In this edition:
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Save the date ~ Oct. 12-14
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NCMS Releases Summary of New Opioid Prescribing Rules for Workers' Compensation
Source: NC Medical Society
The North Carolina Medical Society (NCMS) is pleased to offer an easy-to-read overview of the new opioid prescribing rules for workers’ compensation. The rules, adopted by the North Carolina Industrial Commission, took effect May 1.
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Included in the provisions are limitations on quantity and dosing, mandatory drug testing, and risk assessments. The rules also encourage prescribers to consider alternative treatment modalities for pain management, and to consider co-prescriptions for naloxone in some circumstances. And, similar to last year’s STOP Act, the rules require providers to review the NC Controlled Substance Reporting System prior to prescribing opioids.
Click here to access the Opioid Prescribing Rules for Workers’ Compensation: An Overview by the North Carolina Medical Society (PDF - 5 pages).
We hope this resource will be helpful to you, and we welcome your feedback.
For more information, the Industrial Commission has also launched a resource page on the rules.
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Tadhg O’Gara Participates in NCMS Leadership College Program
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Congratulations to Dr. Tadhg O'Gara (Winston-Salem) on being selected to participate in the NC Medical Society’s Leadership College Program. Dr. O’Gara is an assistant professor of orthopaedic surgery and neurosurgery at Wake Forest School of Medicine. Dr. O’Gara is among 20+ scholars selected for the Leadership College’s Class of 2018. Selection for Leadership College participation is competitive, with more applicants than there are seats available in the year-long program. Prior participants include NCOA President Dr. Chad Mather (Durham) and NCOA PAC Chair Dr. Will Silver (Durham).
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You, too, can enhance your leadership skills by taking part in an NCMS leadership development program. The Kanof Institute for Physician Leadership is currently accepting applications for two exciting leadership development programs: Leadership College and the Health Care Leadership and Management Program (HCLM).
The NCMS Leadership College builds and enhances physician and PA leadership skills and equips graduates to become more influential and motivating leaders in their medical practice settings and their communities. Members interested in a letter of nomination from the NCOA should contact Denna Suko at dsuko@ncmedsoc.org, or 919-833-3836. Partial sponsorship may be available to NCOA members in good standing. Applications for Leadership College are due July 30, 2018.
The NCMS Health Care Leadership and Management (HCLM) Program provides a critical framework for physicians based on economics, finance and leadership development. With this framework, graduates are provided the necessary vocabulary for the business realm and are equipped to take on greater leadership positions in their career. The curriculum is designed with greater emphasis on deeper leadership development and skills that include strategic planning, negotiation and financial literacy and application. Applications for HCLM are due August 31, 2018.
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NC Health Information Exchange Update
Christie Burris, Executive Director of the NC Health Information Exchange Authority (NC HIEA), has reported that NC HealthConnex, North Carolina’s state-designed Health Information Exchange is now live with more than 1200 active participants, with an additional 300+ in queue for onboarding. By June 1, 2020, the date by which LME/MCOs and PHPs are required to be connected and submitting encounter claims data, the NC HIEA estimates that 98% of NC health care providers will be connected to the NC HealthConnex. It is also projected that NC HealthConnex will offer visibility into 90% of citizens receiving treatment in NC and will also provide access to data from other states through connections to national health care data networks.
The feasibility study is required to examine:
- The availability of connection, exchange and data submission standards established by the Office of the National Coordinator for Information Technology within the US Department of Health and Human Services.
- The adoption of national standards for connection, exchange and data submission standards by provider type.
- Cost estimates by provider type to connect and submit data to the HIE and any availability of federal or State funds to meet connection or submission requirements.
- Data captured in the treatment of patients, segmented by provider type.
- Activity of other states and payor plans with respect to the establishment of an HIE Network.
- Alternatives to the connection and submission of demographic, clinical, encounter and claims data through the HIE Network.
Burris presented this information in an update on the NC HIEA’s progress toward completing its legislative requirements to the Joint Legislative Oversight Committee on Health and Human Services on January 16. The North Carolina General Assembly created the NC HIEA in 2015 to facilitate the creation of a modernized HIE to better serve NC health care providers and their patients. The NC HIEA is governed by an 11-member Advisory Board, appointed by the General Assembly and made up of various IT and health care representatives that include the Secretary of the Department of Health and Human Services, the Secretary of the Department of Information Technology and the Director of the Government Data Analytics Center.
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Protect Yourself and Your Patients In the New Medicaid System
Source: NC Medical Society
The North Carolina Medical Society (NCMS) has steadfastly held that the protections for physicians and patients laid out in state law under Chapter 58 must be carried forward in the new Medicaid managed care system. A bill currently under consideration by the North Carolina House of Representatives, HB 156, however, does not include these essential protections.
This bill would require Medicaid Prepaid Health Plans to obtain a license from the Department of Insurance and lists minimum requirements for the application process. It also contains language on penalties, enforcement, management agreements, fees, fiduciary responsibilities, continuation of services and suspension of licenses. But currently, the bill does not contain any of the Chapter 58 patient and provider protections. The NCOA and the NCMS continue to actively work to ensure that these protections are included moving forward.
Please reach out to your legislator and insist that the Chapter 58 protections, which are crucial to the success of Medicaid managed care, be included in this bill.
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Introducing the NCMS LEAD Health Care Conference
The North Carolina Medical Society (NCMS) is pleased to announce its new and not-to-be-missed annual event – the LEAD Health Care Conference. Mark your calendar now for Oct. 18-19, 2018 to be part of this innovative conference focused on Leadership, Education, Advocacy and Discovery – LEAD. For more details, visit the NCMS website.
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NCTracks 2018 Regional Seminars Schedule
Regional Seminars are back! NCTracks Regional Seminars are a great opportunity for new providers and existing providers with new staff who use NCTracks - or anyone who needs refresher training. This in-person training is provided local to you and allows you to meet our Regional Provider Relations Representatives.
NCTracks will conduct four Regional NCTracks Seminars in the coming months. The purpose of these Regional NCTracks Seminars is to help educate new providers, educate new billing staff of existing providers, and serve as a refresher for current and experienced provider staff. Regional seminars allow for participation by more providers, particularly those who cannot travel to attend single Instructor-Led Training classes. They will also allow providers an opportunity to meet and become familiar with their Regional Provider Relations Representatives. It is a learning opportunity and a chance to network.
Each of the seminars runs from 9:00 a.m. to 4:00 p.m. and are offered on different dates and locations across the state. Providers can register for the seminar most convenient for them:
- Concord, North Carolina (May 25)
Cabarrus County Cooperative, 715 Cabarrus Ave West, Concord NC
- Raleigh, North Carolina (June 14)
CSRA, 2610 Wycliff Rd, Raleigh NC
Seminars will feature the following:
- Provider Communication booth
- Hub for guidance on locating provider resources
- Help Center
- SMEs from Enrollment, Claims, Prior Approval and Provider Relations to help providers who bring in specific examples
Topics include:
- Common reasons Enrollment and Manage Change Request (MCR) applications are delayed and how to avoid delays
- Helpful hints for submitting Prior Approvals
- Top 10 denial reasons for Professional and Institutional claims and the resolutions
- Submitting Pharmacy Prior Approvals
- Expectations when contacting the NCTracks Contact Center
- Helpful hints for Family Planning
Providers can register for the NCTracks Regional Seminars and the Provider Help Centers in SkillPort, the NCTracks Learning Management System. Logon to the secure NCTracks Provider Portal and click Provider Training to access SkillPort. Open the folder labeled Provider Computer-Based Training (CBT) and Instructor Led Training (ILT). The sessions for the 2018 Annual Regional Seminar and the Provider Help Center Sessions can be found in the sub-folder labeled ILTs: On-site. Specific dates and times can be selected for registration under 2018 Annual Regional Seminar or the Provider Help Center Session.
Refer to the Provider Training page of the public Provider Portal for specific instructions on how to use SkillPort. The Provider Training page also includes a quick reference regarding Java, which is required for the use of SkillPort. Walk-ins will be allowed based on capacity.
Thanks and we hope to see you there!
The NCTracks Team
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Avalon's Lab Network Updated April 1, 2018
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) reminds providers that Avalon Healthcare Solutions (Avalon) manages the exclusive network of independent reference laboratories for Blue Cross NC’s commercially insured and administered products. Only laboratories contracted with Avalon are eligible to provide in-network laboratory services and receive payments under our members’ in-network benefits. If your health care organization makes referrals for Blue Cross NC’s patients’ laboratory tests and services, please review the participating laboratory list to find an eligible, in-network laboratory location.
Please remember:
- Your patients with Blue Cross NC coverage depend on participating providers’ use of in-network laboratories.
- The costs of lab services are aligned to your patients’ benefit designs.
- Patients have the lowest out-of-pocket costs when in-network services are obtained.
- Referrals to out-of-network labs can subject patients to much higher out-of-pocket costs, which can be the full cost when out-of-network benefits are not available.
- In addition, using out-of-network lab services will result in higher total costs for medical services, which directly affect the future cost of health care benefits for our members. For this reason, our agreements with participating providers require ordering lab services from in-network laboratories.
Our use of the Avalon laboratory network applies for all Blue Cross NC insured and administered products for members under the age of 65. This includes, but is not limited to, the North Carolina State Health Plan, the Federal Employees Program, and non-Medicare Advantage products accessed through the BlueCard® program. This change does not affect our Medicare Advantage products or BlueCard members when enrolled in other Blue Cross and Blue Shield-offered Medicare Advantage products.
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