Practice Management Insight

September 2011

A report on events affecting Oklahoma providers

Predictable billing Tired of sharing your private billing information? Having a hard time even predicting that bottom line each month as patient activity fluctuates? Is your percentage rate simply too high? If that’s you, call OrionNet Systems today!

Automatic free updates Being a member of ThinkHealth means more than just walking away with a software package. We continually update our software for you when the State changes procedures or rates. Never pay for an expensive package that will soon be obsolete. With ThinkHealth, we will always keep you compliant and up to date—free of charge.

September 5

Labor Day

September 7

Social Marketing  101

Register Online

September 8

Persuasive Storytelling

Register Online

September 8

OHCA Board Meeting

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September 8-9

National Suicide Prevention Week

www.recoverymonth.gov

September 8-9

A SIST  Training

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September 9

Ethical Dilemmas

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September 9

Living Choice Advisory Committee Meeting

Oklahoma City

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September 12-13

Wraparound/TIP Training

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September 14

Drug Utilization Review Board Meeting

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September 14-16

SOC Training of Coaches

More information

September 15

Medical Advisory Committee Meeting

More information

September 15-16

Problem Gambling Core Level Training Part I

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September 16

Methadone Myth and Facts

Durant

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September 19 - 23

RSS Training

OKC

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September 20

Perinatal Task Force Meeting

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September 20-21

Case Management Training

OKC

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September 21

Mindfulness for Clinical Intervention

Lawton, Ok

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September 22

DMEPOS

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September 22-23

SOC Wraparound 101

Oklahoma City

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September 28

Statewide Serving Older Adults With MH &SA

Woodward

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September 29

Ethic and  Cultural Competency

McAlester

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Oxytocin’s Dual Role

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Oasis

Counseling was formed to meet the needs of  people who felt there was no way out of their problems. Oasis can help you find your way forward no matter what your problem is. We are an outpatient, home based mental health counseling agency. All of our counselors are licensed by the state, have master’s degrees, have successfully completed a rigorous, 3000 hour supervision program. Our goal is to help children feel safe

in their home environment.

Oasis Counseling Center currently has positions available. If you are a clinician and have the qualifications for this position and would like to apply. Please call or send an email to the information provided below.

www.myoasishelp.com/index.html

Fax resume

to 405-601-5682

Or email us at

[email-masked]

Medicare More Critical than Social Security

Congressman James Lankford (R) of Edmond recently told the Edmond Sun that funding for Social Security is the easiest of the governmental entitlement programs to resolve.

“Social Security has a consistent income. It is looking to go insolvent by 2036. It gives us the longest time period to be able to resolve things,” Lankford told the Sun.

The summary of the 2011 annual report by the Social Security and Medicare Board of Trustees affirmed that Social Security has $2.6 trillion in its two trust funds, and earned 4.6 percent interest in 2010. The cost to administer the program is listed at .9 percent of total expenditures. After 2036, there will be sufficient non-interest income coming into the trust funds to pay approximately 77 percent of scheduled benefits, according to the report.

In 1983, then-President Ronald Reagan and then-Speaker of the House Tip O’Neill worked out a deal to raise the beneficiary age of Social Security from 65 to 67 years of age, Lankford said.

“Because they looked at all the options that far out, they were able to set some things in place that would make sense at that point,” Lankford said. “We’re at that point again to say we’re 20 years out or 30 years out with a major issue with Social Security.”

Medicare and Medicaid are the least solvent entitlement programs, Lankford said.

Lankford told The Edmond Sun in January that several options are on the table to consider. One option is to begin shifting Medicare to the private sector, he said. An insurance formula for Medicare could be created for the future of younger Americans. Users would receive an insurance stipend to purchase private insurance, Lankford said.

“Currently the trustees are saying Medicare will be insolvent by 2024 in the best case,” Lankford said.

He said the best case presented by the Medicare trustees is to cut doctors’ payments by 30 percent by 2013, and to raise taxes that will happen with the Affordable Care Act. Cutting reimbursement rates to hospitals beginning in 2014 is also part of the best-case scenario according to the Medicare trustees, Lankford said.

“If we do all of those things, they say we can make it to 2024,” Lankford said.

Lankford said there will not be enough physicians willing to take Medicare payments in hospitals if those actions occur.

We’ve got major problems with Medicare and we’ve got to be able to resolve those things quickly,” Lankford said.

TO LEARN MORE about Social Security actuarial publications, go to www.ssa.gov/OACT/TRSUM/index.html.

Changes to the CDC

The following changes are being made to the CDC form for the new information

As Optum comes in to take over APS, October 1st OHCA/ODMHSAS has decided to make a few necessary changes to the CDC form and process. Theses Changes are listed below. Staying with their core principle of great member support OrionNet Systems has been working long and hard with Optum to add the new changes and making sure the transition is seamless for OrionNet members. Clyde Wafford, President of OrionNet Systems, said  “he wants to switch from APS to Optum to be seamless to ThinkHealth members. “He want them to sleep easy on September 30th and wake up on October 1st and just see Optum in place of APS, with no other  worries.”

Add presenting problem “635 Posttraumatic Stress Disorder”

Add Presenting  problem “633 Attention Deficit/Hyperactivity Disorder”

Add presenting “634 Oppositional Defiant Disorder “ Elimination of                  transaction type 25

Change the code for Presenting Problem“Other Non Behavioral Health                  Problem” from 000 to 100

The following files are companion documents to the HIPAA Guidelines for Electronic Transactions, version 5010. The specifications in this document are clarifications that are allowed within the HIPAA transaction sets. The documents only clarify segments as they apply to the Oklahoma Medicaid Management Information System.

837 Professional Health Care Claim – Typical Providers Only

837 Institutional Health Care Claim – Typical Providers Only

837 Dental Health Care Claim – Typical Providers Only

270/271 Health Care Eligibility Benefit Inquiry and Response – Typical

276/277 Health Care Claim Status Inquiry and Response - Typical

835 Health Care Claim Payment/Advice – Typical Providers Only

834 Benefit Enrollment and Maintenance

820 Premium Payment for Insurance Products (OHCA Cap. Payment

837 Professional Health Care Claim - Non-Typical Providers

270/271 Health Care Eligibility Benefit Inquiry and Response - Non-

276/277 Health Care Claim Status Inquiry and Response - Non-Typical

835 Health Care Claim Payment/Advice - Non-Typical Providers

okhca.org/providers.aspx?id=13062

5010 HIPAA Companion Documents

OrionNet Systems would like to welcome OPTUMHealth! Oklahoma’s new Behavioral Health Health QIO vendor. OptumHealth specializes in health management solutions that address the physical, mental and financial needs of individuals and organizations. OptumHealth is working to partner with providers in the Oklahoma behavioral health community. OptumHealth provide health information and services to nearly 60 million Americans.

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Introducing OPTUMHealth

The OptumHealth contract begins October 1, 2011.  This contract covers all inpatient and outpatient SoonerCare behavioral health services.  To facilitate a smooth transition from APS to OptumHealth, timelines/deadlines have been established for APS Healthcare to begin the transition to OptumHealth, beginning September 25, 2011 at 11:59 pm.