February 14, 2005

 
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DHHS Videoconferences on MECMS Transition Issues Re-scheduled to Friday, Feb. 18
The conferences originally scheduled for this past Friday were cancelled because of the snowstorm. The new date is Friday, Feb. 18th with sites available in Portland, Augusta and Bangor. You must register online at http://mainegov-images.informe.org/bms/mecms/provider q a.pdf
Staff from the Bureau of Medical Services and the Department of Technology Services will host the sessions.  The format of the teleconferences will be as follows:

  • Introduction and presentation of common MECMS transitional issues and solutions
  • Questions and answers from the audience
  • Suggestions on follow-up to issues specific to your organization

You can find more information about the new DHHS claims management system on the web at: http://www.maine.gov/bms/MECMSHomePage.htm.

MMA has received many calls the past week about the delays in MaineCare payments which are the result of the transition to the new claims management system.  Many practices report that they have received little or no payment since the transition and that BMS staff is unable to inform them as to when payment may be expected.  MMA staff has passed these concerns on to the acting  Bureau Director.

The delay in payment reached the public media the end of this week with stories on WMTW on Friday and a front-page story in the Sun Journal on Saturday.  Many of the stories have featured providers who can not meet payroll and are borrowing money to stay afloat until payments resume.  MMA has encouraged the Bureau to make interim prospective payments to those providers particularly vulnerable and we understand that a contingency plan exists to do so.

Please continue to let MMA staff know of the problems you are having so that we may assist where possible.  Send the information to gsmith@mainemed.com/

State Budget Hearings on MaineCare upcoming this Week; MMA Legislative Com. to Meet
The Appropriations and Health & Human Services committees will hold public hearings this week on the Governor's 06 and 07 biennial budget.  On Wednesday, MMA will testify on those budget sections dealing with MaineCare - Payments to Providers, including physician, hospital and nursing home payments.  MMA will express strong support for the nearly $20 million in state and federal increased payments to physicians proposed over the two-year budget.

The MMA Legislative Committee meets on Tuesday evening (Feb. 15) and will consider a growing list of legislative proposals, including bills to lessen CME requirements for deployed military physicians, to amend the content of reports to the Board of Licensure in Medicine from insurance carriers and hospitals and the notice to be given to individuals under state custody in clinical trials.  The meeting will be at the Frank O. Stred Building in Manchester at 6:00pm. [return to top]

GAO Issues Report on Sustainable Growth Rate and Physician Medicare Payments
CongressDaily reports that members of the House Ways and Means Committee are "ready to scrap" Medicare's payment formula for physicians.  The Government Accountability Office (GAO) issued its report on the sustainable growth rate system for Medicare physician payments, which discussed how the system works, why it is resulting in proposed decreases in payments and what options are available to revise or replace the system.  Lawmakers must consider the physician payment issues this year because a temporary formula adopted under the Medicare Modernization Act is due to expire and payments will begin to decrease on Jan. 1, 2006 if nothing is done.  One option being talked about links payment to performance.  The GAO report is available at: 

               http://www.gao.gov/cgi-bin/getrpt?GAO-05-326T [return to top]

Governor to Announce Maine Health Care Claims Data Bank on Thursday
Governor Baldacci will hold a news conference on Thursday, Feb. 17, and announce the availability of the first data coming from the all-payor healthcare claims data bank.  The announcement will take place at the State House in the Hall of Flags.  The event will mark an important milestone in the public-private partnership between the Maine Health Information Center and the Maine Health Data Organization in developing the new data bank.  Data from the data bank will be available for the first time in March.

The Claims Data Bank is the nation's first comprehensive, publicly-available repository of statewide medical, pharmacy and dental insurance claims data.  Today, the Claims Data Bank contains data for more than 5 out of every 10 residents, an estimated 681,000 privately-insured individuals.  That number will increase dramatically in 2005 as claims data from MaineCare and Medicare are added to the data bank.

Because the Data Bank includes claims data from all health care settings, it is expected to become a rich source of never-before-available information about how Maine people use health care services, and how much is paid for care.  The data will be made available through the Maine Health Data Organization.

Currently, MHDO rules prohibit the release of data on an individual physician, but the Maine Quality Forum has asked for the MHDO rules to be changed so that specific physician data could be released, under a protocol that would allow physicians to see their own data well in advance of any public release. [return to top]

Cigna Filing Deadline Feb. 18th in Federal Court Settlement
Physicians and practice administrators are reminded that this coming Friday, Feb. 18 is the filing deadline for the filing of claims in the Cigna court settlement.  Any questions regarding the preparation and the submission of Cigna claims should be directed to Poorman Douglas, Settlement Administrator, at 1-877-683-9363.

Visit CIGNAPhysicianSettlement.com for more explicit instructions.  You can download the Category I Code List along with the forms that are required to accompany any re-filed HCFA/CMS 1500s.

Practices are eligible for a settlement fund distribution if they provided medical services to any individual covered by Cigna or a Cigna subsidiary between August 4, 1990 and Sept. 5, 2003.

Another helpful website is www.hmosettlements.com. [return to top]

Maine Anesthesiologists, Urologists and Ob-Gyns Hold Winter Meetings
Three of Maine's specialty societies have recently concluded winter meetings at Sugarloaf.

This past weekend the Maine Society of Anesthesiologists held its Annual Meeting and elected the following slate of officers to two-year terms, beginning immediately.

  • President:  Cynthia Jenson, M.D. (Waterville)
  • Vice-President:  Gary Palman, DO (Portland)
  • Newsletter Editor:  Richard Flowerdew, M.B., B.S. (Portland)
  • ASA Director:  Christopher Cary, M.D. (Portland)
  • Alternate ASA Director: Ray Nichols, M.D. (Jonesport)

Dag Holmsen, M.D. (Waterville) continues in the role of Secretary-Treasurer.

The meeting also featured presentations by Ronald Szabat, Director of Governmental and Legal Affairs of ASA and Alex Hannenberg, M.D. of Newton, MA.  Dr. Hannenberg is the nation's leading authority on the complex issue of Medicare reimbursement for anesthesiology.

The previous weekend the Maine Urological Association and the Maine Section of the American College of Obstetrics and Gynecology met in combined CME sessions and in separate business meetings, also at Sugarloaf.

All three societies will meet next at the MMA's 152nd Annual Session in Bar Harbor Sept. 9-11, 2005.  The meetings will be at the Harborside Hotel and Marina in downtown Bar Harbor. [return to top]

President Bush Submits 2006 Budget to Congress
Last week, President Bush submitted his proposed budget for 2006 to Congress.  While again advocating for support for liability reform, the President calls for deep cuts in Medicaid expenses.  Medicare was largely spared.

Governor Baldacci released a document noting that the proposed federal budget would translate into a potential loss of $342 million to Maine associated with the reductions in Medicaid.  Included in the Medicaid reform are limitations on the use of governmental transfers and a reduced cap on provider taxes from a maximum of 6 percent to 3 percent. [return to top]

Fourteenth Annual MMA Physician Survival Seminars May 18 and June 8
Please look inside your Jan/Feb copy of Maine Medicine to find registration materials for MMA's two upcoming physician survival seminars being held in Portland on May 18th and in Bangor on June 8.  These popular programs are MMA's effort at least once yearly to give to practice administrators and physicians the information and tools they need to practice lawfully in the state.

This year's program features keynote presentations on "Pay for Performance" and includes an important presentation on how to improve outcomes which are deserving of reward. Twelve breakout sessions are scheduled for the afternoon which gives attendees an opportunity to interact in a smaller session with some of the best presenters in the state.

 If you can't find your registration materials, contact Chandra Leister at 622-3374 or e-mail her at cleister@mainemed.com and we'll send materials to you.  [return to top]

NHIC Interactive Voice Response System
The Medicare Modernization Act (MMA), Section 921, includes provision that require tools be available to providers to assist them in having their questions answered accurately, consistently and in a timely manner. CMS issued Change Request 3376 to implement the Provider Customer Service Program. Section 3376.1.1 of the Change Request instructs contractors to maintain an interactive voice response unit.

National Heritage Insurance Company is pleased to announce that it has developed an Interactive Voice Response (IVR) system which will be available in March 2005. This system will allow users to obtain answers to numerous issues through a speech-enabled, self-service telephone interface driven by the user's voice.

This enhanced automated system will include options for eligibility, claim status, check information, deductible information, pricing, seminar schedules, telephone numbers, addresses, and appeal rights information. This is your first avenue of inquiry for basic information about your patient's eligibility and claims submitted on their behalf.

The system is easy to use and directs the caller through the process. To further assist practices in use of this new technology, a complete navigational guide is also being developed, and will be posted on the NHIC website soon.

Please watch the NHIC website or join the site mailing list for the latest updates and information on when the guide will become available. [return to top]

For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association