The Navigator. Important news for Samaritan Health Plan Operations network physicians and health care professionals

Transcription

1 The Navigator J U L Y Important news for Samaritan Health Plan Operations network physicians and health care professionals Important plan changes, updates and announcements... 2 Quality improvement project: bone density screening... 2 Samaritan Healthy KidsConnect: health care coverage from head to foot and everything in-between... 2 Provider survey please let us know how are we doing... 3 Provider resources... 3 Billing Add-On Codes (+)... 3 Modifiers 80 and AS... 4 Newly paneled providers... 4 PLEASE ROUTE to appropriate physicians and professional health care providers in your office.

2 Important plan changes, updates and announcements 2 QUALITY IMPROVEMENT PROJECT: BONE DENSITY SCREENING Samaritan Health Plan Operations (SHPO) implemented a quality improvement project focusing on increasing the screening rate for osteopenia and osteoporosis through bone density exams and we continue to need your assistance. The healthier your patients bones are now, the fewer problems they may face later. Talking to them is the first step. Loss of bone density is certain as people grow older, but the sooner deteriorating bone health can be identified, the sooner it can be treated. Please remember to follow SHPO s recommended adult preventative screening and immunization guideline for bone density exams, listed below. WOMEN: 65 and older screening once every two years 60 and older if at increased risk for osteoporotic fracture At any age for a woman at high risk Risk factors for osteoporosis o family history of osteoporosis o tobacco use o exceptionally thin or have a small body frame o early menopause o eating disorder o long term use of corticosteroid medications o thyroid replacement o SSRI use o history of breast cancer o sedentary lifestyle o excessive caffeinated soda consumption o depression MEN: Assessment and screening as determined by the provider SAMARITAN HEALTHY KIDSCONNECT: HEALTH CARE COVERAGE FROM HEAD TO FOOT AND EVERYTHING IN-BETWEEN Two years ago, Oregon made a promise to its children: you will have health care your parents can afford. To fulfill this promise, a new health care program called Oregon Healthy Kids has been created. It provides free or low-cost health insurance that covers all the health care kids need. Health coverage from head to foot and everything in between. To join a plan, the child must be age 18 or under and be uninsured. The cost for the plan depends upon the size of the family and their income. Here is an example of family size and incomes. Family Size FREE PLAN LOW-COST PLAN $22/month and up 2 $0 - $29,420 $29,421 - $44,130 3 $0 - $37,060 $37,060 - $55,590 4 $0 - $44,700 $44,700 - $67,050 5 $0 - $52,340 $52,340 - $78,510

3 3 What are you being asked to do? Direct people to enrollment assisters. There are Healthy Kids Partners in your community that would love to help a family enroll. You can send your patients to any enrollment assister. A list can be requested by calling Samaritan Resource Line at or helpkids@samhealth.org. Know what the program is. If the answer you are looking for is not readily available, you can call the Samaritan Resource Line at or helpkids@samhealth.org. Hand out enrollment kits. Request a provider toolkit by calling or ing helpkids@samhealth.org everything is prepared for you just ask for a toolkit. All you need to do is help an uninsured child by giving them the application packet we have provided you. Display brochures. Our brochures have been State-approved and can sit next to the brochures you may already have in your office. By allowing these brochures to be displayed, you are already helping families. These stands are in the provider toolkit mentioned above. Who can help my patients to enroll in the plan? You can use the enrollment assisters list to find a local advocate that can help your patients enroll in a Healthy Kids insurance plan. The Office of Healthy Kids partners with schools, PTAs, coaches, community non-profits and advocates, insurance agents, businesses, health care workers and others. Contact the Samaritan Resource Line at or helpkids@samhealth.org: Get provider toolkits and enrollment kits for your patients Order more brochures Ask questions PROVIDER SURVEY PLEASE LET US KNOW HOW ARE WE DOING Your opinion is important to us! In recent months, we have made a number of changes in the ways that we provide service and support to you. We have made new web tools available for you to use and expanded the type of phone service we provide. Our goal was to make it easier and more convenient for you to work with us. We are checking in to see what you think. Would you please take a few minutes to let us know? We have posted a survey online at: We know you are busy, so we have kept the survey short and to the point it should only take about 5 minutes of your time. Bonus! Your completed survey will be placed in a drawing for two $20 Safeway gift cards. Drawing will take place on July 29, Winners will be notified. Provider resources BILLING ADD-ON CODES (+) Add-on codes are CPT codes that describe additional intra-service work associated with the primary procedure. The add-on code must always be reported with the primary procedure. Add-on codes are not to be used as the primary procedure, as a standalone procedure, or with a HCPCS code. To identify add-on procedure code(s), look for the plus (+) symbol on the left-hand side of the procedure code in the CPT codebook. At the end of the CPT description, in parentheses, you will find a listing of the add-on codes that can be used. Complete listings of add-on codes are located in Appendix D of the 2011 American Medical Association CPT Manual Professional Edition.

4 4 MODIFIERS 80 AND AS Modifier 80 and Modifier AS identify assistants at surgery who provide full assistance to the primary surgeon. Modifier 80 is intended for board-certified physicians. The assistant surgeon(s) submit their own claim, separate from the primary surgeon s claim, identifying their individual services provided for the surgical encounter. The assistant surgeon is to append modifier 80 to the appropriate CPT code where assistance was rendered. The primary surgeon may not submit a claim on behalf of the board-certified assistant surgeon using modifier 80. Modifier AS is intended for non-physician types, for example, Physician Assistants (PA s), Nurse practitioners (NP s), or Clinical Nurse Specialists (CNS). If a non-physician type provider has is an NPI, such as a PA, NP or CNS, the nonphysician provider may submit a separate claim from the primary surgeon appending Modifier AS. If the provider type does not have an NPI and/or the provider is not valid for billing services to SHPO, the primary surgeon may bill on behalf of the assistant. Modifier AS is to be appended to the appropriate CPT code where assistance was rendered. Newly paneled providers From April 1, 2011 to June 30, 2011: Alphabetized by location Provider Name Participating Plans Specialty Location John A. Andrew, MPT Physical Therapy Andrew Physical Therapy Grant A. Bortnem, DPT Physical Therapy Andrew Physical Therapy Melissa Schussman, DPT Physical Therapy Andrew Physical Therapy Bonnie A. Lorenz, LAC Acupuncture Bonnie A. Lorenz, LAC Center for Behavioral Health Outpatient Chemical Center for Behavioral Health Dependency Facility Christopher Elgin, LPC, (new Mental Health Christopher Elgin, LPC with SHKC) Christopher W. Edwardson, Family Medicine Dallas Family Medicine, LLC MD Windsor Health and Skilled Nursing Facility Evergreen Healthcare Management Independence Health and Skilled Nursing Facility Evergreen Healthcare Management Janet Wilks-Reynolds, LPC Mental Health Janet Wilks-Reynolds, LPC Kartini Clinic, PC Mental Health Facility Kartini Clinic, PC Illana (Hana) Lynn Takusagawa, MD Ophthalmology Legacy Devers Memorial Eye Institute Lincoln City Physical Therapy Physical Therapy Lincoln City Physical Therapy (new with IHN) Amy M. Lamb, FNP Nurse Practitioner Lincoln County Health & Human Services Igor Michael Gladstone, MD Pediatrics Legacy Clinics, LLC

5 5 Provider Name Participating Plans Specialty Location Adam Goddard, CADC, LPC Mental Health Northwest Health & Healing H. Russell Sampley, MD Psychiatry PeaceHealth Medical Group Colleen M. Grimes FNP Family Nurse PeaceHealth Medical Group Practitioner Carolyn M. Hartman, MD Psychiatry PeaceHealth Medical Group Hollie M. Hennessy, PT Physical Medicine PT Northwest, LLC Kyle M. Bidgood, DPT Physical Therapy PT Northwest, LLC Rachel Ann Feit-Leichman, Surgery Rachel Ann Feit-Leichman, MD MD David E. Greenberg, MD Diagnostic Radiology Radiology Associates, PC Eric Stowell, MD Kathrin A. Weller, MD Victor Kochi Lin, MD Physical Medicine & Physical Medicine & Physical Medicine & ilitation Medicine Associates of Eugene-Springfield ilitation Medicine Associates of Eugene-Springfield ilitation Medicine Associates of Eugene-Springfield Douglas Eliason, DO Family Medicine Salem Family Physicians,PC Jeffrey Forrest Jarvi, MS Physician Assistant Salem Pediatric Clinic Raymond B. Brumbaugh, MD Physical Medicine Salem ilitation Associates Patrick J. Boyle, MD Endocrinology Samaritan Depoe Bay Clinic John K Kadlecik, PT Physical Therapy Samaritan Hand & Upper Extremity Therapy J.K. Gavin Shumate, MD OB/GYN Samaritan Pacific Women s Health Group Tyler M. Arkless, MD Family Medicine Samaritan Waldport Clinic Sergiy Barsukov, PsyD Mental Health Seriy Barsukov, PsyD Angela K. Bohlke, MD MPH Pathology Silver Falls Dermatology, MD Stayton Family Practice, Inc Family Medicine Stayton Family Practice, Inc. (new with IHN) Caitlin C. Haley, PAC Sleep Medicine The Corvallis Clinic Gary Michael Gray, MPT Physical Medicine The Corvallis Clinic Richard Wong, MD OB/GYN The Corvallis Clinic Steven N. Schechterman, MD Oncology/Hematology The Corvallis Clinic

6 6 Provider Name Participating Plans Specialty Location Hsinchen Jean Lin, MD General Surgery The Surgical Center, Inc. Maureen Finley Arthurs, OD Optometry Valley Eye Care,PC Valley Eye Care, PC (new with Optometry Valley Eye Care,PC IHN) Anna Macasa, MD Rheumatology Willamette Valley Rheumatology, PC Daniel C. Schrinsky, MD OB/GYN Women s Healthcare Associates, LLC David P. Johnson, MD OB/GYN Women s Healthcare Associates, LLC Walter G. Hoffman, MD OB/GYN Women s Healthcare Associates, LLC