The State Advocacy (SA) Committee has developed a summary of ongoing updates in the state regarding insurance company collaboration, and healthcare reform. As always, if there additional advocacy concerns that you have please reach out to us at firstname.lastname@example.org.
Critical Incident Reporting: Highmark Health Options Blue Cross Blue Shield (HHOBCBS) of Delaware
DPA State SA Chairperson, Traci Bolander, PsyD issued a written statement in January 2017, to the Director of Clinical and Services Quality of HHOBCBS of DE, (hereafter referred to as “director”), requesting concise directives regarding the behavioral health practitioners’ responsibility in notifying HHOBCBS of DE about critical incidents. Unfortunately, the concern appears to remain under internal review given that a formal response from the director has not been issued. As a result, the SA committee sought the support of the DPA Executive Committee (EC) to submit a formal letter to the director requesting a directed response.
During the March DPA EC meeting, the committee approved the development of a formal letter to be written by the State Advocacy committee. The letter will be submitted to the DPA President, Cynthia Diefenback, PsyD, ARNP in early April for final review.
Blue Cross and Change Healthcare (Billing and Coding) Educational Opportunity
In response to the national and local trend of insurance company auditing that are resulting in the assessment of significant repayments by providers because coding and documentation do not meet guidelines SA felt it was important to provide opportunities for our members to be proactive in ensuring they are not subject to takebacks. To that end, SA is planning an educational webinar focused on what auditors are looking for in CPT psychotherapy coding and documentation which will likely be in May. This webinar will facilitated by the Change Healthcare team (a company contracted by Highmark to do coding trending and education). In order to be as responsive to your concerns in the development of this webinar, please submit questions/concerns that you would like to have addressed during the webinar to email@example.com.
DE Behavioral Health Electronic Medical Record Incentive Program
The availability of funding scheduled for February 2017 has not been released. Our understanding is that funding will be released but the time frame is undetermined at this time. We recommend continued monitoring of the Bid Solicitation Details website at http://bids.delaware.gov/bids_detail.asp?i=4124&DOT=N
The SA committee is dedicated to keeping you abreast of any updates. Please keep in mind that funding availability of this incentive program is contingent upon available federal funding provided through the Testing Cooperative Agreement Grant from the Center for Medicare and Medicaid Innovation (CMMI) State Innovation Model (SIM). You can find the original document outlining the incentive program at http://bidcondocs.delaware.gov/HSS/HSS_16037A_emrincent_rfp.pdf