February 20, 2006

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MaineCare MECMS Update
At the Governor's Provider Advisory Committee meeting on Feb.16, MaineCare officials acknowledged new problems with the processing of Part A cross-over payments which are expected to cause further delays in the processing of the Part B cross-over payments. Given that these payments have not been processing electronically for over 13 months, this further delay may be the proverbial straw that breaks the camel's back. Until this delay, the cross-over claims had been expected to be paid in April, with the system being re-tooled in March to be able to make the payments.
All in all, the news presented at the meeting was disappointing, with a delay in the adjustments functionality announced and the claim portal access having been shut down temporarily on Feb. 10.  The claim portal is again functioning, and the changes made during the shutdown should produce more reliable production of results files.

If there was any good news, it was in the weekly metrics which showed that for the week ending Feb. 12, over 90% of the new claims were processed through the system, with 74.12% paid and 16.13% denied.  It was the first time that fewer than 10% of claims were put into suspension.  The total suspended claims amount was also down from previous weeks, with 236,707 claims in this category.

A lot of the meeting focused on the return of the interim payments.  The 30 day window for responding to the first round of  recoupment letters expired on Friday, Feb. 17 and the state will begin to recoup from the 26 providers who did not respond.  The Department did try to notify providers again via fax sent on Feb. 15.  In the initial round of recoupments, only 277 letters were sent, with 35% of recipients having accepted a % of recovery (about $16 million) with 26% pending and 33% in research.

Over 500 providers are in the so-called second round, with 26% of these providers having agreed to the % recovery.  Bear in mind that many of these providers are not physician practices, but represent additional categories of providers.  When one considers that physician payments are less than 3% of the MaineCare costs, the interim payment recapture process is likely to fall much more harshly on other providers.

The Committee meets again on March 2 and MMWU readers may expect a full report on Monday, March 6.  At that meeting, MMA intends to press more more information on the non-payment of the primary care case management fees which apparently have not been paid for some time.

In related news, the Legislature's Health and Human Services Committee did recommend  last week to the Appropriations Committee, on a vote of 12-1, that the $4 million in the Governor's supplemental budget for covering some provider expenses associated with the MECMS problem be approved.  MMA will provide further information to members regarding how to apply for these funds when the final budget is approved and the Department issues further guidance.  The legislature is expected to adjourn in early April so we should have solid information by then. 

MMA Website Update

The Maine Medical Association's website, www.mainemed.com, is getting a new look!  On Friday evening, 2/17/06, some of the changes as highlighted below were rolled out.
  • A new look for the home page which allows for more information to be shared on the home page.  
  • New navigation allowing  for quicker access to those pages most frequently visited (still in process).
  • New calendar that shows MMA events, events taking place at MMA, and Specialty Society Meetings.
  • Updated information for contacting the MMA which lists MMA staff and their individual contact information.  (First stage on this)
  • Affiliate Focus area on the home page which will highlight a different corporate affiliate each time someone enters the site or refreshes their screen.
  • Updated Student Loan page which basically takes them to a new site that has just been created which will continue to share the latest options/information.
  • New area "Patient Resources" which currently has a physician finder and the advanced care directives.    
Several other updates to the site are in progress, so you will continue to see additional changes to the site over the next few weeks.   Some of the additional changes include:
  • MMA Committee Listings - This will be under "Members Only" and will have all MMA Committees listed, have committee descriptions, committee members, meeting agendas, and meeting minutes.
  • MMA Staff Listing will be including information on what responsibilities each person has (i.e., committees, specialty groups, CME, etc.)
  • List for areas of assistance so that individuals can find what it is they need help with, and click on the item and it will tell them who at MMA they should contact.
  • Capability to pay MMA Dues online with credit card payments in a totally secure environment.
  • Capability to register for MMA "First Fridays" online with credit card payments in a totally secure environment.
  • Revised Member Registration providing greater security to our members only area so that we keep that area exclusively for members.  

We also hope to have the 2006 edition of The Physician's Guide to Maine Law on the site within the next three months.

We are very excited about updating our site to better serve our members.  Should you have any suggestions, we would appreciate hearing from you.  Check out the site today and email Shirley Goggin at sgoggin@mainemed.com with your ideas. 

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Bush Budget Enhances Funds for HealthCare IT
President Bush's fiscal year 2007 proposed budget calls for a significant increase in funds available to support development of a nationwide health information network.  The increase to $169 million is up from $111 million in the current year.

The majority of the funds would be appropriated to the Office of the National Coordinator for Health Information Technology (ONCHIT), including funds to increase the staff from 30 persons to 38. 

Under the proposal, David Brailer, M.D., the national coordinator for health information technology, would continue current programs to support public and private sector efforts to develop a nationwide, interoperable health information network by the year 2014.  Among the specifics in the proposed budget are the following:

  • advancing the effort toward establishment of an nationwide health information network, intended to protect both the privacy and security of personal health information
  • continuing development of working prototype networks, such as the MHINT project under development in Maine
  • developing personal health record architectures that would allow patients and families to manage their own versions of health records now utilized by physicians
  • developing standards required for health information data portability, and creation of a process to maintain and update such standards
  • developing a certification process for health IT hardware and software, specifically criteria for inpatient and ambulatory patient electronic medical records, as well as certification criteria for the planned network architecture; and
  • evaluating variations in state law and organizational business policies vis-a-vis the health data privacy and security requirements of HIPAA.

The proposal also asks the ONCHIT to advance the use of healthcare IT to further the cause of patient safety and to produce an evaluation of the current state of EHR adoption by physicians.











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AMA's Updated FAQs on Medicare Physician Payment Issue
As expected, the U.S. House of Representatives has approved legislation to halt the 4.4% Medicare physician pay cut that went into effect on January 1, 2006.  President Bush signed the bill on February 8, 2006.  This situation has generated a number of physician billing questions.  Decisions on certain issues are not yet clear.  In the interim, however, AMA staff after consultation with Medicare staff and medical specialties have attempted to answer some of the most frequently asked questions.

You may review the updated AMA Q&A document on the web at:  http://www.ama-assn.org/ama1/pub/upload/mm/-1/medicare06qanda.pdf. [return to top]

NCQA/AHA/ASA Heart/Stroke Recognition Program Announcement
To provide physicians with tools to support the delivery and recognition of consistent, high quality care, the National Committee for Quality Assurance (NCQA) and the American Heart Association/American Stroke Association (AHA/ASA) have developed the Heart/Stroke Recognition Program.  It is a voluntary program developed to help physicians use evidence-based measures and provide excellent care to patients with cardiovascular diseases.  Achieving recognition through the Heart/Stroke Recognition Program sets you apart from others - it demonstrates to your patients that you are giving them the best care possible.  In turn, you earn increased respect from your peers and patients, and distinguish yourself as a leader in your community.  Increasingly, physicians who earn NCQA/AHA/ASA Recognition are rewarded financially.    By knowing you are providing excellent care, you are free to spend more time building satisfying relationships with your patients and building a healthy practice for years to come.  The program is open to individual physicians or small or large practices and not exclusively to cardiologists or neurologists - to primary care physicians as well.  For more information, please contact Dennise Whitley, MHA, Director of State Health Alliances and Advocacy, Northeast Affiliate, American Heart Association.  You may reach Dennise by phone at 207-523-3007 or by email at Dennise.Whitley@heart.org. [return to top]

Payor Liaison Committee Hears Update on CIGNA Care Network
On Thursday, February 16, 2005, the MMA's Payor Liaison Committee met with Richard "Skip" White, CIGNA's General Manager for Maine, who provided an update on implementation of the CIGNA Care Network, a more limited network of physicians in 21 specialties who meet certain quality and efficiency criteria.  This new network became available to self-insured groups in Maine and 15 other markets on January 1, 2006 and CIGNA expects to make it available nationwide on January 1, 2007.  Selection for the CIGNA Care Network is based upon 4 factors:

  • Board certification;
  • NCQA recognition;
  • an "efficiency index;" and
  • use of evidence-based medicine based upon claims review.

In Maine, patients who choose physicians from the CIGNA Care Network pay a $10 lower co-payment than they would from the broader network.  You can read CIGNA's overview of the new network on the web at:  https://secure.cigna.com/health/provider/medical/CIGNACare.html.

Committee members discussed their experiences with the new network selection process and challenged Mr. White primarily about the last two selection criteria.  For example, physicians expressed concern that the "efficiency index" penalizes physicians who work in higher-cost hospitals.  Mr. White replied that CIGNA was counting on the physicians to have an influence on those higher-cost facilities to lower their costs.  Mr. White also mentioned that managed care is moving from a failed restrictive model to a consumer-based model in which patients are given information and will make choices based on that information that will drive the market.

The Payor Liaison Committee, chaired by Thomas Hayward, M.D., will next meet on Thursday, April 13, 2006 and the guest will be Anthem.  If you have an issue with Anthem that you would like to put on the agenda for this meeting, please email it to Diane McMahon at dmcmahon@mainemed.com. [return to top]

National Task Force Releases Preventative Services Guide
A national Task Force on Community Preventive Services has created the first edition of The Guide to Community Preventive Services: What Works to Promote Health?

The independent task force, which is supported by the Centers for Disease Control and Prevention, has developed recommendations for interventions that promote health and prevent diseases in the nation's communities and health care systems.

The publication addresses the effectiveness, economic efficiency, and feasibility of interventions to combat risky behaviors such as tobacco use among pregnant women and adolescents, physical inactivity, and violence. Social determinants of health such as education, housing, and access to care are also explored on in the guide, which can be read at http://www.thecommunityguide.org [return to top]

New Affiliate Relationship with OfficeMax to Benefit MMA Members
The Maine Medical Association and OfficeMax have recently signed an affiliation agreement which continues the previous relationship with Boise Office Solutions but with better terms.  OfficeMax is the exclusive provider of Boise office supplies in Maine under the restructuring of the company which took place year.  OfficeMax had previously been acquired by Boise but now exists as an independent company specializing in office supplies.

Maine Medical Association members and their practices will receive a 10% discount off the OfficeMax catalog price and will receive free shipping on a next day basis.  OfficeMax will also match competitor's prices in most circumstances.  The MMA contact with the company has changed.  Our new account manager is Nancy Emery who can be reached at 877-633-2629 x5662 or via e-mail to nancyemery@officemax.com.  New catalogs are available quarterly.

Enroll now in this purchasing program and assist both your practice and MMA, which receives a 1% royalty on your purchase.  Non-dues revenue to MMA helps to keep your membership dues as modest as possible.

OfficeMax is one of over seventy-five companies and firms that participate in the MMA Corporate Affiliate Program.  Please consider these corporate affiliates in making your practice purchasing decisions.  [return to top]

The Coding Center's Coding Tip of the Week
Use of Modifier 79: Unrelated Procedure or Service by the Same Provider During the Postoperative Period--Modifier 79 is used for unrelated procedures by the same provider (or provider of the same specialty in the same surgical group) during the postoperative period. Unrelated procedures are usually reported using a different ICD-9-CM diagnosis code. A new postoperative period begins when the second procedure is billed.

Note: If appropriate, the use of RT and LT modifiers can be helpful and should be used following modifier 79, not in place of it.

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

March 3 Program for Women Physicians also Available to Office Managers
The March 3 CME program for women physicians, being presented as part of MMA's "First Fridays" programming, is also available to office managers or other women in the medical office who believe they would benefit.  The title of the program is "Negotiating for the Future" and it focuses on the power of aligning personal and professional goals and priorities with one's vision and values. Attendees are expected to:

  • Gain new and critical skills to take charge of their careers and act strategically as they gain a more positive work-life balance
  • Build an effective network of mentor/support relationships
  • Enhance their ability to turn conflict into opportunities and negotiate successfully to achieve their goals

As a result of attending this unique and interactive professional development experience, participants will begin to:

  • Recognize and apply the power of goal setting
  • Align goals with vision, values and priorities
  • Negotiate skillfully and productively
  • Find winning solutions to conflict

The program is conducted by Dr. Harriet Nezer, founder and principal of Metamorphasis Consulting and will be presented at the MMA offices in Manchester from 9:00am to noon on Friday, March 3.  Registration is just $60 (residents in training are free) which covers breakfast and all course materials.  Call MMA today for a brochure or to register (622-3374 and press O). [return to top]

MMA Ad Hoc Committee on Health System Reform to Examine Employer-Mandate on Wednesday
MMA's Ad Hoc Committee on Health System Reform, chaired by MMA President Jacob Gerritsen, M.D., will meet on Wednesday night, Feb. 22, to consider the issue of including an employer-mandate in the Association's White Paper on Health System Reform, first issued in May of 2003.  At that time, the paper endorsed the use of an individual health insurance mandate to achieve universal coverage but did not recommend use of an employer-mandate.

At the meeting on Wednesday evening, representatives of the Maine Merchants Association and the National Federation of Independent Business have been invited to present their arguments in opposition to the use of such a mandate.  The meeting begins with dinner at 6:00pm and any MMA member is invited to attend.  Please do call the office though so that we may have an accurate count for dinner (622-3374). [return to top]

Physicians' Day at the Legisature Thursday, March 2
MMA members are reminded that Thursday, March 2nd, is Physicians' Day at the Legislature.  Any physician not actively taking care of patients that day is invited to join Maine's physician leadership in the Hall of Flags at the Capital, beginning at 9:00am.  This is an important opportunity to share the concerns of medicine with legislators and to learn what is going on in Augusta.  Attendees will have an opportunity to attend meetings with legislative leaders and to attend a number of hearings and work sessions on bills directly affecting medicine.

On the schedule for the day are bills affecting the Certificate of Need process (L.D.'s 1973, 1784 and 1814), a bill to improve MaineCare (L.D. 1757) and work sessions on the much debated Dirigo Health related bills, L.D. 1845 and 1935.  It is fortuitous that March 2nd has so much health care legislation going on that day, which had been scheduled as the "Physicians'  Day at the Legislature" months ago.  Let's take advantage of it!  Just call Charyl Smith at MMA (622-3374 X 211) if you are able to join us for all or part of the day.  The hearings and work sessions begin at 1:00pm with the House and Senate both in session in the morning. [return to top]

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