Access Companies Newsletter
1st Quarter 2017
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A Note from Renee

We've been busy moving, reorganizing and getting ready for changes ahead in post-acute (PAC) payment models.

Our long standing fee-for-service contracting continues to grow as our payer partners build out new HMO, narrow network products in the marketplace. Many of you call and ask. "What's this?", when we send out payer contract revisions. It's always a great opportunity for us to discuss market changes directly with you. Your insight is often very helpful as we work on your behalf to secure managed care contracts and market relationships useful to you.

Our goal continues to be pushing forward our Access Membership into preferred provider status for all managed care contracting. As we see emerging Value Based Purchasing initiatives we are pressing hard to develop the expertise and infrastructure that will be needed to secure and retain preferred status. See two articles below, one on data collected by the Kaiser Family Foundation on Medicare beneficiary elections into narrow, HMO Medicare Advantage Plans and the other on CMS Pilot activities.

Our own CMS Payment Pilot, Access Innovations, is a CMS approved BPCI (Bundled Payment Collaboration) initiative. We are working with a small group of our Access Member's developing new expertise and infrastructure needed for emerging Value Based and Episodic Payment. In combination with our remarkable heritage owned Network of PAC providers, our progressive, replicable and scalable deliverables will continue to distinguish us in the growing value based marketplace of the future. Our initiative is succeeding! We had a Medicare visit in December to review our project and were delighted to have first-hand affirmation our focus on evidence based pathways, care transitional post discharge protocols and lean, electronically assessable tools and resources are right on track where CMS is headed.

Always focused on service, we've included an Access Service Staff Guide below, and are excited to be out and above for upcoming Spring visits with you! Call if you'd like to schedule one now, or call anytime at all if you have questions or need assistance.

Thanks for letting us serve you!

Renee Cummings, CEO
Access Advantage - Access Innovations - Access Elite

Senior's Elect HMO Medicare Advantage Products

Based on Medicare Advantage enrollment data over 64% of all Medicare Advantage senior's are now enrolled in a closed network, HMO product. Before the more recent PPO network designs we are accustomed to seeing, HMO's reigned. In an HMO, all care must be delivered by contracted, in-network providers. When taken in combination with acute care focus on rehospitalization, payer competition for enrollment and new CMS "big data" collections related to value based outcomes, it's not likely decision makers will let up any time soon on payment reductions and demands for outcomes improvement.
Ohio is one of the most deeply penetrated managed care markets in the United States. Nationally one in three (31% of 17.6 million) beneficiaries is enrolled in Medicare Advantage in 2016. Currently, 34% of Ohio seniors are enrolled in an MA Plan.

Nationally, four plans dominate the Medicare Advantage market: United HealthCare, Humana, Blue Cross Blue Shield Affiliates (Anthem), and Aetna.

CMS Focus on Bundled Payments Continues

With a new Trump administration we are watching CMS value based payment initiatives very closely to assure our Access activities remain closely focused on our key goal: securing and retaining PAC preferred market status for our Membership.

The Trump administration has delayed the effective date for a rule that launched several new cardiac and orthopedic bundled-payment models under Medicare will not slow the launch of the initiatives, an HHS spokesman has confirmed. Launch plans remain intact that would make hospitals in 98 markets financially accountable for the cost and quality of all care associated with bypass surgery and heart attacks. Revisions in rule also expanded Medicare's first mandatory bundled-payment model - which covers total hip and knee replacements - to include surgeries to repair hip and femur fractures. Launch date is October 1st.

New HHS Secretary Tom Price comments specific to the payment pilots would appear to focus predominately on the mandatory participation requirements, as opposed to redirecting CMS payment pilot initiatives overall.

Access will continue to watch CMS activities closely to assure our activities on behalf of our Membership remain effective related to payment reform. A number of our managed care payer partners are quite interested in our growing capabilities related to transitions in care and performance.

Feel free to contact Bryce Henson, Development Director at if you have more questions or would like to talk with him about this further.

Access Updates!

Anthem Network 'Right Sizing' Initiative

Anthem will be reviewing the network to 'right size' and remove 1 and 2 Star and lower performing SNFs.
Prior to termination, they will be reviewing on several key factors:
- Existing relationships,
- LOS and discharge planning upon initiation admission,
- Ability to take complex cases,
- Service responsivity.

It is important to have Anthem UM departments positive feedback
We will continue to advocate to Anthem but it is imperative for all SNFs, no matter the Star rating, to be mindful of Payer needs. Please take some time now to look at your admissions practives with this information in mind.

Contact Amanda Ratliff, Director of Network Development, for more information.
Phone: 614-345-5001 X202

Paramount LTC Admissions fro Medicaid Population

In working with Member Paramount Medicaid admissions we've learned more about Paramount's Medicaid authorization process and will be revising our Provider Reference Guides. In the meantime, please remember Paramount DOES approve both skilled AND long term care admissions for their Medicaid enrollees. More to come on this shortly.
If you need more immediate information, please contact
Anna or Amanda in Contracting at 614-345-5001
Have you logged into your ZirMed account lately?
Zirmed is our transparent, electronic claims clearinghouse tool used to submit Member managed care claims to payers, document collection activities, and rapidly access eligibility information.  To stay on top of your managed care claims and admissions activitis, you will need to log in on a regular basis to keep your account active.

ZirMed passwords expire every 90 days.
If you find your account has been locked or if you need general assistance with ZirMed, please contact
Fred Fuller
877-708-2223 X207 or email at

Medical Records New Dedicated Inbox

Access Advantage now has an exclusive medical Record Inbox for Medical Record Submissions! Upon receipt of a medical records request from us, please send your encrypted records to The new inbox is designed for receipt of all records, inclusive of therapy logs for Part B Therapy claims.
When submitting records to AA, we ask that you please identify the following in your subject line:
-Provider Name
-Patient First intial and Last Name
-Date of Service
- Number of associated messages
ABC Nursing Home, J Smith, 1/1-1/28/17,1 of 1
For questions or concerns regarding transmission of medical records, please email the AA service box at

Meet the Staff:


Darren Horrigan, RN, BSN, MBA
Director of Care Services

Our new Director of Care Services, Darren Horrigan, RN, BSN, MBA, is currently onboarding to Access Companies to continue the work of Diane Todd. Diane is leaving Access Companies in mid-April. Diane has been wonderful with our BPCI transitional PATCH (Post Acute Transitional Care to Home), working directly with BPCI patients discharging from our pilot Access sites to home. We wish Diane well. As Director of Care Services, Darren's first priority is the success of our transitional patients. He additionally will work closely with Amanda Ratliff and Anna Nelson on our Contracting Team with the revisions/updates to our Provider Reference Manual and payer authorizations protocols; and with Missy Chapman on our Credentialing Team and on our new NCQA Model Credentialing activities. You should hear from Darren shortly if your are one of our Access Innovations BPCI pilot locations.
Darren can be reached at
Welcome Darren!

Access Service Staff Guide

Casey Beard - Director of Provider Network Services Responsible for all Network Service, call Casey at any time for a visit to discuss any of your Access Advantage needs. Casey is working on our new Access Advantage Auto-Pricer, designed to reconcile payment to the contract electronically.
877-709-2223 X212

Amy Plummer - Senior Manager of Revenue Cycle Amy manages day to day billing and payment processes. Let Amy know if you need assistance with claims payment, reconsiderations or adjustments.
877-709-2223 X217

Amanda C. Ratliff - Director of Network Development Focused on growing the Access Advantage Network, Amanda is building out payer contracting, adding new PAC sites and leads our expansion into Michigan, Indiana and Pennsylvania.
877-709-2223 X202

Anna Nelson - Provider Services Representative Member Service and contract support is Anna's forte. Anna distributes Payor Specific Attachments, BAA's and contract changes and amendments to payer agreements. Contact Anna if you'd like a summary of your payer agreements.
877-708-2223 X211

Missy Chapman - Credentialing Services Director Most of our Member's first work with Missy, who collects and maintains provider credentialing necessary for all payer contracts. Missy will contact you from time to time for updated documentation for our files.
877-708-2223 x201

Fred Fuller - Director of Systems/Operations Former manager of our billing/processing Team, Fred now focuses on internal operations and systems. Fred also manages ZirMed. For ZirMed access or permissions reset, contact Fred.
877-708-2223 x207
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