peia weight management provider training
DESCRIPTION
PEIA Weight Management Provider Training. April 29, 2011, Morgantown May 5, 2011, Lewisburg. Goals for today. Familiarize providers with new fee schedule Familiarize providers with new eligibility guidelines Ensure clarity regarding process for claims submission - PowerPoint PPT PresentationTRANSCRIPT
APRIL 29 , 2011 , MORGANTOWNMAY 5 , 2011 , LEWISBURG
PEIA Weight Management Provider Training
Goals for today
Familiarize providers with new fee schedule
Familiarize providers with new eligibility guidelines
Ensure clarity regarding process for claims submission
Ensure provider awareness of program resources, outcomes and best practices
Provide forum for feedback among providers and to PEIA
Eligibility is changing!
THE OLD:BMI of 30 or greater; or
BMI of 25 or greater with related condition (hypertension, diabetes, heart disease, metabolic syndrome or sleep apnea)
New guidelines, July 1, 2011
THE NEW:Body mass index of 25 or greater (no
cormorbid condition required) ORWaist circumference of 35 inches or greater
for woman ORWaist circumference of 40 inches or greater
for a man
WHY?
Outcomes research provides sufficient validation of improved health
Averted bariatric surgeries
Cost beneficial
Member requests
Provides “engagement” for members to make lifestyle changes
Marketing
New program brochures available
Good time to market to PEIA policyholders and their families
Historically enrollment picks up in the Fall
PEIA now has web enrollment: go to www.wvpeia.gov/healthandwellness programs/weight management
Why the new fee schedule?
IRS regulations regarding “fitness memberships”
PEIA can only pay for professional services
Member copayment will serve as the “membership fee”
Simplify copayments
Better distribution of services over time
New schedule of services
EP visits alternate with RD visits
Personal training more consistent
New code for personal training (S 9451)
EP payment increased from $12.50 per 15 minutes to $15.00
Providers to all use CHERI to cut down on confusion and errors given the change
Member copayments
All will go to $20 monthly effective July 1, 2011
For new participants, it is a win
For current participants, they will view as fee increase although they will gain also in regards to personal training
For those about to begin, we need full disclosure, so they can make an informed choice as to when to begin
Anticipate increase in participants starting in July
