Newsletter Q2 2013

June 28, 2013

Thank You For Being Apart of the Integra Network

There probably has never been a time in the history of DME and O&P like today’s challenging environment.  Delayed or not delayed, the Competitive Bidding process will have a major impact on the DME space and how the industry will evolve in the next several years. As your network manager we feel it is our job to constantly think and work on ways to add value to your membership, now more than ever.  The Integra team has     worked hard in the last 6 months on several projects, all with the goal to create efficiencies and additional business opportunities for our members.

We are excited to tell you about our progress in this newsletter. You will learn about our a new payer contract as well as expanded relationships with existing payers, an improved document upload feature, changes to the training process and lots more.

We will continue to work hard on making your membership a valuable one and encourage you to reach out to us with your feedback, ideas, suggestions and questions.

We wish you a warm, happy and safe summer and look forward to talking to you soon!

Contributed by Bianca Flikweert


HHH Choice Health Plan, LLC Selects Integra Partners As Its Preferred Provider of DMEPOS

 Integra Partners has been selected as the Preferred Provider for HHH Choices Gold (HMO Special Needs     Plan). The contract, effective April 1, 2013 covers Orthotics, Prosthetics, and Durable Medical Equipment. HHH Choices Gold services members in the Bronx, Kings, New York, Queens, and Westchester counties. For more information regarding HHH Choices Gold, please visit the company’s website at www.hhhchoicesgold.com.


VNSNY Choice Expands Relationship with Integra Partners to Include Durable Medical Equipment Services

We are happy to announce that in addition to our existing contract with VNSNY Choice covering Orthotics and Prosthetics, Integra providers are now also able to provide Durable Medical Equipment services for these members. VNS Choice serves the 5 Boroughs of New York City, Nassau, and Westchester counties. For more information regarding VNS (Medicare Advantage), please visit the company’s website at www.vnsny.org.

*Please note that this expanded relationship does not cover VNSNY MLTC plan. This plan will remain O&P only. 


Integra Partners and WellCare of New York Enhance Their Partnership

We are excited to announce the expansion of our relationship with WellCare of New York, Inc. Effective May 1, 2013 Apria Healthcare will no longer be a participating provider with WellCare. Instead, Integra Partners will be WellCare’s new provider for respiratory services and durable medical equipment needs.

WellCare of New York is dedicated to meeting the health care needs of New York residents. From its regional office in Manhattan, WellCare has been a leading provider of New York State  government sponsored health plans including Medicare, Medicare PDP, Medicaid and State Children’s Health Insurance Programs.


Want to Win a Tablet?

In the coming weeks Integra Partners will be launching our first full network survey! We would like to thank all of our providers in advance for participating in this survey as the feedback will be invaluable to us.We strive to continuously improve and enhance our customer service to better suite all unique needs. These survey’s allow us to continuously gain insights into how our network is progressing and allows us to measure areas of the network that we could improve upon.

One lucky winner will be randomly chosen to win a brand new tablet!!!


Patient Eligibility File

Have you seen the new patient eligibility feature built into our billing platform?! This new tool allows providers to verify if the member’s insurance is active, check the spelling of their name, date of birth, gender and other demographics to assist in making the patient-provider experience more seamless. This is a great tool to determine if the patient is eligible for service coverage as well as other details regarding their plan. We hope that you will enjoy this as much as we do!

*This is not a substitute for verifying eligibility and benefits with the members plan


Integra Forms and Videos At Your Fingertips

Integra has been hard at work creating new ways for providers to access documents and training materials. With that, we have added a Forms and Videos section under the Resources tab on our website(www.accessintegra.com). When accessing the site, you may utilize your billing system username and password to login.

This page will be continuously updated with new forms and other training materials to assist our providers in their day to day activities.


Contract Amendment: Non-NY Providers/Health Plans

As Integra Partners continues to expand we want to ensure that we are providing you with the greatest access to service the covered lives within our plans. In doing so, we will be sending our out of state providers a Multi-State Agreement so that they may service members in New York State as well as any additional states we may expand to in the future. Please be on the look out for this agreement over the next several weeks and once received, please sign and return accordingly.


 

New Billing System Upload Feature  

A new document uploading feature has been added to our billing system for your convenience! Remember, when submitting a claim, all necessary documentation must be submitted in order for us to process your claim and get you paid! This new feature will serve as a reminder as well as streamline the process. For more information visit our website–>click on Resources–> Forms and Videos–> Login using your doc-tor.com credentials–>Browse all of our resources!

Newsletter Q1 2013

March 26, 2013

30,000 Feet with CEO Andrew Saltoun

First of all, thank you for being part of our network!

Healthcare is evolving rapidly and the changes precipitated by President Obama are having broad impacts to our healthcare system. While the constant challenges of increased documentation standards, reimbursement     pressure, and too much news to read and digest can be daunting, I thought I would take a few minutes to share a more positive perspective.

There are a multitude of demographic tailwinds that make P&O and DME an attractive place to be.  I am sure many of you are aware that Obamacare structured a program to generate coverage for about 30 million, previously uninsured, individuals who will be included in our healthcare system as a result of the ACA.  It is estimated that between 1 and 2.5 million new members will be insured in New York starting in 2014, which will increase our Medicaid eligible population by over 20% (the vast majority of these individuals will be in our state’s Managed Medicaid programs).  In addition, the baby boomer generation’s growth is exploding and seniors are in significant need of P&O and DME.  Obesity levels have reached  all-time highs and the CDC projects diabetes will affect 1 in 3 Americans by 2050 – we see these patients every day as they are 10x more likely to see P&O professionals than non-diabetics and much higher utilizers of DME.  Lastly, the healthcare system has recently embraced homecare as a more cost effective model of care than hospitalization.  This trend, above all else, will make our providers some of the most important caregivers for our nation’s patients over the next 5 years.

With all of this demand and a system that we all know is economically strained, now is the time to focus on the fundamentals of great patient care, efficiently delivered.  At  Integra, we are constantly thinking about how we can generate more value for our network of providers. We know that you want, and need, access to insurance companies so that you can serve your communities, and that is what we are doing.  As you know, this quarter, we announced a Preferred Provider partnership with CenterLight and an increased relationship with Aetna, adding 1 million New Jersey members to our coverage area.  In addition, we expect to add 1-2 additional plans in New Jersey and are constantly adding plans in New York.

Also, I am pleased that so many of you have taken advantage of our direct deposit program, which has resulted in a 3-5 day reduction in your outstanding AR and no interruption of payment during Hurricane Sandy or other such future issues.  Over the course of this year, we hope to continue to create efficiencies for you.  We are exploring technological improvements to our billing system that will further speed-up provider receivable collection and payments, we are working with payors to further streamline our interfaces, we are developing patient eligibility solutions to reduce errors in eligibility checks, and much more, all in effort to improve your working capital.

I recognize that our system presents a lot of challenges as well, but I thought it would be refreshing to hear a positive point of view.  I wish you all a great spring and please keep us posted if you have ideas, suggestions, improvements, etc. – we want to hear from you!

Contributed by Andrew Saltoun


CenterLight Selects Integra Partners as its Preferred Provider

As of March 1, 2013 Integra Partners will be the preferred provider for Orthotics, Prosthetics, and Durable Medical Equipment for all CenterLight members. For more than 90 years, CenterLight Health System, formerly Beth Abraham Family of Health Services, has been working to improve the quality of life for New Yorkers in need, from all backgrounds and all walks of life.  CenterLight currently ranks among the nations leading resources for long-term residential and community-based healthcare. It is with great pleasure to have been selected as their preferred provider and we hope that you are as excited as we are to begin servicing their member population!


Integra Adds 1 Million Covered Lives in New Jersey

We are happy to announce that in addition to our Aetna contract for the State of New York, Integra Partners network providers may now also see Aetna members in the State of New Jersey. The new contract with Aetna NJ went into effect on March 1, 2013 and covers more than 1 million members in the state. Integra is committed to growing its New Jersey network and we are looking forward to procuring additional value added contracts for our providers.


WellCare Expands its MLTC Coverage

On March 5, 2013 WellCare Health Plans Inc. announced the New York State Department of Health’s (DOH) approval of its MLTC expansion.  Previously serving the Bronx, Kings, Queens, New York, Buffalo, Orange, Rockland, Erie, and Ulster counties WellCare’s MLTC plan has expanded is coverage to include Nassau, Richmond,Suffolk, and Westchester counties.

 

What this means for you: You may begin to see increased  volume in these areas as WellCare continues to actively recruit new members. Open enrollment in these geographies began on March 1st and will continue to grow.  As a participating provider on the Integra network (once given a WellCare ID), you may service this new population utilizing our existing WellCare contract!


Congratulations to Our Survey Drawing Winner- Five Star Pharmacy

We are pleased to announce the winner from our New Provider Survey drawing. The winner is Five Star Pharmacy who will receive a $75 gift card! We would like to thank all those who participated in this survey. Your feedback is invaluable to us as we strive to continuously improve our processes and enhance our customer experience.

Do you want a shot at winning a gift card of your own? In the coming weeks, simply be on the lookout for our Existing Provider Survey, answer a couple of questions, and submit it back to us for a chance to win!

Cruisin’ Down the 101- California Here We Come   

From the streets of New York City, to the beaches of California, Integra Partners continues to expand its coverage. As the largest Orthotic and Prosthetic and Durable Medical Equipment IPA in the state of New York, Integra has begun adding providers to its west coast     network. From all of us here at Integra, we welcome you to the Integra Family and look forward to working with all of you!

 

February Educational Update

The 8 Keys to Getting Paid

As the contracted entity for our health plan partners Integra follows all CMS guidelines. This includes submitting the appropriate documentation at the time your claims are submitted. By submitting these 8 key pieces of information with your claim, you will be on your way to fewer denials, and a quicker turnaround time!

  1. Copy of patient’s insurance card- must include any secondary or co-insurance information as well
  2. Signed and dated physician order and/or prescription
  3. Signed and dated delivery ticket
  4. Signed and dated letter of medical necessity
  5. Signed and dated patient consent form
  6. Signed and dated patient assignment form
  7. Patient medical history form
  8. Provider patient contact history

Local Coverage Determination

Do you have the latest LCD for Ankle-Foot/Knee-Ankle-Foot Orthosis?  If not, be sure to e-mail Nicole Robinson on our Network Development Team at nrobinson@accessintegra.com for the latest on; bill type codes, revenue codes, modifiers, prescription requirements, and much more!

Prescription Footwear Benefit Coverage

Prescription footwear is orthopedic shoes, shoe modifications or shoe additions. Benefit coverage is limited to:

  • Children under 21 years of age who require orthopedic footwear to correct, accommodate or prevent a physical deformity or range of motion malfunction in a diseased or injured part of the ankle or foot; to support a weak or deformed structure of the ankle or foot.
  • When a shoe is attached to a lower limb orthotic brace. Prior Approval is required for beneficiaries who are age 21 and older, using only codes L3224 and L3225 and any addition and/or modifications to those shoe codes.
  • As a component of a comprehensive diabetic treatment plan to treat amputation, or pre-Presfulcerative calluses, or peripheral neuropathy with evidence of callus formation of either foot, or a foot deformity or poor circulation. For DVS authorization and billing, see below for codes limited to shoes, inserts and/or modifications for diabetics only.

A5500    # For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay   shoe manufactured to accommodate multi-density insert(s), per shoe.

A5501   # For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient’s foot (custom-molded shoe), per shoe.

A5503   # For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe.

A5504   # For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe

A5505   # For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe.

A5506   # For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe.

A5507   # For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth inlay shoe or custom-molded shoe, per shoe.

A5512   # For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher, total contact with patient’s foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer of 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each

A5513   # For diabetics only, multiple density insert, custom molded from model of patient’s foot, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer, (or higher), includes arch filler and other shaping material, custom fabricated, etc.

Questions may be directed to the Division of Provider Relations and Utilization Management, 1-800-342-3005 option 1.   

 

KX Modifier Billing Reminder

Below is a list of LCDs which include a KX modifier requirement for some or all items within that specific LCD. Use of the KX modifier with any other DMEPOS is inappropriate language.

Please note that repeatedly billing incorrect or missing modifiers will result in a mandatory training session with the Integra Partners billing department. If you have questions or concerns regarding the appropriateness of modifiers please e-mail Nora Strong, Supervisor of Billing & Senior Claims Resolution Specialist at nstrong@accessintegra.com.

  • Ankle-Foot/Knee-Ankle-Foot Orthosis
  • Automatic External Defibrillators
  • Cervical Traction Devices
  • Commodes
  • External Infusion Pumps
  • Glucose Monitors
  • High Frequency Chest Wall Oscillation Devices
  • Hospital Beds
  • Immunosuppressive Drugs
  • Knee Orthosis
  • Manual Wheelchair Bases
  • Nebulizers
  • Negative Pressure Wound Therapy Devices
  • Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
  • Oral Appliances for Obstructive Sleep Apnea
  • Orthopedic Footwear
  • Patient Lifts
  • Positive Airway Pressure Devices
  • Power Mobility Devices
  • Pressure Reducing Support Surfaces
  • Refractive Lenses
  • Respiratory Assist Devices
  • Speech Generating Devices
  • Therapeutic Shoes for Persons with Diabetes
  • Transcutaneous Electrical Nerve Stimulators (TENS)
  • Urological Supplies
  • Walkers
  • Wheelchair Options and Accessories
  • Wheelchair Seating

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Questions may be directed to the Division of Provider Relations and Utilization Management, 1 800 342-3005, option 1.

January Educational Update

Completing an Accurate Letter of Medical Necessity

National and local Medicare policy specifies that upon complete of a face-to-face examination, the treating practitioner or physician must complete a written order containing seven specified elements. As the supplier of these services you may choose to provide physicians with a form that outlines the necessary fields to ensure the necessary requirements are met.

If you submit an LMN without proper documentation the claim will not be processed and you will NOT be paid on the claim. In order to ensure efficiency’s before submitting a claim, be sure to check that the LMN contains the following;

1. Beneficiary Name
2. Item Ordered
3. Date of Face-to-Face Examination
4. Diagnosis/Condition Relating to Need for Item
5. Length of Need
6. Physician Signature
7. Signature Date

It is not permissible for a supplier to “lead” the referring physicians as to the type of equipment rendered. No forms should be pre-inscribed with items ordered or any other pertinent information. An example of what not to do includes but is not limited to;

• A form with “Power Mobility Device” already entered in the “Item Ordered” field.
• A form that contains check boxes for certain items.

Click Here for a Documentation Checklist by Product Category


New Requirement of a Face-to-Face Encounter Prior to Ordering DME

Effective July 1, 2013, in accordance to rules governed by Medicare and Medicaid, orders for durable medical equipment (DME) must include physician documentation that a face-to-face encounter with the patient occurred during the previous six months.

What does this mean for DME Suppliers?
Beginning July 1, 2013, DME Suppliers must obtain a written order and supporting documentation from the treating physician indicating that a healthcare practitioner had a face-to-face encounter with the beneficiary within a period no greater than the previous six months.

 

Newsletter Q4 2012

 

The Aftermath of Hurricane Sandy

These past few months have brought difficult times to our area as we are still picking up the pieces in the aftermath of Hurricane Sandy.  Many of our providers, health plans, and employees were affected by the storm. An Integra Employee Relief Fund was established to help our employees combat these unexpected expenses and our thoughts and prayers remain with all those affected in our area.

Please note that many of our health plan partners in the Tri-State area were without power for 6-9 days (MetroPlus, GHI & HIP are still experiencing some issues). This resulted in a stalemate on payments being received, processed and released for claims pending in their system during this time frame. We ask that you remain patient as they are working diligently to get back on track.

Additionally, as a result of the storm, the previously scheduled NJ AAOP conference was canceled for 2012. We would like to thank all of you who had planned on attending the event and visiting us both at our booth as well as at our private reception.  Although we did not get the chance to meet this year, we look forward to seeing all of you at the event next year!

 

Direct Deposit- Speeding up the Flow of Your Money

With our NEW Direct Deposit feature, Integra Partner providers are being paid quicker than ever before! With 75 providers already enrolled, they no longer need to wait for paper checks to come in the mail, walk down to their local bank, and then continue to wait as the check goes through the clearing process. With ACH deposit, the money is automatically deposited directly into their bank accounts! Not to mention, for those 70+ providers who were already enrolled in ACH when Hurricane Sandy hit, they were able to receive their deposits without any delays!

Fast Facts for Existing ACH Enrollees

  • Our bank requires us to schedule ACH payments at least one business day before the payment date.
  • Generally, the ACH instructions are uploaded to the bank on Sunday evenings.
  • Since Sunday is not a business day, the payment cannot be scheduled until Tuesday.
  • Some receiving banks will post to your account the same day, other banks do over-night posting.
  • If your bank does overnight posting, you may not see the deposit in your account until Wednesday.

If you have any questions or concerns please feel free to e-mail Frank Bianco at fbianco@accessintegra.com or call him directly at (718) 819-3914.

 

Integra Partners Cultural Elements

  1. Create a WOW Company
  2. Value Each Other
  3. Push the Boundaries
  4. Make it FUN!

 

Provider Spotlight- Mt. Carmel Pharmacy     “A Thanksgiving Story”

Thanksgiving – The Past and The Present
The tradition of Thanksgiving has been a long standing American tradition which dates back to the Pilgrims in 1621. After a plentiful harvest season, Governor William Bradford proclaimed a day of giving thanks, inviting Indian Chief Massasoit and many of his people to this three-day feast.  These rich principles of community, selflessness, and valuing one another are still on display today as every year we gather with friends, family, neighbors, strangers, and everything in between to share in what has become more than just a meal.

Dating back to 1993, Bronx, NY based Mt. Carmel Pharmacy and Surgicals has exemplified this behavior and has become a pioneer in their local community. From serving 75 people at their first annual Thanksgiving Day feast, they now proudly serve between 1000 and 1200 people every year for the past 15 years. From the homeless, to elderly couples, to lonely, to young and old, all are welcome as their doors remain open for any and everyone.

The Spark
In 1993, Iris Garcia was working as a receptionist in a doctor’s office that was run by the Paganelli brothers – Armand, Michael, and Roger who are third generation Bronx-based pharmacy owners.  One day, she was approached by a friend of hers asking if she would put together a Thanksgiving feast for the poor in the Church Gym. At the time, Iris had lived across the street from the Church where she also was/is a parishioner. Having had some Thanksgivings where she had nothing for her own family, Iris felt as though this was her chance to help others and to give back.

She decided to speak with the Paganelli brothers who were already involved in other community outreach programs. They loved the idea and the passion Iris brought to the table and an arrangement was quickly made. Mt. Carmel Pharmacy would become a sponsor and help provide the financial support to make it happen and Iris, along with help from her family, friends, and neighbors would make it happen.

Going Strong
That first year, Mt. Carmel purchased 7 turkeys and Iris and her dedicated team provided all of the fixins’. They served 75 people that day in 1993, a number which surprised many of the organizers. They had no idea that there were so many people in the community that needed a place to share Thanksgiving. Little did they know that as the years went on, that number would increase to over a thousand attendees each year!  They now prepare 50-60 turkeys every year and the volume prepared by Iris and her crew is quite remarkable. That doesn’t even count desert, where they go through 150 pies and more than 50 lbs of cookies!

Whether you come to fill a carry out container to bring home or choose to dine in the beautifully decorated gymnasium filled with balloons, centerpieces, and candles, Governor Bradford would be proud of the tradition Mt. Carmel Pharmacy and Iris Garcia continue to make special.

Thank You
For the efforts put forth by Mt. Carmel Pharmacy, Iris, and all of those involved in this heartwarming story we recognize your efforts and commend you on a job well done.

 

Affordable Care Act- Reimbursable Products

Did you know that under the ACA breastfeeding support and supplies will be covered by the insurance companies? Breastfeeding is one of the most effective preventative measures mothers can take to protect their health and that of their children. One of the biggest barriers over the years has been the cost of purchasing or renting breast pumps and nursing related supplies. Pregnant and postpartum women will now have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment.

The service of this equipment will primarily come from Durable Medical Equipment suppliers. If you are already selling these items, please e-mail Scott Brennan at sbrennan@accessintegra.com so that you can become eligible for referrals!

 

Are Your Requests for Consumable Supply Refills Being Denied?

The Durable Medical Equipment Medicare Administrative Contactors have been conducting reviews on claims for consumable supplies and they have found that there are a large number of denials on requests for refills due to incomplete documentation. The most prevalent error is the way in which the suppliers are documenting the quantity of an item the beneficiary has remaining.

A few examples of items which are categorized as consumable products are; ostomy, urological supplies, surgical dressings, glucose supplies, etc.  When filling out documentation for reimbursement for items such as these it is essential that the supplier assess the quantity of each item that the beneficiary still has on hand. This will aid in determining that the amount left is nearly exhausted.

Below are a few examples of situations where insufficient documentation to justify reimbursement occurs (not all inclusive);

  • “Yes” or “No” questions only regarding whether the beneficiary wants or needs more supplies.
  • Documentation which only provides information regarding the amount of supplies the beneficiary is requesting.
  • Documentation which only states that the beneficiary has less than the required threshold number of supplies left.

To minimize denials on consumable goods it is essential that the supplier presents a customized and detailed record specific to each beneficiary’s requested refills. A physical count is recommended but not necessary. However, it is vital that the documentation proves that there was an individualized assessment completed.