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DCH and GaHIN Launch GeorgiaDirect to Automate Healthcare Referrals

GeorgiaDirectThis week,  the Health Information Technology Division (Health IT) of the Georgia Department of Community Health and the Georgia Health Information Network Inc. (GaHIN) launched GeorgiDirect, a free, secure e-mail, and easy-to use messaging service to automate health care referrals between patients, physicians, hospitals, laboratories and other authorized healthcare stakeholders.

The goal of GeorgiaDirect is to “better serve patients and increase efficiencies in health care across Georgia,” said former DCH Commission David A. Cook. Cook also stated, “This network – which should not be confused with a health insurance exchange – will literally transform health care in the years to come, delivering on our goal of a healthy Georgia through greater coordination of care, delivering better health outcomes, increasing administrative efficiencies and more. Additionally, privacy of health information is paramount to the department, and GeorgiaDirect is much more secure for the transmission of information than current methods.”

The more than 2,100 healthcare providers across Georgia who have registered for the free service are able transmit patient health information between authorized providers for a more efficient and secure exchange of patient data versus the current system of faxes, mail, couriers and telephones.

According to a press release by DCH, “GeorgiaDirect was developed using national standards from the Office of the National Coordinator for Health Information Technology’s Direct Project.” GeorgiaDirect also enables healthcare providers to connect with other states, including Alabama, Florida, Hawaii, Mississippi and Wisconsin. The goal is for GeorgiaDirect to expand and include more states so providers can obtain medical records when patients move to another part the country.

To learn more about GeorgiaDirect, you can watch this video or visit the GeorgiaDirect Web site.

 

 

Georgia Medicaid Providers Can Now Access HP Online Portal

Georgia Health PortalAccording to a press release issued by the Georgia Chapter of the American Academy of Pediatrics, currently enrolled and future Georgia Medicaid providers can now access the HP online portal to submit their attestation to become eligible for the Affordable Care Act (ACA) Rate Increase. The initial enrollment period will last until July 31, 2013. When accessing the site, click on “Provider Information”, then select “Forms”, and then select the “Enrollment” link.

For more information, click here

Healthcare Providers Unprepared for New ICD-10 Codes

ICD-10 CodesAccording to the latest edition of Georgia’s Department of Community Health’s newsletter, most healthcare providers are not ready for the conversion for the ICD-10 Code set.

ICD-10 survey* says most providers are ill-prepared!

  • 62% of Georgia physicians have not begun to prepare for the conversion to ICD-10 Code Sets.
  • 83% said that they have either been too busy with other priorities to embrace and implement ICD-10 or are unaware of where to start and what they need to do.
  • 11% know ICD-10 is coming but don’t think it will be difficult to handle.

*Physician Survey of ICD-10 Awareness and Readiness, Medical Association of Georgia and the Department of Community Health (2/2013)

DCH is offering a free Webinar on March 26, 2013, to help providers prepare. Visit http://dch.georgia.gov/icd-10 for more information

Georgia Senate Approves Hospital Medicaid Financing Program Act

On January 17th, the Georgia Senate passed Senate Bill 24, also known as the Hospital Medicaid Financing Program Act.  The bill passed with a 46-9 vote, and authorizes the Department of Community Health to establish a financial structure to protect Georgia’s healthcare system and obtain additional federal funding for the state’s Medicaid program.

The bill was sponsored by Sen. Charlie Bethel (R – Dalton) who is quoted as saying “A failure to pass SB 24 would mean devastating cuts in reimbursement rates for medical providers. Hospitals could face up to a 32% percent reduction in Medicaid reimbursements, which could also mean a loss of services and jobs. The impact of hospital closures and layoffs as a result of reduced reimbursements on rural communities and local job markets would be devastating.”

Notably, the state’s hospital industry has been supportive. It has been reported that the proposed Act will raise $689 million in state and federal funds to help provide health care to about 100,000 additional low-income and disabled Georgians expected to join the Medicaid rolls as a result of federal health-care reform.

During his State of the State address, Governor Deal warned lawmakers that without the additional revenue, the state would be forced to slash Medicaid reimbursements to hospitals by 20 percent.

Introduced into the Senate on behalf of the governor, the legislation would turn over responsibility for assessing the 1.45-percent tax on adjusted gross patient revenues to the Georgia Department of Community Health (DCH).

The Georgia House of Representatives is expected to take up the bill when lawmakers return to the Capitol Jan. 28 following a week-long recess.

UPDATE 2/2/13: Georgia House of Representatives passed Bill 24, and Governor Deal is expected to sign the bill ensuring $450 million in federal money for the Medicaid insurance program.

Read more: http://www.sfgate.com/news/article/Ga-House-adopts-Medicaid-financing-fix-4242885.php#ixzz2JkwBESwB

DCH Proposes New Payment System Based on APCs

News Alert: Department of Community Health Proposes Replacing Current Outpatient Reimbursement System with Prospective Payment System based on APCs

Click here to read DCH’s Public Notice

Georgia Department of Community Health Conservative with Medicaid Changes

The Georgia Department of Community Health has decided not to move forward with an overhaul of Georgia’s Medicaid program.  There are two main reasons for the change:  (1) the Supreme Court’s decision to uphold the Affordable Care Act and (2) the upcoming election.  The Supreme Court left the decision of whether to expand Medicaid up to the individual states, and Georgia’s governor has not made a definite decision about whether or not the state will move forward with expansion of Medicaid under the Affordable Care Act.  In addition, some political leaders are voicing their intent to repeal the Affordable Care Act.  According to the DCH news release, “[T]he department concluded that the current health care environment is so volatile that acting now with a full redesign would not serve the best interests of all Georgians.”

DCH’s decision to implement only small changes based on information it received from the redesign process seems prudent in light of the current state of federal healthcare reform.  Implementing a complete overhaul of the entire Medicaid system in Georgia without definitive knowledge of whether Georgia will expand Medicaid under the Affordable Care Act or whether the Affordable Care Act will be overturned could create substantial problems for the state on many levels.  One impact is financial – the Medicaid budget is already facing a deficit, and DCH would be in an unfavorable position if it prematurely overhauled Medicaid at unnecessary expense to the State.

One final important point to note about the announcement is that DCH said that a Medicaid overhaul will not occur “at this time”, which means it could still happen after the political turmoil settles down. Any future changes to Georgia’s Medicaid program will be detailed here.

Tips on How to Request Medicaid Hearings in Georgia (Part III of III)

In the final part of our “How to Request Medicaid Hearings in Georgia” series, a final tip in this process is to make sure you’re well versed in your policies AND the Department of Community Health’s (DCH’s) policies.  While you may understand and know your own internal policies extremely well, it may be helpful to hire a healthcare attorney that specializes in and has experience with DCH’s policies and administrative appeals to ensure the best possible outcome of your hearing.

Knowledge of the facts and your and DCH’s policies are critical.

For the hearing:

  • Make sure you know the member
  • Determine what the medical records do and do *not* say
  • Identify if information used by DCH was correct
  • Determine if anything has changed

 

Again, here’s where engaging a healthcare attorney with experience in administrative hearings will be helpful.

Finally,  being proactive will help you minimize the amount of money lost to denied claims and increase your effectiveness in challenging denials issued by the Department.

Jeyaram & Associates has successfully handled more than 200 Medicaid hearings before the Georgia Department of Community Health and is well positioned to help with your administrative hearings. Contact DJ@Jeylaw.com

 

Tips on How to Request Medicaid Hearings in Georgia (Part II of III)

This post is the second in a three part series about how to request Medicaid Hearings in Georgia.Georgia Medicaid Hearing

Planning and preparing is always important, but the one of most important steps is making sure your Request for Hearing is submitted to the Department on time.

Once a hearing has been requested, it becomes even more important to make sure you have a plan in place.

• Providers can represent members at hearings (federal law)

• Get written authorization to represent

• Ask “Why” 10x. . . And then ask 10x more! (Then “how” and “what”)

• Rates can be provider or member appeals

• Meet all deadlines for filing

• Ask for all documents to be used by the other side at the hearting (subpoena)

• Make the state prove each piece of its reduction/denial

Here are some tools that you can leverage during this process:

Subpoenas

  • Can subpoena documents or people
  • Must be reasonable to the case
  • Can get form from OSAH
  • Must be served by certified or registered mail 5 days before hearing
  • See OSAH Rule 19

 

Request a Pre-hearing conference with ALJ

  • Request a Pre-hearing Order
  • Exhibit exchange
  • Witness lists

 

One of the best ways to help you navigate through this process is to engage a lawyer that specializes in healthcare, specifically Medicaid Hearings to help ensure the best possible outcome.

Next week, we’ll post the final tips segment on how to request Medicaid Hearings. www.jeylaw.com 

Tips on How to Request Medicaid Hearings in Georgia (Part I of III)

Jeyaram & AssociatesGeorgia’s Medicaid system has been the subject of numerous television reports and newspaper articles recently.  However, one Medicaid topic that usually does not receive enough attention is the appeals process.  We are devoting the next several blog posts to information about the Medicaid appeals process as it relates to members and providers.  The first in our three part series is how to request an appeals hearing if you’re a healthcare provider in Georgia.

Following are steps on how to request an appeals hearing:

The Department of Community Health (DCH) must receive the request within 30 days from when the administrative decision was received by the member.

Request must be in writing and include the following:

– That you want a hearing

– A copy of the administrative decision issued by the Department

– Evidence as to why the Department’s decision is incorrect

– Declaration of what the Department’s decision should be

If you do not raise an issue in your administrative review, it is considered waived

Filing a request for hearing will not delay the Department from enforcing its decision.