Spring 2013
Leading the way
A Newsletter for Providers of Medical Associates Health Plans
New Chief Medical Officer at Medical Associates Clinic & Health Plans
Dale Dreiling, M.D., has joined Medical Associates Clinic & Health Plans in the
role of Chief Medical Officer. Dr. Dreiling provides leadership in all areas of
clinical quality including continuous assessment and improvement of patient care
practices. He works closely with our physicians and professional staff to promote
the delivery of excellent healthcare to all patients.
Dr. Dreiling’s background includes executive management experience as Senior
Vice President of Tanner Medical Group in Carrollton, Georgia, as Chief Executive
Officer of Staten Island Physician Practice in Staten Island, New York, and
leadership experience with Geisinger Health System in Danville, Pennsylvania.
In addition, Dr. Dreiling was President and co-founder of Eagle Physicians and
Associates in Greensboro, North Carolina, where he practiced Family Medicine for
18 years.
Dale Dreiling, M.D.
Dr. Dreiling received his Bachelor of Science degree in Business from Virginia
Tech, his Doctor of Medicine degree from the Medical College of Virginia, and a
Masters of Medical Management from Carnegie Mellon University in Pittsburgh.
Dr. Dreiling is married to Dr. Karen Dreiling, a practicing pediatrician. They are the
parents of two children.
Medical Record Documentation
medical
record for your
documentation
Complete medical records are the cornerstones of quality healthcare. Wellorganized, legible medical records allow for a clear picture of the patient’s
complaint, symptoms, procedures, medical treatments, status, and the outcome
of care.
In compliance with both the National Committee for Quality Assurance and
Medicare, we offer the following recommendations:
•Patient medical information is kept confidential and well organized.
•Each page in the chart has patient name and ID number.
•Medical history includes current and past diagnoses, surgeries, allergies,
adverse reactions, and immunizations. Family history of parents,
grandparents, and siblings.
•Documentation of each patient visit including subjective, objective, lab,
x-ray, action, treatment, medications, therapies, all consistent with
diagnosis.
•Evidence of continuity and coordination of care between primary and
specialty physicians; evidence of preventive health screenings/services
offered.
information
Communication
All practitioners
participating with Medical
Associates Health Plans
may freely communicate
with patients regarding
treatment options
available.
This may include
medical care, risks,
benefits, consequences
of treatment or nontreatment, the opportunity
to refuse treatment, and
to express preferences
about future treatment.
CODING TIPS
Positive Air way Pressure (PAP) and
Respiratory Assist Device (RAD) Accessories
Positive Airway Pressure (PAP) and Respiratory Assist Device
(RAD) Accessories
The key to correctly billing for PAP and RAD accessories
is to be aware of the allowable quantity. A supplier must
not dispense more than a certain quantity of PAP/RAD
accessories at a time. Quantities of supplies greater than
those described in the policy as the usual maximum amounts
will be denied as not reasonable and necessary.
HCPCS DESCRIPTION
USUAL MAXIMUM
AMOUNT
A4604 TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH
POSITIVE AIRWAY PRESSURE DEVICE
1 per 3 months
A7027 COMBINATION ORAL/NASAL MASK,
USED WITH CONTINUOUS POSITIVE
AIRWAY PRESSURE DEVICE, EACH
1 per 3 months
A7028 ORAL CUSHION FOR COMBINATION
ORAL/NASAL MASK, REPLACEMENT
ONLY, EACH
2 per 1 month
A7029 NASAL PILLOWS FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT
ONLY, PAIR
2 per 1 month
A7030 FULL FACE MASK USED WITH POSITIVE
AIRWAY PRESSURE DEVICE, EACH
A7031
1 per 1 month
A7032 CUSHION FOR USE ON NASAL MASK
INTERFACE, REPLACEMENT ONLY, EA.
2 per 1 month
A7033 PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY,
PAIR
2 per 1 month
FACE MASK INTERFACE, REPLACEMENT
FOR FULL FACE MASK, EACH
1 per 3 months
A7034 NASAL INTERFACE (MASK OR CANNULA 1 per 3 months
TYPE) USED WITH POSITIVE AIRWAY
PRESSURE DEVICE, WITH OR WITHOUT
HEAD STRAP
A7035 HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE
1 per 6 months
A7036 CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE
1 per 6 months
A7037
1 per 3 months
A7038 FILTER, DISPOSABLE, USED WITH
POSITIVE AIRWAY PRESSURE DEVICE
2 per 1 month
A7039 FILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
1 per 6 months
A7046 WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY
PRESSURE DEVICE, REPLACEMENT, EA.
1 per 6 months
TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE
Source: https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_lcds/positive_airway_pressure_pap_devices_for_the_treatment_of_obstructive_sleep_apnea.htm%3f
HEALTH CARE SERVICES
AVAILABLE 24/7
health care
Our nurse case managers in the Health Care
Services Department are available to help
coordinate a variety of needs for your Medical
Associates Health Plan patients, from out-of-plan
referrals, to hospital pre-authorizations and benefits
determination.
Normal business hours are Monday through Friday,
8:00 a.m. to 5:00 p.m. Members and practitioners
may communicate with the Health Care Services
staff in these ways:
• Telephone: 563-584-3275 or toll-free within U.S. 800-325-7442
• Fax: 563-585-1545
• E-mail: healthcareservices@mahealthcare.com
• Personal visit: 1605 Associates Drive, Suite 101, Dubuque Iowa
After-hours and on holidays, the local and toll-free
numbers are forwarded to our 24-hour Patient
Services Help Nurse line. Information is collected
by the Patient Services staff and sent to our Health
Care Services nurses the next working day via fax. If
an immediate care decision is required, the Patient
Services staff will contact a member of the Health
Care Services nursing staff at a designated afterhours telephone number. Department, 584-3275 or
toll free 800-325-7442.
UTILIZATION MANAGEMENT
utilization
Criteria.
If you wish to have a copy of our utilization
management criteria, feel free to call the Health
Care Services Department at 584-3275 or toll free
800-325-7442.
External Review.
We comply with state regulations regarding external
appeal. Some denials (after they exhaust internal
appeal) may be eligible for review by an Independent
Review Organization. For most of our plans, the
denial of coverage must be based on medical
necessity to be eligible. If you would like more
information, please contact our Member Services
Manager at 563-584-4857.
Physician Reviewer Availability.
If you wish to speak with a physician reviewer
regarding a utilization decision (including behavioral
health), please call our Health Care Services
Department, 584-3275 or toll free 800-325-7442.