS Manual (V1.01) as well as the two Question and Answer documents. A Fact Sheet regarding HIS completion timing guidelines and a HIS Checklist are also available. If you have any quality-related questions about the HQRP, please contact the Quality HelpDesk at

 The HIS Technical Information web page contains the final HIS data specifications and information related to software systems for HIS record completion and submission. In addition, hospices may want to review the Hospice Training Modules available on theQIES Technical Support Office website.

*Information above provided by NAHC.

Hackers Targeting Healthcare Providers

According to security experts, your medical information is worth 10 times more than your credit card number on the black market. Last month, FBI warned healthcare providers to guard against cyber attacks after one of America’s largest hospital operators had been broken into, stealing the personal information of 4.5 million patients. Security experts warn that these cyber criminals are increasingly targeting the $3 trillion U.S. healthcare industry. Hackers sell names, birth dates, policy numbers, diagnosis codes and billing information, sometimes using this data to create fake IDs to buy medical equipment or drugs that can that can resold. They may even combine a patient number with a false provider number and file  made-up claims with insurers. Because medical identity theft is not immediately recognized, criminals have more time to use the stolen credentials. With the shift to electronic medical records, experts predict more cyber attacks.

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Talk To Patients To Prevent Hospitalizations

Healthcare providers around the country are starting to change their strategy for dealing with rising costs. Some are deciding to invest money in care coordination, saying it will save money in the long run and improve the quality of care. These same providers also want to teach patients to care for themselves, believing that management of medical conditions outside the hospital will prevent crises from happening. One of the reasons behind this shift is that Medicare is penalizing hospitals with lower reimbursements when patients have been admitted repeatedly for specific conditions. Focusing on prevention will help avoid some of these repeat visits. Speaking with patients has lead to patients taking their medication and making other lifestyle changes that positively affect their health. Only time will tell but maybe lots of little improvements will add up to big savings to the health system while simultaneously improving the health of patients.

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NCQA Releases Annual Health Plan Rankings

The National Committee for Quality Assurance’s Health Insurance Plan Rankings 2014-2015 looked at nearly 1,400 plans on the commercial, Medicare and Medicaid markets and ranked them based on their combined HEDIS, CAHPS and NCQA Accreditation standards scores.

The top 10 plans are:

  1. Tufts Associated Health Maintenance Organization-HMO/POS
  2. Harvard Pilgrim Health Care-HMO/PO (MA, ME)
  3. Harvard Pilgrim Health Care-PPO (MA)
  4. Kaiser Foundation Health Plan of the Northwest-HMO (OR, WA)
  5. Kaiser Foundation Health Plan of the Northwest-HMO (OR, WA)
  6. Tufts Benefit Administrators-PPO (MA, RI)
  7. Kaiser Foundation Health Plan of Southern California-HMO (CA)
  8. Kaiser Foundation Health Plan of Northern California-HMO (CA)
  9. Martin’s Point US Family Health Plan-HMO (ME)
  10. Blue Cross and Blue Shield of Massachusetts-PPO (MA)

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