Practice Support Update Blog

Fifth Annual Virtual Statewide Quality Forum

Sep 23, 2025 11:16:13 AM / by Practice Support Team posted in Medicaid, Medicaid Managed Care, Quality Improvement, practice management

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NC Medicaid, in collaboration with the five NC Medicaid Managed Care Standard Plans, hosts the...

 

 

 

 

Fifth Annual Virtual Statewide Quality Forum

Wednesday, October 8 from noon-1:30 p.m.

Topics will include:

  • Administrative Simplification Workgroup Updates
  • Early Intervention and EPSDT: Proven Strategies for Success – Feedback from Providers 
    and Standard Plans
  • Key Updates from NC Medicaid


The forum is designed for providers, practice managers, and quality managers to engage in 
focused discussion about how to successfully apply Medicaid Managed Care quality initiatives to 
generate positive outcomes.


Please register to participate in this valuable and informative forum that will offer practical 
applications to enhance and improve your services to NC Medicaid members.

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Highlighted Resource: Trends in workplace violence for health care occupations and facilities over the last 10 years

Sep 18, 2025 9:23:00 AM / by Janice Moore, MLS posted in workplace violence

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Workplace violence in healthcare has been discussed with increasing frequency since the COVID pandemic.

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Join us at the Second Annual Piedmont Area Falls-Free Expo!

Sep 17, 2025 11:30:00 AM / by Practice Support Team posted in Primary Care, Geriatric, falls, physical therapy, Adult health

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fall birches

Register now to attend the (free) Second Annual Piedmont Area Falls-Free Expo!

Open to health care professionals and the adults they serve, this year's expo is filled with events--- from stability and balance exercise classes to chair yoga, to educational presentations including the importance of hearing in fall risk and other concepts related to fall prevention in older adults.

Did we forget to mention there is also free food and raffles to win prizes?

WHEN: Wednesday, September 24, 2025

WHERE: Intergenerational Center for Arts and Wellness

114 West 30th Street, Winston-Salem, NC  27105

TIME: 9:30 AM - 2:30 PM

Registration is available online or by phone at (336) 904-0328.

Use these links to  learn more and view the schedule of events.

 

Need free Contact Hours on this topic? Could your staff benefit from a refresher on falls in older adults?

Northwest AHEC has two self-paced, interactive, online courses on the topic! Check them out!

Falls: Screening, Risk Assessment and Care Planning for Older Adults in the Community

Double Trouble: Diabetes and Falls

 

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NC State Health Director Issues New Standing Orders for COVID-19 Vaccine

Sep 15, 2025 9:40:35 AM / by Practice Support Team posted in COVID-19, Vaccines, immunization

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On September 12, 2025,Governor Josh Stein directed the State Health Director, as a measure for the prevention and control of communicable disease, to issue statewide standing orders to facilitate access to the COVID-19 vaccine in accordance with NC laws and FDA approvals for those who wish to receive it.

These orders allow an immunizing pharmacist licensed with the NC Board of Pharmacy and practicing in North Carolina in accordance with the conditions of their licensure to administer COVID-19 vaccines approved by the FDA per the conditions outlined in the orders.

These include Comirnaty (manufactured by Pfizer), Mnexspike (manufactured by Moderna), Nuvaxovid (manufactured by Novavax) and Spikevax (manufactured by Moderna).

Source: NC State Health Director Standing Orders

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Payers in NC Implement Downcoding Claims and Code Review Programs

Sep 2, 2025 9:30:00 AM / by Practice Support Team posted in coding, practice management, claims, insurance

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Strong Connection between Chrome Carabiner and two Red Ropes Symbolising the Insurance. Selective Focus.-1

Several health insurance companies in North Carolina have recently implemented programs to review claims and codes that results in the down coding of Level 4 and Level 5 Evaluation and Management (E/M) claims.

According to the North Carolina Medical Society, Aetna's process does not target all Level 4 and 5 codes, nor does it include all providers within the state. However, there remains confusion about why the insurer has implemented this program. Cigna's approach is broader and applies to all physicians and to six E/M codes: 99204-99205 (new patient), 99214-99215 (established patient), and 99244-99245 (consult for new & established patients). Cigna will implement this review nationally on October 1, 2025.  

Along with the North Carolina Medical Society, many professional societies across the country are also alerting their members to this issue. 

It is critical to follow the appropriate appeals process for any claims you believe to be inappropriately down coded! 

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2024 MIPS Final Scores and Targeted Review Available Mid-September

Aug 27, 2025 4:42:00 PM / by Practice Support Team posted in MIPS, quality payment program, CMS

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Medicine doctor hand working with modern computer interface as medical concept-4

From CMS Quality Payment Program Newsletter:

 

As previously announced (QPP listserv sent 7/25/2025), there was a delay with receiving some of the final Medicare claims data needed to calculate cost measures, which is delaying the release of MIPS final scores for the 2024 performance year and the Targeted Review period.

  • We’re currently targeting mid-September for releasing 2024 MIPS final scores and opening the Targeted Review period.

MIPS payment adjustments for the 2026 MIPS payment year will be released approximately one month after the release of final scores. The Targeted Review period will close 30 days after the release of MIPS payment adjustments. From now until mid-September, you’ll continue to be able to access measure and activity-level scores for the data you reported during the submission period. However, performance period benchmarks are part of final scoring and won’t be available until final scores are released. In the meantime, we encourage you to confirm your MIPS eligibility and review the following scoring resources so that you’re prepared to understand your scores when they’re released. To confirm your eligibility for a MIPS payment adjustment, enter your National Provider Identifier (NPI) on the QPP Participation Status Look Up tool (check “PY 2024”) or sign into the QPP website and navigate to the Eligibility & Reporting page on the left hand navigation. Review pages 12 – 16 of the 2024 MIPS Eligibility and Participation Guide (PDF) for more information about what you see.

Review these scoring resources:

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Highlighted Resource: Effectiveness of naloxone distribution in community settings

Aug 20, 2025 1:22:09 PM / by Janice Moore, MLS posted in overdose, adl, naloxone

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August 31 is recognized each year as Overdose Awareness Day, to share knowledge necessary to end overdose deaths and to remember those who have passed from overdoses.

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Medicaid Managed Care Webinar Opportunity

Aug 19, 2025 10:30:00 AM / by Practice Support Team posted in Medicaid, Medicaid Managed Care, Quality Improvement

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NC AHEC and DHS Logos_WHITE on BLUE-01

WEBINAR

Medicaid Managed Care

NC Medicaid Quality Measurement & Benchmarking

Tuesday, September16|noon-1p.m.

Please join us on September 16 at noon for a webinar on NC Medicaid Quality Measurement and Benchmarking which will include the following:

  • Introduction to NC Medicaid's quality measurement strategy and the Advanced Medical Home (AMH) measure set.
  • Summary of annual update process for the AMH measure set & review of changes to MY2026 AMH set.
  • Update to NC Medicaid's benchmarking approach for quality measures. We will walk through the Gap-to-Goal and Beat the Trend methodologies and how they apply to the AMH measure set.

Register by clicking on the blue button below.

Register for the NC Medicaid Quality Measure & Benchmarking Webinar

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Medicaid Managed Care Virtual Office Hours

Aug 19, 2025 9:45:00 AM / by Practice Support Team posted in Medicaid, Medicaid Managed Care, Primary Care, practice management

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NC AHEC and DHS Logos_WHITE on BLUE-01WEBINAR

Virtual Office Hours

STAY IN THE KNOW: Key NC Medicaid Updates for Provider Office Staff

Thursday, September 4 | noon - 1 p.m.

Please join us on Thursday, September 4 from noon-1 p.m. for an informative Virtual Office Hours webinar to get updates and hear the latest statuses on hot program topics that are impactful to the provider community! Get the insights and resources you need to navigate upcoming developments with NC Medicaid. 

Webinar topics will include:

  • EPSDT: Pay and Chase
  • Carolina ACCESS Enrollment Refresher
  • Maintaining Eligibility Program
  • Children and Family Specialty Program – Provider Contracting
  • Credentialing Committee Updates
  • Avoid Common Enrollment Application Issues Cont’d
  • Key Resource: NC Medicaid Provider Ombudsman

Register by clicking the blue button below. We look forward to connecting with you!

Register for theMedicaid Managed Care Virtual Office Hours

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A Collaborative Path to Better Pediatric Behavioral Health: How Twin City Pediatrics Transformed Care with Support from Northwest AHEC

Aug 13, 2025 3:00:00 PM / by Brooke Kochanski posted in mental health, behavioral health, Pediatric, practice support, collaborative care

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In the face of rising pediatric mental health needs, Novant Health Twin City Pediatrics found itself at a crossroads. As adolescent mental health concerns such as depression and anxiety became more prevalent, clinicians found themselves increasingly fielding complex and time-consuming questions. These mild to moderate conditions required consistent follow-up and oversight, yet the surge in demand for mental health services made it difficult for patients to access timely care, particularly from providers who accepted their insurance. Many adolescents went without necessary treatment. 

Thanks to a powerful partnership with Northwest AHEC and the guidance of Lara Dickerson, MHA, Senior Quality Improvement Specialist, the practice chose a different path—one of innovation, collaboration, and compassion.

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Adair Stewart, Dr. Elizabeth Allen, Dr. Gretchen Hoyle, Lara Dickerson, Jennifer Cleland Green, Lauren Stokes

The Challenge

Primary care pediatricians face a dilemma. Mental health visits are longer, emotionally taxing, and historically under-reimbursed. Yet the need is undeniable. Twin City Pediatrics chose to lean in—embracing the challenge rather than deflecting it.

The question became: Can mental health care in pediatrics be both impactful and financially viable? The answer, it turns out, is yes.

The Solution: Collaborative Care Model (CoCM)

With coaching from Lara Dickerson and guidance from AHEC Practice Support Services, Twin City Pediatrics implemented the Collaborative Care Model (CoCM).  A practice which emphasizes collaboration between primary care physicians, care managers, and psychiatric consultants to improve access, outcomes, and patient satisfaction within the pediatric medical home. 

Key components of the model include:

  • A Behavioral Health Care Manager (BHCM) providing core services like parent coaching, brief therapeutic interventions, and referral coordination.
  • A Psychiatric Consultant offering oversight and subspecialty advice..
  • A Primary Care Provider trained in pediatric physical health.
  • Validated clinical tools (PHQ-9, GAD-7, Vanderbilt, etc.) for measurement-based care.
  • Customized EHR workflows and a patient registry to track progress and enable billing for behavioral health services within the primary care practice.

Practice Support Team Impact

The journey began with a conversation at the 2023 NC Pediatric Society Meeting, leading to a partnership with Northwest AHEC. Practice coach Lara Dickerson became a key ally, meeting monthly with the team for two years. Her support included:

  • Coordinated with internal Novant departments (HR, billing, IT, compliance).
  • Billing guidance and documentation templates.
  • Consultation with NC Medicaid on psychiatric consultant roles.
  • Staff training modules.
  • Troubleshooting billing issues.
  • Setting BHCM workload benchmarks.
  • Secured a $50,000 Capacity Building Fund grant from Community Care of NC to support BHCM staffing.

Thanks to this comprehensive support, the program not only launched - it thrived.

The Results

By June 2025, the program became revenue-positive, six months ahead of schedule. With monthly BHCM costs of $5,400 and over $13,000 billed in June alone, the practice expects $6,500 in revenue—exceeding expenses by more than $1,100 per month. Today, the program includes a growing number of enrolled patients - many with complex needs - and is delivering tangible improvements in the lives of children and their families.

“The Psychiatric Collaborative Care Model has empowered our practice to provide meaningful, evidence-based mental health care for our pediatric patients. Our success is replicable, sustainable, and deeply impactful.”
 Gretchen S. Hoyle, MD - Twin City Pediatrics

“It was amazing to see how this model enables primary care practices to spend adequate time with each patient on physical and mental health concerns, developing treatment plans collaboratively with specialists and making a significant difference for kids in our community.”
 Christopher Jones, DrPH, MHA - Northwest AHEC

From Patients & Families

“I’m so glad he’s finally going to get the help he needs.”
“I’ve felt so alone for so long. Having someone to talk to means everything.”
“She is so much better. I can’t thank you enough.”

Read the full Report from Twin City Pediatrics & Gretchen S. Hoyle, MD

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