February 27, 2006

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MaineCare MECMS Continues to Plague Providers; An Update
Maine Medical Association representatives met this past week for two hours with Acting HHS Commissioner Brenda Harvey, Deputy Commission Mike Hall and Rebecca Wyke, Commissioner of the Department of Finance and Administration. Announcements the previous week of further delays in the processing of the Part B cross-over claims and a presentation before the legislature's Appropriations Committee led to the meeting. "MaineCare providers just can't take it anymore, is the message we are getting from our members," stated MMA EVP Gordon Smith. "Enough is enough!"
A follow-up meeting has been scheduled for this coming Wednesday, March 1, at which time further information is to be provided regarding payment of the cross-over claims and the extent of physician involvement in the recoupment of interim payments.

MMA is also concerned about reports that the state may not have sufficient funds in the MaineCare budget to pay claims after April 1, or the last quarter of the state's fiscal year.  The anticipated shortage is one reason the state is getting more aggressive on the return of interim payments.  But previously, the state had announced that no practice would be expected to pay back interim payments until their claims were processing regularly and accurately.  "Given that the cross-over claims have not been processed for thirteen months, and that the primary care case management fee has not been paid in nearly a year, how can the state assert that the system is approaching functionality?" noted Smith.  

Conversations with the state officials have been courteous but direct, with patience running out on the part of MaineCare providers.  MMA representatives, joined at the meeting by representatives of the Maine Osteopathic Association, made clear that failure to fix the claims payment system was pushing providers over the edge and that the situation was urgent.  More resources must be committed by the state, based upon the fact that it has now been over thirteen months since the ill-fated system was turned on.

Watch for reports on this week's meeting in the Weekly Update next Monday.

AMA Pact with Congress on Quality Measures to Pave Way for Medicare Payment Reform
The American Medical Association announced last week that it had signed an agreement with three of the Committee leaders in the Congress to produce up to 140 clinical measurements by January 1, 2007.  The so-called "pact" was actually entered into Dec. 16, 2005 between the AMA and Senate Finance Committee Chairman Charles Grassley, R-Iowa, Health Ways and Means Committee Chairman William Thomas, R-California, and House Energy and Commerce Health Subcommittee Chair Nathan Deal, R-Georgia. 

The agreement calls for the AMA to develop a total of approximately 140 physician performance measurements covering 34 clinical areas.  The AMA noted last week, in response to the New York Times article, that 90 measures have already been developed through the AMA Clinical Guidelines Consortium.

The agreement also provides that in 2007 physicians would voluntarily report to CMS on at least three to five of the quality measures and that physicians who report should receive an additional quality update to offset associated administrative costs.

Several national medical specialties have expressed concern about the agreement, noting particularly the tight timeframe and the fact that other medical organizations were not part of the "pact." [return to top]

Maine Chapter AAP Hosts "Pediatric Potpourri", May 6-7, 2006 at Samoset Resort

Maine Chapter, American Academy of Pediatrics

Spring Educational Conference

Pediatric Potpourri

May 6-7, 2006

Samoset Resort, Rockland, ME

Featured Speaker: Dr. Lewis First, Chairman of the Department of Pediatrics at the University of Vermont College of Medicine

Topics include: Newborn Screening, Asthma, Atopic Dermatitis, Calcium Intake Guidelines, Pediatric Consent, Immunizations Review, as well as sessions on Coding and EMR.

For more information visit www.maineaap.org. Registration information will be available online and packets will be mailed to members on March 13th.

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Surveys: EHR Implementation Gains Momentum Among Providers, Hospitals

The majority of health care providers and hospitals plan to implement electronic health records (EHRs) in the near future, according to two surveys. A survey of 364 health care providers by Oracle found that 77 percent plan to implement electronic health records and 85 percent expect to complete deployment within five years, Government Health IT reported. The survey also found that 86 percent of physician practice groups surveyed plan to implement EHRs and 92 percent of clinics and community health systems plan to do so. A separate Healthcare Information and Management Systems Society survey of more than 204 information technology professionals representing more than 473 U.S. hospitals found that 87 percent of the hospitals have an EHR system in place or plan to implement one, Health Data Management reported. The survey also found that 24 percent of hospitals currently have operational EHR systems, compared with 18 percent of respondents in the 2004 survey. For more information:



http://www.healthdatamanagement.com/html/news/NewsStory.cfm?articleId=12994 [return to top]

State Request for Feds to Extend Drug Benefits Approved
U.S. Senators Olympia Snowe and Susan Collins announced Friday that Health and Human Services Secretary Michael Leavitt had approved the state's request to extend reimbursement for low-income Mainers who can't get their full Medicare prescription benefit until March 8th.  The previous deadline had been Feb. 15.

Maine , along with many other states, has covered the costs of prescriptions for people whose benefits were held up because of computer errors and other start-up problems when the new Medicare Part D benefit went into effect in January.

The announcement ensures that such persons will continue to receive full Medicare Part D benefits and that the state will be compensated by the federal government for its costs. [return to top]

Thursday, March 2, is Physicians' Day at the Legislature: All Welcome
Thursday, March 2, is Physicians'  Day at the Legislature.  While normally this event is held only during the first year of the two-year legislative session, MMA and MOA decided to have such an event again in 2006 because of the significant focus on healthcare this session and the many issues confronting physicians that legislators could help resolve.  Issues currently pending include MaineCare reimbursement for provider expenses associated with the MECMS fiasco, funding for DirigoChoice, Certificate of Need, and Advanced Directives/DNR orders.

The day begins with coffee and refreshments with legislators in the Hall of Flags on the second floor of the State House.  A briefing will take place later in the morning and attendees will be addressed by the two physicians in the legislature, Lisa Marrache', M.D. and Thomas Shields, M.D.  Later in the day, meetings will take place with individual legislative leaders, including Senate President Beth Edmonds.  A meeting with Governor Baldacci will also occur sometime during the day.

Although it is largely a coincidence, rather than the result of superior planning, there are several hearing and work sessions on  Thursday that physicians may attend.  The issues being worked on  Thursday include Certificate of Need (Health and Human Services Committee), DirigoChoice (Committee on Insurance and Financial Affairs) and Advanced Directives and Do not Resuscitate Orders (Judiciary Committee).

MMA and MOA leadership will be present to host the event and all physicians are welcome.  Contact Charyl Smith at MMA (622-3374  x211 or csmith@mainemed.com)   if you can attend or if you have questions about the day.  We hope to see you! [return to top]

Maine Medical Association to Offer Weekly Newscan to Members
Online capabilities have greatly expanded the types of services that associations can offer members.  Within the next week,  MMA will send to each member for whom we have an e-mail address a weekly summary of newsclips involving healthcare in Maine.  There is also a section on New England News and National Healthcare News.  All the major daily papers in Maine are included, with emphasis currently on news and editorials regarding Dirigo Health, MaineCare and Health System Reform.  Each article or editorial is briefly summarized and then a link is provided to the full article.

The electronic weekly newscan will have a convenient "unsubscribe" feature so with one quick click, you can avoid receiving this publication beyond its first edition.  We hope that many members and office staff will find the weekly publication of value.  There is no charge for this service.

If you are certain, even without seeing it, that you do not wish to receive it, you may send an e-mail to Lauren Mier at lmier@mainemed.com and you will be removed from the list. [return to top]

AHRQ Launches New Health IT Learning Resources

The Agency for Healthcare Research and Quality (AHRQ) launched a new learning resource February 13th to help health care providers adopt health information technologies (IT) quickly and effectively. The site includes a library with links to more than 5,000 health IT resources, an evaluation toolkit to help those implementing health IT projects, a summary of key topics and other resources explaining current health IT activities and funding opportunities. For more information and a link to the new resource center:

http://www.ahrq.gov/news/press/pr2006/learnhitpr.htm [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]

The Coding Center's Coding Tip of the Week
Use of Modifier 22:  Unusual Procedural Services-

Modifier 22 is used to identify services, which require individual consideration and should not be subject to the automated claims process. Claims submitted with modifier 22 must be accompanied by documentation explaining the unusual services. Documentation includes, but is not limited to, descriptive statements identifying the unusual circumstances, operative reports, pathology reports, progress notes, office notes, etc.

The submission of a service with modifier 22 does not ensure coverage or additional payment. All claims, submitted with modifier 22 and appropriate documentation, are reviewed by medical staff to determine whether payment is justified.Modifier 22 can be used on all procedure codes with a global period of 0, 10 or 90 days when unusual circumstances warrant consideration of additional payment.

Questions? Call the Coding Center: 1-888-889-6597.

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