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PROGRESS NOTES NEWS YOU CAN USE

Special Edition

AIP Partners with Banner HealthPG 2

Seven Steps to a Sound Financial FuturePG 4

Discharging a Member from Your CarePG 5

Banner MediSun PharmacyPG 6

PCP Contracted Dermatology ProceduresPG 6

AIP Practice SolutionsPG 7

Latest Additions to Practice SolutionsPG 8

What is 5010?PG 9

Pioneer ACO Highlights PG 10

Arizona Regional Extension CenterPG 11

Medicare Pay MenuPG 11

Are You Prepared for an AuditPG 12

Physician Staff Education SessionsPG 13

Health Net Partners with AIP-Banner Health Network

PG 14

Office Managers MeetingsPG 16

www.arizonaphysicians.com 16155 N. 83rd Avenue, Suite 201

Peoria, Arizona 85382

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AIP Partners with Banner Health in CMS

Selected Medicare Pioneer ACO

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Arizona Integrated Physicians (AIP) announced that its partnership with Banner Health, the Banner Health Network (BHN), has been select-ed to participate in the Pioneer Accountable Care Organization (ACO) model, a transformative new initiative sponsored by the Centers for Medicare and Medicaid Services (CMS) Innovation Center. �rough the Pioneer ACO Model, BHN will work with CMS to provide Medicare bene�ciaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination.

The Pioneer ACO Model is designed to encourage the development of ACOs, which are groups of doc-tors and other healthcare providers who work to-gether to provide high quality care for their patients. As one in a diverse group of leading-edge health care organizations from around the country, BHN was chosen specifically by the Innovation Center to test the effectiveness of several models of payment in helping organizations make a rapid transition to higher quality care at a lower cost to Medicare.

“These Pioneer ACOs represent our nation’s leaders in health systems innovation, providing highly coor-dinated care for patients at lower costs,” said Marilyn Tavenner, Acting Administrator of CMS. “The Banner Health Network has demonstrated significant experi-ence in providing high quality, coordinated care and we are excited to partner with them,” Tavenner said.

AIP, which represents more than 225 separate West Valley primary and specialty care physician practices, believes that the current health care system is too costly and unsustainable. “To ensure continued success physicians and hospitals will need to partner

to lead the transformation to a value-based model of population health management. This call to ac-tion is the catalyst for the development of Banner Health Network” said Dr. Thomas Maxwell III, MD, Chairman of the Board for AIP and internal medicine physician in Sun City. “This new model of clinical and business alignment will allow BHN participants to align a comprehensive network of providers (hos-pital, primary care, specialty physicians, post-acute, home care, ancillary, and pharmacy) with payers. BHN and its providers will have the accountability for managing and improving the health and coordina-tion of patient care for beneficiaries. This new model of care and alignment will provide the opportunity to reward physicians for providing high quality, patient-centered, cost effective care that they were trained to provide,” Maxwell said.

BHN is a patient care and financial accountabil-ity partnership between Arizona Integrated Physi-cians (AIP), a physician-owned organization, Banner Medical Group (BMG) and the Banner PHO (BPHO). This partnership of more than 2,600 primary care and specialty physicians, along with Banner hospitals and

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other related health care services will serve patients throughout Maricopa County and into Pinal County, a population base of more than 4 million people. Further provider member growth is anticipated as additional physicians and other professionals, particularly in the central valley, will be sought.

BHN’s comprehensive provider network accepts patient care and financial accountability for those served by the network. It is one of a few networks in Arizona serving patients in a population health management model. This model offers a highly co-ordinated patient experience through a primary care setting that seeks to improve patient outcomes. It emphasizes wellness, including wellness at the highest level possible for patients suf-fering from chronic diseases. A key feature of this patient-centered model is the close collaboration among providers that will result in greater efficiency and improved control of costs. A foundation of the Banner Health Network’s ability to deliver collab-orative, highly coordinated and integrated patient care is an enhanced electronic medical records system that is utilized in all Banner hospitals.

“BHN is unique in Arizona in that it is the only organization that integrates and aligns physicians that practice in independent practice across the Valley (AIP in the West Valley and BPHO in the East Valley) and as part of an employed multi-specialty group (Banner Medical Group),” stated Dr. Joseph Caplan, the president of AIP and interven-tional cardiologist practicing in Peoria. “This provides for distinctive opportunities for peer to peer best practices sharing across varying care delivery platforms and ensures optimal choice of providers in different settings for beneficiaries and insurers.”

Under the Pioneer ACO Model, CMS will provide incentive for participating health care providers who form an organization to coordinate care for patients. Providers who band together through this model will be required to meet quality standards based upon, among other measures, patient outcomes and care coordination among the provider team. “This push towards higher quality and controllable costs through a highly coordinated patient care experience must move forward,” Banner Health President and CEO Peter S. Fine said. “Our current system in this country isn’t sustainable,” he added.

“Through accountable care, the population health management model has real potential to emerge as a key element for controlling the rising costs of health care,” said Fine. “Our deep involvement at this early stage of accountable care positions Banner Health and its BHN partners extremely well to thrive during this transformative phase of health care,” he added.

“The Banner Health Network will be regarded a wonderful resource for patients seeking high qual-ity health care in nearly every community within the greater Phoenix area,” said Dr. Maxwell. Patients within the BHN can expect enhanced and effective

management of chronic diseases, outstanding pre-ventative and wellness programs, and the highest levels of hospital and post-hospital while optimizing clinical outcomes. “We’re confident this partnership with Banner will serve as a model for similar efforts in cities across the nation,” Maxwell continued.

“We’re extremely pleased and proud to be part of the leading edge of an effort that I believe will transform health care delivery in America,” said AIP CEO Keith Dines. “In the not-too-distant future we envision BHN to be serving hundreds of thousands of members who will appreciate the enhanced level of care and service available through BHN.”

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1. Analyze your cash �ow. When your income is greater than your expenses, the excess is called a positive cash flow. When your expenses exceed your income, the shortfall is termed a negative cash flow. A positive cash flow means that you may have funds you can set aside as savings. A negative cash flow can indicate that it may be a good idea to reorganize your budget to minimize any unnecessary expenses.

2. Develop a program for special goals. For every financial and retirement goal you establish, identify a projected cost, a time horizon (how long it will take to reach the goal), and a funding method (such as through savings, liquidating assets, or taking a loan). Consider your goals in terms of a “hierarchy of importance.” The bottom—or “foundation” tier—should include emergency funds to cover at least three months’ worth of living expenses. The middle tier should include such essentials as your children’s education. On the top tier, place the “nice-to-haves,” such as a new car, home renovation, or vacation.

3. Boost your retirement savings. Employer-sponsored pensions and Social Security may not provide sufficient income to maintain your existing lifestyle when you retire. Thus, it is essential to identify your retirement needs and plan a disciplined savings program for the future. Maximize your contributions to retirement accounts, and if possible, make “catch-up” contributions. Taxpayers, who are 50 years old, or older, are allowed to make additional contributions to their retirement plans. Traditional Individual Retirement Account (IRA) and eligible Roth IRA holders can save an extra $1,000 a year in 2010. Those with eligible 401(k), 403(b), or 457 plans can save an additional $5,500 in 2010.

4. Minimize income taxes. Why give Uncle Sam any more of your money than is necessary? It is in your interest to take advantage of all income tax deductions to which you are entitled. Consider exploring any possible ways of reducing your income taxes. For instance, under appropriate circumstances, losses or expenses from prior years may be carried over to the next tax year. A qualified tax professional can help you implement a tax strategy that meets your needs.

5. Beat in�ation. Your income and retirement savings must keep pace with inflation in order to maintain your buying power. This means that if the inflation rate is currently 3%, you need to achieve at least a 3% annual increase in income just to break even. If your long-term savings plan fails to keep pace with inflation, you may be unable to maintain your current standard of living.

Today, many people find themselves bombarded by a constant stream of financial news from television, radio, and the Internet. Yet, does all this “information age” data really help you manage your finances any better than in the past? The truth often is that the “old-fashioned” practices, such as periodic financial reviews, lead to greater success in the long run. Why not spend a few hours reviewing your finances? The changes you make today could result in increased savings. Consider these seven steps...

Seven Steps to a Sound Financial Future

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6. Manage unexpected risks. As you undoubtedly know, life can sometimes throw you a “curve ball.” Without warning, a disability or untimely death can cause financial hardship for your family. Adequate insurance is an important foundation for your financial program—it offers the protection you need to help cover potential risks and liabilities.

7. Consult a nancial professional. In today’s complex financial world, everyone needs help in making informed decisions. A qualified financial professional can help ensure that your financial affairs are consistent with your current needs and long-term goals.

Reviews can help bring focus to your overall financial picture. In the future, you will have the opportunity to alter your programs due to changing goals and circumstances. By faithfully tracking your progress, you will be in a better position to build financial security and realize the retirement of your dreams.

Provided by: Bert C. Hunt, CLU and Matt A. Roberts, MBA of Strategic Wealth Associates5050 N 40th St., Suite 100Phoenix, AZ 85018602-956-0956

Discharging a Member from Your Care

As a Primary Care Physician, determining the healthcare needs of a patient is one of the many responsibilities. If at any point during a patients care, a PCP discovers that a patient is not complying with

the medical treatment or is behaving disruptively, a PCP may discharge the patient from their care. The PCP must follow guidelines for appropriately discharging a patient. The guidelines for discharging a member from your care are listed in the MediSun Provider Manual in Section G, page 9.

�e guidelines are as follows:

• PCPmustprovidethepatientwitha30-daywrittennoticeofdischarge• Thelettershouldindicatethatthepatientisbeingdischargedfromyourcareandincludedirectionsforhim

or her to contact their Health Plan for assistance in selecting a new PCP• PCPmustbeavailableforurgentandemergencycareduringthistime• Sendtheletterviacertifiedmailwithreturnreceiptrequested• AcopyofthedischargelettermustbesenttoAIP,Attention:ProviderRelations,16155N.83rdAve. Peoria, AZ 85382

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Banner MediSun pharmacy network is contracted through Express Scripts. As you may already know, Walgreens chose to terminate its contract negotiations with Express Scripts, and has publicly announced it will no longer be a participating provider in the Express Scripts pharmacy network. As a result, effective January 1, 2012, MediSun members will no longer have the option of using Walgreens as their pharmacy provider. To ensure continuity of care, it is recommended patients change pharmacies now rather than waiting until the end of the year. Express Scripts is communicating directly with patients to explain how they can easily move their prescriptions to another pharmacy.

Please take these steps to ensure a smooth transition for your patients:

1. Make sure your office staff is aware that Express Scripts members have a choice to move their prescriptions now instead of waiting until December 31, 2011.

2. Electronically prescribe for retail pharmacies other than Walgreens. If a prescription is for a maintenance medication, consider writing a 90-day prescription for home delivery from the Express Scripts Pharmacy.

3. If not prescribing electronically, provide patients with a paper prescription and advise them to fill it at another retail pharmacy in their network.

Banner MediSunP H A R M A C Y

Thank you to all the AIP physicians that re-cently attended the Dermatology Training session conducted by Dr. James McNabb.

The codes listed below are included in your AIP Physician Services Agreement and are payable to capitated and FFS PCPs.

10040 - 1018011000 - 1104411055 - 1105711100, 1110111200, 1120111300 - 1131311400 - 1147111600 - 1164611719 - 11770

12001 - 1202112031 - 1205713100, 13101, 13120, 13121, 13131, 13132, 13150, 13151, 1315216000, 16020 - 1603017000 - 1710617110 – 1725017260 – 17286

P R I M A RY C A R E P H Y S I C I A N S

Contracted Dermatology Procedures

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In today’s healthcare business climate, the pressure for private practices to reduce costs and maximize operational efficiencies has never been greater. More than ever before, physicians are looking for ways to streamline their operations, control overhead costs, increase profitability and improve patient care. This is why AIP has introduced, AIP Practice Solutions, a comprehensive portfolio of mission critical services that will enhance the viability and sustainability of independent physician practices.

•Didyouknow that theAIP /MICARiskManage-ment Program has helped 89 MICA insured physicians implement risk management policies and procedures that have been demonstrated to reduce the risk of claims and suits, while saving those same physicians up to 10% on their MICA professional liability premiums?

•DidyouknowthatAIPpracticeshavesavedover$125,000 in discounts available only to AIP physi-cians for the purchase of the eClinicalWorks elec-tronic medical records system?

•DidyouknowthatAIPhas provided technical support assistance for 23 AIP practices in their successful implemen-tation of electronic medical records?

•DidyouknowthatAIPhas partnered with the Arizona Region-al Extension Center and eClinicalWorks to provide educational tools, resources and training to help physi-cians become Mean-ingful Users of elec-tronic medical records systems?

•Did you know that through the AIP Real EstateSolution, 13 AIP practices have utilized the expert resources of Transwestern to address the commer-cial real estate needs of their practices?

•Did youknow thatover125physiciansareusingpractice management tools and resources avail-able in the AIP WebCenter to improve their practice operations and assist with regulatory compliance guidelines?

�e following strategic solutions are available for all AIP practices: • ElectronicMedicalRecords(EMR)

Implementation and Support Services• MeaningfulUseSolution• AIPPracticeManagement&Compliance

WebCenter• CommercialRealEstateSolution• RevenueCycleManagement• FinancialandWealthManagement.• HumanResourceServicesandBenefits• Premier,Inc.,GroupPurchasingOrganization• WebsiteDevelopmentSolution• AIP/MICAMedicalProfessionalLiabilityRisk

Management Discount Program

Independent Physician Practices BecomeMore Successful!

AIP PRACTICE SOLUTIONS IS HELPING

For More Information about AIP Practice Solutions, please

visit our new website at www.arizonaphysicians.com, or contact

Provider Relations at (623) 215-9430 or email

info@arizonaphysicians.com.

C O N T A C T U S

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Premier, Inc., Group Purchasing OrganizationAIP has teamed with Banner and Premier Purchasing Partners to offer significant savings to AIP physicians throughthePremierProviderSelect:MDprogram.Premier’sProviderSelect:MDprogramisthenation’slargest physician group purchasing program and is dedicated to providing measurable savings and un-precedented opportunities to control supply chain and operating expenses in your physician practice, including:

• Pharmaceuticals• Officeandexamroomfurniture• Medicalequipmentandsupplies• Merchantcardservices• Generalofficeandcomputersupplies• Imagingequipmentandsupplies

Revenue Cycle ManagementAIP has partnered with two premier revenue cycle management companies, Asterino and Associates, Inc., and Scinet-APER Solutions, Inc., that have the expertise, experience and technology necessary to maximize your practice’s revenue, minimize your costs and provide you and your staff more time to do what you love and do best - provide quality care for your patients!

Financial and Wealth ManagementAIP is pleased to introduce the AIP Financial &Wealth Management Solution for AIP physicians. As proven experts in financial and wealth management services, both the Self Wealth Management team and the Physician Division of Strategic Wealth Associates, can provide AIP physicians with the resources that they need to plan and manage their personal and professional assets.

Website Development SolutionAIP and Omedix have collaborated on the develop-ment of a website development solution that is custom tailored specifically for AIP physicians, creat-ing a unique opportunity for our physicians to develop professional and affordable websites for their practices. Since 2004, Omedix has worked exclusively with medical practices to deliver the best websites in the industry. Today, Omedix serves nearly 1,000 physicians across the country.

Contact UsFor more information about AIP Practice Solutions, pleasevisit our new website at www.arizonaphysicians.com, or contact Provider Relations at (623) 215-9430 or email info@arizonaphysicians.com.

AIP is excited to announce the

latest additions to AIP practice solutions!

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5010 TRANSACTION DATASETS INCLUDE:270/271 – Health Care Eligibility Benefit Inquiry

and Response276/277 – Health Care Claim Status Request

and Response278 – Health Care Services – Request for Review and

Response; Health Care Services Notification and Acknowledgment

820 – Payroll Deducted and Other Group Premium Payment for Insurance Products

834 – Benefit Enrollment and Maintenance835 –HealthCareClaimPayment/Advice837 – Health Care Claim (Professional , Institutional,

and Dental), including coordination of benefits (COB) and subrogation claims

NCPDP-D.0 – Pharmacy Claims

W H AT is5010?

5010 enhances the way insurance plans / payers exchangeinformation, about patients. If you submit electronic healthcare transactions, such as filing a claim, checking a patient’s eligibility, or receiving remittance advice you should be aware of HIPAA 5010 specification created by the Accredited Standards Committee (ASC) and approved by the Department of HHS for implementation.

How does upgrading to 5010 relate to ICD-10? ICD-10 is the upgraded version of ICD-9. The ICD-10 codes have a different format and length than the ICD-9 codes. The new format of the ICD-10 codes cannot be reported in the current version of the HIPAA transactions. So, the upgrade to 5010 needs to be completed before the ICD-10 codes can be reported in the HIPAA transactions. Additionally, ICD-10 codes cannotbeusedinHIPAAtransactionspriortotheOctober1,2013compliancedate.LearnmoreontheICD-10resource page.

What do I need to do now to prepare for upgrading to 5010? Bynow,yourPM/EMRVendor has completed their upgrade process and the 5010 format has been installed on your system. However,intheeventyourPM/EMRsoftwareVendorhasnotupgradedto5010,thentherearestepsyouneedto take to prepare for the conversion to 5010.

• Talktoyourpracticemanagementorsoftwarevendor.Determinewhentheywillhaveyoursoftwareupdatesavailable and when they will be installed in your system.

• Talk to your clearinghouses, billing service, and payers. Determine when they will have their upgradescompleted and when you can begin testing with them.

• Identifyanyworkflowchangesthatyouneedtomakeinyourpracticetoaccommodatechangesin5010. You may need to collect new data or report data differently than you do in the current version.

• Identifystafftrainingneedsandcompletethenecessarytraining.• Conductinternaltestingtomakesureyoucangeneratein5010thetransactionsyousend.• Conductexternaltestingwithyourclearinghousesandpayerstomakesureyoucansendandreceivethe

5010 transactions.

If I finish all of this work before the compliance deadline, can I start to use the 5010 transactions?Yes. If you are prepared to send and receive 5010 transactions and any of your clearinghouses or payers are ready as well, you can begin to use the 5010 transactions with them if you mutually agree to this. No one is required to begin using the transactions prior to the compliance deadline. Using the transactions before the deadline will give you the ability to see that the transactions are working smoothly and are continuing to be processed. If any issues are identified, you can solve them before the compliance deadline. http://www.getready5010.org/

ICD-10 Resources:• GeneralEquivalenceMappings (GEMs)assist inconvertingdata fromICD-9-CMto ICD-10.Forwardand

backward mappings – Information on GEMs and their use (click on ICD-10-CM or ICD-10-PCS to find most recent GEMs);

• TheCMSSponsoredICD-10Teleconferenceswebpageprovides informationonupcomingandpreviousCMS ICD-10 National Provider Calls, including registration, presentation materials, podcasts, video slideshow presentations, written transcripts, and audio recordings http://www.cms.gov/ICD10/Tel10/list.asp

• Provider Resources (for all providers)http://www.cms.gov/ICD10/05a_ProviderResources.asp

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Which Payors are contracted with Banner Health Network?Currently, BHN is contracted with CMMI for a Pioneer ACO, Health Net for commercial and senior products and Aetna for a narrow network commercial product. Additionally, BHN is in discussions with all the major health plans in Phoenix to develop additional attribution, ACO and value based partnerships and contracts.

What is the Pioneer ACO Model initiative? ThePioneerACOModel isanew initiative launchedbytheCenters forMedicare&Medicaid Innovation(CMMI) designed to test how moving experienced organizations more rapidly to population-based payment arrangements working in coordination with private payers can achieve cost savings across the ACO, which will improve health outcomes for Medicare beneficiaries.

How will payments to the Pioneer ACO work? CMMI developed a target per capita expenditure level (benchmark) based on previous CMS expenditures on the group of beneficiaries aligned to the ACO. At the end of each of the year, participating ACOs will be evaluated against this benchmark, and rewarded with a portion of the savings or held accountable for increased expenditures.

How are physicians paid?Medicare will continue to pay providers directly and at the same Medicare reimbursement rates that exist today. There is no change in the claims submission process for traditional Medicare Fee-For-Service claims; continue to send claims using your existing processes for paper or electronic claims submission.

How are providers rewarded for providing cost e�ective, quality care?Unlike today, participating providers in the Pioneer ACO will be eligible for an upside, shared-savings based on cost effective care and quality measures. Should the BHN Pioneer ACO provide more efficient care as a result of improved care coordination the savings resulting from that efficiency will be shared between CMS and BHN and subsequently to the individual providers impacting that care.

What is my nancial risk?In the first year of operations there is no individual provider downside risk. All downside risk will be held or absorbed at the BHN or individual network entity levels (AIP, BPHO or Banner Health).

How will I know if a Medicare beneciary is a BHN Pioneer ACO member?Generally, CMMI has attributed all traditional Medicare Fee-For-Service patients into the BHN Pioneer ACO, therefore you should assume all traditional Medicare beneficiaries are attributed to the ACO.

Can I refer outside of the BHN Pioneer ACO network?Medicare Beneficiaries have the option to receive services from providers outside of the ACO at any time, and ACOs are forbidden from restricting which providers a beneficiary may seek care from. The foundation of the ACO model is to enhance care coordination across the continuum, therefore referring within the BHN network is the preferred model as the BHN network includes a provider network that has been built on integration and care coordination processes to optimize the patient experiences as they move through the continuum to facilitate continuity of care and ensure appropriate access into programs such as disease and case management. The Medicare Fee-For-Service benefits remain the same and there are no prior authorization requirements to receive services.

How will patients be a�ected by the Pioneer ACO Model? Pioneer ACOs are designed to provide CMS beneficiaries with higher quality, more seamless healthcare, by Pioneer ACO Model facilitating coordination between healthcare providers, resulting in better care for patients aligned with ACO.

How can providers participate with Banner Health Network?Providers must be a part of one of the networks that compose Banner Health Network – AIP, BPHO or BMG, in which a subset of providers was submitted to CMS for participation. BHN is anticipating significantly expanding the provider network for 2013.

Pioneer ACO HighlightsFAQs to help you understand more about Banner Health Network’s Pioneer ACO

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What’s on theMedicare Pay Menu?The American Medical Association recommends that Medicare test several physician payment mod-els over five years that could form part of a replace-mentoftheMedicarefee-for-servicesystem:

Partialcapitation:AnAccountableCareOrganiza-tion (ACO) receives a per-patient monthly payment to cover all the costs of care for a group of patients.

Virtual partial capitation:AnACO receives aper-patient budget for a group of patients instead of an up front fee. Physician payments are adjusted to keep total pay within the budget.

Condition-specific capitation: A group of physi-cians receives a fixed amount to care for a specific patient condition, such as congestive heart failure.

Accountablemedicalhome:Agroupofphysiciansreceives up-front resources to restructure the way they deliver primary care. In return, the practice or group, commits to reducing hospital admission rates in patients.

Inpatientcarewarranties:Physiciansandhospitalsset Medicare payment rates and give warranties for inpatient treatment, agreeing not to charge more for infections or complications.

Mentoringprograms:Medicareoffersfinancialandtechnical support to small physician practices work-ing with regional health improvement collaborative.

Private contracting: Patients and physicians free-ly contract for services, allowing them to agree rates for services without having to forgo Medicare payment.

Source: American Medical Association

Arizona RegionalExtension CenterAIP is working collaboratively with the Arizona Regional Extension Center (REC) to ensure that AIP physicians have access to the latest informa-tion on Electronic Health Records and Meaningful Use. For a limited time, the REC is offering FREE memberships to all AIP physicians who join the Arizona Regional Extension Center.

The REC has been awarded federal funding to assist primary care providers to adopt and become Meaningful Users of EHRs and receive federal incentives, up to $44,000 for under Medicare and $63,750 under Medicaid, for each eligible provider. In order to qualify, providers must use certified EHR software according to “Meaningful Use” guidelines published by the Centers for Medicare and Medic-aid Services (CMS). The following providers qualify forthefree‘PrimaryCareProvider’membership:

Physicians, physician assistants or nurse practitio-ners with prescriptive privileges, practicing in family medicine, general/internal medicine, OB/GYN orpediatricsinanyofthefollowingsettings:

• Individual and small group practices (ten or few professionals with prescriptive privileges) primarily focused on primary care

• PublicandCriticalAccessHospitals• Community Health Centers and Rural Health

Clinics• Other settings that predominantly serve unin-

sured, underinsured and medically underserved populations

While the REC currently does not offer “hands-on” technical assistance to specialists, it does offer free educational services to specialists, including access to a new online website portal with the latest infor-mation on meaningful use.

To learn more about how the Arizona Regional Extension Center can serve you, please call 602-688-7200, email ehr@azhec.org or visit www.azhec.org.

Youmay also contact Kelly Lynn, SeniorHealthIT Consultant at Arizona Integrated Physicians, at (623) 215-9437 or email klynn@arizonaphysicians.com.

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Source: American Medical Association

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The Tax Relief and Healthcare Act of 2006 requires a permanent and nationwide Recovery Audit Con-tractors (RAC) program no later than 2010 to detect and correct past improper payments so CMS can implement actions that will prevent future improper payments to physicians billing Medicare. Under the RAC program, any entity or individual that bills Medi-care is fair game for an audit. The RACs will examine Medicare Part A and Part B claims to identify both underpayments and overpayments. CMS guidelines permit RACs to review physicians’ evaluation and management (E&M)codinganddocumentationforup to three years past the date of the initial payment.

To conduct the audit, RACs will request patients’ medical records from physicians. RACs link the num-ber of records they request from a practice to its national provider identifier (NPI) number. So if you are in a practice with two to five physicians, RACs can examine 20 records per billing NPI, per 45-day period. RACs limit record requests from solo practi-tioners to 10 records per 45-day period.

TheRACsarehereandE/Mcodingisdefinitelyontheauditradar.ApplyingproperE/Museisanabso-lute must for those practices that want to both assess and mitigate their risk for an outside audit or review.

Protect Your PracticeCorrect coding by physicians is critical to getting paid for what you do and for avoiding external audits by Medicare and other payers. An Internal Billing Au-dit can help insure appropriate payment and compli-

ance with applicable laws and car-rier regulations. An internal audit gives the physician and medical practice staff the opportunity to identify incorrect coding and bill-ing patterns, and over utilization of procedures and services.

In addition, the Of-fice of Inspectors General (OIG) devel-oped and published

guidelines for individual and small group practices to implement a compliance program. The creation of compliance program is an initiative of the OIG to engage the private health care community in pre-venting the submission of erroneous claims and in combating fraudulent conduct. The development of a compliance program is based on the belief that a health care provider can use internal controls to more efficiently monitor adherence to applicable statutes, regulations and program requirements. To ensure that documentation satisfies the level and scope of services provided, health care providers should be aware of government and third-party insurance carrier billing requirements.

Many insurance carriers recoup millions of dollars in refunds from providers unable to justify the care provided. The practice of medicine has undergone a trans-formation with the advent of federal coding and reimbursement regulations. To ensure that docu-mentation satisfies the level and scope of services provided, health care providers should be aware of government and third-party insurance carrier billing requirements. Staff and physician training & education can pro-vide an in depth understanding of the coding and documentation procedure and establish criteria for appropriate charge capture. Accurate coding and documentation, as well as a documented compli-ance program within the practice, can reduce your liability exposure and your risk for third- party audits.

Audits and Coding Quality ReviewsAIP is excited to announce the launch of the AIP PracticeManagement&ComplianceWebCenter,aweb-based platform providing AIP practices with 24/7 access to tools, resources and educational material necessary to effectively address today’s healthcare administration and regulatory challenges.

A R E YO U P R EPA R EDfor a RAC Audit of your E/M Services?

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AIP strongly encourages the office staff to stay informed about new initiatives offered through AIP, health plan updates, and the latest information on healthcare trends. AIP Provider Relations invites you to join us for lunch at our next Physician Staff Education Sessions. The same information is presented on several dates and locations for your convenience.

1st Quarter Physician Staff Education Sessions 2012 11:45am – 1:30pm

February 14, 2012 – Banner Estrella Medical CenterFebruary 16, 2012 – MediSun Sales Office – Thunderbird LocationFebruary 21, 2012 – Banner Del E. Webb Medical Center February 28, 2012 – Banner Boswell Medical Center

AccesstotheAIPPracticeManagement&Compli-ance WebCenter is FREE to all AIP contracted physicians.

Coding CornerThe Coding Corner allows you to submit your ICD-9, CPT, and/or HCPCS coding questions, and by uti-lizing the information from your practice’s medical record, we will provide the most accurate coding advice for ethical and optimal reimbursement.

• Noteauditsbycertifiedcodingexperts• Codingquestionsansweredbycertified coding experts• Ensureoptimalcodingformaximum reimbursement • Ensure compliance with OIG fraud and abuse

laws under the patient Protection and Affordable Care Act of 2010.

After conducting a note audit, your practice will re-ceive a case-by- case analysis and report on the find-ings designed to provide physicians with the infor-mation they need to use on a daily basis to optimize reimbursement, reduce fraud-and-abuse risks, and properly document patient care.

Resource Center – Organized web-based database of solutions to assist your office manager and staff

in areas such as practice management, regulatory compliance and risk management, as well as, instant access to documents, checklists and webinars on a variety of topics.

• ComplianceProgramToolkit –This is a stepbystep guide on how to develop and implement a compliance program in your practice that will meet the obligatory requirements of the OIG.

• DownloadPracticeManagementforms• EmployeeOrientationformsandtrainingtoolsIn

today’s healthcare business climate, the pressure for physicians to reduce costs, ensure compliance and maximize operational efficiencies has never been greater. We encourage you to schedule a training overview (maximum of 15 individuals per training session) of the AIP Practice Management &ComplianceWebCenter.Thetrainingoverviewwill take approximately 30 to 45 minutes to com-plete and may be conducted via the Internet or onsite. Follow-up training sessions will be avail-able upon request.

To schedule your training overview and obtain your login credentials, please contact Kris Gates with Health Endeavors at 480.585.9657 or email gates@healthendeavors.com.

Physician Staff Education Sessions to join us for lunch at our next Physician Staff Education Sessions. The same information is presented on

1st Quarter Physician Staff Education Sessions 2012 11:45am – 1:30pm

Thunderbird LocationMedical Center

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Medicare Advantage HMO ExcelCare

PRIMARY CAREPHYSICIAN

ASSIGNMENT

All assigned MA HMO members affiliated with primary care physicians (PCPs) that join or elect to join AIP-BHN become participating under AIP-BHN

All assigned members (including dependents) must select an ExcelCare PCP through their employer during open enrollment

ROUTINE AND ELECTIVE SERVICES

MA HMO members assigned to AIP-BHN will have their care directed through their assigned AIP-BHN PCPs utilizing AIP-BHN participating provid-ers, which may also include existing Health Net participating providers

Members assigned to ExcelCare have their care directed through their assigned PCPs to ExcelCare participat-ing providers, which may include existing Health Net participating providers

REFERRALS, PRIOR AUTHORIZATION AND

NETWORK PARTICIPATION VERIFICATION

Contact AIP-BHN at (480) 684-7070. As a designated tailored network for MA HMO members, AIP-BHN is responsible for prior authorization and notification requirements that may differ from Health Net’s existing prior authorization and notification requirements

Contact Health Net’s Customer Contact Center at (800) 289-2818. ExcelCare providers are subject to Health Net’s existing prior authoriza-tion (including high-tech radiology and nuclear cardiac imaging) and notification requirements

DELEGATED FUNCTIONS

AIP-BHN is responsible for credential-ing, utilization management (including inpatient review and prior authoriza-tion) and claims adjudication for services rendered by AIP-BHN partici-pating providers

There are no administrative functions assigned to AIP-BHN for ExcelCare. Participating providers follow the current Health Net prior authoriza-tion, notification, claims, and appeal processes and requirements as they would for non-ExcelCare commercial HMO members

Health Net Partners with AIP-Banner Health Network

Effective January 1, 2012, the Banner PHO (BPHO) network for Medicare Advantage (MA) HMO is part of the Banner Health Network (BHN). BHN will include all BPHO, Arizona Integrated Physicians (AIP) and Banner Health-employed physicians (Banner Medical Group). Providers holding direct contracts with BPHO and AIP will be reimbursed under the terms of those agreements for MA HMO members assigned through BHN.

Additionally, effective January 1, 2012, Health Net is offering the ExcelCare product, a new tailored- network commercial HMO product developed with BHN, which is serving as the exclusive provider network for ExcelCare.

BHN is comprised of physicians, hospitals and other providers to offer health care services to Health Net’s ExcelCare commercial HMO and MA HMO members in all of Maricopa County and portions of Pinal County (limited to members residing in ZIP codes 85140, 85142 and 85143).

Formoreinformation,pleasecontact:AIPProviderRelationsat(623)215-9430.

AIP participating providers who care for MA HMO or ExcelCare members should refer to the table below for appropriate responsibilities.

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Medicare Advantage HMO ExcelCare (commercial HMO)

NETWORK PARTICIPATION

INQUIRY

AIP West Valley providers (westofI-17):(623) 215-9430

AIP West Valley providers (westofI-17):(623) 215-9430

PAPER CLAIMS SUBMISSION

Health Net of Arizona-BHNP.O. Box 16423Mesa, AZ 85211-6423

ACS/HealthNetofArizonaP.O. Box 14225Lexington,KY40512-4225

CLAIMS APPEALS Health Net of Arizona-BHNP.O. Box 16423Mesa, AZ 85211-6423

Health Net of Arizona, Inc.Attention:ProviderAppealsP.O. Box 872Shelton, CT 06484

PRIOR AUTHORIZATIONREQUESTS AND NOTIFICATIONS

AIP-BHN:(480)684-7070 (800) 977-7518 or(800) 978-3424

ELIGIBILITY AND MEMBERBENEFIT VERIFICATION

HealthNet:(800)289-2818orwww.healthnet.com

HealthNet:(800)289-2818orwww.healthnet.com

CLAIMS AIP-BHN:(480)684-7070 HealthNet:(800)289-2818orwww.healthnet.com

Contact InformationAIP-BHN participating providers should use the appropriate contact information below as it applies to the member’s network affiliation.

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February 1, 2012 7:00-8:00 AM (breakfast served)

April 4, 2012 12:00-1:00 PM (lunch served)

June 6, 2012 7:00-8:00 AM (breakfast served)

August 1, 2012 12:00-1:00 PM (lunch served)

October 3, 2012 7:00-8:00 AM (breakfast served)

December 5, 2012 12:00-1:00 PM (lunch served)

All Office Manager Meetings Will Be Held at Banner Boswell Support Services Bldg. - Chapman Board Room

We look forward to seeing you there!

Mark Your Calendars!– Attention Office Managers –

AIP welcomes all Office Managers and Practice Administrators to join us for our bi-monthly Office Managers Meetings. These meetings are a great opportunity to network, share information, be informed and get involved with AIP. The range of topics may include healthcare and health plan updates or changes, AIP Practice Solution information; information about AIP initiatives and open discussion. AIP encourages you to share your feedback with AIP related to healthcare and how we can help your practice.