February 6, 2006

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Congress Enacts Deficit Reduction Act; Medicare Payment Reduction to be Restored
As hoped, Congress enacted the Budget Reconciliation Bill on Feb. 1, meaning that the Medicare payment reduction of 4.4% for physicians will be restored. CMS has stated that the payments will be restored retroactive to Jan. 1, 2006 and that it will not be necessary to re-submit claims to receive the differential amount.
The bill passed 216 to 214 which rivaled the Senate passage of the bill which required Vice-President Cheney to break a 50-50 tie.  Most democrats opposed the bill because of the inclusion of cuts to Medicaid and student loans.

In other Medicare payment news, the Medicare Payment Advisory Commission voted last month to recommend a 2.8% increase in doctors' payments next year in place of the next 4.6% reduction anticipated under current law.  Unfortunately, the Budget Reconciliation bill provides only a one-year fix to the continuing problem with the payment formula based upon the Sustainable Growth Rate (SGR).  The AMA and national medical specialty societies will, once again, by pre-occupied with fixing the formula prior to Jan. 1, 2007.

Congress is not required to accept the recommendations of MedPAC.  In fact, since 2003, Congress has pretty much taken its own path.  In March, 2001, MedPAC first urged lawmakers to scrap the SGR formula and has made recommendations for an update each year.  But while MedPAC has recommended increases totaling nearly 13% since 2002, Congress has increased payments only 0.1% since that time.  The freeze this year at the 2005 level is more of the same.

BOTTOM LINE:  While the AMA and all other organizations involved are to be congratulated for eliminating the proposed reduction of 4.4%, a freeze is still a cut when one considers the increasing expense of running a practice.

The Coding Center's Coding Tip of the Week
Use ofModifier 58: Staged or Related Procedure or Service by the Same Provider During the Postoperative Period--Modifier 58 can be used when a second surgery is performed in the postoperative period of another surgery when the subsequent procedure was done for any of these reasons:

  • planned prospectively or “staged” at the time of the original procedure
  • more extensive than the original procedure
  • for therapy after a diagnostic surgical procedure
  • for the reapplication of the cast within the 90-day global period

Example:Removal of a breast lesion (CPT 19120) followed by the removal of the entire breast (CPT 19240), within the 90-day global period. Report CPT 19240-58 for the second procedure.Remember, a new postoperative period begins when the second procedure in the series is billed.

Questions? Call the Coding Center: 1-888-889-6597 [return to top]

MECMS (MaineCare) Update; From MaineCare Providers' Advisory Group
The Governor's MaineCare Providers' Advisory Group met on Thursday, Feb. 2 and heard reports on the current status of the MECMS system.  Highlights from the meeting are as follows:

  • Total fresh claims submitted, for the last three weeks, have been more than 170,000 in total which is a higher than normal volume.
  • Suspended claims are at 258,694 which is trending up largely because of the higher volume.
  • Largest error codes for suspended claims relate to prior authorization and suspect duplicate as opposed to exact duplicate.
  • Weekly metrics sheet shows for the week ending 1/29/06 63.14% of claims paid, 22.33% denied and 14.52% suspended.
  • Of total interim payments made ($466,102,315), $11,453,685 has been recouped.

Payment on the Part B cross-over claims (which have only been paid when submitted on paper), is on track to a mid-March delivery date which should translate into payments sometime in April for physicians who have been waiting for electronic payment.

The Committee agreed on the need to continue bi-weekly meetings.  Deputy Commissioner  Mike Hall briefed attendees on the search for a Communications Director.  In the meantime, an interim Communications Director has been named.  It is hoped that more consistency can be applied to the list serve messages.

The results from the Provider Survey conducted in the fall will be released shortly.

The most negative part of the meeting was the discussion of the current status of the provider relations staff.  One person has recently resigned and another two persons are out on leave.  Therefor, what appeared to be a full-team just weeks ago now is significantly under-resourced at a time of great need.

Many providers at the meeting described their billing staff personnel as moving from "anger to despair." Complaints were also made about providers not being willing to see MaineCare patients.  All attendees, OMS staff and providers alike, agreed that there are still several months of hard work ahead before the system stabilizes and a new permanent management team is hired and put in place.

The Cmmittee will meet next on Thursday, Feb. 16. [return to top]

MeMGMA Presents Annual Third Party Payer Seminars, February 8, 9
Wednesday February 8, 2006: Ramada Conference Center, 490 Pleasant Street, Lewiston, Maine
Thursday February 9, 2006:  Jeff’s Catering, 5 Coffin Avenue, Brewer, Maine


Registration for both seminars begins at 8:30 AM - continental breakfast will be served.
Sessions begin at 9 AM
A full Buffet lunch is included with the registration.
The final speakers will conclude by approximately 4 PM
(Speakers from each insurance company may be presenting at different times each day, so an exact schedule is not available).


Provider Representatives from the major payers will be speaking at this seminar and providing updates as to the status of claims processing.  We expect representatives from the following companies to attend:

    **  Brewer only

Participants will have the opportunity to ask questions concerning reimbursement issues affecting physician practices in general, but should not expect specific answers to questions concerning individual account situations. 

The cost for this seminar is only $40 either day for any MeMGMA member or $50 per person for non-members.


If you have any questions concerning this seminar, or for late registration, please contact Peter Allen at 1-800-640-0545 [return to top]

Maine Quality Forum Advisory Committee to Meet on Friday, Feb. 10, 2006
The Maine Quality Forum Advisory Committee, established in the Dirigo Health legislation, will hold its regular monthly meeting this Friday, Feb. 10.   The Committee meets at the Dirigo Health offices on Water St. in Augusta, usually the 2nd Friday of each month.

The Committtee will meet from 9:00am to noon with the Performance Indicators Subcommittee scheduled to meet for two hours following the meeting.

Included on the agenda are a Dirigo update, a review of CON laws and processes by Cathy Cobb and Denise Osgood of HHS,  input on several CON applications (York Hospital, CMMC, and Maine General, among others) and a review of a draft paper on quality in cardiac care.

Maine Quality Forum Director Dennis Shubert will report on the progress to date on the Practice Assessment project currently being prepared by MMA and MOA. [return to top]

Annual Practice Education Seminar to be Held in Bangor, Wednesday, June 21
MMA will hold just one of the popular Physician Survival Seminars this year, with the presentation being in Bangor at the Spectacular Event Center on Wednesday, June 21.  Plenary  sessions will be held in the morning with three tracks of breakout sessions in the afternoon.  Watch for registration materials in the March-April issue of Maine Medicine or call the MMA office at 622-3374 (Press 0) to reserve your place.

Topics will include improving quality in the office setting, Pay for Performance, Medicare, MaineCare, Medicare Part D and a host of other practice related-issues.  Andrew MacLean, the Association's Deputy Executive Vice-President and General Counsel will present his yearly legislative update.

Please save the date and watch for more detailed information forthcoming.  A flyer will be sent to each past attendee within the next month.

The annual practice education seminars present a singular and unique opportunity for MMA to share,in one day, the most significant and practical information practice managers and physicians need to have to operate a productive and efficient medical practice in Maine today. [return to top]

Ad Hoc Committee on Health System Reform, Subcommittee on Employer Mandates to Meet Feb. 22
A subcommittee of MMA's ad hoc Committee on Health System Reform will meet on Wednesday evening, Feb. 22, at 6:00pm at the MMA offices in Manchester to discuss the pros and cons of adding an employer-mandate to provide health insurance to employees to the Association's White Paper on Health System Reform which was first released in May, 2003.

Representatives of the Maine Merchants Association and the Maine Chapter of the National Federation of Independent Businesses are expected to be present at the meeting to discuss their opposition to such a mandate.

Any MMA member is welcome to participate in this discussion, but do give Charyl Smith (207-622-3374 x211) a call if you are planning to come so that we can have anough food.  Dinner will be available.

MMA President Jacob Gerritsen chairs the ad hoc Committee. [return to top]

Updated "First Fridays" CME Programs
Watch next week's Maine Medicine for a flyer with the updated list of the First Fridays CME programs which occur at the MMA offices in Manchester the first Friday of each month from 9:00am to noon.  The next program is for women physicians only and will be held on March 3rd.  It is a highly interactive session focusing on the power of aligning personal and professional goals and priorities with one's vision and values.  It will be presented by Harriet Nezer, PhD, of Metamorphosis Consulting of Boston.

The April program will be held the second Friday of the month, April 14th, and will consist of a HIPAA update, prepared especially for new staff.  If your office has hired staff in the past few months and not done HIPAA training for them, this program is your chance to take care of it through some of the most knowledgeable HIPAA experts in the state.

The May 5 program will be an expanded four hour program (9:00am to 1:00pm) focusing on using physician specific data to improve the quality of medical practice.  Representatives from the Maine Quality Forum, The Maine Health Data Organization and Pathways to Excellence will be presenting, as well as MMA EVP Gordon Smith who will discuss the new anticipated collaborative practice assessment program with the Maine Quality Forum and MMA's office-based quality improvement program.

You may reserve your place for any of these programs by calling the MMA office at 622-3374 (press 0).  The year's listing of programs is also on the MMA website at  www.mainemed.com

  [return to top]

Maine Health Information Technology Summit - Feb 28, 2006

Health Information Technology Summit
Tuesday, February 28, 2006
8:30 - 12:00
Augusta Civic Center

You are invited to attend a winter Health Information Technology Summit with Governor John Baldacci offering the keynote address and Karen Bell, MD, MMS, from the Office of the National Coordinator for Health Information Technology as the featured speaker.  Dr. Bell will address the group on Federal Health Care IT Initiatives.

The program will also include a panel from the Maine Health Information Technology (MHINT) project ( www.mhint.org) will discuss the progress and direction of Maine’s statewide inter-operability effort.  A second expert panel will discuss the opportunities and challenges for health IT in Maine.

Attached is an announcement and a registration form.  There is no charge for this event but seating is limited.

If you have any questions, please contact the Maine Primary Care Association (207) 621-0677 or the New England Council (617) 723-4009.
[return to top]

Health Security Board releases final report
The Health Care System and Health Security Board released its final report last week. The report is available at http://www.maine.gov/legis/opla/HSBfinalreport.pdf.


The board was originally formed by the Legislature to explore the feasibility of a single-payer health system in Maine.  When Dirigo was formed, the landscape changed and so the board’s work was extended.


The board concluded:


·         Universal coverage remains the Health Security Board’s highest priority—every man, woman and child living in Maine must have health care coverage.


·         While a single-payer health plan seems feasible, implementation of a single-payer health plan at this time is unlikely.


·         The Health Security Board, with the exception of one member, supports the State’s efforts to achieve universal coverage through the operation of the Dirigo Health Program and the expansion of the MaineCare program, but believes the current timeline toward universal coverage must be accelerated so that all of the uninsured in Maine have coverage by 2009.


·         The State’s policymakers and the Legislature should consider additional mechanisms to expand access to health care coverage for Maine residents including, but not limited to, expanding eligibility and participation in the DirigoChoice program and exploring regional partnerships to purchase health care coverage. [return to top]

DHHS Issues One-Month Progress Report on Medicare Part D Benefit
On February 1, 2006, HHS Secretary Mike Leavitt released a one-month progress report on the Medicare Prescription Drug Benefit that takes a hard look at what is working and what needs to improve.  The report details action steps HHS and health plans are taking, such as extending transition coverage for a beneficiary's current drugs to 90 days and reducing call wait times.  The report also includes new estimates showing the costs of the Medicare drug benefit are significantly less than expected.

"While the new prescription drug benefit has worked for the vast majority of participants, the first trip to the pharmacy has been frustrating for some, particularly for certain people with Medicare and Medicaid.  We make no excuses.  These are our problems to solve and this report shows that we are making progress," Secretary Leavitt said.

"We are working around the clock to help everyone use their coverage," said Dr. Mark McClellan, CMS Administrator.  "As we improve our data exchanges with plans, provide new support for pharmacists, work with states, and help beneficiaries who call 1-800-MEDICARE resolve any problems, many more beneficiaries are using their new coverage every day."

Secretary Leavitt announced that Medicare will notify plans that the 30-day transitional coverage period in effect will continue for 60 more days - in effect, this means that plans will provide up to 90 days of coverage for a beneficiary's current drugs. This provides more time for beneficiaries to find out if they can save by using other drugs that work in a very similar way and cost significantly less.  This action reinforces steps already taken by many plans, like extending their transitional coverage, to help assure a smooth transition for beneficiaries.

Leavitt noted that call wait times for pharmacists and customers had been "unacceptable," and announced efforts to get them significantly reduced.  The call-wait time for 1-800-MEDICARE has been around 5 minutes since the beginning of January, and, at the end of the month, the time was even shorter (less than a minute).  While most plans have also taken steps to reduce wait times for customers and pharmacists to acceptable levels, HHS will increase its monitoring and reporting of drug plan wait times and will take corrective actions in the specific cases where plans do not improve. 

The progress report also highlights new information about significant savings for taxpayers.  The Secretary notes that the latest estimates show that the costs of the Medicare prescription drug benefit are significantly less than expected.  Examples include:

· Latest estimates project premiums of $25 a month - about a third less than previously estimated.

· The federal government is now projected to spend about 20 percent less per person in 2006 and, over the next five years, payments are projected to be more than 10 percent lower than first estimated.

The savings result from lower expected costs per beneficiary; projected enrollment in the drug benefit has not changed significantly.

At the report's conclusion, the Secretary outlines action steps that Medicare is taking, including:

· Making sure drug plans have up-to-date information on all their dual eligible beneficiaries;

· Improving the "data translation" between Medicare, health plans, and states;

· Calling 1-800-MEDICARE means virtually no wait time;

· Monitoring and reporting call wait times for drug plans;

· Assuring plans meet contractual payment terms for pharmacies;

· Extending transition coverage for a beneficiary's current drugs to 90 days;

· Working with the states to assure a backup system is no longer needed;

· Establishing a reimbursement plan for the states and if needed, providing a temporary extension to state reimbursement plan; and

· Continuing the process of problem-solving and improvement -- guided by the lessons we've learned

The Secretary added, "The measure of our success should not be that we have no unexpected problems at the outset but rather that we find, fix and finish with these problems quickly so that all seniors have access to coverage that saves them money, keeps them healthier and gives them peace of mind."

 A copy of the full report is available at <http://www.hhs.gov/secretaryspage.html>. [return to top]

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