August 29, 2005

 
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More on MaineCare MECMS Problem
Department of Health and Human Services Officials presented information to the Legislature's Joint Standing Committee on Appropriations and Financial Affairs on Thursday. While officials stated that MECMS "has shown a trend toward more consistent claims processing in recent weeks'" actual data from the Provider Advisory Committee meeting that morning showed continuing problems, with the system paying less than one-half of the claims submitted and with nearly 400,000 claims still in suspension.
MMA was shocked to hear that the Part B cross-over claims may not be paid until February, as we were previously told that every effort would be made to get to them by Fall.

"While we appreciate the effort that Commissioner Nicholas and Deputy Commissioner Hall are putting into this, it is obvious to all affected that the system is not improving fast enough to avoid a disaster," noted MMA EVP Gordon Smith in press interviews following the Appropriations Committee meeting.  "Each meeting of the Provider Advisory Committee brings new revelations about the length of time and complexities involved in fixing the problem.  MaineCare providers, some of whom have not been paid since last November, deserve to know that every possible effort is being made to fix the system sooner as opposed to later.  It appears to us that not enough resources are being brought to bear on the problem," noted Smith.

Among the continuing problems discussed at the Provider Advisory Committee meeting Thursday morning were the following:

  • The delays in the IVR system which providers must rely upon to verify eligibility.
  • The 5 question limit when providers are able to get through on the provider inquiry line.
  • The current vacancies in the Provider Relations staff.
  • Status of the Interim Payment Report (were promised weeks ago)
  • Issues with missing RA's (the RA listing report has also been promised previously.)

The Department is in danger of losing credibility with MaineCare providers of all types.  As Winston Churchill once said, "It is not enough to do the best we can.  At some point, we have to get the job done."

The Provider Advisory Committee will meet again on Sept. 8 at 10:00am at the DHHS office on Civic Center Drive In Augusta.  MMA will keep members abreast of the information coming from these meetings thorough Maine Medicine Weekly Update.

Commissioner Jack Nicholas and Deputy Commission John Michael Hall will present a MaineCare Update for MMA members and guests at the upcoming Annual Session.  The update will be at 8:30am on Saturday morning, Sept. 10, just prior to the opening of the "Town-Meeting" style General Membership Meeting at the Bar Harbor Club in Bar Harbor.  All MMA members and their staffs are welcome to attend.  There is no charge for attending just the membership meeting on Saturday morning.  Governor Baldacci will conclude the business meeting with a presentation at 11:30am.

Not To Late to Register for MMA Annual Session, Sept. 9-11 in Bar Harbor
There are still a handful of rooms available for those MMA members or guests wishing to register for the Association's 152nd Annual Session, to be held Sept. 9-11, 2005 at the Harborside Hotel and Marina in downtown Bar Harbor.  Guests will include Governor Baldacci, Congressman Mike Michaud and DHHS Commissioner Jack Nicholas and Deputy Commissioner John Michael Hall.

At the Saturday morning general membership meeting,  Resolutions will be considered in the areas of professional liability, MaineCare, health planning, cancer screening, auto emission standards, and health literacy (partial listing).  Time has been set aside during the meeting to allow for comment by any MMA member with any concerns that the MMA should be aware of.

As the meeting is only 10 days away, the best way to register would be through the MMA website at www.mainemed.com or call the office at 622-3374.  It may be time this year for you to be an active participant in the MMA Annual Meeting.

In addition to the usual governance activities, the meeting offers 11 hours of CME on the topic of "Emerging Threats in Infectious Disease."  Specialty societies representing urologists, orthopedic surgeons, psychiatrists and anesthesiologists will all be meeting during the session.

We hope to see you in Bar Harbor! [return to top]

First Public Board Member of AMA to Address "Protecting the Public/Restoring the Professional" Sept. 8 in Bar Harbor
MMA is pleased to announce the addition of a luncheon speaker at the important conference taking place in Bar Harbor on Sept. 8th on the subject of  impairment of professionals and the public responsibility of licensing boards regarding such.  The meeting, to be held at the Harborside Hotel and Marina in Bar Harbor, will be held on the Thursday preceding MMA's Annual Session.

Mr. Robert McMillan, Esq.,  the first public member of the AMA Board of Trustees, will attend the conference and discuss his perspective on the topic of the conference at a noontime luncheon. 

Mr. McMillan, of counsel in the law firm of Bee Ready Fishbein Hatter & Donovan, LLP., in Mineola, N.Y., was elected on June 15, 2002 to the AMA Board of Trustees as its first public member.  He currently chairs the Board's Audit Committee and is a candidate for re-appointment in 2006.

A regular presence in the media, Mr. McMillan currently co-hosts, "Face-Off," a weekly PBS television program seen throughout the New York City area.  Among his accomplishments, Mr. McMillan was appointed by President George H.W. Bush to the Panama Canal Commission in 1989 and subsequently became Chairman of the Commission.  In 1988, Mr. McMillan was the Republican nominee for the United States Senate in New York State.

Interested person may still register for the conference by calling MMA at 622-3374. The registration fee is only $50 which includes breakfast, lunch and all course materials.  Seven hours of CME are available at the conference. [return to top]

Register Now for Sept. 2 CME Program on "Minors' Healthcare; RIghts, Responsibilities and Consent
MMA begins its new series of educational seminars entitled "First Fridays" with a program on minors' healthcare on this Friday, Sept. 2nd from 9:00am to noon at the MMA office in Manchester.  Three hours of CME are available and the cost is a very reasonable $60 which includes a light breakfast and all course materials.

Faculty for the Friday program include Kenneth Lehman, Esq, Gordon Smith, Esq., and Andrew MacLean, Esq.  The program is co-sponsored by the Maine Chapter of the American Academy of Pediatrics.  Topics include consent to care, confidentiality, compelled treatment, parental rights, financial responsibility, reporting obligations and emergency treatment.

If your office treats minors in Maine, this is a conference you won't want to miss.  Capacity is 40 persons but there are still a few spots left.  Call Chandra Leister today at 622-3374 or via e-mail to cleister@mainemed.com if you want to reserve a slot.  We hope to see some of you on Friday.

First Fridays will be presented the first Friday of each month at MMA and is intended to present CME programs for the benefit of physicians and office staff on a series of topics that come up in everyday medical practice.  Remaining topics for the rest of the year are, "Preventing Prescription Drug Abuse," (Oct. 7), "The Medicare Modernization Act - What Every Practice Needs to Know" (Nov. 4) and "Best of the 2005 Physician Survival Seminar "(Dec. 2).  The Dec. 2nd program includes segments on managing the unruly patient (Mike Duddy, Esq), managing the angry physician (Margaret Palmer, Phd.) and an Update on Employment Law (John Gleason, Esq.).

To register for any of the First Friday Programs, contact Chandra Leister at 622-3374 or via e-mail to cleister@mainemed.com. [return to top]

Governor’s Health Office to Hold “Health Care Listening Tour”

(Augusta) – Governor Baldacci’s Office of Health Policy and Finance (GOHPF) will hold what it is calling the “Health Care Listening Tour” – a series of regional public forums to hear from Maine people how they think health care should work in Maine. These forums are part of a strategic effort to engage the people of Maine in developing the State Health Plan – a roadmap to make Maine the healthiest state.

The State Health Plan is a key component of Dirigo Health Reform. It assesses the cost and quality of health care and access to services as well as the health of Maine people. The State Health Plan sets goals for improving health and health care and identifies ways to meet those goals; with all efforts working to make Maine the healthiest state. The Plan is issued every two years.

“The State Health Plan is for the people of Maine; it must reflect their needs and priorities,” said Trish Riley, Director of GOHPF. “Input from all Maine people across the state is absolutely vital. These forums will help ensure the Plan reflects the diverse needs and resources of our health care system.”

The public forums will be held according to the following schedule:

  • September 8, 2005 – Brewer, 9:30 a.m. to 11:30 a.m., Jeff's Catering, 5 Coffin Avenue
  • September 8thPresque Isle, 5:00 p.m. to 7:00 p.m., University of Maine at Presque Isle, Campus Center, Allagash Room
  • September 9thCalais, 11:00 a.m. to 1:00 p.m., Calais Motor Inn, Banquet Center, 203 Main Street
  • September 12thLewiston, 11:00a.m. to 1:00 p.m., University of Southern Maine/Lewiston-Auburn College, Room 170 (ABC), 51 Westminster Street
  • September 12thAugusta, 5:00 p.m. to 7:00 p.m., Augusta Civic Center, Piscataquis/Sagadahoc rooms (2nd floor)
  • September 15thPortland, 8:00 a.m. to 10:00 a.m., University of Sourthen Maine, Hannaford Hall/Abromson Community Education Center
  • September 15thSaco, 3:00 p.m. to 5:00 p.m., Holiday Inn Express Hotel and Suites, Conference Center, 352 North St.

This public engagement effort began with the Tough Choices in Health Care meeting held in May and will help ensure all Maine people can provide direct input into shaping the State Health Plan. The Advisory Council on Health Systems Development is advising the Governor’s Office in developing the State Health Plan and will participate in these forums.

Anyone needing special accommodations should contact the Governor’s Office of Health Policy and Finance so that arrangements can be made. Only those needing special accommodations should contact the Office. Please contact the Office by August 31st and indicate which forum you plan to attend. Please call 624-7442, TTY: 287-6548, or e-mail GOHPF@maine.gov. [return to top]

AAPC –Approved Professional Medical Coding Course to be Held

The Coding Center, sponsored by the VMS, the N.H. Medical Society, and the Maine Medical Association, is sponsoring a 15-week coding course, which began August 25. Classes will be held on Thursdays at St. Mary’s Regional Medical Center, Lewiston, M.E., from 3 p.m. to 7 p.m. Instructors are Laurie Desjardins, CPC, CCS-P, and Jana Purrell, CPC. The program includes a one-year membership In the AAPC, student workbooks, the CPC exam, and group discussion and networking opportunities. Cost is $1,500 inclusive. For more information, call 207-622-3374. It is not too late to enroll. [return to top]

November 17 Is Deadline For Filing Claims on Anthem/Wellpoint Settlement
November 17 is the deadline for physicians to claim their share of the $135 million cash settlement under the Anthem/Wellpoint settlement. Even physicians who did not treat Anthem/Wellpoint patients are eligible for a pro rata share of the fund. To be eligible, a physician needs only to have provided covered services to any patients covered by any of the defendants in the case: CIGNA, Aetna, Anthem, Coventry, Health Net, Humana, Pacificare, Prudential, United Healthcare, and Wellpoint.

For claim filing instructions and a claim form, visit HMOSettlements [return to top]

REMINDER: Congressman Allen Fundraiser in Portland This Week
The MMA's Political Action Committee, the Maine Physicians Action Fund, joins the Maine Hospital Association, the Maine Osteopathic Association, the Maine Health Care Association, Anthem Blue Cross and Blue Shield, and the American Hospital Association in sponsoring a fundraising event for Maine's First District Congressman Tom Allen (D).  The event will be held from 6 to 8 p.m. on Wednesday, August 31, 2005 at the Regency Hotel in Portland.  The suggested donation is $100 per individual or $1000 per PAC. 

You can call Congressman Allen's campaign office at 774-9696 or email at rsvp@tomallen.org, if you would like to be placed on the guest list.  Andrew MacLean, MMA Vice President & General Counsel will attend the event.

Congressman Allen is a co-sponsor of H.R. 2356, the Preserving Patient Access to Physician Act, the AMA-backed legislation to fix the Medicare payment problem, the sustainable growth rate (SGR). [return to top]

DHHS Updates Hospital Free Care Guidelines
The DHHS, Office of MaineCare Services recently has adopted Rule Chapter 150, Free Care Guidelines.  The revised rule updates the poverty guidelines to dollar amounts for 2005.  It also makes technical changes that will allow the Department to automatically update Federal Poverty Guidelines each year without additional rulemaking.  You can find the revised rule on the web at:  http://mainegov-images.informe.org/dhhs/bms/rules/downloads/c_150_other_proposed.pdf.  While this rule applies specifically to hospitals, it may be helpful to physician practices as they decide upon a charity care policy. [return to top]

AMGA Survey Shows Modest Physician Income Increases in 2004
On August 10, 2005, the American Medical Group Association released its 2005 Medical Group Compensation & Financial Survey, suggesting that physician compensation was at or just above the rate of inflation in 2004.  Practices in the northern and eastern U.S., however, operated at a loss on average.  Primary care specialties has increases of 6 - 8.8% after several years of losses or minimal increases.  The 3 specialties receiving the largest compensation increases in 2004 were general surgery (8.89%), pediatrics and adolescent medicine (8.76%), and hematology and oncology (8.52%).

The survey was based upon data from 34,500 physicians from around the country and from 105 specialties.  The survey is available for $195 for AMGA members and for $395 for non-members.  See www.amga.org. [return to top]

Contingency Period for Non-HIPAA Compliant Medicare Claims Ending Soon
Beginning October 1, the Centers for Medicare & Medicaid Services (CMS) will no longer process incoming electronic Medicare payment claims that are not compliant with the Health Insurance Portability and Accountability Act (HIPAA). All non-compliant claims will be returned to the filer for resubmission. As of June, only about 0.5 percent of Medicare fee-for-service providers submitted non-HIPAA-compliant electronic claims. As of May, the highest rate of non-compliant claims were from clinical laboratories, at 1.72 percent. Only 1.45 percent of claims from hospitals were non-compliant and 0.45 percent of claims from physicians.  For more information, visit the CMS website. [return to top]

MMA Welcomes Maxim Health Systems, New Corporate Affiliate

Maxim Health Systems, a division of Maxim Healthcare Services, is proud to be a new sponsor of the Maine Medical Association through its corporate affiliate program. Maxim offers a broad range of immunization, home health care and supplemental staffing services to individuals and organizations across the nation. Established in 1988, Maxim has excelled rapidly in its industry through building solid relationships with its clients and placing a strong emphasis on customer service and uncompromised care.

As a community driven organization, Maxim is committed to creating safe and convenient access to flu and pneumonia vaccine across the country and throughout Maine. Since 1996, Maxim Health Systems has been building relationships with physician practices who find flu vaccine administration cumbersome and distracting to normal office operations. As a result, it has developed effective strategies that creatively provide your patients access to flu and pneumonia vaccine while easing the burdens and costs of vaccine administration and waste to your practice.

For more information about Maxim's flu vaccine administration programs or about their other services please visit www.findaflushot.com or contact Frank Mastrella at 617 558 0395 or at frmastre@maxhealth.com. [return to top]

Aetna to Share Physician's Discounted Rates with Consumers

Aetna insurance company has announced a new program that will enable consumers to find out the actual discounted rate charged by their primary care or specialist physician for up to 25 of the most common office-based services. The pilot program will cover about 600 distinct procedures provided by 5,000 individual physicians and physician groups in Ohio, Kentucky and Indiana. Rates for office visits, diagnostic tests and minor procedures will be available so that consumers can better gauge their out-of-pocket health care expenses. The program was developed with physician input and will be refined before it is introduced in other markets. For more information:
[return to top]

CMS Issues New HIPAA Security Rule Advice

The Centers for Medicare and Medicaid Services (CMS) has released the sixth of seven educational papers on the security rules under the Health Insurance Portability and Accountability Act (HIPAA). The paper covers risk analysis and management, and reviews pertinent security rule implementation specifications, as well as the general steps involved in conducting a risk assessment. To access all six educational papers:
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For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association