Complete Story



Dear Member,
Last week, like most weeks recently, was filled with geographic challenges as I moved around the state and the eastern part of the country to obtain what seems like an excessive amount of material to consume and reiterate.  With everything going on in our provider worlds, it often feels like the direction healthcare is moving is in a diametric fashion making it feel very dysfunctional.  It reminds me of rafting down a class V rapid, to the left is a calm pool and to the right a whirlpool.  Below the rapid the current continues moving with additional turbulence to challenge one’s skills.  There is a spirit of excitement and yet a real sense to respect the power of all that energy.  The struggle is trying to navigate a steady course, for your program, staff, community and most importantly the individuals you serve.  This memo is full of information to help you chart your course.

Midwest Care Alliance Annual Conference

Keeping your skills honed and those of your staff are critical components in navigating a changing environment.  There is a lot of competition for your education dollar this fall with several national and state conferences to choose from. The Midwest Care Alliance Annual Conference is a premier educational event not only from a content perspective but also a cost perspective.  Every year, both members and non-members come together to network and learn about the evolving industry of care and how to enhance their abilities.  We are less than two-weeks away from our Annual Conference being held October 30-November 1.  We will begin our event on Monday evening, October 29th, with our PATRON reception and Leadership dinner, hearing about the latest updates regarding ICDS and its impact on our industries. The week continues with excellent opportunities for you and your staff to continue building excellence.  Remember, it is your experience and education that sets you apart from your competitors!  Join us in Columbus!  To view the 2012 Annual Conference registration brochure click here.

Managed Care Organization/ICDS Reviews

On Monday, I was in West Cleveland for one of the health plan ICDS Reviews.  While the news and updates are still sketchy, the health plans (Managed Care Organizations) are beginning to form their business plans and move forward.  While some basic elements are still not resolved, it is clear that this demonstration is a footprint which will leave a mark on the Ohio healthcare industry.  While there are many angles to consider how a provider might best fit into this care arrangement, one of the first steps is to make contact with the plans in your region and begin having discussions.
Some common goals to consider:
 1. Call to make an introduction and be prepared to describe your organization.
2.  Consider their company profile and listen for those care elements they find critical in carrying out their duties for the state:
  • What is the MCO roll out plan for ICDS?
  • What are their objectives and how will they manage clients?
  • What will health plans be looking for in their providers (quality goals, readmissions, visits, case management, benchmarking)?
  • Have they begun and how will they approach the contracting process?
  • What are the top 2 strategic aims that the health plan will focus on in the demonstration program?
  • What are their top two concerns?
  • As a managed care organization, what do you look for (credentials) in post-acute providers?
  • How do you plan on managing the care for acute/emergent and post-acute services?
  • Have the health plan describe their case management model and how inclusive or independent provider activities are around care management?
  • How do they plan on developing future provider networks?
  • Do the plans anticipate any problems with keeping provider payments within 30 days?
Providers should plan on describing or talking about:
  • What services you provide and what sets you apart?
  • What does your client profile)s) look like?
  • Do you serve a unique population and how is this advantage for you and the plan in crafting a model of care around these clients?
  • Next steps: How should the plans and providers follow up with one another to discuss contracting?

Click here for a complete list of the ICDS Health Plan Contacts and the regions they serve.

Voting for Midwest Care Alliance Board of Directors

Voting is Open!  Cast your vote TODAY for the 2013 Midwest Care Alliance Board of Directors!  Your membership, your vote, your organization!  It is time to voice your opinion and vote for the Midwest Care Alliance Board of Directors. Each dues-paying provider member is eligible to vote on matters related to the organization regarding bylaws and electing members to the Board of Directors.  There is one vote per dues-paying provider member.  Ballots were sent to Executive Directors on Friday, October 5 via email.  There are seven open seats total and nine candidates representing all three areas of organizational focus. You must vote for at least one candidate in each categoryPlease review each candidate’s bio carefully to help make your decision.  Voting closes on Friday, October 19, 2012 at 5pm! 

Political Action Committee Debuting at Annual Conference

A Political Action Committee (PAC) is an important tool in an organization’s advocacy tool shed. A PAC is a combination of two or more persons with the primary or major purpose to support or oppose any candidate, political party, or issue, or to influence the result of any election through express advocacy. Organizations like Midwest Care Alliance can use a PAC to help support political candidates who are leaders and supporters of home care, hospice, and palliative care issues in Ohio.
At this year’s Annual Conference, members will be introduced to the Midwest Care Alliance Political Action Committee (MCA-PAC)! The MCA-PAC is a way for our members to come together as one and support legislators in Ohio who are friends and leaders in home care, hospice, and palliative care issues in Ohio. Please join us and consider making a contribution to MCA-PAC at Annual Conference by participating in the new MCA-PAC Raffle!
The MCA-PAC Raffle features several fun, themed gift baskets. You can purchase tickets to enter for your chance to win a gift basket, and find out more about MCA-PAC, at our PAC booth. Winning raffle tickets will be drawn Tuesday, Oct. 30 during Casino Night. Thank you for your support of home care, hospice, and palliative care advocacy!  If you have any questions, please contact please contact Jeff Lycan at (614) 545-9016 or

System Issues with Occurrence Code 55 & Referring Physician

Let me briefly describe two issues we spent a lot of time on during a meeting between the Hospice Coalition, (chaired by Midwest Care Alliance) and Palmetto GBA this last Friday.  First is payment, if you bill electronically your billers are no doubt experiencing difficulty with both Occurrence Code 55 and Referring Physician Information.  This issue is affecting all hospice providers across the country and CMS is working to resolve them as quickly as possible.
Issue #1:  Occurrence code 55, which was implemented with Change Request 7792, is required to be reported when the discharge status code reported on the claim is a 20 (expired), 40 (expired at home), 41 (expired in a medical facility), or 42 (expired – place unknown).  However, claims submitted with the occurrence code 55 via the 5010 format are being rejected before entering the Fiscal Intermediary Standard System (FISS). 
Issue #2:  Change Request 7755 requires hospice providers to report the certifying physician information (when different than the attending physician) on the claim in the referring physician 2310F loop of the 5010 format.  However, claims reporting physician information in the 2310F loop are being rejected before entering FISS. This problem is currently only affecting hospice providers, and is being researched.  Some providers have reported that batching their claims, where the Hospice Medical Director and the Attending Physician are the same, claims are electronically processing.
The problem with Occurrence Code 55 is affecting all provider types, and is being researched.  The issue with CR 7755 is hospice specific.  Until these issues are resolved, providers may choose to submit claims via Direct Data Entry (DDE).  Please continue to monitor the Palmetto website and occurrence log for any updates to these issues.

Related / Unrelated Diagnosis

Another item on our agenda Friday was to discuss many questions regarding the hospice wage index and requirement to report all related diagnoses on the hospice patient claims.  While this is still being sorted out, several terms were discussed in detail such as coexisting, additional, secondary, comorbid, related and non-related.  MCA is expecting more information around this subject matter but as a general rule of thumb, the additional claims should be related to the terminal diagnosis.
While the date of the notice was effective on October 1, the perspective provided in our discussions was that this notice just clarified existing policy.  Yes, the expectation is that providers that have not been listing related diagnoses will start listing those on forthcoming claims.  While MCA doesn’t have any control of CMS or MAC actions, there doesn’t appear to be a massive edit in place to check this element field on claims beginning November 1.  However, providers should work proactively to bring their claims into compliance if they are not currently.
What this change does is heighten the discussion around related diagnoses and secondary conditions.  The link below includes two documents provided by Palmetto describing responsibility around providing the necessary services to palliate and manage the terminal illness and related conditions. While these documents are dated, both Drs. Feliciano and Beeler were in attendance and spoke to this item.   Click here to access the documents.

Take Time

Lastly, I had the pleasure of meeting a new director in Northeastern Ohio on Tuesday and when leaving their office I decided to take an alternate route back to Columbus.  The fall colors were magnificent and breathtaking.  How often do the days pass where we don’t take the time to see the beauty and essence of the world around us?  All the work we do as providers is to help others mend and have more life!  We should appreciate the essence of what it is that we work so hard to deliver.  Take a second to stop and notice the vibrant colors of fall!

See you at the Conference! 

 Jeff Lycans Signature