Your Practice de Humana

Update Medicare Patients' Suspect
Conditions Online with Humana e-STAR

Physicians can now update Humana-insured Medicare patients’ suspect conditions electronically using Humana e-STAR. This free, Web-based tool replaces the former procedure of making notes on hard copy condition reports, a change that will help ease administrative burden and improve accuracy.

A Humana e-STAR pilot program in two large practice groups allowed Humana to learn more about how physicians would use the Web-based tool, and what enhancements were needed to better fit their needs. The practices involved in the pilot were enthusiastic about Humana e-STAR and its impact on their work flow.

Susan Allen, CPC, CCS-P, a compliance coder for JSA Healthcare Corp. in St. Petersburg, Fla., was involved in the pilot program and was very positive about Humana e-STAR’s functionality. “It is a very useful tool and assures accuracy,” said Allen. “We are a large center with 25 offices, and all are using Humana e-STAR to track Medicare members’ condition status. The neat thing is that for a large practice, it provides a great auditing or tracking device via the activity log. It is very easy to see what has been worked on.”

Through Humana e-STAR, users can also print current member listings based on selection criteria, view activity logs showing all updates to their Humana-insured patients’ suspect conditions and view a condition status report detailing average risk scores by provider within the group and the community in total.

Humana e-STAR is available to all physicians contracted with Humana to serve Medicare members. Physicians interested in signing up at no cost for Humana’s e-STAR application should contact their local Medicare Risk Adjustment representative. Once sign-up is complete, Humana e-STAR can be accessed via the secure Provider Resource Center on www.humana.com. Click on the “Humana e-STAR” link in the Resources and Communications section.

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Medicare Risk Adjustment Updates

The Centers for Medicare & Medicaid Services releases changes and additions to the ICD-9-CM codes each April and October. The ICD-9-CM coding tool, available on www.humana.com, has been updated to reflect the most recent changes made to the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Categories (HCC) model. To download the updated coding tool:

•	Access the home page at www.humana.com, then click on “Providers,” then click on “Provider Resource Center.”
•	Choose “Health Plans and Products” from the left side of the page. Desplácese hacia abajo y haga clic en el enlace "Medicare Advantage".
•	Enter your ZIP code, and then select the appropriate Medicare Advantage plan from the drop-down menu.
•	On the following page, click on the link to download the free MRA ICD-9-CM coding tool to a personal computer or personal digital assistant (PDA). This page also links to more information on the CMS-HCC Medicare risk adjustment model.

Remember to update your superbills to reflect the latest release of new ICD-9-CM codes. There are many new codes; some old codes are no longer valid, and some now require additional digits.
Remember that requests from Humana for medical records for purposes of data validation do not require an authorization from the patient for release of information. Humana may request information for data validation for HMO members, as well as for private fee-for-service members; these requests will be made by mail or telephone.

NOTE: The coding tool is a Microsoft Excel spreadsheet (IDC9W-SPLT.xls). You will need Microsoft Excel or a compatible software application on your PC or PDA to use the coding tool.

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