1.
  • Who is Renaissance Health Systems (RHS)?

Renaissance is a Florida-based business that contracts with multiple health plans to coordinate the care of patients in a proactive and cost effective environment. Renaissance Health Systems has developed a new model for the benefit of patients, Providers and insurers alike - the community health system. In a community health system, the patient is recognized as the true consumer of healthcare services.
2.
 What distinguishes Renaissance Health Systems from others?
The mission of Renaissance Health Systems, Inc. is to provide quality, proactive and cost effective healthcare to our patients while simultaneously improving their quality of life. We as an organization provide leadership in our industry and our community, with our employees and our stakeholders.
3.
 When was the Company founded?
Renaissance Health Systems was incorporated in the state of Florida on December 13, 2002.
4.
 Where is RHS available?
For a detailed map identifying where RHS is available, please click here.
5.
 How does one obtain access to the RHS Provider Network or other products?
To obtain the RHS Provider Network or other RHS products, please visit us on the web at www.RHSFL.com or call 877.778.9300 to speak with one of our customer representatives.
6.
 How does RHS contract with providers?
We have Provider Specialists in your area who visits provider offices on a daily basis to establish contracts that expand our provider network. To have a Provider Specialist contact you, please feel free to visit us on the web at RHSFL.com or call 877.778.9300 and you will receive a call back within 24 hours.
7.
 What is a community health system?
The community health system is a new model for the benefit of patients, providers and insurers alike. In a community health system, the patient is recognized as the true consumer of healthcare services. Patients are engaged to actively work alongside their physician in pursuit of their improved healthcare lifestyle. This tandem approach to a patient's health then benefits the insurer (payer), the physician and most importantly, the patient as it emphasizes a proactive approach to wellness.
8.
 What lines of business does RHS participate in?
RHS is designed to participate in Medicare Advantage, Medicaid, Commercial and PPO Insurance Plans.
9.
 Do all providers have to participate in all lines of business?
RHS encourages the providers who are part of their network to participate in providing healthcare services to all members of the community. However, providers have a choice as to which lines of business they wish to participate in.
10.
 How does RHS compensate providers?
RHS has a flexible compensation plan to meet the needs of all providers. They include traditional fee for service; percentage of Medicare approved rates; primary and/or specialist no risk capitation and limited risk capitation; as well as "gains share" incentives or options.
11.
 Does RHS contract with multiple payers in each region?
Yes, RHS contracts with multiple payers in each region to allow for more comprehensive coverage options for patients.
12.
 Does RHS charge providers any management fees or other fees for becoming part of its provider network? No fees are charged for participation in our network.
13.
 What systems does RHS have in place for providers to confirm a patient's eligibility?
A provider can confirm a patient's eligibility by calling Renaissance at 877.778.9300 or login to the RHS Provider portal (RHSPortal.com).
14.
 Will PCPs be able to limit their enrollment at any given time?
Yes, PCPs may limit their enrollment at any given time. This can be accommodated by submitting a written request to RHS.
15.
 How long does RHS take to pay providers for approved services provided?
RHS and its affiliates pay providers for any approved services administered within thirty (30) days of receipt of a clean claim according CMS guidelines.
16.
 Does RHS require preauthorization for all procedures?
Preauthorization is determined by the insurance and benefit plan selected by the patient; therefore procedures and provider services may vary. To be certain, we recommend you contact us with any questions at 877.778.9300 or via the web at RHSFL.com.
17.
 What is a payer?
A payer is another term commonly used in the healthcare industry to refer to an Insurance or HMO plan.
18.
  • What is the Medicare Program?
    There are four parts to the Medicare Program.
    • a.
    Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
    b. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
    c. Medicare Part C is the Medicare Program that gives the Medicare beneficiary the option, of having their Medicare covered health care through a Medicare Advantage Plan that include:
     
    i.
    Medicare Health Maintenance Organization (HMOs)
    ii.
    Preferred Provider Organizations (PPO)
    iii.
    Private Fee-for-Service Plans
    iv.
    • Medicare Special Needs Plans
      When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services
    d.
    • Medicare Part D is the Drug Benefit Program: Effective January 1, 2006, Medicare prescription drug coverage will be available to all Medicare beneficiaries. Medicare Prescription Drug Coverage is insurance. Beneficiaries choose the drug plan and pay a monthly premium.
19.
  • What is an HMO?

An HMO (Health Maintenance Organization) is a plan that contains a contracted network of providers that must be used to receive benefits. HMOs often provide additional benefits not found in original Medicare.
20.
  • What is a participating provider?

A participating provider is a physician or other healthcare provider who knows of a member's enrollment in an RHS contracted Health Plan and has been given a reasonable opportunity to obtain the terms and conditions for payment for services provided to Plan enrollee. Physicians and other healthcare providers must be licensed and must be eligible to provide care to Medicare-eligible patients, with no sanctions against their licensure. If a physician or healthcare provider renders care to a member of an RHS contracted Health Plan, the physician or healthcare provider is considered participating for that member.
21.
  • How can a physician become a participating provider for RHS?

With Renaissance, providers have the opportunity to become part of our revolutionary community health system. We seek providers who understand the delicate balance that exists within "the art and science of healthcare", and who recognize the patient as a true consumer of healthcare services. Join us and make a difference. For more information contact us at info@RHSFL.com or call 877.778.9300. RHS will then schedule a meeting to go over the contract, the rate and the payers we are contracted with.
22. How long is the term of the contract? Is it automatically renewed?
Generally, the network contracts are approved without a time length and it is automatically renewed until one either party decides to terminate with or without cause. The termination period is 60 days upon receipt of written notice.
23.
  • Which Fee schedule does RHS use to determine the physician payment rate?

The prevailing Medicare fee schedule where the services are rendered is used to reimburse physicians and other healthcare professionals.
24. When we are ready to start, will there be an initial in-service for physicians and their staff to attend?
Yes, our staff will ensure that your office personnel are well briefed, on how to work with RHS and our participation plans. We will provide briefings both initially, and on an ongoing basis.
25.
  • What is the advantage of contracting and credentialing with RHS?

RHS Providers have access to multiple payers with only one contract and one credentialing process. Further, the processes for all the payers are combined into one and providers have continuous support from our customer service representatives and Patient Care team.
26.
  • How long does the credentialing process take?

RHS holds a credentialing committee meeting every quarter. Once RHS has received a completed credentialing application our credentialing process begins, which can take between 30 to 60 days. Its completion will depend on how close to the next meeting the documentation was submitted.

27.
  • How often do the providers need to be credentialed?

RHS credentials providers one time and re-credential the providers every three years.
28.
  • Is the re-credentialing process just like the credentialing process?

No, the re-credentialing process is a lot easier. About 6 months before the provider's 3rd anniversary, he/she will receive a pre-populated re-credentialing application. All they need to do is confirm that everything is correct and update what isn't correct. Fill out a couple fields and sign the application.
29.
  • Do I have to be board certified?

No, RHS does not require that the provider be board certified but they must be board eligible.
30.
  • Does RHS participate with CAQH?

RHS does not participate with CAQH, however, if the provider's profile is on CAQH please contact RHS as it will facilitate your process.
31.
    What type of providers does RHS contract with?
    a.
    Primary Care Physicians
    b.
    Specialists (i.e. cardiology, dermatology, endocrinology, etc)
    c.
    Ancillary facilities (i.e. surgery centers, radiology facilities, DME, home health, etc.)
    d.
    Physician's Assistants, ARNPs, CRNAs, Nurse Midwives (if they are associated with an Ob-Gyn group)
32.
  • What type of providers RHS doesn't contract with?
    • a.
      Hospitals
      b.
      Chiropractors
      c.
      Mental Health professionals
      d.
      Dental
      e.
      Vision
      f.
      Laboratories
33.
  • If I need training or Provider Services whom do I contact?

RHS has an assigned Provider Specialist for each area to assist you on any questions/problems.
34.
  • What happens if a member leaves the plan and goes back to the original Medicare? How are the members cost-shares calculated?

If a member disenrolls and returns to original Medicare, then original Medicare cost-sharing provisions would apply.
35.
  • What format does RHS require for claims?

The format required for claims will depend on the health plan; most health plans accept paper claims with the CMS approved 1500 form and electronically filing as well.
36.
  • Do we need to use a specific Lab?

Most health plans have an agreement with a specific lab and require that their entire membership be referred to that specific lab.