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Practice Transition – What to Expect
The goal of HealthTexas Provider Network (HTPN) is to provide accessible, cost-effective, quality health care by maximizing efficiency of a physicians’ practice. In support of that goal, HealthTexas strives to relieve the burden of practice management from the individual physician so that our physicians can concentrate on serving patients and focusing on the art of medicine.
Services provided by HTPN include:
Network Management: Facilitates the credentialing, licensing, payer support and hospital privileges for HTPN physicians. Network Management works directly with Physician Recruitment and Baylor Health Care System to ensure that all new physicians receive their credentials, Texas Medical License and Hospital privileges in a timely manner. Additionally, Network Management recredentials physicians, physician assistants, and advanced practice nurses every three years.
The payer support function of Network Management consists of two categories:
Government: Our staff obtains a National Provider Identifier (NPI) for any physician joining HTPN who does not already have an NPI. We also manage the enrollment of Medicaid, Medicare and obtaining Blue Cross Blue Shield provider numbers for all new physicians. We provide ongoing support by facilitating all paperwork related to Medicare and Medicaid demographic changes, billing changes, and new locations.
Managed Care: Network Management submits physician information to HTPN’s contracted managed care providers after physician approval by the HTPN Credentials Committee and Board of Directors. Network Management provides participation reports to the practices regarding payer effective dates as they are received for new physicians. Network Management supports new managed care contract implementation by distributing to each practice a contract summary, fee schedule and signature page for new HTPN payer offerings.
Other services we provide are the resolution of any participation issues, CPT specific fee schedules, miscellaneous reports, and review of direct mail from insurance companies.
Billing and Collections: Baylor Health Network Inc. (BHNI) provides billing and collection services for physician locations within the Health Texas Provider Network (HTPN). BHNI services 400+ physicians in 107 locations throughout the Metroplex. HTPN understands the importance of our physician’s reputations in their communities and believes that the patient experience doesn’t end after care is received, but continues through the billing and collection process. We focus on providing the most positive customer service experience, so that the goodwill established between our physicians and their patients remains untarnished.
Physician Recruitment: Recruits physicians worldwide and coordinates interviews between physician candidates and network practices. We develop tools and interviewing techniques for the Health Texas Provider Network (HTPN) practices so they can conduct effective interviews and attract top quality physicians to our network. We answer questions that potential physicians may have regarding long-term practice goals, ethical considerations, call schedules, patient load, earning potential and overhead expenses. Once a physician is hired into HTPN we coordinate relocation logistics, credentialing, practice location, office set-up and various human resource functions.
Patient Relationship Management/Service Excellence: Works to improve the quality of patient service throughout HealthTexas. This work focuses on the patient’s experience and the systems that work or fail to work to meet individual patients’ needs. Service is one of four concepts (along with Quality, People, and Finance) that define the Circle of Care. This work is led by the Service Excellence Committee and includes patient surveying, data collection and reporting, training, coaching for improvement and tool development to help all HTPN employees achieve service excellence. In addition, service excellence is a key link to improved job satisfaction and decreased turnover and stress, which allows us to serve our patients better. The Circle of Care means that when we serve patients well, we serve each other well, and when we serve each other better, we serve our patients better.
Compliance: The Compliance Committee is appointed by the HealthTexas Board of Directors to facilitate the establishment of a culture that promotes prevention, detection, and resolution of conduct that does not adhere to applicable federal and state law as well as to the program requirements of federal, state, and private payer health plans.
Lab Advisory: The Laboratory Advisory Committee is appointed by the HealthTexas Board of Directors to provide advice to HealthTexas physicians and administration on laboratory services. The committee provides guidance for on-site testing performed by HealthTexas practices and acts as a liaison with the HealthTexas preferred reference laboratory in terms of service levels and pricing.
Marketing: Develops and implements marketing strategies that promote physicians to both medical and consumer communities. HTPN marketing works closely with the Operations team to identify opportunities to improve patient volumes and community relations throughout the network, including both primary and specialty care marketing. Additionally, the department develops marketing plans for new physicians joining the network. Working closely with the Baylor Health Care System, HTPN marketing ensures brand standards are met on all communications. Marketing identifies, develops and implements a wide variety of promotional activities such as direct mail, brochures, announce cards, advertising, physician relations, press releases, community events, newsletters, corporate promotions, website development and internet presence.
Decision Support: Creates, maintains and distributes management reports with data retrieved from various electronic sources. This department supports compliance, accounting, operations and other business functions with research and data analysis so that business decisions can be made based on actual, fact-based data.
Information Systems: Support the overall systems infrastructure for telecommunications and networking. This department also coordinates with Baylor Health Care Systems Information Services and OIS services as well as manages the deployment of an electronic medical record system that enables ambulatory care physicians and clinical staff to document patient encounters, streamline clinical workflow, and securely exchange clinical data with other providers, patients and information systems.
The HTPN electronic medical record system allows knowledge to be exchanged using the latest advancements in secure, web-based platform technology. Health records are provided in a manner that ensures safe, reliable data integrity and HIPAA privacy and security compliance – without the need for the physician or practice to purchase expensive computer systems, software, and maintenance contracts.
Coding: The Coding Department is your resource for any coding and compliance issues you may encounter within your practice. We also educate providers on code accuracy so that optimal reimbursements can be obtained by the practice. Coding education is covered on an annual basis during Evaluation and Management Service reviews as well as New Physician Orientation.
Clinical Performance Excellence: The Clinical Performance Excellence department establishes clinical skills guidelines to ensure clinical excellence within the HealthTexas Provider Network. The following programs are offered on a regular basis to address specific clinical needs within HealthTexas Provider Network (HTPN):
- Clinical Skills Orientation: an all-day clinical skills class involving didactic instruction and selected demonstration of the 20 clinical skills most often performed in HTPN clinics
- “Focus Four”: covers four critical skills areas: (1) Performing EKG’s, (2) Blood Pressure Measurement, (3) Medication Injections, and (4) Handwashing. These skills are given in-depth focus and presented together or separately during the lunch hour at the clinic
- “Train the Trainer”: A program designed to place within HTPN a clinical employee who assists with the required annual check-off of skills for each clinic. This program gives each trainer hands-on opportunities to teach critical skills during the training class
- On-site Visits: a trained clinical registered nurse is made available for clinic visits to evaluate clinical staff and operations with the aim of improving clinical outcomes within HTPN
- The Nursing Task Force: represents a cross-section of HealthTexas clinics and serves HTPN with guidance concerning policy and procedures for the performance of nursing skills in HTPN. The Nursing Task Force meets once monthly to discuss clinical nursing issues and review and update nursing policy.