How do I interpret the Family PACT (Planning, Access, Care, and Treatment) Provider Profiles? Where is the Interpretation of Provider Profiles Report?
Why don’t I have an individualized Family PACT provider Profile online?
Will I be audited by the Department of Health Care Services (DHCS) as a result of the profiles?
If I make a change in my practice, when will it show in my profiles?
The profiles show my data in relation to my professional peers. How do you decide who my peers are?
How will new indicators be added?
INDICATORS AND METHODOLOGY
The number of clients or the number of encounters (the “n”) used in each indicator is not the same from one graph to the next. In other words, there does not seem to be a common denominator between measures. Why is that?
Why does my profile show “NA” for some of the indicators?
A. The Interpretation of Provider Profiles Report is located on the Family PACT website
A. The most current Provider Profiles and supporting documents are conveniently available online at www.familypact.org/Providers/provider-profiles . Follow the “click here to access your Family PACT Provider Profile” link. By entering the National Provider Identifier (NPI) associated with your clinical site(s) when prompted, you may view and download your profile(s). All Family PACT providers who served more than 50 clients in any of the four six-month periods identified in the report have individualized profiles. If the number of clients served was less than 50 in any of the six-month periods, that portion of the profile will be marked “NA” meaning these data are not available. The number of clients served is based on paid claims data.
A. Your Provider Profiles report is intended to be informational feedback regarding your practice. Practice patterns that reflect consistently significant outlier patterns in relation to peer groups may result in additional review by DHCS. It is unlikely that aberrant profiles alone would generate an audit. However, they may be a component of the information that the DHCS uses in determining who is audited.
A. Should you elect to make changes in your practice as a result of the data, the impact will appear in future profiles that reflect the six-month time period in which you make the changes.
A. Two peer groups have been defined: “Private Sector Providers” and “Public Sector Providers.” Your designation as a public or private sector provider is determined by the “provider type” that your practice was assigned when you enrolled as a Medi-Cal provider. In general, “public sector” providers are licensed as governmental, non-profit agencies, and community clinics; and “private sector” providers are the remainder of the network. For additional information on peer groups, please see Interpretation of Provider Profiles Reports.
A. We will be working on developing several new measures and welcome your feedback. To participate, watch for announcements through the Family PACT e-news system. If you are not currently signed-up to receive announcements, you may do so through our website http://www.familypact.org/Providers/e-news-sign-up.
A. Family PACT hopes that this information will be useful to you in reviewing your utilization management and quality of care practices for Family PACT clients. Options for using this information may include but are not limited to:
• Developing an internal quality improvement plan
• Identifying needs for additional staff and biller training
• Assessing communications among front-office staff, clinicians, and billers
• Instituting chart prompts
• Improving client eligibility screening and intake practices
• Improving oversight of services ordered
Immediate assistance for client enrollment and billing is available by contacting the Xerox Telephone Service Center (TSC) at (800) 541-5555. Upon request, a field representative will contact you directly to assist you. Future Family PACT educational events, such as webinars, will include professional quality improvement topics. Information regarding these events may be found on our Provider Training page www.familypact.org/Providers/provider-training.
A. The claims data for your practice are determined by how you registered your NPI with Medi-Cal Provider Enrollment, plus the ZIP code of the service site on your claim form. As claims are adjudicated, an attempt is made to assign the claim to a service site by a ZIP code that has been registered with Medi-Cal Provider Enrollment. When this is successful, we can correctly attribute services to the appropriate site. Alternatively, if you are billing for numerous locations under one NPI location number, your claims data may be an aggregate of more than one site.
Another explanation may be that your second site did not meet the threshold number of 50 Family PACT clients served in any of the reporting periods. That site can access the online statewide Provider Profiles comparing public to private providers. If you believe you should have a profile, please contact Family PACT.
A. To correct any discrepancies in the name listed for physician owner/medical director or the mailing address (including suite number and ZIP code), please contact Family PACT Provider Enrollment.
Updating your information with Medi-Cal is a separate process and requires contacting DHCS Provider Enrollment Division at (916) 323-1945 or e-mailing them at PEDCorr@dhcs.ca.gov. Providers must notify Medi-Cal within 35 days of any change to previously submitted information.
A. Please e-mail Family PACT at firstname.lastname@example.org or call (916) 650-0414.
INDICATORS AND METHODOLOGY
Q. The number of clients or the number of encounters (the “n”) used in each indicator is not the same from one graph to the next. In other words, there does not seem to be a common denominator between measures. Why is that?
A. While drawn from the same large data pool, the subsets of clients included in each measure are different among the three indicators. Consequently, the denominators for each indicator will differ since the size of the subsets will vary depending upon the rules of the analysis.
A. Several criteria have been identified that allow providers to receive individualized Provider Profiles. These criteria are:
• Profiles reflect only the activity of the provider(s) and the site associated with the billing NPI printed on the report.
• Providers will have served, and successfully billed for, more than 50 Family PACT clients in the six-month reference period.
• Where the indicator represents female clients only, the provider will have served more than 50 female clients in the six-month reference period.
• Where “per client” data are reported, the provider is the only identifiable clinician serving the client in the referenced timeframe.
Where your data are insufficient for a given indicator during an identified six-month period, you will see “NA” (not available) meaning that the data for the measure is not available for the time period.
A. The primary source for billing assistance is Xerox, the fiscal intermediary for Medi-Cal.
There are several ways to receive billing assistance:
• Request individualized contact with your Xerox regional field representative by calling the TSC at (800) 541-5555. Listen for the menu prompt for “Health Access Programs: Family PACT”. Regional field representatives can come directly to your site when necessary.
• Attend Medi-Cal Training Seminars that offer sessions dedicated to Family PACT as well as live claims assistance. Information about these seminars may be found on the Medi-Cal website (www.medi cal.ca.gov) in the Medi-Cal Learning Portal subpage and
in the monthly Family PACT Update bulletin.
New staff members are welcome to attend Family PACT Provider Orientation held quarterly throughout the state. Important information is presented on client enrollment, program standards, and provider responsibilities. Attendees receive an introduction to Family PACT’s contraceptive method-specific services, as well as education and counseling office visits unique to Family PACT.
There is no charge to attend this all-day session, and the current schedule and reservation instructions are posted on the Family PACT Web site at www.familypact.org and in the monthly Family PACT Update bulletins.