MaineCare MECMS Continues to Struggle

The MaineCare MECMS system was back in the news this week, with both positive and negative news to report.  Read the article below to see what transpired at the bi-weekly Provider Advisory Committee meeting and for a report on what to expect in the next few weeks if you are a MaineCare provider.

There was both positive and negative news this past week on the MECMS front.  On the positive side, claims in suspension were under 182,000, a marked improvement from the last few weeks.  The weekly metrics showed that the system was processing new claims at 91.9%, with 17.6% denied.  The ten new provider relations staff have completed their fourth week of intensive training and will be in the field soon.  With the new staff, it is expected that the Office of MaineCare Services will be able to do more provider education sessions around the state.  The OMS would welcome meetings with various specialties and will begin with a meeting with the Maine Society of Anesthesiologists at MMA on the evening of Sept. 20.

On the negative side, the results of Release 1, which was deployed on July 1, 2006, was mixed and has delayed the scheduling of the remaining 4 Releases.  Originally, the fix to allow for electronic processing of the Part B cross-over claims was part of Release 2 due for deployment on Sept. 1.  This will now be delayed with a new schedule of future Releases to be provided by MaineCare officials next week.

In addition, Kirsten Figueroa, Deputy Commissioner of Finance, DHHS, described an aggressive plan to recoup all the remaining interim payments by the end of the state's current  fiscal year (June 30, 2006).  This will be attempted despite the fact that it is now clear that the MECMS system will not be fixed until later in the year and perhaps even into next year.  MMA representatives objected to a gobal recovery effort if it applied to physician practices whose claims were not being processed accurately or for any physician practice still owed funds from the Part B cross-over claims.  These claims are being processed on paper but the MECMS system is not presently able to pay these claims electronically.  MMA staff met with Governor Baldacci on Saturday and learned that as a result of a meeting on Friday with Commissioner Wyke,  Ms. Figueroa and the Governor, the recoupment of the interim payments may be slowed down.  Once this is confirmed by MaineCare officials, readers of the Weekly Update will be notified.

In addition to the delays, the OMS sent a communications to all providers this past week noting an error in processing that was causing a number of claims to be rejected. Further information should be sent out on this latest snafu this coming week.

The Augusta area newspaper the Kennebec Journal recently republished an updated version of the article on the MECMS fiasco from CIO magazine.  The three part series ran on August 13, 14 and 15 with MMA Pesident-elect  Kevin Flanigan interviewed for the final article. The original article is on the MMA website at www.mainemed.com.

The next MECMS Provider Advisory Committee meeting will be held on August 31.  MMA has asked that the issue of the $1 million appropriated to reimburse providers for some of their MECMS-related costs be added to the agenda.

MMA is expecting either Commissioner Harvey or Deputy Commissioner Hall to be present at the MMA Annual Meeting to discuss the current status of the program.  Their presentation would be on Saturday morning, Sept. 9, as part of the General Membership meeting.

MMA 153rd Annual Meeting to Consider Nine Resolutions

The Maine Medical Association will hold its 153rd consecutive Annual Meeting at the Fairmont Algonquin Hotel in St. Andrews-by-the-Sea, New Brunswick, Canada  Sept. 8-10, 2006.  At the General Membership meeting on Saturday morning, to which all members are welcome to attend,   members will consider nine resolutions, as well as enact a budget for MMA for 2007, elect officers and vote on bylaw amendments.  During the morning meeting, attendees will also hear from Dora Ann Mills, M.D., MPH, Director of the Maine CDC, Terrance Sheehan, M.D., President of Medical Mutual Insurance Company of Maine and from representatives of MaineCare.

The topics of the nine resolutions follow and the the complete text of each will be available on the MMA website at www.mainemed.com by the end of this week.

• Filling the Medicare Part D Doughnut-Hole
• Educating Maine's prescribers on anti-depressants and stimulants
• Encouraging Maine's Youth to Pursue Careers in Medicine
• Promoting CoughSafe, Influenza Prevention Techniques
• Advocating for Primary Enforcement of Maine's Seatbelt Law
• Advocating for Adequate VA Funding for Middle East Casualties
• Reversing the MaineCare Limits on Non-Categoricals for Substance Abuse Treament
• Advocating for Fair Workers' Compensation Practices by Maine's Employers and Insurers
• Advocating for Support of Private Practice in the State Distribution of Influenza Vaccine

A few rooms are still available and a registration form for the meeting is available on the MMA website at www.mainemed.com [return to top]

The Coding Center's Coding Tip of the Week

Review of Systems

§ To document a “comprehensive” Review of Systems (ROS) which includes a review of 10 systems, list pertinent positives and then state “all others negative”.   Be sure to ask the patient about the “other” systems but you do not have to list each separately.  This is required to bill the higher levels of all E/M services, including both the level 2 and 3 admissions to the hospital.   

§ It is also acceptable to have your patients complete a “current” ROS form that you then review and sign off on as part of your documentation

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

Avian and Pandemic Influenza Summit Planned for September 20, 2006

September 20, 2006 The Maine State Government (five agency) Avian and Pandemic Influenza Preparedness Steering Committee is planning an Avian and Pandemic Influenza Summit at the Augusta Civic Center on Wednesday, September 20th.  Please mark your calendars!    For more information contact Sue Dowdy at the Maine CDC at sue.dowdy@maine.gov. To register, contact Tammy McLaughlin at tmclaughlin@neias.org. [return to top]

Medicaid a Problem for Physicians Nationwide

The Center for Studying Health System Change released a study this past week demonstrating that the percentage of physicians nationwide treating new Medicaid patients has decreased significantly over the past ten years.  Low reimbursement and high administrative demands were the primary reasons given.

The change was much more pronounced among solo and small group practices. 

Overall, reimbursements on average nationally for Medicaid are 69% of Medicare (in Maine, it is 53% of Medicare).

In l996-97,  29% of solo physicians reported not taking new medicaid patients.  Nearly a decade later, 35.3% of solo physicians reported accepting no new medicaid patients.  A similar trend was found in small groups where the percentage of physicians not accepting medicaid patients grew from 16.2% to 24% (small groups defined as less than 9 physicians).

In Maine, MMA is lobbying for a substantial increase in MaineCare fees to be part of the Governor's budget, effective July 1, 2007.  Watch the Weekly Update and Maine Medicine for more details on this initiative which would follow up on the $10 million increase in the last fiscal year. 

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Institute for Medical Improvement Announces Collaborative on Chronic Obstructive Pulmonary Disease

The Institute for Medical Improvement (IMI) at Eastern Maine Healthcare System announces a learning Collaborative on Chronic Obstructive Pulmonary Disease (COPD) starting October 18 in Brewer. Starting with a "pilot" program in Aroostook County and now in its third year, the IHI style learning Collaborative will focus on office system changes in managing patient care. This is a grant funded program with limited enrollment; registration closes on September 29. For more information, visit the IMI web site: http://www.emh.org/imi/ or the MMA website at www.mainemed.com (under the topic Spotlight). [return to top]

Maine Physician Action Fund Trustees to Meet Thursday Night

With an important election year upon them, the trustees of the Maine Physician Action Fund, MMA's political acton committee,  will meet this coming Thursday night (August 24) at MMA offices in Manchester.  Along with reviewing the candidates for the state house and senate, the trustees will interview First District Congressman Thomas Allen.  Congressman Allen's opponent, state representative Darlene Curley, R.N. was interviewed last month.  At stake is a recommendation from the trustees to the American Medical Political Action Committee as to who should receive AMPAC support in this election.

The meeting will begin with dinner at 6:00pm and any MMA member is invited to attend.  Please call the office at 622-3374 so we will be prepared for our dinner count, however.  Ask to speak with Charyl Smith or press extension 211 (622-3374). [return to top]

First Bird this Year Tests Positive in Maine for West Nile Virus

State CDC officials announced last Thursday that a bird found in Belfast was the first this year to test positive for West Nile.  The bird, a grackle, was found  by an unidentified Maine resident and reported to the state's dead-bird hot line.  Though the first this year, it was the 199th bird that has tested positive for West Nile virus since the state began testing birds in 2000.

There have been no known West-Nile related illnesses in Maine to date, but more than 3,000 people in the country were diagnosed last year, with ll9 deaths.

The hotline number is 888-697-5846.

For more information on mosquito-borne illnesses, visit online: www.mainepublichealth.gov

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