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Network Update 30: 1/4/2013

Friday, January 4, 2013

In the News

Medicare, Medicaid fees for primary care rise under Affordable Care Act. There were several stories on increases in primary care reimbursement for Medicare and Medicaid that began January 1, 2013.

  • Durham Herald-Sun coverage  is available here.  Also, please note the related Sun editorial on Medicaid.
  • Triad Business Journal coverage on Medicare fees is here.

Security leak to cost South Carolina millions. Security weaknesses at the South Carolina Department of Revenue allowed hackers to steal personal financial data belonging to 6.4 million consumers and businesses. The agency’s failure to encrypt data and require use of dual passwords has so far cost the state $20 million and the price tag is expected to rise. For details, see the story in The State (Columbia, SC).

Medication Access and Review Program goes live. On December 17, CCNC began hosting and providing technical assistance for the Medication Access and Review Program (“MARP”). The application helps nonprofits manage prescription assistance programs for low-income patients. The MARP database includes more than 3,600 medications offered by pharmaceutical manufacturers through approximately 140 patient assistance programs.

MARP helps users keep abreast of the ever-changing nuances of these programs, as well as tracking the value of medications. The application also helps identify drug-to-drug interactions, duplicative therapy, patient allergies, drug-to-food interactions and minimum/maximum dosages. MARP is already seeing heavy use: from December 17 through year end, MARP hits totaled 4,667,454, with 1,243,460 total pages viewed.The North Carolina Office of Rural Health and Community Care developed this application with funding from the Duke Endowment and North Carolina Foundation for Advanced Health Programs.

NCQA issues changes/clarifications. NCQA has announced “clarifications and policy changes” for the PCMH 2011 Standards and Guidelines. The revised standards define “personal clinician,” require additional documentation, and make changes in requirements impacting meaningful use and electronic health records. Details on the latest changes are also available on CCNC's PCMH Central page.

Updated Medicaid Resource Guide posted on CCNC website. A new guide aimed at helping providers understand Medicaid eligibility and covered services has been posted on the Medicaid section of CCNC's Patient Management Toolbox. The guide provides online links to various NC Medicaid databases and policy documents, helping providers locate the most up-to-date information. Thanks to DMA Managed Care Consultants Rosemary Long and Tiffany Ferguson-Cline for their assistance in updating this useful guide.

Medicaid Bulletin highlights. A few items you don’t want to miss in the November and December Medicaid bulletins.

  • New $523 federally-required enrollment fee for providers who enroll in Medicare
    • Individual physicians do not pay a fee, but physician practices will be subject to the fee (per location)
    • A $100 enrollment fee also applies when enrolling, reenrolling and recredentialing through NC Tracks.
    • CCNC Networks the Central Office are not subject to the fee as they do not bill providers.
  • Providers excluded by the (U.S.) Health and Human Services. Providers excluded by HHS-OIG are barred from payment for services furnished, ordered or prescribed for Medicaid/SCHIP enrollees. This ban includes all methods of reimbursement (claims, fees, prospective payments, etc.) as well as payments for administrative or management services or to cover an excluded individual’s salary or benefits.
  • Affordable Care Act Changes
    • Enhanced payments to primary care providers. Beginning in 2013, Medicaid is federally required to pay 100 percent of the Medicare Cost Share rate for primary care services render and paid in calendar years 2013 and 2014. (See news stories at the top of this newsletter).
      • Eligible clinicians include physicians with a primary specialty designation of family medicine, general internal medicine or pediatrics. Providers rendering 60% of their services under E&M codes for vaccines and toxoid would also be eligible for enhanced reimbursement.
      • The rule also provides for higher payment for services provided by advanced practice clinicians.
    • No prescriptions from non-participating providers. NC Medicaid is prohibited from paying for prescriptions written by providers who are not enrolled in the Medicaid program. Starting January 1, pharmacies will receive point-of-sale notifications that Medicaid cannot reimburse for these prescriptions.
  • Want to keep up-to-date on Medicaid changes? DMA gives providers the opportunity to sign up for NC Medicaid/NC Health Choice alerts by going to

Welcome new faces!  Please give a warm welcome the following new CCNC employees, all starting January 14, 2013:

  • Data Analyst Marcus Jeffers
  •  IC Reports Administrator Kathleen Evans
  • Software Engineer Stephen Benton

Career opportunities at CCNC. Applications are currently being accepted for the following positions. For more information, please see the CCNC Careers page.

  • Senior Data Analyst
  • Informatics Center Outreach Coordinator
  • Project Coordinator
  • ETL Programmer

CCNC is now posting local CCNC network jobs as well as positions here in Raleigh. Note to CCNC networks: If you have local job openings that you would like posted to the CCNC Careers page, please let us know.

Social media update. Please help support CCNC's social media presence by following us on Twitter (@communitycarenc) and “liking” us on our Facebook page.

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