October 21, 2021

Wv Health

Health Simplified

ACOG’s payment advocacy and coverage portal

Kober:

So we’re going to be chatting now about ACOG payment advocacy and coverage portal, which introduced in 2020. Can you briefly summarize for our audience what this portal is all about?

Satterfield:

Certain, I’m joyful to do that. To give a small qualifications prior to 2020, we had clinical coders that were acquiring email messages from tactics and ob-gyns inquiring the questions. What I wanted to do is have a far better way of monitoring not only the communications among procedures and ACOG, but also what those difficulties ended up. So, a way of classifying them so that if the identical problem commenced coming in from a certain condition or region, we could say, “Hey, possibly there is certainly a thing else heading on right here.”

There could have been a coverage transform by a personal payer or Medicaid, you know, a little something which is more systemic than just 1 challenge with a exercise. So we released the portal for individuals uses to definitely collect info on what the difficulties are out in the area for ob-gynecology offices.

Kober:

Why is that an organizational precedence in just ACOG?

Satterfield:

When I joined ACOG in 2019, we had been engaged in some health and fitness plan advocacy with Medicaid and Medicare, but we experienced not truly engaged in policy advocacy with the non-public wellbeing options. And as you know, non-public wellness strategies deal with a lot more than the Medicare and Medicaid populations of ob-gynecology patients. And now even there are non-public health programs that are covering Medicare and Medicaid sufferers as perfectly with the introduction of the ACO (Accountable Treatment Corporations) is in the Medicaid care, accountability organizations and other contracts that the govt has with these non-public options.

When I came on, it was a precedence of the business to genuinely be productive in impacting the working day-to-working day company of the ob-gynecologist. And to do that, we genuinely had start off partaking with the personal payers.Which is a substantial undertaking to accomplish, as you can consider. There are about 900 distinct private payers in the United States. While we have the big gamers like United Health and fitness, Aetna, Cigna, Humana, there are quite a few hundred area payers as well and local contracts.

Satterfield:

So just say you’re likely to begin advocating for personal payer advocacy. It is not quite possible. The to start with aspect in all of this is to gather the data, to attempt to concentrate on where the issues are. And so that’s in which the policy payment and advocacy portal came in. Incredibly considerably advocating for greater coverage and a lot less administrative burden for ob-gynecologists is an ACOG precedence.

Kober:

So then who was eligible to entry the payment advocacy and policy portal? Is it just for ACOG members or is it open up to non-customers as properly?

Satterfield:

It is open to non-users as nicely. In truth, we stimulate ACOG members to plug their administrators and their professional medical billers into the portal, since at the close of the day, people are the individuals that are dealing with the denials and working with the prior authorization requests and all of the administrative pieces of an ob-gynecology exercise. So unquestionably you can find not a membership cost. It is funded by ACOG but it is open for any person at no cost.

Kober:

So as you observed, 1 of the principal elements of the portal includes the skill for end users to post a ticket reporting, a reimbursement or payer problem. How precisely does that work and, and who is checking and responding to these tickets on ACOG’s stop?

Satterfield:

The to start with stage in getting a element of the portal is that you have to sign up as a consumer and the registration, once again, it truly is free, but it can be a phase so that we can accumulate knowledge on wherever you are from. Are you a gynecologist and obstetrician, or are you an administrator or are you a payer? We have some payers that have engaged in the portal as very well. So just some normal demographics so that you will not have to response that every time. And then we have a verification approach where you would get an e-mail to confirm you are an true human being that retains the spam out of the program for us. At the time you are registered as a consumer, you have obtain to the complete portal, which does contain distributing a ticket and you are asked, is the ticket for a coding problem, or is it for a coverage concern or a prior authorization? So there are some categories that we classify. We even get down to, at some issue, if it really is particular to a payer, and then you check with the problem, and at the other stop is my crew. We are, as you outlined, the wellness economics and practice administration workforce.

We also have contracted with accredited clinical coders and a qualified observe supervisor who is familiar with all of the coding and all of the ins and outs of an obstetrician-gynecologist observe. Those people inquiries are filtered relying on what the selection has been upfront, and then they are presented to the correct men and women to solution the inquiries.

Kober:

So then how rapidly can people normally assume to acquire a reaction at the time they’ve submitted a ticket?

Satterfield:

Which is a excellent query. I essentially looked this up prior to our dialogue now, and our reaction time to inquiries for the very first response of acknowledging that we’ve acquired your question is 15 hours. So which is an normal. So rather a lot inside of a day, working day and a 50 % or so, you really should get a response that we are seeking into your query. I located way too that 83% of all concerns we’ve gained have been finalized in just 2 times. So that signifies that all the research has been done for that query and it is a shut ticket following 2 days. That’s what the information was telling me this early morning when I appeared (at it).

Kober:

That really sounds great. I’m sure that helps make it quite valuable. I think men and women most likely would submit a ticket and in all probability never have the time to wait around for a week for a reaction. So that’s why a turnaround is surely really important from your stop. What kind of means further than the capability to post a ticket on a particular reimbursement situation are accessible in the payment advocacy and coverage portal?

Satterfield:

Ideal. The portal just just isn’t (for) publishing a ticket and having an solution. We do have content articles on the portal that traverse all sorts of billing and coverage subjects from cervical dilation and how to monthly bill for that IUD to obstetric care the world codes and, our most common (subjects) proper now are the preventive services and analysis administration support codes. So we have articles or blog posts on all of these unique matters and basically when a person is getting into the issue, if they enter the proper code words, so to discuss, and the system acknowledges the words, an post advice will pop up and say, “Hey, we see you happen to be asking about this. Have you appeared at this article?”

So that is a rather awesome attribute. The posts are current. We also put bulletins on there. So for example, United Health and fitness is transforming platforms for their prior authorization. So we have that announcement up on the portal as well. So maybe you did not see it appear by the United Health way. You can kind of verify and see what’s heading on with payers in that regard.

Kober:

What type of metrics do you have pertaining to consumer participation of the portal? How numerous folks are accessing it? How frequently are men and women distributing tickets?

Satterfield:

(As) I pointed out, I appeared this morning and we are just shy of a thousand registered customers. So about 50- 55% of individuals consumers are administrators and billers. And about 42% are ob-gynecologists or physicians and the relaxation are sort of in this other class, they could be, policy folks, they may well be payers, but we are just so close to hitting that 1,000-individual mark. So that will be a bash when we get that. We have answered, in the very last year, all around 750 questions. So 750 around the past handful of months. Apparently our content have had about 8,000 views.I was stunned at that truly. So, plainly, people today are hunting to the portal for billing and coding sources and hunting at people articles to see if there’s facts they can uncover there.

Kober:

So just a person final query and probably the most crucial query: How can practising ob-gyns and their directors indication up to entry the portal?

Satterfield:

We ship out at ACOG a concept termed ACOG Rounds every Friday and about just about every other 7 days we involve a “Click This Link” and a sign up for the portal. So if ACOG users are hunting by their emails on Friday evenings, they will see that. Each member will get just one from (us) that’s termed ACOG Rounds, and they can just click on a connection there. ACOG Rounds, if I could just plug a small little bit, also involves any brief updates that may have happened that 7 days, just a rapid summary, so that’s a single way to sign up.

The other way to indicator up is to go online and just talk type acogcoding.freshdesk.com. That’s A-C-O-G-C-O-D-I-N-G.freshdesk, F-R-E-S-H-D-E-S-K.com. And that’ll choose you to the web page exactly where you can register as a person.

Kober:

I consider this has really been a great dialogue about some of the function that ACOG is focusing on each to assist its customers and people as effectively. So thank you so a lot for signing up for me now, Lisa.

Satterfield:

I truly recognize it. Thank you, Scott.