Current Bulletin

  • NCTracks Offers Audit Guidelines

    The February Medicaid Bulletin offers guidelines on responding to post-payment audit requests from the Division of Medical Assistance (DMA) Office of Compliance and Program Integrity (OCPI), which oversees audits by several agencies. The guidelines clarify that:

    • You do not need to get a signed record release consent from the patient to access their records for an audit. When applying for Medicaid, beneficiaries must sign a release authorizing access to their records by appropriate regulatory agencies.
    • Prompt response is key. If you are notified you need to submit service provision documentation for a Medicaid client, the submission process is extremely time sensitive. Timelines may vary slightly among audit agencies; but, usually the materials are due within 30 days upon the date of the notification letter, not the received by date.
    • If the auditing entity requests additional documentation about the case, the time limit for returning this information is often shorter than the time limit indicated in the initial request. To minimize any delay, all documents related to the claim should be sent with the initial request.
    • Audit notification letters will include a list of specific items from within the specified Medicaid beneficiary’s file to send to the requesting agency.
    • If providers have any doubt regarding the request, they should first contact the listed OCPI representative. Additionally, providers may call the Medicaid Contact Center in RTP. The local number is 919-813-5550, and the long-distance number is 1-888-245-0179. The call center staff will provide general facts and resolution of the information requested. OCPI will make every effort to ensure the provider’s claims are reviewed fairly.
    • If the additionally requested information is not submitted in a timely manner, there is an increased risk of the case being designated as an error. Not only will the State be held responsible for this designation and be required to implement corrective action plans with the providers; but, the provider will potentially be required to pay back all monetary gains that had been reimbursed related to the claim.
     
  • Apply for the 2018 NURSE Corps Loan Repayment Program

    The Health Resources and Services Administration’s NURSE Corps Loan Repayment Program (LRP) offers registered nurses and advanced practice registered nurses substantial financial assistance in exchange for full-time service either at a Critical Shortage Facility or an eligible school of nursing. Applications are now being accepted through March 8, 2018. Read the 2018 Application and Program Guidance

    Apply Now

     
  • NCMS’ Seligson’s Commentary Has Broad Reach

    North Carolina Medical Society (NCMS) CEO Robert W. Seligson’s commentary piece “Good Health Means More Than Visiting Your Doctor,” which was originally published in the Raleigh News & Observer on Jan. 4, 2018, has gotten broader exposure.

    With several additions about the work of The Physicians Foundation, on whose board Seligson serves as treasurer, the piece is now part of the Forbes blog and was specifically called out by Avik Roy, opinion editor at Forbes, in his weekly digest of top blog posts for the week.

     
  • In the News

     
  • Learning Opportunities

    The Office of the National Coordinator for Health IT (ONC) will offer a webinar on the Draft Trusted Exchange Framework and Common Agreement (TEFCA) on Feb. 15, from 1:30-2:30 PM. The 21st Century Cures Act requires ONC to develop or support a trusted exchange framework, including a common agreement among health information networks nationally. The Draft Trusted Exchange Framework focuses on policies, procedures, and technical standards that build from existing health information network capabilities.  The intent is to provide a single “on-ramp” to patient information regardless of what health IT developer, health information exchange or network is used, or how far across the country the patients’ records are located. The webinar will provide an overview of the draft framework and a question and answer session. Comments on the draft framework need to be submitted to exchangeframework@hhs.gov before 11:59 pm ET on Feb. 20, 2018. Learn more and register.

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    The Office of Continuing Medical Education of the Brody School of Medicine of East Carolina University, UNC Eshelman School of Pharmacy and Eastern Area Health Education Center will offer “Being Resilient and Renewing Your Purpose in Healthcare” on Feb. 2, March 8 and April 20, at the Education Center at Eastern AHEC, Greenville, NC. With a focus on individual and team resilience, this program will engage participants in creative approaches to self-care based in the neurobiology of well-being. Faculty will examine structural challenges that contribute to burnout as well as offer direct experiences with mind-body practices that reduce stress and help build resiliency and joy in practice. Attend any combination of days or all three. Please create or update your MyAHEC account to register for this program. Learn more and register.

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    The Governor’s Institute and the NC Medical Board is offering “Controlled Substance Prescribing: What Every Provider Needs to Know” live training sessions across the state. These free CME panel sessions are designed for controlled substances prescribers to complete up to two hours of the required education in opioid prescribing. A one hour online training is recommended before the live training. Register for 1-hour online training here. Together they fulfill the three hour requirement.  Here are the upcoming sessions:

    March 15, 2018 – Cape Fear Medical Center, Fayetteville (2 hrs)

    April 3, 2018 – 6:00 p.m. Carolinas Medical Center, Concord (2 hrs)

    May 8, 2018 – 6:00 p.m. Carolinas Medical Center, Shelby (2 hrs)

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    Learn How Physicians Get Elected to Public Office through the AMPAC Candidate Workshop held March 2-4 in Washington, D.C.Registration is now open. The deadline to register was Feb. 2. For more information visit AMPAC online. To apply, simply fill out the online registration form or email your questions to: politicaleducation@ama-assn.org. _____________________________________________________________________________________

    ECU’s Brody School of Medicine and Eastern AHEC offer the 20th Annual Women’s Health Conference, Feb. 16, at the Education Center at Eastern AHEC, Greenville. Learn more and register.

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    The North Carolina Foundation for Alcohol & Drug Studies will hold its 2018 Winter School, Feb. 18-21, at the Embassy Suites in Greensboro.  The gathering will address Substance Use Disorder, identify population specific interventions and examine techniques and concepts to use with those affected by substance use disorder. Learn more and register.

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    Save the Date: The NC Population Health Collaborative’s first quarter meeting will be held on Thursday, March 15, from 11:30 am until 3:30 pm at a location yet to be determined. Watch your email and the Bulletin for details on the location, agenda and registration instructions. A small fee will be charged for the event, which includes lunch.

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    Save the date for the next meeting of the NC Department of Health and Human Services Opioid and Prescription Drug Abuse Advisory Committee, Friday, March 16, from 9 a.m. to 12:30 p.m. (with 8:30 to 9:00 a.m. reserved for sign-in and networking). The location will be the McKimmon Center, 1101 Gorman St., Raleigh

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    The National Rural Accountable Care Consortium (NRACC) will offer Quality Improvement Workshops North Carolina on April 17 in Fayetteville and April 19 in Elkin. During the interactive workshops, participants will learn from Caravan Health experts about best practices to improve the health of their community, increase practice revenue and improve quality scores. Click here for cities and dates. Registration will open Feb. 1. For more information please contact qiworkshops@caravanhealth.com.

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    Registration is now open for the NC Ob/Gyn Society & NC Section of ACOG’s 2018 Annual Meeting,
    April 20-22 at the Omni Grove Park Inn in Asheville
    . Other specialties may be interested in the Hands-on Ultrasound workshop and the Treatment of Opioid Use Disorder course, which provides the required education needed to obtain the waiver to prescribe buprenorphine. Learn more and register.

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    The 9th Annual Addiction Medicine Conference will be held April 26-28, in Asheville. The conference will provide clinically practical and up-to-date substance use related training, applicable across general medical as well as addiction specialty practices. Learn more.
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    The 2018 Spine Society of Australia 29th Annual Scientific Meeting will be held April 27-29 at the Adelaide Convention Centre, Australia. Learn more and register.

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    NCTracks has Computer-Based Training (CBT) courses on a variety of topics available to providers 24 hours a day, 7 days a week, every day of the year. Anyone who is a registered user with NCID access to the NCTracks secure Provider Portal can access and take a self-paced course. A list of courses available can be found here and under Quick Links on the NCTracks Provider Training page of the public Provider Portal.

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    MAHEC, working with the North Carolina Academy of Family Physicians, The Governor’s Institute on Substance Abuse and Project Lazarus: A Project of CCNC, is offering A Guide to Rational Opioid Prescribing for Chronic Pain, an online education course. The course is designed for all prescribing health care practitioners who are interested in an overview of the rational prescribing approaches for persons with chronic pain disorders. It will fulfill the North Carolina Medical Board’s requirement of at least one hour of continuing education designed specifically to address prescribing practices for chronic pain management. The course cost is $15 for the first 6 months. Offers 3 hours of AAFP, AMA/AAFP Equivalency, and CDE; www.mahec.net/opioid.

     

     
  • NCMS Board Seeks to Encourage Member Participation

    At its regular meeting on Saturday, Jan. 13, the North Carolina Medical Society (NCMS) Board of Directors adopted a new policy to encourage broader member participation in the Society’s leadership. Member volunteers will be able to serve on two NCMS or affiliated groups’ committees or boards at one time, under the new policy.

    “With our growing membership, we want to be sure to cultivate a large group of member leaders who represent the diversity of our Society,” said NCMS President John L. Reynolds, MD. “This policy ensures the Board will have the range of perspectives when considering actions or new policy.”

    The 2018 committee rosters are now being finalized and will be published in the next Bulletin.

     
  • Physicians Health Program Offered Help To Hundreds Last Year

    The head of the North Carolina Physicians Health Program (NCPHP), Joe Jordan, Ph.D., presented an overview of the program’s 2017 annual report to the North Carolina Medical Society (NCMS) Board of Directors at their meeting on Jan. 13. The statistics for 2017 show more physicians are self-referring to the NCPHP for problems like burnout and workplace stress – a growing concern in the health care community. Also notable was the fact that 24 percent of the 225 people who received services from the NCPHP last year were self-referrals – physicians who identified a problem and sought help from the NCPHP on their own.

    Jordan also shared results of exit surveys of program participants, which revealed the vast majority of respondents (90.5 percent) felt NCPHP contributed to “feeling better off” than when they first presented for services.  Most of the survey respondents were participating in NCPHP due to substance related issues (66.67 percent), followed by workplace stress (28.6 percent) and anxiety (28.6 percent).

    “It’s inspiring to see physicians being self-aware and seeking out help when needed,” Jordan said. “We’re also encouraged that NCPHP is seen as helpful and is a positive influence on personal, professional and interpersonal areas of life.”

     
  • NCMS’ LEAD Health Care Conference Taking Shape

    While Oct. 18-19 may seem a long way off, the North Carolina Medical Society (NCMS) is hard at work developing innovative content for this new and exciting conference. At their meeting on Jan. 13, the NCMS Board of Directors discussed what topics would be most timely and intriguing to their colleagues throughout the state, and how to make this the not-to-be-missed health care event of the year.

    The LEAD Health Care Conference website is now live, www.ncms-lead.com, and is the place to go to stay up to date on additions to the line-up of speakers and entertainment for the conference. If you or some organization you know might be interested in sponsorship or exhibiting at the conference you can download the Sponsor Prospectus or the Exhibitor Prospectus to explore these opportunities.

    See you in Raleigh in October!

     
  • Coalition Issues Statement on Prior Authorization Reform

    Last week, an AMA-led coalition including the North Carolina Medical Society (NCMS) issued a Consensus Statement outlining the shared commitment to industry-wide improvements to streamline the prior authorization approval processes to enhance patient access to timely, appropriate care and minimize potential disruptions. The statement is the result of more than a year’s work including a survey of physicians, including NCMS members, on their impressions of prior authorization (review the results here) and follows a series of Prior Authorization and Utilization Management Reform Principles.

    According to the Consensus Statement, health care leaders will work together to:

    • Reduce the number of health care professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices, or participation in a value-based agreement with the health insurance provider.
    • Regularly review the services and medications that require prior authorization and eliminate requirements for therapies that no longer warrant them.
    • Improve channels of communication between health insurance providers, health care professionals and patients to minimize care delays and ensure clarity on prior authorization requirements, rationale and changes.
    • Protect continuity of care for patients who are on an ongoing, active treatment or a stable treatment regimen when there are changes in coverage, health insurance providers or prior authorization requirements.
    • Accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

    The coalition is committed to continued collaboration to improve the prior authorization process. Visit the Prior Authorization page on the AMA website to stay up to date on this reform initiative.

     
  • Vaccine Underpayments Will Be Paid by July 1, 2018

    The $10-$12 million in underpayments for vaccine administration in 2013 and 2014 will be paid by the end of June, the North Carolina Department of Health and Human Services Deputy Secretary for Medical Assistance Dave Richard told the General Assembly’s Joint Legislative Committee for Health and Human Services last week. The underpayment affected approximately 2.5 million vaccinations administered to Medicaid patients under the Vaccines for Children (VFC) program.

    Last year, the North Carolina Pediatric Society and the North Carolina Academy of Family Physicians (NCAFP) along with eight member practices were victorious in their lawsuit to correct underpayment of the vaccination administration fees. In November, the NC Division of Medical Assistance (DMA/Medicaid) decided not to appeal the Superior Court’s decision that they must rectify the underpayment of Medicaid vaccine administration payments made in 2013 and 2014. Superior Court Judge Beecher R. Gray allowed DMA until November 2018 to reprocess the claims.

    Richard told committee members NCTracks programming to re-process the underpayments is underway and will be made by the end of the state fiscal year, June 30. DHHS is identifying all codes that were underpaid and will remit the difference directly to each affected practice, so no action is needed by practices and physicians who may be owed payments. Practices will be reimbursed $6.74 per qualifying vaccine.

    The North Carolina Medical Society (NCMS) once again congratulates the NC Pediatric Society and the NCAFP for this important legal victory on an issue that the NCMS and the other organizations have long advocated to correct.