By Sarah Howarth, Billing Manager
On March 27, 2015 electronic prescribing of all controlled and non-controlled prescriptions will be mandatory for all prescribers in New York. E-Prescription is defined as a prescription that is created, recorded and transmitted electronically. E-Prescriptions are transmitted directly from the prescriber to a pharmacy or pharmacist. Prescriptions generated on an electronic system that is printed out or faxed prescriptions do not meet the requirements of E-Prescribing.
Providers may request a waiver to E-Prescribe if they meet one of the following criteria:
- Economic hardship
- Technological limitations that are not reasonably within the control of the practitioner
- Or other exceptional circumstance demonstrated by the practitioner
Waivers are granted for a time period of one year. To request a waiver from E-Prescribe contact the New York State Department of Health at 866-811-7957, option 1.
UNIVERA COMMUNITY HEALTH
Currently, Univera Healthcare and Monroe Plan for Medical Care are partners in Univera Community Health. In July of 2015, Monroe Plan for Medical Care will become the sole owner of Univera Community Health. A new name for the Community Health product will be released at that time. Univera Community Health encompasses the PlusMed and Child Health Plus products. Additional information will be released closer to the transition date.
UNIVERA Medicare Advantage
Effective January 1, 2015, if observation services are required for Univera Medicare Advantage patients, the member cost-sharing for these services will be included in the cost-sharing for hospital outpatient services. The member will not pay a separate copayment for observation services. If the patient’s status is changed to inpatient, only an inpatient copayment will be applied.
Independent Health Medicare Advantage
IHA Medicare Advantage is introducing a new “Enhanced Annual Visit” (EAV) for patients seen between January 1 and June 30, 2015. The visit incorporates many of the services that are already provided during preventive and wellness visits, with an expanded focus on assessment and management of chronic diseases. The EAV is reimbursed only once per calendar year for Primary Care Practitioners only, using the HCPCS code G8496. Reimbursement for the EAV performed between January 1 and June 30, 2015 is $300.00. Any additional preventative or wellness visits performed during the same calendar year, by the same provider group will be denied. The EAV will be denied if a preventative and annual wellness visit has already been performed during the same calendar year by the same provider group.
In order to receive payment for the Medicare Advantage Enhanced Annual Visit (EAV), all of the following criteria must be met. Upon record review, if all criteria are not met and well documented the payment may be retracted.
- Completion of a Health Risk Assessment (Independent Health form or other CMS compliant form).
- Review of the patient’s Health Risk Assessment (HRA) and make it part of your permanent clinical record.
- Document discussions related to issues noted by the patient on the HRA.
- Document the status of each and every medical condition (even those identified and managed by specialists), including goals for treatment and management plans for each active problem.
- Document standard visit elements: vital signs, interval history, past history, family history, medication reconciliation, review of systems, physical examination, update medication, problem and health maintenance lists, impression/assessment, plan and counseling of patient.
- Provide a summary of the visit to the patient, including when to expect follow-up on test results Medical and Chronic Condition Management (must be performed by a physician, nurse practitioner or physician assistant).
- Documentation of the entire visit including the Health Risk Assessment from your medical record must be submitted with the claim.
To assist providers in ensuring all of the requirements of the EAV are met, the Enhanced Annual Visit Program Guide is available on the IHA website. Please contact Sarah Howarth at 716-348-3923 or firstname.lastname@example.org for assistance in obtaining these materia