Georgia Department of Community Health Media | Contact Us | Translate | Site Map Search within this site Search About Us Divisions & Offices Programs Providers Publications Budget & Performance Meetings & Notices Home DCH-i October 2011, Vol. 1 Issue 1 DCH-i October 2011, Vol. 1 Issue 1 Welcome to DCH-i Welcome to our first issue of DCH-i, a publication of the Georgia Department of Community Health (DCH), especially for you, our stakeholders in all matters DCH. Whether you're a physician, hospital, CMO, third-party payer, vendor, health care advocate, consumer or legislator, we've developed DCH-i to share news and information you can use to help us create A Healthy Georgia. We're interested in your comments, your questions and your feedback. Write to us at DCH-i@dch.ga.gov. In This Issue From the Commissioner - Welcome to DCH-i Straight Talk: DCH Addresses Physicians' Medicaid Concerns Medicaid Redesign - Contract Awarded 5010/ICD-10 Conversion - Deadlines Approach Rural Hospital Tour - Medicaid at Work Medicaid EHR Incentives - First Payments Delivered Medicaid, PeachCare for Kids - $2.5 Million Grant Speaking Up! - Commissioner's Speaking Engagements Race to the Top - DCH Support Board News - Welcome Jack Chapman, M.D. Do You Want to Be Heard? Do you have a question or a comment? A special request, perhaps? Tell us what's on your mind at DCH-i@dch.ga.gov. From the Commissioner This is an exciting and challenging time for health care in Georgia and the nation. With the changes coming as a result of health care reform, plus tighter budgets and our growing population, the success in meeting these challenges depends on solid cooperation and coordination between DCH and all of you in the health care community. That's why we've created DCH-i: to help keep you informed about DCH initiatives that affect you and all Georgians. As a stakeholder in Georgia's health care system, you are a vital link in the delivery of affordable health care across the state. We at DCH value your association with our Department as we move forward to meet these challenges and opportunities head-on. As the lead agency for Georgia Medicaid and the Children's Health Insurance Program/PeachCare for Kids, DCH provides health care to more than 1.7 million Georgians. Additionally, DCH manages the State Health Benefit Plan (SHBP) that insures nearly 700,000 state employees, teachers, school employees, retirees and dependents. Together these programs provide health care access to nearly one in four Georgians. DCH is also responsible for Healthcare Facility Regulation of more than 14,000 hospitals, nursing homes, personal care, long-term care and hospice centers. DCH's Office of Health Information Technology is leading the charge to transform health care delivery in Georgia with initiatives aimed at more effectively managing costs and enhancing the delivery of quality, affordable health care. In the coming months, you will see and experience the positive changes taking place in health care in Georgia. We welcome your input, comments, questions and suggestions. David A. Cook Commissioner, Georgia Department of Community Health Return to Top Straight Talk: DCH Addresses Physicians' Medicaid Concerns Earlier this year, nine Georgia-based physician member-driven associations and societies submitted a joint letter to DCH outlining issues related to Georgia Medicaid. Many of those issues centered on the physicians' processing of claims through DCH's new Hewlett-Packard Enterprise System (HPES)- Medicaid Management Information System (MMIS). While extremely satisfied with the system's implementation, DCH recognizes that an undertaking of this size is not without its challenges. The detailed information provided by these organizations was immensely helpful in looking at how the system and our policies could be improved. Issues Reported, Issues Resolved Today, in response to the letter from these physician groups, DCH is pleased to report that of the 70 unique issues noted (containing 59 unduplicated issues), all 70 have now been resolved. Here's a rundown on the issues submitted and how they were resolved: 21 percent of the issues required a system change. Those changes have been implemented. 79 percent of the issues were not system related. Those included provider billing errors or training opportunities (40 percent); a variety of business process improvements such as online paper documentation submissions and Interactive Phone Response changes (13 percent); Medicare issues rather than Medicaid issues (6 percent); field representative visits (6 percent); and the remainder were informative or complimentary comments as well as changes in Medicaid policy such as increasing the number of obstetric ultrasounds available without prior authorization. The types of issues raised by these physicians are not significantly different from those raised by others. And while we continue to identify and correct system errors, we have found that a majority of the issues received relate to billing errors on the part of providers or their clearinghouses. More Changes Ahead Beyond ongoing improvements to our MMIS system, DCH is underway with a comprehensive review of Georgia Medicaid. During this Medicaid Redesign, we're listening to stakeholders, looking at new and innovative delivery models and we're exploring ways to ease administrative burdens, enhance efficiencies and improve healthy outcomes. We're also preparing for the federally mandated conversion to the 5010 transaction standard by January 1, 2012 and the ICD-10 transaction code sets by October 1, 2013. With these 5010/ICD-10 changes, we anticipate that claims errors will increase if providers are not ready. CMS has stated repeatedly that claims submitted without 5010 and ICD-10 compliance will not be accepted. Moving forward, DCH is exploring additional MMIS training, more HP field representatives for one-on-one problem solving, and more forums to listen and learn about what's working -- and not working -- in Georgia Medicaid. We appreciate the invaluable input from these physicians representing the Medical Association of Georgia, Georgia Academy of Family Physicians, Georgia College of Emergency Physicians, Georgia Obstetrical and Gynecological Society, Georgia Society of Anesthesiologists, Inc., Georgia Chapter/American Academy of Pediatrics, Georgia Chapter/American College of Physicians, Georgia Neurological Society and the Georgia Society of Clinical Oncology. DCH welcomes the continuation of an ongoing dialogue with the physician community in Georgia. In fact, we've created a special Medicaid Redesign web survey to get your feedback. We hope you'll visit www.dch.georgia.gov/MedicaidRedesign to tell us what you think. Return to Top Medicaid and CHIP Redesign Initiative Underway The Georgia Department of Community Health (DCH) has awarded the contract for a comprehensive assessment and recommended redesign of Georgia's Medicaid Program and the Children's Health Insurance Program (CHIP) to Navigant Consulting Inc. of Chicago, Ill. DCH is the state agency responsible for Medicaid and CHIP, providing access to medical services and health care coverage for nearly 1.7 million Georgians. "Nationally, Medicaid accounts for 22 percent of state budgets and is projected to consume about $4.6 trillion of Washington's budget over the next 10 years," said Georgia Gov. Nathan Deal. "The President's health care law, the national recession and a fast-growing population will dramatically expand Medicaid enrollment in Georgia. This Medicaid review and redesign positions Georgia to become a leader in innovative ways to provide high-quality care in a cost-effective manner." "Today's health care environment is one of rapid and dramatic change that requires us to plan for and develop new ways to administer health care programs," said DCH Commissioner David Cook. "The goal is to assess our current Medicaid system and to look at new and innovative delivery models that can meet the growing challenges of delivering quality and affordable health care to our Medicaid population." Medicaid in Georgia is facing a number of challenges in the coming years under the expanded eligibility criteria of the new health care reform law. It is projected that the state's Medicaid rolls will increase by at least 650,000 between 2014 and 2020. The state estimates that an additional $25 billion in state and federal funding will be needed to cover Medicaid expansion for this period. "During our review, we will be learning what is working around the nation and how we can make it work even better here in Georgia," Cook said. "We will be looking for opportunities to ease administrative burdens, enhance efficiencies, promote access and improve outcomes in a fiscally responsible way." The work by Navigant will include a comprehensive environmental scan of the Medicaid and CHIP programs on both a national and Georgiaspecific basis; options for innovative redesign or modification of the current Medicaid and PeachCare for Kids, Managed Care and Fee-forService programs; and assistance with the procurement process and implementation of the Department's final Medicaid and CHIP Design Recommendation. It is expected that the work by Navigant will address: the most appropriate approach for providing services to the varied Medicaid populations and CHIP members, plans for sustained access to quality health care services in all geographic areas of Georgia, opportunities to enhance administrative efficiencies for DCH, providers and contractors in the oversight and delivery of health care services to Medicaid and PeachCare for Kids members, overall Medicaid and CHIP expenditures, and opportunities for budget predictability and cost management, and pragmatic implementation strategies to include an analysis of service gaps or potential weaknesses in the current Medicaid and PeachCare for Kids programs, and how to address such gaps or weaknesses. "In light of a growing Medicaid population, increasing expenditures and the potential Medicaid expansion as called for under the amended Patient Protection and Affordable Care Act, we are solidly committed to providing continued quality health care to the people of our state," said Jerry Dubberly, Georgia's Medicaid Chief. "This timely review of our Medicaid programs will help us do an even better job of serving our members and be prepared for the changes that will be taking place in Medicaid because of health care reform." Medicaid and CHIP Redesign Initiative -- Your Input is Needed! This is your opportunity to share your ideas, concerns and suggestions for improving our programs. Tell us what you think works best -- and what needs improvement. For Medicaid and PeachCare for Kids Members and Caregivers-- If you or someone you know is a Medicaid or PeachCare for Kids member, family member or caregiver, DCH wants to hear from you now! To participate in an upcoming consumer focus group in Marietta, Macon, Rome or Valdosta, e-mail us at MyOpinion@dch.ga.gov. For Medicaid Providers, Health Advocates, Vendors and Medicaid Consumers-To participate in our online surveys, click Medicaid & CHIP Redesign for more information, or you may click below on the survey link that applies to you: Providers Consumers Advocates Vendors Your input is needed now! Return to Top 5010 and ICD-10 Conversion Deadlines Loom Diagnostic and procedural codes are connected to nearly every system and business process in health plans and provider organizations, including reimbursement and claim processes. Current 4010 and ICD-9 coding systems have become outdated and must be replaced with the new 5010 and ICD-10 coding systems. Without these new HIPAA-compliant electronic transaction claims and code sets, your claims will be rejected and you will incur payment delays. Act now to prevent claim rejections and payment delays. Electronic Transaction Claim Version 5010 should be tested and ready by January 1, 2012. ICD-10 Code Sets should be tested and ready by October 1, 2013. Frequently Asked Questions What's the big deal about 5010 and ICD-10? As a physician, do I have to upgrade to 5010? What happens if I'm not ready by the 5010 HIPPA-compliance date of January 1, 2012? If I am not in compliance by this date, will my Medicaid claims transactions and payments be delayed? Shouldn't my trading partners handle this for my practice? For the answers to these questions and more, read on. What is "5010"? 5010 is the next version of the HIPAA electronic transaction standard. Improvements in the new 5010 electronic transaction claim include clearer instructions, reduced ambiguity among common data elements used in different transactions, and elimination of redundant and unnecessary data elements. The updated version of the 5010 transactions increases the diagnosis field size from 5 to 7 characters and has data reporting requirements that differ from the current transactions. This change may require you to collect additional data or report data in a different format. Understanding these changes and how they will affect your practice will prepare you for a smoother transition to the updated transactions. Do I have to upgrade to 5010? Yes. Providers, including physicians, are HIPAA-covered entities, which means that you must comply with the HIPAA requirements when submitting HIPAA electronic transactions. If you currently send and receive HIPAA transactions and plan to continue doing so, then you are required to upgrade to 5010. Health care clearinghouses and payers are also HIPAA-covered entities, so they will need to upgrade to 5010 as well. When do I have to upgrade to 5010? The compliance deadline for using only the 5010 transactions is January 1, 2012. The necessary software and system changes need to be in place by the compliance date for you to continue sending and receiving HIPAA electronic transactions. What happens if I'm not ready by the compliance deadline? Any 4010/4010A1 transactions sent on or after January 1, 2012, will be rejected as non-compliant and will not be processed. You will have disruptions in your transactions being processed and the receipt of your payments may be delayed. If you will not be ready by the compliance deadline, you will need to talk to your trading partners (such as payers, clearinghouses and billing services) to determine what actions you can take to have your transactions processed and payments received in a timely manner. How does upgrading to 5010 relate to ICD-10? ICD-10 is the upgraded version of ICD-9. The ICD-10 codes have a different format and length than the ICD-9 codes. The new format of the ICD-10 codes cannot be reported in the 4010/4010A1 version of the HIPAA transactions. So, the upgrade to 5010 needs to be completed before the ICD-10 codes can be reported in the HIPAA transactions. Additionally, ICD-10 codes cannot be used in HIPAA transactions prior to the October 1, 2013, compliance date. To learn more about using ICD-10 codes in the HIPAA transactions, please visit CMS' ICD-10 resource page at http://www.cms.gov/ICD10. When do I need to be HIPAA-compliant with the ICD-10 code sets? October 1, 2013. What do I need to do now to prepare for the upgrade to 5010? Talk to your practice management or software vendor. Determine when they will have your software updates available and when they will be installed in your system. Your conversion to 5010 will be heavily dependent on when your vendor has the upgrades completed and when they can be installed in your system. Talk to your clearinghouses, billing service and payers. Determine when they will have their upgrades completed and when you can begin testing with them. Identify staff training needs and complete the necessary training. Conduct internal testing to make sure you can generate the transactions you normally send using 5010. Conduct external testing with your clearinghouses and payers to make sure you can send and receive the 5010 transactions. All testing must be successfully completed by December 31, 2011. Identify any workflow changes that you need to make in your practice to accommodate the changes in 5010, as well as any data reporting changes that impact your practice. You may need to collect new data or report data differently than you do in the current version. For more information, visit the DCH website at www.dch.georgia.gov/ICD10 or the CMS website at www.cms.gov/ICD10. Return to Top Rural Georgia Hospital Tour Connects Funding, Policy, Patients and Providers Seven critical access hospitals, 40 health care executives, nearly 600 miles and two full days of meetings and tours put a face on the realities of rural medicine in Georgia. DCH's Jerry Dubberly and Edwinlyn ("Twig") Heyward, along with Cheryll Collier and MaryAnn Williams of Hewlett-Packard, traveled through the state recently on one of four HomeTown Health hospital tours this year. "Connecting with providers on the front lines and seeing how new technology and health care delivery techniques are being used across the state were invaluable experiences for us," said Georgia Medicaid Chief Jerry Dubberly. "We were all very impressed with the work being done in the rural areas of Georgia to help assure the delivery of quality, cost-effective health care." On the first day, the group visited five hospitals: Warm Springs Medical Center, Warm Springs; Stewart Webster Hospital, Richland; Calhoun Memorial Hospital, Arlington; Pioneer Community Hospital of Early County, Blakely; and Miller County Hospital, Colquitt. On the second day, the group toured two larger facilities in the morning: Mitchell County Hospital, Camilla; and Crisp Regional Health Services, Cordele. The afternoon was filled with an in-depth interactive conference with approximately 100 hospital executives from the Hometown Health network who provided additional insight into the issues and challenges they face and how they are addressing them. Various hospitals presented demonstrations of their use of technology, including telemedicine and ventilator programs. Dubberly and Heyward also talked with these providers and administrators about billing issues. "These hospitals are a critical part of the delivery of health care in rural Georgia," Heyward said. "The chance to tour these facilities helped me put a face on what I do every day in working with these hospitals to help them continue to serve their communities." HomeTown Health's CEO Jimmy Lewis said he welcomed the opportunity to bring various stakeholders into the field. Each year, the organization hosts four trips, including staff from the House Budget Office, the Governor's Office, DCH and the Senate Budget Office. "These tours are first-hand, sleeves-rolled-up experiences in rural health care that can be found no other way," Lewis said. "It's a chance for budget writers, policy makers and those associated with Medicaid to see the results of their work in practice." Return to Top Georgia's Medicaid EHR Incentive Program Delivers First Provider Payments Eighteen health care providers are the first in the state to receive payments from the Medicaid Electronic Health Records (EHR)Incentive Program being administered by DCH's Office of Health Information Technology. The last week in September, these eligible professionals and eligible hospitals received more than $6.4 million in Centers for Medicare and Medicaid Services-funded incentive payments for successfully qualifying for the program. "Advancements in technology have helped make American medical care the best in the world. We are now seeking to apply technology to improve the administrative side of the equation through the use of electronic health records," said DCH Commissioner David A. Cook. "Medicaid has offered these incentives to reward those providers who adopt EHR for the advancement of our nation's health care system." Since the program's launch on September 5, incentive payments totaling $6,405,605.57 have gone out to six hospitals and 12 professionals around the state who were among the first to qualify. "The program is seeing a steady increase in the number of eligible providers applying for the incentive payments since we opened registration in early September," said Kelly Gonzalez, DCH's Interim State Health Information Technology (HIT) Coordinator. "These providers are already experiencing the benefits of using EHR to improve patient workflow and administrative efficiencies." Georgia's Medicaid EHR Incentive Program is open to eligible Medicaid professionals (physicians, nurse practitioners, certified nursemidwives and dentists) and eligible hospitals (acute care hospitals, critical access hospitals and children's hospitals). This federally funded incentive program will serve two main goals: to promote the meaningful use of certified electronic health records to improve the quality, safety and efficiency of patient care, and to reward and support providers as they transition into new technology within the nation's health care system. "Through our Medicaid EHR Incentive Program, we project that we will issue incentive payments in excess of $480 million dollars during the next 10 years," Cook said. To receive the incentive payments, eligible professionals and hospitals must meet specific Medicaid patient volume thresholds as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology during their first year of participation. In subsequent participation years, eligible providers are required to demonstrate meaningful use of the technology defined as how the certified EHR technology moves beyond being a digital medical chart into being a valuable tool to transform health care service delivery and improve health outcomes. Through annual incentive payments, eligible Medicaid professionals may receive $21,250 in their first year and up to a maximum of $63,750 during their six years of program participation. The incentive payment formula for eligible Medicaid hospitals is based on multiple variables and will be paid over three years of program participation. Funding and support for the Medicare and Medicaid Incentive Programs is provided by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) as part of the American Recovery and Reinvestment Act of 2009. Georgia's Medicaid EHR Incentive Program will be administered by DCH; CMS will administer the Medicare Incentive Program. Registration at the federal level (www.cms.gov/ehr) opened earlier this year. Registration at the state level (www.mmis.georgia.gov), which began on September 5, is also required. Once eligible participants have attested to meeting all program requirements and their applications have been approved, payments will be made within 45 days. Return to Top DCH Receives $2.5 Million Grant to Enhance Medicaid, PeachCare for Kids The Georgia Department of Community Health (DCH) has received a $2.5 million grant from the U.S. Department of Health and Human Services (HHS). The grant, which is the largest awarded across the nation, will be used for technology that will streamline member enrollment and renewal for Medicaid and PeachCare for Kids, Georgia's Children's Health Insurance Program (CHIP). The two-year grant is authorized under the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009. "Reducing costs and becoming more efficient is a top priority at DCH," said DCH Commissioner David Cook. "The work to be accomplished by this grant will help simplify the enrollment and renewal process for eligible children while making the program more efficient and cost-effective. By being able to use the latest technology to verify eligibility and improve the application process, we hope to improve access to quality health care for our Medicaid members." The funds will be used to introduce a series of technology solutions including: pre-populated renewal forms and redesigned notices; enhanced citizenship verification; equipment to facilitate off-site enrollment and verification; implementation of an on-line renewal module; and development of an electronic referral from Medicaid to PeachCare for Kids so that children may access care sooner and not lose coverage when their family circumstances change. "Georgia Medicaid is dedicated to incorporating greater use of technology and implementing administrative simplification where feasible and appropriate," said Jerry Dubberly, Georgia Medicaid Division Chief. "This grant is coming at a time when we face increased enrollment, and it will assist us in making certain that we can continue to properly manage our processes that help support the delivery of high quality care for our young members." PeachCare for Kids funding is provided by the state of Georgia, the federal government (Title XXI funds), and premiums collected for children ages 6 to 19. Under the provisions of Title XXI, federal matching funds are available to subsidize more than 75 percent of the benefit cost, less premiums, with the remaining percentage coming from the state. The percentage of federal matching funds is adjusted annually. PeachCare for Kids is a comprehensive health care program for uninsured children living in Georgia. The health benefits include primary, preventive, specialist, dental and vision care. PeachCare for Kids requires documentation of the child's citizenship and the payment of reduced premiums based on family income. Children in a family with income at or below 235 percent of the federal poverty level (about $51,818 for a family of four) may qualify. Income is verified annually as part of the renewal process. Currently Georgia's PeachCare for Kids program provides health care insurance to 203,000 children to age 19. The HHS grant amounts range from $200,000 to $2.5 million with the largest grants going to the technology focus area. For a complete list of grantees, please visit CHIPRA Grants. Return to Top Speaking Up! Commissioner Cook will address these organizations during October and November: October 18 -- Georgia State Retirees Association-www.mygsra.com November 3 -- Georgia Chapter of the American Academy of Pediatrics-www.gaaap.org November 18 -- HomeTown Health-www.hometownhealthonline.com He will cover a variety of issues, including Medicaid, Health Information Technology and the State Health Benefit Plan. Return to Top Race to the Top Support The Board of Community Health passed a Resolution in support of the state's application for a Race to the Top-Early Learning Challenge grant. The U.S. Department of Education competitive grant program focuses on improving the quality of early learning and ensuring school readiness to help close the achievement gap. Read the Resolution. Return to Top Board of Community Health Welcomes Dr. Jack Chapman Gov. Nathan Deal has appointed Jack M. Chapman, M.D., to serve on the Board of Community Health. A practicing ophthalmologist in Gainesville, he serves on the board of directors of the Medical Association of Georgia, the Georgia Chamber of Commerce, the Alliant/Georgia Medical Care Foundation, the Georgia Partnership for TeleHealth and the Physicians Institute. He succeeds Mary Eleanor Wickersham, DPA, who served on the board for one year. Return to Top Get News You Can Use Join our mailing list for DCH-i by contacting Denise Smith at dlsmith@dch.ga.gov. Editor-in-Chief Pamela A. Keene Graphic Design Karen Rothschild Production Iris McIlvaine Circulation Denise Smith Peggy Woodruff Interim Director of Communications About the Georgia Department of Community Health DCH conducts the business of health care for Georgians. Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and underserved populations. DCH is responsible for Medicaid and PeachCare for Kids, the State Health Benefit Plan, Healthcare Facility Regulation and Health Information Technology in Georgia. We are dedicated to A Healthy Georgia. 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