February 28, 2005

 
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MaineCare MECMS Still Experiencing Difficulties; MMA Needs Your Input
MMA continues to hear from members regarding significant delay in MaineCare payments because of implementation of the new claims management system (MECMS). Some practices have not seen a check in nearly four weeks and patience is waning. Provider staff does not seem to be able to answer provider questions regarding when a check is coming or what the problem with a particular claim is. Let us hear from you about your situation so that these matters can be brought to the attention of the Commissioner's Office and the Acting Director of the Bureau of Medical Service.
Despite the provider meetings held on Feb. 18th,  physician practices still are not receiving timely payments and are confused about how to request an interim prospective payment.  Communicate with gsmith@mainemed.com about your situation so that we may continue to monitor the situation.  While the professionals leading the Department are aware and we believe genuinely sympathetic about the situation providers find themselves in, they seem to be unable to do much about it.  However, we and they, will certainly continue to try.

On Feb. 24, the Bureau sent out the following notice:

  • Providers submitting electronic UB-92 files using version 6.0 of the record format standard have experienced acceptance problems due to software defects.  A common misconception has been that only version 5.0 will be supported by MECMS.  The defects have been corrected.  Effective 2/28/05, the corrections will be implemented and both versions 5.0 and 6.0 of the UB-92 record format will be accepted.  Providers who have submitted electronic claims using versions 6.0 of the UB-92 record format will have received acknowledgments indicating errors.  If you have encountered this situation, please resubmit those files.

For more information, see http://mailman.informe.org/mailman/listinfo/provider

Calls to Legislators Still Needed to Ensure MaineCare Fee Increase
Despite some quality contacts last week, MMA remains concerned that legislators are not hearing nearly enough from physicians regarding the need for a MaineCare fee increase.  The Legislature's Health and Human Services Committee is currently developing its recommendations on the Governor's proposed budget and will present these to the Appropriations Committee this coming week.  The fee increase will be specifically discussed at 3:00pm Monday, Feb. 28 in the HHS Committee. 

HHS Committee members and their contact information is below.  In addition, you may call them at 1-800-423-2900 (House members) and 1-800-423-6900 (Senate members).

The Governor's proposed budget contains a number of cuts that are vigorously opposed by several groups and organizations.  Without effective advocacy from physicians, it will be relatively easy for the legislators to ignore 25 years of flat fees and use the $3 million to restore someone else's cut.  Don't let that happen.  Call today.

To contact members of the Health & Human Services Committee:

Sen. Arthur Mayo, III (D-Sagadahoc), Senate Chair:442-8053 (H); artmayo@gwi.net

Sen. John Martin (D-Aroostook):444-5556 (H); SenJohn.Martin@legislature.maine.gov

Sen. Richard Rosen (R-Hancock):469-3779 (H); rrosen113@aol.com

Rep. Hannah Pingree (D-North Haven), House Chair:867-0966 (H); Hannah@pingree.com

Rep. William R. Walcott (D-Lewiston):783-4059 (H); mainewill@verizon.net

Rep. Carol A. Grose (D-Woolwich):443-2843 (H); RepCarol.Grose@legislature.maine.gov

Rep. Richard J. Burns (D-Berwick):698-1526 (H); burns_for_145@hotmail.com

Rep. Elizabeth S. Miller (D-Somerville):549-7171 (H); lisammaine@mac.com

Rep. David C. Webster (D-Freeport): 865-4311 (H); RepDavid.Webster@legislature.maine.gov

Rep. Thomas F. Shields (R-Auburn): 782-7451 (H);tas5256@midmaine.com

Rep. James J. Campbell, Sr. (R-Newfield):793-2396 (H); jscampbell@psouth.net

Rep. Sarah O. Lewin (R-Eliot):439-0354 (H); sallymehse@comcast.net

Rep. Kevin J. Glynn (R-South Portland):799-5319 (H); glynn@maine.rr.com

To find contact information for your local legislators:

Check janus.state.me.us/legis & click on "The House of Representatives" or "The Senate."Or call the MMA at 622-3374 & ask for Charyl, Andy, or Gordon & we will provide this information to you.

Some Budget Talking Points:

  • The Medicaid rolls continue to swell with nearly 270,000 individuals now enrolled - the most ever! It is patently unfair to continue offering such a broad range of benefits to more & more enrollees and expect Maine's health care community to subsidize the program.
  • Physician reimbursement rates currently are inadequate to cover the cost of providing care - the rate increase is necessary to prevent a reduction in access for patients.
  • Physician reimbursement is approximately $50 million per year - less than 5% of the Medicaid budget.
  • Maine's physician reimbursement rates are 44th in the country (Comparing Physician and Dentist Fees Among Medicaid Programs, Medi-Cal Policy Institute, June 2001).
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Watch for Coalition for Health Care Access and Liability Reform Communication
A mailing was sent to over 4,000 Maine physicians last week from the Coalition for Health Care Access and Liability Reform, asking for financial support for the Coalition's efforts to enact meaningful medical liability in Maine.  The Coalition is chaired by Lee L. Thibodeau, M.D., a Portland neurosurgeon who has strong ties to Aroostook County.  Twenty-one organizations have joined the Coalition including MMA, the Maine Osteopathic Association and the Maine Hospital Association.

The Coalition has prepared legislation that would establish a $250,000 limit on non-economic damages in medical liability cases, eliminate joint and several liability and allow a physician to express remorse after an incident, without such expression being admissible in court.  The legislation does not yet have an L.D. number, but is expected to be printed soon.  The legislation is sponsored by Sen. Karl Turner of Cumberland and  is expected to be referred to the Judiciary Committee and have a public hearing in the Spring.

A lot of the physician advocacy efforts on the bill will focus on Wednesday, March 23, 2005 which is the traditional Physicians Day at the Legislature.  Please plan now to attend or have someone from your practice attend.  Details are available from Charyl Smith at MMA which is coordinating the day's activities along with the Maine Osteopathic Association.  Charyl can be reached at 622-3374 or via e-mail to csmith@mainemed.com.

Please watch for the Coalition mailing and respond if you are able. [return to top]

Now's your chance; the DEA calls for physicians' comments
The January 18 Federal Register contained a notice from the Drug Enforcement Administration seeking comments from physicians and others about the law pertaining to dispensing of controlled substances for pain.  Find the notice at www.access.gpo.gov/su_docs/fedrega050118c.html by scrolling down to the Drug Enforcement Agency heading.

An earlier policy statement contained "misstatements."  Therefore, an upcoming document as intended to take "into consideration the views of the medical community."  The DEA advised the new document will reiterate legal concepts incorporated into federal laws and regulations for many years. 

Please write the DEA indicating areas of the law relating to controlled substances you would like addressed or explained in the upcoming document.  Submit comments by March 21 referring to "Docket No. DEA-261."

Send e-mail to dea.diversion.policy@usdoj.gov or mail to:

              Deputy Administrator
              Drug Enforcement Administration
              Washington, D.C.  20537
              Attn: DEA Federal Register
              Representative/CCD [return to top]

Mail-order Drug Program Opposed by Pharmacists
A plan to allow Maine residents to purchase prescription drugs over the Internet from a warehouse on Indian Island is being met with opposition from pharmacists as reported in the Maine press last week.  The state and the Penobscot Nation are moving forward with a plan to establish a pharmaceutical storage and distribution facility on the Penobscot reservation where a warehouse for the operation is currently being constructed. 

The plan calls for the facility to fill 90-day supplies of "maintenance medications" that are offered through the MaineCare program.  The plan is similar to a program that has been operating in Connecticut through one of the Indian tribes in that state.  Maine officials hope to have the program up and running by May 1. [return to top]

Anthem Medical Director Meets with Payor Liaison Committee
Jeffrey Holmstrom, D.O., Medical Director for Anthem Blue Cross Blue Shield of Maine met with MMA's Payor Liaison Committee last Wednesday.  Dr. Holmstrom discussed the first few months of activity in his new position, having served previously in a similar capacity for Aetna. 

Dr. Holmstrom noted the recent merger of WellPoint and Anthem and expressed his belief that the Maine plan is able to operate with a lot of local control and direction.  In many of the quality initiatives, Maine is really driving Anthem East which includes the plans in Connecticut and New Hampshire, as well as Maine.  Anthem has announced a pay for performance plan that has been previously discussed in Maine Medicine Weekly Update.  The first financial benefits of the plan for primary care physicians will be effective July 1, 2005 based upon the 2004 program of the Pathways to Excellence group.  In July of 2006, Anthem will participate in an Anthem-East pay for performance program which will be based upon performance in 2005.  In response to a question, Dr. Holmstrom stated that any pay for performance initiative for specialists was still a ways off, largely because of the difficulty with getting well-established criteria to measure, specialty by specialty.

The Committee meets next on Wednesday evening, April 27.  MMA members or office staff wishing to participate in the Payor Liaison Committee should contact Chandra Leister at MMA (622-3374 or cleister@mainemed.com) who staffs the committee. [return to top]

Last Chance for HIPAA Security Programs-Wed. in Bangor; Friday in Auburn
MMA and the Maine Primary Care Association host the final two sessions of the HIPAA Security programs this week on Wednesday, March 2 in Bangor and on Friday, March 4 in Auburn.  The programs are from 8:30am to noon on both days and feature four presentations on HIPAA security and privacy.  The HIPAA security regulations take effect on April 21, 2005 and mandate that physicians protect confidential information maintained, stored, sent or received in electronic format, including e-mail and other internet transmissions.  These programs are designed specifically to get your practice into compliance with the security rule, and to revisit the privacy requirements now that the privacy rule is going into its third year.

The one-half day sessions feature presentations and materials from Sari Greene, Bryan Michaud,  Gordon Smith and John Kelley.

The program fee is $75 for members.  Call Chandra Leister at MMA at 622-3374 or via e-mail to cleister@mainemed.com to register.

The Bangor program is at the Spectacular Event Center and the Auburn program is at the Hilton Garden Inn. [return to top]

Fourteenth Annual Physician Survival Seminars Coming May 18 in So. Portland and June 8 in Bangor
MMA's popular Physician Survival Seminars continue this year with two full-day programs in So. Portland and Bangor.  The So. Portland location is the Sheraton Hotel and the Bangor location is the Spectacular Event Center.  The format will continue with plenary sessions in the am and a choice of break out sessions in the afternoon.  Topics this year include Pay for Performance, Quality Improvement in the office setting, and afternoon tracks on technology, compliance and practice management.

Registration materials were included with the Jan./Feb. issue of Maine Medicine.  If you did not receive yours or need another, check in with Chandra Leister at 622-3374 or via e-mail to cleister@mainemed.com.

These once-per-year programs are a chance to receive in one setting what practices need to know for the year.  Updates from MaineCare, Medicare and Dirigo Health will also be presented in the morning sessions.

MMA gratefully acknowledges the support of the following sponsors of the programs:

  • Boise/Officemax
  • HRH Northern New England
  • Integrity LLC
  • Medical Mutual Insurance Company of Maine
  • Network Systems, Inc.
  • Northern Data Systems, Inc.
  • The Coding Center
  • The Thomas Agency
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Medical Liability Reform Action in Several States
The national medical liability reform debate has resulted in recent action in Arizona, Georgia, and Missouri.

On February 22, 2005, the Arizona Senate passed S.B. 1036, a bill that contains positive procedural reforms as well as the physician apology provision contained in the MMA's proposal.

On February 17, 2005, Georgia Governor Sonny Perdue (R) signed S.B. 3, a bill that establishes a limit on non-economic damages in medical malpractice cases of $350,000 or $1.05 million in multi-defendant cases.  The bill also raises the malpractice standard against emergency rooms and emergency physicians to "gross negligence," eliminates joint and several liability, and includes the physician apology provision.

Also, on February 17, 2005, the Missouri House passed H.B. 393, a bill that would amend the venue rules, eliminate joint and several liability, lower the cap on non-economic damages to $250,000, and establish new limits on punitive damages.  The bill also would amend the definition of health care provider to include drug manufacturers thereby bringing them under the protections of the state's medical liability laws.  The Senate leadership and the Governor have committed to enacting medical liability reform legislation.

All three of these states have a strong Republican presence in the elected leadership.  In Georgia and Missouri, both houses of the legislature and the Governor's office are held by Republicans.  While Arizona has a Democratic Governor, the legislature is controlled by the Republicans. [return to top]

March 9 Review Meeting on Medicare Practice Expense Geographic Adjustment Data; Input Needed
Maine, once again, has an opportunity to impact the national scene when MMA hosts a meeting on the Medicare Physician Practice Expense GPCI  next Wednesday, March 9th at the Association offices in Manchester, Maine.  The meeting will be held from 9:00am to 4:00pm and will consist of presentations to representatives from the Urban Institute and RTI International who have a contract with CMS to review the practice expense data as required in the Medicare Modernization Act.

After the announcement in last week's newsletter, several practices have agreed to share practice expense data on such items as medical supplies, rent, staffing costs and transportation.  We still need one or more surgical practices, however, and any other practice with good data is welcome.  Contact Gordon Smith at MMA if you are interested in making a brief presentation on the data from your practice.  Gordon can be reached at 622-3374 or via e-mail to gsmith@mainemed.com

As noted in the announcement on the meeting last week, the goal of the meeting is to assess current data sources and discuss alternative data sources.  Only two meetings of this type have been scheduled nationally, with an earlier session having taken place in Iowa in December.  The MMA participates in the Geographic Equity in Medicare (GEM)Coalition which seeks to increase Medicare reimbursement to rural areas, by demonstrating that practice expenses in rural areas are not markedly different from expenses in urban areas.  This meeting gives rural areas an important opportunity to make their case.

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Coding Center Offers "Coding Necessities" March 29 in Portland
The Coding Center is presenting a new full-day seminar entitled, "Coding Necessities" on Tuesday, March 29 at Keeley's in Portland.  The seminar features nationally known presenter Nancy Reading, RN, BS who is CEO of CedarEdge Medical Coding and Reimbursement. 

Topics include:

  • Anatomy of Coding
  • Medical Necessity & ICD 9 Coding
  • Coding for Midlevels
  • Strategies for Charge Capture

Registration for the program, including lunch and all materials is $140 for an MMA member or staff.  Contact Kathalene LaCroix at MMA for further information or for registration materials.  She can be reached at 622-3374 or via e-mail to klacroix@mainemed.com [return to top]

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