HMSA Payment Transformation Providers   The following is a summary of items covered at an HMSA meeting of Physician Organizations last week:

  • GET (General Excise Tax) Collection   Under Payment Transformation, it has been unclear which charge providers can fairly use to pass on GET to HMSA members. Under Fee For Service (FFS), providers could collect GET from a portion of their panel (eligible PPO members) to offset the amount the provider owed to the state. HMSA has determined that the PMPM is “compensation in full” and PCPs are asked not to collect GE tax on a PMPM basis. To recognize the hardship this creates to providers and protect HMSA members from being incorrectly taxed, HMSA will compensate PCPs for the portion of GET that providers previously could collect from HMSA members. For 2017, HMSA will make a one-time payment in October to providers. In 2018, HMSA will adjust the Commercial PMPM payment rates accordingly.

  • Quest Integration Enhancement Checks   HMSA received Q1 2017 Reimbursement data on 8/1/17. PCPs can expect their checks in about 3 weeks. There are increases in payment for certain primary care services (E/M and vaccine administration to eligible PCPs who attested. PCPs still able to attest. See: http://www.med-quest.us/providers/PrimaryCarePhysician.html

  • Electronic Fund Transfer (EFT)   Direct deposit for PCPs is hoped to be available for the September 2017 payment. Those who are already set up for EFT for regular claims payment will be first. Other PCPs may also apply.

  • Patient Attribution Process   There was much discussion about the flaws in patient attribution process based on claims.  Starting in mid-October PCPs will only be able to add PPO patients to their panel via COZEVA and HMSA patients will no longer be attributed via the claims process. For HMO, Akamai Advantage or Quest patients, member needs to call HMSA to change PCP or offices may FAX a completed Patient Selection form to HMSA. See attached slides for detail.

  • ShareCare Requirement   EHI sent a letter to HMSA stating that a number of our providers do not believe that their payments should be affected by whether or not they upload their photo and profile to ShareCare, as it has little to do with providing quality patient care. We are awaiting a response.

  • Tiffany Pa, HMSA Provider Services Coordinator, continues to be available to visit your office to assist with your COZEVA performance measures and patient attribution issues.  Please contact Jane if you would like her to visit your office. jbontuyan@ehiipa.com

New Members   The following providers were approved as new IPA members as of January 2017: Shallon Craddock, MD – Pediatrics; Sarah Howard, MD – Primary Care; LaRae Barnes, APRN – Primary Care; Louis Pau, MD – Anesthesiology/Pain Management; Dwight Johnson, MD – Primary Care;  Michael Russo, MD – Neurology/Sleep Medicine

East Hawaii IPA Symposium – August 18-20, 2017   The Symposium is open to REGISTERED GUESTS ONLY, so if you are interested in attending any of the lectures or the vendor trade show, you MUST REGISTER IN ADVANCE. The IPA OFFICE WILL BE CLOSED ON FRIDAY, AUGUST 19. We can be reached at the Fairmont Orchid Hotel if you have an urgent matter at 808-885-2000.

Announcements

  • Healthcare Ecosystem Referral Resource: Chronic Disease Self-Management Program – August 22, 29, September 5, 12, 19, 26 – 9 AM – 11:30 AM at ADRC. Flyer attached.

  • HMSA Webinar: “Quest Integration Basics” – Wednesday, August 23, 12:30 – 2:00 PM. Flyer attached. Please RSVP by August 21.