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The Department of Health and Human Services (HHS) The Department of Health and Human Services (HHS) Releases Final Rule on “Meaningful Use” - July 13, 2010.

As part of the Health Information Technology for Economic and Clinical Health Act (HITECH), healthcare providers may be eligible to receive incentive payments for implementing a certified electronic medical record (EMR) system and becoming “meaningful users” of that EMR.

“HITECH’s goal is not adoption alone but “meaningful use” of EHRs — that is, their use by providers to achieve significant improvements in care. The legislation ties payments specifically to the achievement of advances in health care processes and outcomes,” National Health Information Technology Coordinator David Blumenthal and Marilyn Tavenner, principal deputy administrator of the Centers for Medicare and Medicaid Services, wrote in an article summarizing the new rule on July 13, 2010, in The New England Journal of Medicine.

Healthcare providers qualifying for incentive payments can receive up to $44,000 for each eligible provider under Medicare and $63,750 for each eligible provider under Medicaid. Those who do not adopt an EHR by

2015 will incur financial penalties. In order to qualify, 2015 will incur financial penalties. In order to qualify, providers must use certified EHR software according to “meaningful use” guidelines published by the Centers for Medicare and Medicaid Services (CMS).

The Stage 1 requirements necessary for healthcare providers to achieve “meaningful use” in years 2011 – 2012 is comprised of two sets of objects. A ‘Core Set’ of fifteen objectives that must be met and an additional ‘Menu Set’ of ten objectives, of which five must be implemented. The remaining objectives will be deferred to Stage 2.

For more information please visit the New England Journal of Medicine’s website, http://healthcarereform.nejm.org, or the U.S. Department of Health and Human Services Health Information Technology website at healthit.hhs.gov.

Please visit the Arizona Integrated Physicians web page for information regarding AIP’s Technology Solutions at http://www.azphysicians.org.

You may also contact Brent Turner, Vice President of Operations and Practice Services at Arizona Integrated Physicians, at (623) 215-9442 or email bturner@azphysicians.org.

Preparing for Meaningful Use

www.azphysicians.org | 623.215.9500 | 16155 N. 83rd Avenue, Suite 201 | Peoria, Arizona 85382

Progress NotesNEwS YOU CAN USE

Arizona Integrated Physicians (AIP) successfully concluded negotiations for a preferred pricing agreement with eClinicalworks on May 17, 2010, that includes significant discounts on behalf of physicians in the AIP network. Additionally, AIP is fully committed to ensuring the successful adoption of electronic medical records systems by AIP physicians and will work directly with each practice and their assigned project manager and implementation team during all stages of the implementation process.

Kelly Lynn, AIP’s Senior EMR Consultant, is responsible for implementation, configuration, training, and re-engineering of practice operations to support the successful adoption of electronic practice management and electronic medical records systems. AIP will also provide on-going support and maintain communication with installed practices to ensure operational effectiveness with the software and overall satisfaction.

AIP’s electronic Medical records (eMr) solution

we encourage you to take advantage of Kelly’s extensive experience and knowledge with electronic health records. She is prepared to provide her expertise to ensure the successful implementation and continued use of electronic health records in your practice. You can contact Kelly Lynn, Senior EHR Account Manager, at (623) 215-9437 or at klynn@azphysicians.org.

For more information regarding the eClinicalworks preferred pricing agreement for AIP physicians, please contact Brent Turner, Vice President of Operations and Practice Services, at: Phone: (623) 215-9442, or Email: bturner@azphysicians.org.

we encourage you to take advantage of Kelly’s extensive

AIP will work with each AIP practice to:

• Discuss the needs of each practice and their timeline

• Assist in scheduling a demonstration

• Assist in obtaining IT services

• Assist in obtaining financing

• Assist during implementation and training

• Assist with clinical and administrative workflow design

• Provide ongoing support following implementation

Arizona Integrated Physicians (AIP) is uniquely positioned to create tremendous value by harnessing the commercial real estate needs of its physicians. AIP is in the process of establishing a partnership with a commercial real estate organization that can effectively analyze AIP’s geographic coverage of health services in the Phoenix market, evaluate our partners and associates facility needs and identify opportunities for AIP physicians to participate in real estate ownership of medical facilities.

The goal is to develop a fully integrated solution for providing real estate services to AIP physicians with a strategic partner that has the expertise, experience and infrastructure to provide the following comprehensive commercial real estate services:

• Strategic real estate consulting • Tenant advisory services • Development, acquisitions and joint ventures • Project and construction management • Executive suites • Maintenance services

AIP is launching this real estate strategic initiative to ensure that that AIP continues to build upon its already strong foundation as a clinically integrated physician network that further enhances the viability and sustainability of independent physicians.

For more information, please contact Brent Turner, Vice President of Operations and Practice Services, at: Phone: (623) 215-9442, or Email: bturner@azphysicians.org.

Introducing AIP real estate solutions

These are exciting times at AIP! Our new logo is just one of the many changes we are implementing. The design reflects our future oriented vision along with a new tagline “Integrating Care. Improving Health.”. The new logo puts concentration on the letters “AIP” and acknowledges the industry’s common referral to us as “AIP” (Arizona Integrated Physicians, Inc. will remain our legal name). we look forward to your continued support as we work to further improve our service in support of the independent physicians we serve.

AIP Has a New Logo

Patient Centered Medical Home (PCMH)Recently, much has been written about PCMH or Patient Centered Primary Care Practice. The original principles of the Medical Home were crafted by the four major primary care medical provider associations: the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association.

The key essential characteristics of a truly patient-centered health care home include:1. Greatly enhanced patient access to their health care team; 2. A personal relationship between patients, families, and caregivers and their assigned and accountable health care team members; 3. Shared decision-making that actively engages the patient and respects his/her personal health goals cultural needs; 4. Direct and ongoing health care team oversight and coordination of all patient care and social needs; 5. Ensuring smooth and timely health care transitions and follow-up; and 6. Actively striving to provide the highest quality care possible, eliminating health care disparities, and driving down care costs by minimizing duplication, reducing medical errors, reducing unnecessary utilization, and

guiding patients to clinically appropriate high value health care.

AIP is participating in the Patient-Centered Primary Care Collaborative (PCPCC), which is a collation of large employers, primary care societies, national health plans, patients’ groups, and others. The PCPCC is dedicated to the advancement of the principles of the Medical Home as stated above, and provides a wealth of practical information on how to implement a Medical Home. Best practices from organizations who have already implemented Medical Home are being carefully evaluated by AIP.

In addition, AIP is currently interviewing vendors, who would provide direct support to primary care practices to undergo the necessary process transformation to qualify as a Medical Home.

The advantages to the practice for being recognized as a Medical Home include:1. The steps to become a Medical Home also qualify a practice to meet CMS’s rules for the meaningful use of electronic health records (EHR). Therefore, the practice would be eligible for up to the full payment of $44,000 for attaining meaningful use with an EHR.2. Opportunity for increased revenue through participation in the CMS Accountable Care Organization (ACO) payment model which begins in 2012, as well as other ACO opportunities through commercial and Medicaid payers. 3. Improved patient, physician and office staff satisfaction due to process improvements.

CMo Updates

Accountable Care organization (ACo)An accountable care organization (ACO) has been defined as a contracting group accountable for the quality and cost of care provided to a defined population. They may be led by a hospital or a physician organization. An ACO must include primary care doctors, must manage care across the continuum of care settings, and must measure and provide data on the quality of care.

Reimbursement may take one of two basic forms. In risk-taking ACO arrangements, organizations take financial responsibility for all inpatient and outpatient care and can profit by meeting quality goals and by keeping the cost of care under budget. Under the shared-savings model that Medicare will use, physicians get paid fee for service and can split savings with Medicare if they reach benchmarks on quality measures.

Because this applies to all fee-for-service Medicare patients, many hospitals, healthcare systems, and physician groups view it as a significant revenue opportunity. The cost reductions, however, will have an impact, particularly on the hospitals, through reduced inpatient admissions. Significant infrastructure will be necessary to measure quality and to accept and distribute the shared savings. AIP has 15 years of experience in these areas, and is preparing to add any necessary elements to support the functions of an ACO.

An accountable care organization (ACO) has been defined as a contracting group accountable for the quality and cost of care provided to a defined population. They may be led by a hospital or a physician organization. An ACO must include primary care doctors, must manage care across the continuum of care settings, and must

Reimbursement may take one of two basic forms. In risk-taking ACO arrangements, organizations take financial responsibility for all inpatient and outpatient care and can profit by meeting quality goals and by keeping the cost of care under budget. Under the shared-savings model that Medicare will use, physicians get paid fee for service and can split savings with Medicare if they reach

Because this applies to all fee-for-service Medicare patients, many hospitals, healthcare systems, and physician groups view it as a significant revenue opportunity. The cost reductions, however, will have an impact, particularly on the hospitals, through reduced inpatient admissions. Significant infrastructure will be necessary to measure quality and to accept and distribute the shared savings. AIP has 15 years of experience in these areas, and is preparing to add any necessary

Center for Medicare and Medicaid services (CMs) stars for Medicare Managed Care PlansCMS rates plans on a system commonly referred to as the “Stars Ratings”. Beginning in 2012 health to as the “Stars Ratings”. Beginning in 2012 health to as the “Stars Ratings”. Beginning in 2012 health plans are eligible for additional payments by achieving either 4 or 5 star rating. Currently Banner MediSun is one of only two Medicare Advantage Health Plans in the greater Phoenix market that has achieved 4 or more stars. This additional payment will grow to 5% per year. Since payments by CMS to health plans will be below historical payments, the additional payments through the Star system are critical to plans to keep up with the rising costs of care. The current sources of data used to determine the Star rating include: CMS administrative data, HEDIS scores, CAHPS (patient satisfaction), and Health Outcomes Survey (HOS). There are 33 measures, across 5 domains.

Measures include the following:a) Staying Healthy: Screening, Tests and Vaccines- examples include percent of plan members who got a flu shot and pneumococcal vaccine, annual monitoring for patients on persistent medications such as ACE/ARB, digoxin, Phenobarbital, chronic corticosteroids, and warfarin, among others. b) Managing Chronic (Long Term) Conditions- such as whether women with bone fractures are tested for osteoporosis, whether diabetics are getting recommended care- including HbA1c, LCL cholesterol, and that the results obtained are achieving outcomes consistent with national standards.

A complete list of the measures will be placed on the provider portal of the AIP web site- www.azphysicians.org.

Medicare Physician Fee Schedule is increased by 2.2%On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent increase to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010.On July 8, 2010, Banner MediSun updated the claims payment system to adjudicate claims with dates of service beginning June 1, 2010 to pay at the increased reimbursement rate.Claims adjudicated prior to July 8, 2010 with dates of service from June 1, 2010 through July 7, 2010 will be adjusted by Banner MediSun. Your office will not need to resubmit claims to receive the updated payment.

• Currently Banner MediSun is processing 97.93% of claims within 14 days of receipt.

• The MediSun claims payment system was updated on July 8th to process claims with a date of service 6/1/10 to present with the 2.2% CMS increase. All claims for these dates of service adjudicated prior to July 8th will automatically be adjusted by MediSun.

• To avoid timely filing denials, claims must be received by Banner MediSun within 100 calendar days from the date of service, including weekends and holidays.

• Requests for reconsiderations may be submitted to Banner MediSun within 100 calendar days, including weekends and holidays, of the remit date. Requests are logged into the system within 48 hours of receipt and may be viewed through the Provider Portal at www.bannermedisun.com.

• Remember to include the physician’s 12 digit Practitioner ID #, assigned by AIP, in box 33 of the CMS 1500 claim form.

• AIP requires all physicians to submit claims for services rendered to Banner MediSun patients regardless of the payment methodology. Additionally, the billed charges must be greater than zero; “0” billed charges will be returned to the provider for correction.

• Box 32 on the CMS 1500 form must be filled in with the physical address of the site of service. Claims received with a P.O. Box or the word “same” in box 32 will be denied.

• MediSun’s EDI Payor ID is 77078. For a list of clearinghouses contracted with MediSun, please contact AIP Provider Relations at (623) 215-9430.

Claims Corner

Fee sCHeDULe

UPDAte

Effective August 1, 2010 the new DME vendor for Banner MediSun is Banner Home Care (BHC). walgreens Home Care is no longer the DME service provider for Banner MediSun Members.

As of July 19th, all NEw DME orders are to be faxed to BHC for processing. This includes referrals, scripts and documentation.

Orders for prosthesis and orthotics should be faxed to BHC for processing. BHC will forward prosthesis and orthotics requests to the appropriate contracted Banner MediSun provider for fulfillment.Banner Home CareTelephone: (480) 497-5535 (ask for Central Intake)Fax: (480) 633-8519

As a result of this transition, patients with standing orders for existing supplies such as colostomy, urostomy, and urinary catheters will need a new prescription.

A new prescription for continued oxygen will be required at the time of recertification. Banner Home Care will contact your office to request a new prescription.

Please contact AIP Provider Relations at (623) 215-9430 should you have questions or require additional information.

Effective August 1, 2010 the new DME

New DMe Vendor for Banner Medisun

The U.S. Food and Drug Administration has approved a vaccine for the 2010-2011 flu season. The latest flu vaccine will help prevent three strains of influenza, including the H1N1 virus, or swine flu. The FDA’s approval means that only one vaccine will be required for all strains of influenza.

Banner MediSun has contracted with the Mollen Flu Shot Clinics to provide flu shots to their members. If members obtain their flu shot at a Mollen Clinic, there is no out of pocket cost. Keep in mind, the Mollen Clinic is not contracted to provide the pneumonia vaccine to MediSun members.

If a PCP elects to provide the flu shot in the office setting, the member is not responsible for a co-pay. Office visit co-pays apply only if the shot is administered during a scheduled office visit. AIP will reimburse PCPs for CPT codes 90471, 90656 or 90658.

For the times and locations of the Mollen Flu Shot Clinics, call 480-563-0072 or visit www.mollenflushots.com.

AIP has a long and committed partnership with Banner MediSun as AIP’s Medicare Advantage payor partner. with all of the pessimistic information in the news about health care reform and the potential impact on Medicare and Medicare Advantage plans it is critically important that we reassure the members of MediSun that depend on AIP for their care that MediSun is committed to continuing to meet their needs and providing a competitive benefit offering while ensuring world class service. The following are several informational points that you may want to be aware of and share with your MediSun patients should they ask questions or inquire accordingly:

2010 Flu shot Clinic Information

Banner Medisun News and Information

• Banner MediSun members are among the most loyal in the country in terms of staying with their Medicare Advantage plan. MediSun retention remains at a remarkable 98%. • CMS continues to recognize Banner MediSun and AIP for its commitment to quality by awarding MediSun a 4.5 star rating (out of 5) in the most recent updated results on the Medicare Compare web site. This is among the best in Arizona. • Banner MediSun remains committed to growing the West Valley membership and is investing significant resources to ensure a strong position in the legacy service area while expanding into other parts of the Valley.• Banner MediSun is featuring the tagline “This is where you belong”. This message reinforces the value proposition associated with MediSun through its use of innovative and affordable plans, outstanding personal service, a strong and committed partnership with our network of independent physicians through AIP, and the commitment and strength that Banner Health brings to the Phoenix market. • The traditional CMS enrollment process is changing for the 2011 Plan year. Although the annual enrollment period (AEP) will continue between November 15th and December 31st 2010, open enrollment (OEP) has been virtually eliminated. This circumstance will result in a concentrated marketing and promotional strategy by all Medicare Advantage Plans to prospective seniors from October 1st through the end of 2010.

Over the course of the last 6 months, AIP has developed and launched the AIP website with the sole purpose to provide valuable information and tools to our physicians and their staff. whether it is the implementation of the Secure Document Delivery (SDD) system to replace many of our current ‘Paper’ processes or the routine ‘updates’ from our Provider Relations department, we want ensure that we are delivering the tools and information that best assists you in managing your practice.we are constantly evaluating our website in an effort to ensure the content available best suits the needs of those using the site. with that in mind, we want to hear from you! The continued feedback of our physician community will transform our website from good to GREAT!Please send your comments to: feedback@azphysicians.org

A MediSun member’s ID card does not guarantee eligibility. Contracted providers may not bill a MediSun member for services denied due to eligibility. Eligibility should be verified prior to rendering care by calling MediSun Member Services at (623) 974-7430 M-F from 8am-5pm, through the website at www.bannermedisun.com, 24 hrs a day, 7 days a week or by faxing the Eligibility Transmittal Sheet document to (623) 974-7439.

A contracted physician is contractually obligated to provide a 90 day written notice to AIP if he/she is wishing to terminate the contract or if the physician is leaving the practice. Please mail notifications to AIP Provider Relations, 16155 N. 83rd Ave., Ste. 201, Peoria, 85382.

AIP Provider Relations is available to provide in-services to contracted physicians and their staff. Topics include but are not limited to, a review of AIP Initiatives, referral/prior authorization guidelines and claims submission. To schedule an in-service please contact Nicki Rice, AIP Provider Relations Specialist, at (623) 215-9430 or nrice@azphysicians.org.

AIP WebsiteYoUr source for everything AIP

Pointers from Provider relations

4th Quarter PCP PoD MeetingNovember 10, 20105:30pm – 7:00pm - Arrowhead Country Club Ballroom

4th Quarter staff education sessions 12/1/10 Banner Thunderbird Medical Center - Conference Room 112/6/10 Banner Estrella Medical Center - Conference Room 212/15/10 Banner Del E. webb Medical Center - Auditorium A & B12/16/10 Banner Boswell Medical Center - Memorial Hall East/West

**PCPs receive $100 for POD Meeting attendance****Attendance will be reflected in PCP ABC scorecards that are used for risk share distribution and future compensation methodology.**

**PCP staff attendance will be reflected in PCP ABC scorecards that are used for risk share distribution and future compensation methodology.**

Mark Your Calendars…

www.azphysicians.org | 623.215.9500 | 16155 N. 83rd Avenue, Suite 201 | Peoria, Arizona 85382