July 10, 2006

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Governor's Blue Ribbon Commission on Dirigo to Include Two Physicians and MMA EVP Gordon Smith
Governor Baldacci on July 5 announced his appointments to a 19-member Blue Ribbon Commission to review financing alternatives for the Dirigo Health program. Included among the appointments are Robert McAfee, M.D., former AMA and MMA President who chairs the current Dirigo Board of Directors, G. Peter Toussaint, M.D., of New Canada, a retired surgeon and Gordon Smith, Esq., EVP of MMA. The group will begin their meetings in August and make a report to the Governor by December 15, 2006.


Governor John Baldacci on July 5th announced the names of the members of the Blue Ribbon Commission on Dirigo Health.  The Governor created the commission by Executive Order on May 24 as the legislative session drew to a close.   

“DirigoChoice is working for over 15,400 Maine workers and families, and 2,000 businesses,” said Governor Baldacci. “Maine is one of only seven states in the country that saw a decrease in the rate of uninsured.  We can do more.

“It is not right that people work hard, play by the rules and pay their taxes do not have the health coverage they need.  With the valuable experience gained in the first year of Dirigo, we need to continue our work together with the Legislature, to build on the foundation we have laid.  Maine people need and deserve affordable, quality health care that we can depend upon.”

The commission will be chaired by Dr. Sandra Featherman, who served as president of the University of New England, in Biddeford, from 1995 until last week.

The commission’s other members represent a cross section of Maine life, coming from backgrounds of business, industry, education, and consumer activism. The members are listed below with their affiliation:

David Brenerman, Assistant Vice President of Government & Public Affairs, UnumProvident Corporation, Portland
Joe Ditre, Executive Director, Consumers for Affordable Health Care, Augusta
Joan Donahue, owner, Hummingbird Home Care, Warren
Carol Epstein, owner, Epstein Commercial Real Estate, Bangor
Kevin Gildart, Vice President, Bath Iron Works, Bath
Tammy Greaton, Director, Maine People’s Alliance, Portland
Merton Henry, Attorney, Jensen, Baird, Gardner and Henry, Portland
Mike Keenan, President, Local S6, Bath
Dr. Robert McAfee, Chairman, Dirigo Health Board of Directors, Portland
Steven Michaud, President, Maine Hospital Association, Augusta
Chip Morrison, President, Androscoggin County Chamber of Commerce, Lewiston and member, Advisory Council, Maine Quality Forum
Katherine Pelletreau, Executive Director, Maine Association of Health Plans, Yarmouth
Ed Pineau, President, Pineau Policy Associates, Inc., Manchester
Keith Small, Director, Down East Business Alliance, Milbridge
Gordon Smith, Executive Vice President, Maine Medical Association, Manchester
Dr. Peter Toussaint, physician, New Canada
Barbara Trafton, realtor, Keller Williams Realty, Auburn
MaryAnne Turowski, SEIU Field Representative, Maine State Employees Association, Augusta
Trish Riley, Director, Governor’s Office of Health Policy and Finance, Augusta, ex officio

The Governor said that he will working with legislators to explore their concerns fully and hear their ideas.  “We will report to Leadership and the Insurance and Financial Services, Health and Human Services and Appropriations Committees to get their feedback and ensure legislators are engaged in the Commission’s work,” he said.

The Governor expects the commission to hold its first meeting in August and to report back to him by December 15.

Reigster Now For 153rd MMA Annual Meeting Sept. 8-10, 2006
MMA's 153rd Annual Meeting Will be held Sept. 10-12, 2006 at the Fairmont Algonquin Hotel in St. Andrews by the Sea, New Brunswick,  Canada.  Registration materials have been mailed to all MMA members but you may also register on-line at www.mainemed.com, the MMA Website.

This year's educational program at the Annual Session is accredited for six and one-half hours of category one credit and is focused around the theme of Medicine in Extreme Environments.  Medicine in space, underseas, at high altitudes and in the wilderness will be featured, in addition to presentations on handling medicine in the face of natural disasters.  Former NASA astronaut and surgeon Story Musgrave , M.D. and Donald Palmisano, M.D., J.D. , are the keynote presenters.

In additional to the educational presentations, the Association's annual "Town Meeting" style membership meeting will occur on Saturday morning and the Annual Banquet will occur on Saturday evening.  Other events will include the 26th Annual Edmund Hardy, M.D. Road Race, golf and tennis competition sponsored by Medical Mutual Insurance Company of Maine and an opening night reception with exhibitors and other guests.

Specialty society meetings to be held this year in conjunction with MMA's meeting include meetings of the Maine Society of Orthopedic Surgeons and the Maine Urological Association. On Friday evening, the Aroostook County Medical Society will hold a dinner meeting at the Hotel.

Last year, over 300 members and guests attended the meeting in Bar Harbor.  Don't miss out on your opportunity to enjoy some leisure time with family and colleagues and to participate in the governance of your professional association. [return to top]

MaineCare MECMS Update; More Provider Relation Reps on the Way
The Governor's MaineCare Providers' Advisory Group met on July 6 and heard updates on interim payment recovery, MECMS Release 1 and staffing.  The following are highlights from the meeting:

  • Relative to interim payments, generally MaineCare is recovering about $5 million each week, and is still paying out about $300,000 to $400,000 in interim payments.   This level of recovery is sufficient to allow MaineCare to resume normal week's payments as well as paying all that had been carried over as the result of the weekly cap that had been in effect.
  • MECMS Release 1 occurred on July 1.  This is the first step in a new more thoroughly tested approach to implement functionality updates to the MECMS system.  It is the first of several releases scheduled for the coming months.  The details of the Release are contained in MECMS Update 70, dated July 3, 2006.  The MECMS Updates can also be found at http://www.maine.gov/bms/member/innerthird/mecms_update_for_provider.htm  You may also sign up for the MECMS listserve to obtain MaineCare Provider information.  To sign up, go to http://mailman.informe.org/mailman/listinfo/provider/
  • Office of MaineCare Services staff announced the hiring of 40 new permanent staff, including 10 additional provider relations specialists.  The new hires will bring the provider relation staff to 20 persons which is much closer to industry standards based upon the number of enrollees and providers.  In addition, the new budget order permits the filling of 7 new temporary positions, 3 of which are in Customer Service.  The remaining permanent positions are assigned to medical claims evaluation (20) and MECMS (10).  Staff shortages have been a chronic problem in OMS for years.
  • Primary Care Case Management (PCCM).  The June PCCM fee is scheduled to be sent out the week of July 10.  In total, OMS has now sent out 8 PCCM payments and has 6 more back payments to make representing payments missed in 2005.  After completion of these, OMS will have to wait until the system generated adjustments are done for the two months that were paid incorrectly.
  • The suspended claims inventory is a 192,576, an increase from the previous weeks. 
  • Processing of paid and denied fresh claims was at 89.25% for the week ending June 25, 2006.

The Committee will meet again on July 20.  If there is further information on the July 1 Release, it will be included in the Maine Medicine Weekly Update July 17.

Last week, MMA representatives als also met with federal CMS officials who are responsbile for funding the majority of the costs of the new MECMS system and who are responsible for certifying when the project is complete.  That certification has not yet been granted, because of the problems with the system, and representatives of CMS will be in state again during the latter part of July to review the MECMS progress.  Non-certification of the system could eventually cost the state millions of dollars in matching Medicaid funds.

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CDC Expects Minimum of 100 million Doses of Flu Vaccine for Next Flu Season
The federal Centers for Disease Control and Prevention expects at least 100 million doses of flue vaccine to be available in the U.S. for the 2007 flu season, a representative of the agency told reporters last Friday at a forum on flu prevention and treatment.

The CDC's Advisory Committee on Immunization Practices expects to recommend that children ages 24-59 months and their household contacts be vaccinated, and also may recommend that previously unvaccinated children aged six months to nine years receive two doses of vaccine.  The Committee currently recommends annual flu vaccination for children ages 6-23 months, persons 65 and older, pregnant women and health care workers who provide direct care to patients.

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MMA/MOA Committee on Technology to Meet at MMA on Tuesday Night
Maine HealthInfoNet (formerly called the MHINT Porject) will be the primary topic of discussion Tuesday night, July 11 when the MMA/MOA Committee on Technology meets at the Association offices in Manchester.  The meeting begins at 6:00pm and dinner will be available.

Three representatives from the HealthInfoNet project will be present to discuss the current status of the project and to solicit ideas on how to more actively engage physicians in the design and development of the project.  As success of the project is partially dependent upon physicians participating in the interoperable system, the input of practicing physicians is critical to the project's design.  As there are no practicing physicians on the HealthInfoNet board,   the MMA/MOA Committee on Technology has been asked to assist in providing input and soliciting additional input.

The meeting is open to any MMA and MOA member, but please call Lauren Mier at 622-3374 ext. 223 to let us know you will be attending so we can be sure to have enough dinner to accommodate all attendees. [return to top]

Maine State Retirement System Medical Board Physician Recruitment
The Maine State Retirement System (MSRS) seeks two or more consulting physicians to join our Medical Board.  We are particularly interested in physicians with experience in internal medicine, as well as physicians with expertise in analysis of musculoskeletal conditions.

MSRS administers a disability retirement program for eligible members.  The primary purpose of the MSRS Medical Board is to review medical records of individuals who are applying for disability benefits, and to advise MSRS on the types and status of the applicant’s conditions.  A team of Specialists, who coordinate the administrative case management aspects of the program, assists the Medical Board.  The Medical Board consists of both retired and active practice physicians representing internal medicine, psychiatry, cardiology and occupational medicine.

Consulting physicians receive records a week in advance for review and analysis.  Medical Board meetings are scheduled on Thursdays at MSRS offices in Augusta.  Reimbursement is $85. per hour.  The rate applies to review time, travel time, and attendance at the Medical Board.  MSRS also reimburses mileage. The average monthly time commitment, including meeting time, is 20 hours/Medical Board meeting.

Physicians interested in exploring this opportunity are encouraged to contact MSRS directly:

Marlene McMullen-Pelsor
Manager, Ancillary and Employer Services
46 State House Station
Augusta, Maine 04333-0046
207 512-3100
800 451-9800

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National Provider Identifier (NPA); Obtain Yours NOW!
The Final Rule adopting the HIPAA standard unique National Provider Identifier (NPI) for health care professionals was published in the Federal Register on January 23, 2004.  Health care providers have been able to apply for an NIP since May 23rd, 2005.  CMS will accept only NPI numbers beginning May 23, 2007.  Currently, CMS accepts legacy numbers and requires a legacy number to be provided in conjunction with the NPI.

If you need to obtain your NPI, you may apply on-line using the web-based application available at https://nppes.cms.hhs.gov.  A paper application may be submitted to the entity that assigns the NPI (the Enumerator).  A copy of the application and the Enumerator's mailing address is available at: https://nppes.cms.hhs.gov.  You may also call the NPI Enumerator at 1-800-465-3203 and request a paper application form to complete and mail back.

As noted above, by May 23, 2007, affected physicians must use their unique 10-digit code for all claims activity, not just for Medicare transactions.  Some payers might ask physicians to start using the number before the deadline.  The NPI, which will not change and which will accompany the physician wherever he or she goes, is mandatory even for physicians who use a separate billing agency to submit electronic claims on their behalf.

Applying for an identifier is a straight-forward, 20-minute procedure.  The single number, conceived as part of the HIPAA administrative simplification provisions, eventually will replace all other physician identifiers that are used to do business with the government, private payors and clearinghouses.

Of the roughly 2.3 million physicians, hospitals and other health care entities that need to obtain NPI's, only about 635,000 have obtained their number so far.

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The Coding Center's Coding Tip of the Week
I recently did cryotherapy of 5 warts in the office and submitted it using 17000 and 17003.  I’m now being told I can bill for each of the warts separately.  Which is the correct way to bill? Do I need modifiers?
The correct way to bill would be 17000 for the first wart and 17003 x 4 for each of the additional warts.  Code 17003 says “second through 14 lesions, each (List separately in addition to code for first lesion)” 
 You do not need to use a modifier as it is an “add on” code and specifically states “Use 17003 in conjunction with code 17000”
Also note that code 17004 states “15 or more lesions “.  You would not use code 17004 with 17000 or 17003.  It should be reported as the only code when removing 15 or more lesions.

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

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