NCMS Morning Rounds 12-2-21

Happy Thursday! Enjoy your NCMS Morning Rounds!

December 2, 2021

Help Future Physicians — Share Your Perspective!

Thinking back on your medical school experience, what do you know now that you wish you knew then? Please share your voice of experience with your colleagues — both those currently in medical school and those who may share or just be enlightened by your perspective. Responses will be published in the next NCMS Bulletin e-magazine, which will focus on medical education. Thank you for your thoughts on what they didn’t teach in medical school and perhaps should have! Please send your insights to Elaine Ellis at elaine@newchaptercreative.net.

HHS Racial Equity in Postpartum Care Challenge

HHS’ Office on Women’s Health seeks innovative strategies to improve postpartum care for Black or African American and American Indian/Alaska Native women enrolled in Medicaid or CHIP. The emphasis will be on follow-up care for diabetes, postpartum depression and/or postpartum anxiety, hypertension, and substance use disorders (SUD). Total cash prize pool is $1,800,000.

Apply by 5:00 p.m. on Monday, January 31, 2022.

Learn more here.

Important NC Medicaid Bulletin Requires Review of Practitioner Affiliation in NCTracks

This Medicaid bulletin article, Organizational Provider Records Without the Required Individual Provider Affiliation Risk Suspension/Termination, signifies a critical change in the NCTracks data system which could impact both Medicaid practice billing and beneficiary attribution in Medicaid managed care.

Beginning Nov. 21, 2021, organizational providers with certain taxonomies are required to have at least one active affiliated individual provider with at least one active taxonomy related to their credentialed status as a taxonomy level 1 provider.

  • This modification will verify providers meet the enrollment criteria for each taxonomy and supports efforts to keep provider enrollment files current.
  • Once implemented, this will become an ongoing requirement, obligating providers to maintain and update affiliations in order to avoid potential claims suspension and/or provider enrollment termination.

Why is this happening? Medicaid Health Plans require the rendering provider to be listed on a claim and the practitioner to be affiliated in NCTracks with the service location on the claim. In Medicaid before MMC, the claim would still pay even if the practitioner wasn’t accurately affiliated because the claim was paid based on the site’s enrollment with Medicaid. With this change to billing in Medicaid managed care, when a practitioner is not appropriately listed with a site NPI, this can (a) negatively impact beneficiary assignment and (b) potentially impact claims processing. Thus, it is critical that all practices review their practitioner information in NCTracks to make sure (a) current practitioners are appropriately affiliated with the site NPIs where they work and (b) practitioners no longer affiliated with your practices/sites are removed.

In the News

Experimental Treatment May Have Cured Type 1 Diabetes For The First Time, Becker’s, 11-30-21

Learning Opportunity 

Medicaid Managed Care WEBINAR SERIES: Quality & Population Health, December 9 | 5:30-6:30 p.m.

The next webinar in the Quality & Population Health Webinar series, formerly the Advanced Medical Home (AMH) Webinar series, will focus on Advanced Medical Homes: Incentives Plan. This webinar series is designed to support clinicians, practice managers, quality improvement professionals, care managers, and CINs.

Register here.

 

If you have policies you’d like your NCMS Board of Directors to consider, please complete the Board input form here. Thanks for reading!

 
 

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