Tools to use: ACOG’s payment advocacy and policy portal

Scott Kober hosts this podcast in which he interviews Lisa Satterfield, senior director of health economics and practice management at the American College of Obstetricians and Gynecologists (ACOG). They discuss the tools and resources available to practicing ob-gyns that are focused specifically on payer and reimbursement issues.

Kober:

So we're going to be talking today about ACOG payment advocacy and policy portal, which launched in 2020. Can you briefly summarize for our audience what this portal is all about?

Satterfield:

Sure, I'm happy to do that. To give a little background prior to 2020, we had medical coders that were receiving emails from practices and ob-gyns asking the questions. What I wanted to do is have a better way of tracking not only the communications between practices and ACOG, but also what those issues were. So, a way of classifying them so that if the same question started coming in from a specific state or region, we could say, "Hey, maybe there's something else going on here."

There could have been a policy change by a private payer or Medicaid, you know, something that's more systemic than just one issue with a practice. So we launched the portal for those purposes to really collect data on what the issues are out in the field for ob-gynecology offices.

Kober:

Why is that an organizational priority within ACOG?

Satterfield:

When I joined ACOG in 2019, we were engaged in some health policy advocacy with Medicaid and Medicare, but we had not really engaged in policy advocacy with the private health plans. And as you know, private health plans cover more than the Medicare and Medicaid populations of ob-gynecology patients. And now even there are private health plans that are covering Medicare and Medicaid patients as well with the advent of the ACO (Accountable Care Organizations) is in the Medicaid care, accountability organizations and other contracts that the government has with these private plans.

When I came on, it was a priority of the organization to really be effective in impacting the day-to-day business of the ob-gynecologist. And to do that, we really had start engaging with the private payers.That's a large task to accomplish, as you can imagine. There are about 900 different private payers in the United States. While we have the big players like United Health, Aetna, Cigna, Humana, there are several hundred local payers as well and local contracts.

Satterfield:

So just say you're going to start advocating for private payer advocacy. It's not quite feasible. The first part in all of this is to collect the data, to try to focus on where the issues are. And so that's where the policy payment and advocacy portal came in. Very much advocating for better coverage and less administrative burden for ob-gynecologists is an ACOG priority.

Kober:

So then who was eligible to access the payment advocacy and policy portal? Is it just for ACOG members or is it open to non-members as well?

Satterfield:

It is open to non-members as well. In fact, we encourage ACOG members to plug their administrators and their medical billers into the portal, because at the end of the day, those are the folks that are dealing with the denials and dealing with the prior authorization requests and all of the administrative parts of an ob-gynecology practice. So absolutely there's not a membership fee. It is funded by ACOG but it is open for anybody at no cost.

Kober:

So as you noted, one of the primary components of the portal involves the ability for users to submit a ticket reporting, a reimbursement or payer issue. How exactly does that work and, and who is monitoring and responding to these tickets on ACOG's end?

Satterfield:

The first step in becoming a part of the portal is that you have to register as a user and the registration, again, it's free, but it's a step so that we can collect data on where you're from. Are you a gynecologist and obstetrician, or are you an administrator or are you a payer? We have some payers that have engaged in the portal as well. So just some general demographics so that you don't have to answer that every time. And then we have a verification process where you would receive an email to verify you're an actual person that keeps the spam out of the system for us. Once you are registered as a user, you have access to the entire portal, which does involve submitting a ticket and you are asked, is the ticket for a coding question, or is it for a coverage issue or a prior authorization? So there are some categories that we classify. We even get down to, at some point, if it's specific to a payer, and then you ask the question, and at the other end is my team. We are, as you mentioned, the health economics and practice management team.

We also have contracted with certified medical coders and a certified practice manager who knows all of the coding and all of the ins and outs of an obstetrician-gynecologist practice. Those questions are filtered depending on what the selection has been upfront, and then they are given to the appropriate people to answer the questions.

Kober:

So then how quickly can users typically expect to receive a response once they've submitted a ticket?

Satterfield:

That's a great question. I actually looked this up before our conversation today, and our response time to questions for the first response of acknowledging that we've received your question is 15 hours. So that's an average. So pretty much within a day, day and a half or so, you should receive a response that we are looking into your question. I found too that 83% of all questions we've received have been finalized within 2 days. So that means that all the research has been done for that question and it is a closed ticket after 2 days. That's what the data was telling me this morning when I looked (at it).

Kober:

That really sounds great. I'm sure that makes it very useful. I think people probably would submit a ticket and probably don't have the time to wait around for a week for a response. So that's why a turnaround is definitely pretty important from your end. What sort of resources beyond the ability to submit a ticket on a particular reimbursement issue are available within the payment advocacy and policy portal?

Satterfield:

Right. The portal just isn't (for) submitting a ticket and getting an answer. We do have articles on the portal that traverse all kinds of billing and policy topics from cervical dilation and how to bill for that; IUD to obstetric care; the global codes and, our most popular (topics) right now are the preventive services and evaluation management service codes. So we have articles on all of these different topics and actually when a person is entering the question, if they enter the right code words, so to speak, and the system recognizes the words, an article recommendation will pop up and say, "Hey, we see you're asking about this. Have you looked at this article?"

So that is a pretty cool feature. The articles are updated. We also put announcements on there. So for example, United Health is changing platforms for their prior authorization. So we have that announcement up on the portal as well. So maybe you didn't see it come through the United Health way. You can kind of check and see what's going on with payers in that regard.

Kober:

What sort of metrics do you have regarding user participation of the portal? How many people are accessing it? How frequently are people submitting tickets?

Satterfield:

(As) I mentioned, I looked this morning and we are just shy of a thousand registered users. So about 50- 55% of those users are administrators and billers. And about 42% are ob-gynecologists or physicians and the rest are kind of in this other category, they may be, policy persons, they may be payers, but we're just so close to hitting that 1,000-person mark. So that will be a party when we get that. We have answered, in the last year, around 750 questions. So 750 over the past few months. Interestingly our articles have had over 8,000 views.I was surprised at that actually. So, clearly, people are looking to the portal for billing and coding resources and looking at those articles to see if there's information they can find there.

Kober:

So just one final question and maybe the most important question: How can practicing ob-gyns and their administrators sign up to access the portal?

Satterfield:

We send out at ACOG a message called ACOG Rounds every Friday and about every other week we include a “Click This Link” and a sign up for the portal. So if ACOG members are looking through their emails on Friday evenings, they'll see that. Every member gets one from (us) that's called ACOG Rounds, and they can just click on a link there. ACOG Rounds, if I could just plug a little bit, also includes any quick updates that might have happened that week, just a quick summary, so that's one way to sign up.

The other way to sign up is to go online and just talk type acogcoding.freshdesk.com. That's A-C-O-G-C-O-D-I-N-G.freshdesk, F-R-E-S-H-D-E-S-K.com. And that'll take you to the site where you can register as a user.

Kober:

I think this has really been a great discussion regarding some of the work that ACOG is focusing on both to help its members and patients as well. So thank you so much for joining me today, Lisa.

Satterfield:

I really appreciate it. Thank you, Scott.