March 20, 2006

 
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Governor Proposes Self-Insurance Option for Dirigo Health Program
Governor John Baldacci on Wednesday proposed a major change in the structure of Dirigo Health by permitting the Agency Board of Directors to provide Dirigo Choice coverage through a self-insurance fund. The plan also amends the governance of the Dirigo Health Agency by adding to the voting and ex-officio members. MMA will need to be assured that the self-insured fund would continue to provide reimbursement based on commercial insurance rates before supporting the proposal.
Rep. Mark Bryant (D-Windham) will present the proposal as an amendment to L.D. 1845 which is currently pending before the Insurance and Financial Services Committee.

You can review the draft amendment on the web at: http://www.maine.gov/legis/opla/commitwork.htm.

Because the amendment is a substantially different from the original bill that would have allowed the Dirigo Board to create a new, non-profit, state-chartered health insurer, the Insurance & Financial Services Committee has scheduled a public hearing on the amendment on Tuesday, March 21, at 1:00pm in Room 427 of the State House.  MMA representatives will testify and again express the view that the DirigoChoice product must be based on market rates for provider reimbursement (rather than MaineCare rates) to win physician support.  The Governor also noted in his statement that by going with a self-insured plan, the profit-making middleman is removed from the picture and the resulting savings could be used to pay for more coverage.

The state's current contract with Anthem expires Dec. 31, 2006.  Allowing the Dirigo Health Agency to contract with a third-party administrator to administer the DirigoChoice product on a self-ensured basis will give the state an additional option if Anthem chooses not to renew the state contract.

The Association's Legislative Committee will consider the MMA's position on the self-insurance proposal during the weekly telephone conference call Wednesday  (March 22) night at 7:00pm.  Any MMA member wishing to participate may do so by simply calling in to the toll-free line which is 1-800-989-2842.  The Passcode is 6223374#.

The Insurance& Financial Services Committee will hold a work session on a related bill, L.D. 1935, regarding the ability of insurers to pass on to insureds the savings offset payment, on Thursday, March 23, 2006.

MaineCare (MECMS) Update
The MECMS Governor's Provider Advisory Committee met this past Thursday and heard updates from senior DHHS staff and contractors regarding the progress in fixing the claims management system.  Primary topics for the meeting included

  • Part B cross-over payments
  • Return of interim payments
  • Slow down in claims payment by instituting a weekly limit on claims
  • Timely filing
  • Primary care case management fee
  • Transformation project; "Voice of the Customer"

While the electronic processing of the Part B crossover payments has slipped further to late August, the Department, at the request of the Governor, has expedited processing of these claims is they are converted to paper claims.  As part  of  the expedited process, offices will not have to attach to such claims the Explanation of Medicare Benefits (EOMB).  This new process will be effective for claims with dates of service beginning Oct. 1, 2004 and will continue until MaineCare is able to appropriately process electronic cross-over claims received from Medicare.

This expedited process does not apply to claims Medicare did not allow or cover.  For these claims, you do need to attach EOMB forms.

All MaineCare physicians should have received a mailing last week from J. Michael Hall, Acting Director of the Office of MaineCare Services (OMS), dated March 10, which gave detailed instruction for paper claims submission for the cross-over claims.  Copies of the CMS-1500 instructions for billing these claims were attached to the memo, with further instructions available at http://www.maine.gov/dhhs/bms.

At the meeting, MaineCare staff indicated that approximately 60% of physicians had dropped these claims to paper.  It is anticipated that most of the remaining offices may do so now, as a result of the expedited process and because of the continuing slippage of the dates for anticipated electronic processing.

Meeting attendees also were given the opportunity to comment on a draft letter to all MaineCare Providers updated them on the requirements for the timely submission of claims.  Although historically claims had to be filed within one year from the date of service, the Department has extended that period to 18 months, with the possibility of a longer period of time with sufficient explanation. Any questions regarding this policy should be directed to your Provider Relations Specialist at 287-3094 or at 1-800-321-5557, extension option 9.

Relative to interim payments, it was stated that physicians, PA's and nurse practitioners had collected nearly $17 million in interim payments and that over $15 million was still outstanding.  This is not surprising, given that over $25 million in claims from these providers are still in suspension.  Most of these providers will not be asked to repay any interim payments until their claims are processing regularly.  These recoveries are not expected to occur before July 1, which is the beginning of the state's fiscal year.

Relative to the collection of the interim payments needed to keep claims being processed through June, staff indicated that $164 million had been collected and that another $60 million needed to be collected to meet the goal.  While the weekly payments of claims is limited to $40 million, so far, no more than one-half of a week's claims have had to be rolled forward.

The most positive news of the meeting involved the primary care case management fee, which is the $2.50 per enrollee per month paid to primary care physicians for some of the enrollees.These monthly payments have not been paid in 14 months but should be paid within the next 3 to 4 weeks.  The kick off for processing the Jan., 2006 fees was March 16.  Once these claims have been generated , staff will process Feb., 2006 fees and then generate claims on a regular monthly basis.  The remaining fees from 2005 will be caught up as soon as the Feb. claims have processed.

Finally, Jay Stave of Deloitte Consulting presented to the group the "voice of the customer" initiative which is intended to improve provider relations within the Office of MaineCare Services.

The weekly metrics showed that about 88% of fresh claims were processed through the MECMS system with 15% of the claims being denied, with slightly over 12% being placed into suspension.  Total suspended claims were up a little from the previous week, but  generally showed a downward trend over the past few months.  Total claims in suspension is slightly over 208,000 presently.

The Committee meets again on March 30. [return to top]

MMA in Washington to Advocate for Medicare Payment Reform
MMA representatives were in Washington D.C. last week attending the AMA Advocacy Conference and meeting with all four members of the Maine Congressional delegation.   Congressmen  Allen and Michaud, and Senators Snowe and Collins were all very generous with their time.  Governor Baldaccci also spoke at the conference, participating in a panel of three presentations on improving access to care.  Following his talk, the Governor met  for over an hour with MMA President Jacob Gerritsen, President-elect Kevin Flanigan and EVP Gordon Smith.  The discussion focused on the problems at MaineCare and on the pending changes in the Dirigo Health Program.

In the meetings with the federal representatives, MMA highlighted the Medicare payment problem, noting the 5% reduction in fees expected again in 2007.  MMA representatives asked for a positive 2.8% update, as recommended by the well respected MedPAC Commission.  If the sustainable growth rate formula is not fixed, the 5% reduction in 2997 would be the first in a series of cuts which would add up to 34% by 2015!

"Physicians can not be expected to make the improvements in health information technology that the government and others are demanding, if their reimbursement drops by a third," noted Dr. Gerritsen.  "Under the current system, physicians have not covered their costs of doing business."

In Maine alone, the 2007 cut would mean a loss of $13 million to physicians.  The over-all loss from 2007 through 2015 would exceed $800 million, again, just in Maine.

On March 16, following the AMA Conference, the U.S. Senate passed S. Cong. Resolution 83, the Fiscal Year 2007 Budget Resolution, by a vote of 51-49.  Attached to the Resolution was an amendment sponsored by Sen. Kay Bailey Hutchison (R-Tx) that would create a deficit neutral "reserve fund to ensure that physicians will receive an appropriate reimbursement rate under Medicare instead of a scheduled cut which would threaten the adequate provision of care for seniors and disabled citizens."  While the amendment does not have the force of law, it does put the entire U.S. Senate on record in support of a favorable solution.  The AMA supported the amendment, which was adopted by unanimous consent.  The Amendment was co-sponsored by five other Senators, including Senator Susan Collins. [return to top]

The Coding Center's Coding Tip of the Week
Can 2 physicians from the same practice bill for critical care services on the same day?  If so, how should it be billed?

 Two physicians from the same specialty and in the same practice cannot both bill for E/M services on the same day.  What you can do is to combine the time spent by both physicians and bill it as one service under one physician, as long as both services are documented appropriately.  So if Doc 1 provided 1.5 hrs of critical care in the morning and Doc 2 provided 1.0 hr of critical care in the afternoon--you could bill for 2.5 hrs of critical care (99291, 99292 x 2) under Doc 1.  I would pick Doc 1 in this case because he provided the majority of the care.

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

RxSecurity Offers Spring Promotion on Tamper-Resistent Prescription Forms to MMA Members

Thank you MMA Members!!!

In appreciation of your overwhelming response, we are pleased to offer a Spring Promotion exclusive to MMA members.
Order Rx Security counterfeit- resistant prescription forms before June 21st and your office can enjoy Coffee On Us!

We’ll include a $20 Starbucks gift card with your next order.

Offer valid until June 21, 2006.

“Our secure forms can’t be duplicated, Neither can our prices”


  [return to top]

Anthem Blue Cross and Blue Shield in Maine Names New Director of Provider Network Management
Amy Cheslock has been promoted to Executive Director of Network Management for Anthem Blue Cross and Blue Shield in Maine. In that capacity, she will oversee all activities related to hospital, physician and other provider contracting in the Maine market.

Cheslock joined Anthem Blue Cross and Blue Shield in April of 2005, when she served as a Hospital Network Development Manager. She received her Bachelor of Arts degree in 1998 from the University of Rochester.

Over the past 8 years, Cheslock has held a variety of increasingly responsible positions in the health care industry throughout Massachusetts and Rhode Island. Prior to joining Anthem Blue Cross and Blue Shield, she served as a Senior Network Account Manager for UnitedHealthcare in Rhode Island where she managed contracting activities for providers in Rhode Island, Massachusetts and New Hampshire.

Anthem Blue Cross and Blue Shield in Maine is a member of WellPoint, Inc., the largest publicly traded commercial health benefits company in terms of membership in the United States.  WellPoint, Inc. is an independent licensee of the Blue Cross Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Blue Cross Blue Shield in 10 New York City metropolitan counties and as Blue Cross or Blue Cross Blue Shield in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at www.wellpoint.com. [return to top]

Hanley Center for Health Leadership Announces Establishment of Hanley Fellows Program

The Daniel Hanley Center for Health Leadership, is pleased to announce the establishment of the Hanley Fellows program.

The Hanley Fellows program is designed to provide individuals with the skills necessary to be effective leaders in Maines increasingly-complex, competitive and demanding health care environment. The Fellows program will focus on developing traits that characterized Dr. Dan Hanleys own leadership: inclusion, collaboration, compassion, courage, hard work, innovation and kindness.

This spring the Center will name three emerging health care leaders to the first class of Dan Hanley Fellows. Over the course of a 24-month period, each Fellow will be paired with an experienced Mentor. Fellows and Mentors will meet for quarterly breakfast meetings and monthly meetings and conference calls. Fellows will attend the annual Hanley Leadership Forum (June 15-16, 2006) and Hanley Leadership Luncheon (October 13, 2006). Both events take place at Bowdoin College in Brunswick.

Each Hanley Fellow also will be enrolled in the Institute for Civic Leaderships (http://www.civicleadership.org) highly-regarded 15-day intensive leadership program beginning in the fall of 2006.

Who is eligible to become a Hanley Fellow? Hanley Fellows are individuals whose leadership holds great promise for improving health care in Maine within the next five years. Learn more about eligibility requirements at the Hanley Fellows section of www.hanleyleadership.org.

Each Fellow will be carefully paired with a Mentor who is able to provide the Fellow with keen insight into what it takes to be an effective leader. The Mentor will draw upon their own experience to help the Fellow address specific needs and interests.

ENCOURAGE A COLLEAGUE TO BECOME A HANLEY FELLOW!

Do you know any emerging leaders who would benefit from becoming a Hanley Fellow?  Please forward this email to prospective Fellows and encourage them to apply! 

MARK YOUR CALENDARS

  • Deadline for Applications is April 10, 2006. 
  • Please visit the Hanley Fellows section at  www.hanleyleadership.org for more information, including the Hanley Fellows "Prospectus," Q&A and application form, which can be printed, completed and mailed to the Hanley Center at P.O. Box 15275, Portland, Maine 04112

 FOR MORE INFORMATION:  Contact Jim Harnar at jharnar@maine.rr.com.  

[return to top]

Staff Need their Annual HIPAA Training? Let MMA do the Work!
The Health Insurance Portability and Accountability Act requires that staff handling protected personal health information (PHI) receive annual training.  In addition, any new staff in your office needs to be trained as soon as is practicable.  Realizing that this training in HIPAA privacy and security can pose a hardship to small staff, MMA is planning a series of regular training sessions as part of its "First Fridays" educational programming.

The next session is Friday morning, April 14, 2006 from 9:00am to noon at the MMA offices in the Frank O. Stred Building in Manchester.  Flyers for the program were sent last last week to each office.  If you did not receive one and are interested in the program, call Gail Begin at 622-3374 (Ext. 10) or e-mail to gbegin@mainemed.com.  The cost is $60 which includes breakfast and all course materials.

Faculty consists of Gordon Smith, Esq, and Andrew MacLean, Esq. on the privacy rule and Bryan Michaud, PhD of Integrity, LLC on the security rule. [return to top]

Appreciate this e-Newsletter? Share it with a Friend
MMA is interested in having as many Maine physicians and practices  as possible receive the weekly information provided in Maine Medicine Weekly Update.  If you know of a practice manager or physician who is not receiving it and would like to, just send their e-mail address to Lauren Mier at lmier@mainemed.com. [return to top]

MHINT Project is Now HealthInfoNet
At a March Board of Director's meeting, the Maine Health Information Network Technology (MHINT) project was renamed and recast as HealthInfoNet.  HealthInfoNet has been adopted as the corporation name for the new non-profit formed to oversee Maine's statewide electronic clinical information-sharing system. A new domain name has been acquired to complement the organizational name and a new web site is underway.

At the March HealthInforNet Board of Director's meeting, the following officers were elected:

  • Chair:  Charles "Chuck" Hewett of Jackson Laboratory
  • Vice Chair:  David Howes, M.D., Martin's Point Health Care
  • Treasurer: Daniel Coffey, Eastern Maine Health Care Systems
  • Secretary:  Nona Boyink, MaineGeneral Health
  • At large:  Carol Carothers, National Alliance on Mental Illness (NAMI)

HealthInfoNet is now on a very fast track to incorporate as a 501 (c) 3 nonprofit organization.A recently-released report that describes what has been accomplished since the MHINT Phase ii Planning & Development process began ten months ago can be found through the link to the web site - http://www.mhint.org/meetings/MHINT_Progress_Rpt_2005.pdf.  The web site at www.mhint.org also is an excellent source of both historical and current information.  It includes the 2004 Phase i report as well as the power point presentations from the Feb. 28, 2006 HIT Summit at the Augusta Civic Center. [return to top]

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