Saturday, July 11, 2009

CVMG and other insurance hoops to run through when on vacation for more than 30 days.

Quoting an email from our office staff from CVMG staff: She (from CVMG - insurance, name with-held) stated that "if a physician is going to be out for more than 30 days, then there is a break of service. It is a NCQA requirement that you both have Re-Initial Credentialing."

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I'm not sure what Re-Initial Credentialing is, I guess I'll figure that out when I get back to the USA to my Plastic Surgery Modesto practice and Acupuncture Modesto practice (another Modesto Acupuncture page). I'm sure it involves a lot of paperwork like what we had to initially to be on CVMG insurance.

NCQA

The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.

The NCQA's mission statement:
NCQA’s mission is to improve the quality of health care. Our vision is to transform health care quality through measurement, transparency, and accountability.

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.

California Pay for Performance (P4P) is a statewide collaboration that creates the business case for physician organization (PO) quality. The Integrated Healthcare Association (IHA), a nonprofit, statewide health care leadership group composed of health plans, physician groups, hospitals, health care systems, purchasers, pharmaceutical, technologic, consumer and academic representatives, engages various sectors of health care delivery in dialogue and collective action to develop policy and special projects centered on integrated health care and managed care. IHA helps California’s Health Plans reward POs for performance in clinical care, information technology (IT) adoption and patient experience by providing a clear set of health plan expectations, using common metrics and public reporting.


Some thoughts on why this isn't a "complete break of service":
  • Our office isn't closed
  • We're still taking calls regarding patient care.

I hope to get in contact with CVMG insurance staff to discuss this more in person. Anyone else have the experience of being on vacation over 30 days who has CVMG insurance?

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