White Coat Wednesday - Tuesday Meeting

[Sembert, Fran - Eagle]

Carol Steckel’s Administrative Assistant asked me today to forward any questions we would like for her to address on June 4^th. Please send those to me ASAP so I can get those to her.

 

Thanks,

 

Fran Sembert, CMPE

Director, Business Services

Eagle Physicians and Associates, PA

324 W Wendover Ave, Suite 200

PO Box 14520

Greensboro, NC 27415-4520

336-268-3201 (P) 336-275-0812 (F)

fsem...@eaglemds.com

 

In Accordance With NC Statute § 131E‑107

 

 

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[Susan Childs]

First, why are the Vanderbilt screenings for ADHD now being only paid through the Mental Health CA provider?  Pediatricians have been using these Medicaid certified screenings for years and now denials with no real explanation as to the sudden change.

 

Second,  just a curiousity question.  How much has the state saved by not paying for circumcisions? I would like to see what % of medicaid boys ages 5 and under have had to have circumcisions done through Urology.

thank you Susan

 

Susan F. Childs, FACMPE

Evolution Healthcare Consulting

www.evohcc.com

ACMPE NC Forum Representative - Eastern Section Forum Coordinator

1005 Walkerfield Drive - Rougemont, NC  27572 

Tel:919.732.6832 Mobile: 919.641.5373

This e-mail, including attachments, is intended for the exclusive use of the person or entity to which it is addressed and may contain confidential or privileged information. If the reader of this e-mail is not the intended recipient or his or her authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you think that you have received this e-mail in error, please advise the sender by reply e-mail of the error and then delete this e-mail immediately. Thank you. Childs

sch...@evohcc.com

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[Sembert, Fran - Eagle]

Regarding your second question, we (our OBGYNs get the circumcision fee upfront when they sex of the baby is determined then we do it right after the baby is born. I think this is pretty typical.

[Susan Childs]

yes, it is now, but primary care used to be able to perform and it was covered. now goes to urologist or other...

why is a peds opffice not approved anymore as a provider to perform this procedure? 

thanks

s

Susan F. Childs, FACMPE

Evolution Healthcare Consulting

www.evohcc.com

ACMPE NC Forum Representative - Eastern Section Forum Coordinator

1005 Walkerfield Drive - Rougemont, NC  27572 

Tel:919.732.6832 Mobile: 919.641.5373

This e-mail, including attachments, is intended for the exclusive use of the person or entity to which it is addressed and may contain confidential or privileged information. If the reader of this e-mail is not the intended recipient or his or her authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you think that you have received this e-mail in error, please advise the sender by reply e-mail of the error and then delete this e-mail immediately. Thank you. Childs

sch...@evohcc.com

[Sembert, Fran - Eagle]

The AAP came out some time ago stating they do not recommend routine circumcision so that’s probably when they stopped paying for it. I’ll put it on the list.

[Susan Childs]

thank you - i think so too -would like to see FP and Peds be able to do that again.

s

Susan F. Childs, FACMPE

Evolution Healthcare Consulting

www.evohcc.com

ACMPE NC Forum Representative - Eastern Section Forum Coordinator

1005 Walkerfield Drive - Rougemont, NC  27572 

Tel:919.732.6832 Mobile: 919.641.5373

This e-mail, including attachments, is intended for the exclusive use of the person or entity to which it is addressed and may contain confidential or privileged information. If the reader of this e-mail is not the intended recipient or his or her authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you think that you have received this e-mail in error, please advise the sender by reply e-mail of the error and then delete this e-mail immediately. Thank you. Childs

sch...@evohcc.com

On May 2, 2013, at 4:06 PM, "Sembert, Fran - Eagle" <fsem...@eaglemds.com> wrote:

The AAP came out some time ago stating they do not recommend routine circumcision so that’s probably when they stopped paying for it. I’ll put it on the list.

 

Fran Sembert, CMPE

Director, Business Services

Eagle Physicians and Associates, PA

324 W Wendover Ave, Suite 200

PO Box 14520

Greensboro, NC 27415-4520

336-268-3201 (P) 336-275-0812 (F)

fsem...@eaglemds.com

 

In Accordance With NC Statute § 131E‑107

 

 

[Dickson Capps]

Question for Ms. Steckel concerns the new credentialing agency/process for Medicaid participation.  Key shortfalls:

 

1. The new printed form is not the same one shown on the web site.  If the provider has to submit documents in order to respond fully to a question, there is no mechanism to submit those on line.  The irony is that the agency WILL NOT begin the application process UNLESS it is activated on line so sending a print out of the application with the required documents will not initiate the process.  A companion problem is that, if the provider fails to submit the documents and the agency searches available data bases and discovers that the response is not complete, it will “deny” the provider’s application.  That means that, should the provider submit another application, the provider MUST disclose that “a prior application was denied” which triggers even more delays.  The process, web site and disclosures need to be updated so that information is consistent and does not create pitfalls.  Note: the denial to participate by NC Medicaid must then be reported on every subsequent credentialing application to Medicare and any third party payer [insurer] that uses a credentialing process.

 

2. The agency fails to fully document its communications with the provider.  I have dealt with receiving two “final” notices to terminate the application process with a reference that an e-mail was sent as the first notice requiring additional information.  We challenged the agency both times and it could not verify that it had sent the first notice.  Their only written record was the final notice which referenced a first notice.

 

Perhaps Ms. Steckel can share what is being done to address the errors in the process.  I’d prefer to ask about the incompetence of the selected contractor but we couldn’t ask about the yo-yo’s running the NPPES site for the first 3 years either.

 

Dickson M. Capps

FASHE, FACHE, FACMPE

336-765-0187

 

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[Sembert, Fran - Eagle]

Same issues we have. We got a “final” notice for one yesterday (had not received anything prior) because a date was missing. They said we had to send a new application. It’s virtually impossible to send an application that won’t be denied for something (even after calling and walking through the entire application with someone on their end).