September 18, 2006

 
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Time Running Out to Fix Medicare Payment Reduction

Despite forty-five percent of physicians telling the AMA that additional Medicare cuts would force them to either decrease or to stop taking new Medicare patients, to this point the Congress has not taken steps to halt the scheduled 5.1% cut, effective Jan. 1, 2007 and are expected to adjourn by the end of September.  The payment reductions would be compounded by four other major policy changes that CMS has enacted to be effective in January, resulting in some specialties seeing reductions as deep as 12% (anesthesia) and 16% (radiology).  Now is the time to call your federal legislators and tell them not to come home until the problem is fixed. 

The Congress is scheduled to be in session for less than ten days between now and the election as members adjourn by the end of the month to campaign.  While a lame duck session is possible, the best chance to restore the scheduled 5.1% reduction is in the next two weeks.  Without congressional action, not only will the Jan. 1 reduction take place, but additional cuts in future years will reduce reimbursement by about 40% over the next nine years.  As practice costs are expected to increase by 20% over the same time period, obviously this action can not be permitted to occur.

This catastrophy for physicians and seniors alike is due to the flawed Medicare physician payment formula.  The calculation punishes physicians with lower payments when increases in spending for their services exceeds growth in the gross domestic product.  But growth in medical care is influenced by factors other than GDP - growing patient health needs, new technology to more accurately diagnose patient illness, and expanded Medicare coverage that encourages patients to seek more care.

For more information on the AMA effort to reform Medicare payment, go to http://www.ama-assn.org/go/medicarepayment.  And if you and others in your office have not communicated your concern about this issue to members of Maine's Congressional Delegation, the time to do so is NOW. 

Important Notice: Members-only Website Access Changes

Modifications to the members-only registration area of the MMA website are now complete, allowing for enhanced security of our site.  Effective Wednesday, September 20, old usernames and passwords for access to the members-only area will no longer be active.  ALL members will need to re-register using the new registration form (found on the home page of the site in the upper right-hand corner) in order to gain access to the members-only area.  This will be a one-time registration process which will then allow unlimited access to the members-only area of the site.

The procedure will require that you complete a short registration form and press submit.  All members-only registrations will require MMA's approval.  Once approved by MMA, you will receive an email stating that you have been given access to MMA's members-only area.

We apologize for the inconvenience of having to re-register, but it is necessary in order for us to continue to bring you valuable information in a secure manner. 

Should you have any questions or experience any difficulties, please feel free to contact Shirley Goggin at 207-445-2260 or sgoggin@mainemed.com.   [return to top]

Reminder of Medicare Claim Hold Sept. 22-30, 2006

CMS recently reminded physicians that a brief hold will be placed on Medicare payments for all claims during the last nine (9) days of the federal fiscal year, Sept. 22-30.   All claims held during this period will be paid Oct. 2.  No interest or late penalties will be paid during this one-time hold period mandated by the federal Deficit Reduction Act of 2005.

Note that this policy applies only to claims subject to payment, not to full denials, no-pay claims and other non-claim payments such as periodic interim payments, home health requests for anticipated payments and cost report settlements.  Also, no advance payments wil be allowed during the nine-day hold period.

For further details see www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047pdf.

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Prepare for New Uniform Claims Forms

Soon the 1500 Health Insurance Claim Form will be released in a modified form, the first such change since 1990.  The biggest part of the change comes as a result of the Health Insurance Portability and Accountability Act, which calls for every physician to be assigned a new identification number to replace those previously assigned by individual insurers.

The National Uniform Claim Committee, a volunteer organization of health care industry professionals chaired by the American Medical Association, was tapped to oversee the changes.  The new modified form will be introduced in two phases.  Beginning Oct. 1, health plans, clearinghouses and other information-support venders should be ready to accept the revised form.  Between Oct. 1 and March 31, 2007, physicians can use the current version or the revised version.  Starting April 1, 2007, only the revised form should be used.

The NUCC does not have enforcement power, so adherence to the schedule will be voluntary.

NUCC officials suggest physicians contact insurers to verify if they are ready to handle the revised forms. [return to top]

Family Planning Association Update on Emergency Contraception OTC

Emergency Contraception OTC Update!

On August 24, 2006, the Food and Drug Administration (FDA) approved Plan B®-the dedicated emergency contraception (EC) product-over-the-counter (OTC) for consumers ages 18 and older. This decision has generated some questions for pharmacists and healthcare providers with collaborative practice agreements for EC. Below is some information about how to provide Plan B® in pharmacies.

 

Consumers 18 and older: 

  • EC is authorized for OTC sale in pharmacies
  •  Directly from your local family planning health center
  •  If proof of age is not available, directly from participating pharmacists in the EC pharmacy access program 
  •   Visit www.mainefamilyplanning.org to see a list of participating pharmacies

    Women 17 and younger:

  • Directly from participating pharmacists in the EC pharmacy access program
  • By prescription from a healthcare provider or family planning health center

  • Visit www.mainefamilyplanning.org to see a list of healthcare providers.

NOTE: Teens in Maine have the right to confidential family planning services and products, including Plan B®

The EC At-The-Counter Projectprovides educational sessions on collaborative practice agreements for EC for you and your staff. Call Cheryl Daggett, NP, Project Coordinator, for more information or to schedule a training session at 622-7524 ext. 23.

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MaineCare MECMS Update

The Governor's MaineCare Providers' Advisory Group met on September 14 and reviewed interim payments (and cash flow), current metrics, Release Management and the customer service action plan. Highlights were as follows:

  • For the previous week, processing of paid and denied "fresh claims" was 90.5%.
  • Suspended claims were down to 157,582
  • Further corrections through Releases have been delayed because of the poor performance of the July 1 Release.
  • On the customer service front, 22 additional staff members have joined the division since April, including 10 additional provider relations' representatives.  Each county in the state now has a provider relations' team.
  • OMS Customer Service now consists of five functional areas with distinct responsibilities.  These are Member Services, Member Services/Pharmacy Help Desk, Provider Enrollment Unit, Provider Relations Unit and the Billing & Information Unit.  An updated Customer Service organizational chart, including county assignments was put on the listserv on September 8.

Provider relations' representatives are planning to visit with providers at DHHS regional offices beginning September 18.  You are invited to attend one of the regional sessions and bring questions, issues, and suggestions.  You can bring samples of claims and remittance advices.

Appointments are available in one-hour time slots beginning between 8:00 and 9:00am, depending on the location.  Enrollment is on a first-requested, first-registered basis and is limited to a one-hour session per provider.  A registration form is available by contacting Deborah Thomas at dthomas@usm.maine.edu [return to top]

"First Fridays" CME Program on Advance Directives Oct. 6 at MMA

The 122nd Legislature enacted legislation changing the laws regarding "Do Not Resuscitate" orders in Maine (Resolves 2005, Chapter 169) and considered other important changes to Maine's laws on Advance Directives. Advance Directives were also in the news last year with the widespread reporting of the tragedy surounding the Terry Schiavo case.

The purpose of this three-hour program, offered from 9:00am to noon at the MMA offices in Manchester,  is to:

  1. Present the history of the development of the law in Maine regarding end-of- life decision-making, including living wills, healthcare powers of attorney, do-not-resuscitate orders and surrogate decision making.
  2. Discuss the current laws and any recent changes.
  3. Provide suggestions on  how to improve end-of-life care in one's practice.

The faculty consists of four presenters who know the development of Maine law in this area as well as anyone in the state.  Beth Dobson, Esq. of the firm of Verrill & Dana in Portland is a frequent lecturer on health law topics and has practiced in Portland for nearly 30 years.  Leo Delicata, Esq., is a senior attorney with the office of Legal Services for the Elderly.  Leo has been involved at the legislative level with every change in this area of law for the past twenty years.  Completing the faculty are Andy MacLean and Gordon Smith from MMA.

The cost per attendee is just $60 for three hours of CME, breakfast and all the materials.  You may register online at www.mainemed.com or call Jess at MMA at 622-3374. [return to top]

More on 153rd Annual Session Held Last Weekend

Over 100 physicians and another 150 guests, speakers and exhibitors attended the 153rd Annual Sesson held Sept. 8-10 at the Fairmont Algonquin Hotel in St. Andrews-by-the-Sea, New Brunswick, Canada.  Among the guests were the President of the New Brunswick Medical Society, Roseanne Goodine, M.D., a family physician from Woodstock and David Balmain, The Executive Director of the New Brunswick Medical Society.  Additional guests were from New Hampshire, Louisiana, Ohio, California, Illinois and Washington, D.C.  Keynoting the CME portion of the meeting was Story Musgrave, M.D., a former NASA astronaut who walked in space and repaired the Hubble Telescope.

On Saturday evening, Jacob Gerritsen, M.D. handed the President's gavel over to in-coming President Kevin Flanigan, M.D.  Dr. Flanigan is an internist and pediatrician practicing in Pittsfield.  William Strassberg, M.D. was elected President-elect and Stephanie Lash, M.D. was selected by the Executive Committee to be its Chair for the coming year.  Dr. Strassberg is an orthopedic surgeon practicing in Bar Harbor and Dr. Lash in a practicing neurologist in Bangor.

At the General Membership meeting on Saturday morning, attendees passed ten Resolutions, including one supporting primary enforcment of Maine's seatbelt law and another advocating for FDA regulation of tobacco products.  The Resolutions as they were presented are available on the MMA website at www.mainemed.com (look under Spotlight).

A full report on the actions taken at the meeting and the awards presented will be included in the September-October issue of Maine Medicine.

The 2007 Annual Session will be held Sept. 7-9, 2007 at the Harborside Hotel and Marina in Bar Harbor. [return to top]

Maine Benzodiazepine Study Group International Conference October 23-24, 2006

Fourth Annual Maine Benzodiazepine Study Group International Conference

&

Third Annual Unused Drug Return International Conference

October 23-24, 2006

Eastland Park Hotel, Portland, Maine

Attention health care professionals, policymakers, law enforcement personnel, environmentalists, substance abuse professionals, and others concerned with the human and environmental impact of prescription drugs: The advance announcement of the 4th Annual Maine Benzodiazepine International Conference and the 3rd Annual Unused Drug Return International Conference has now been published. Your calendars should already be marked for Oct. 23 and 24, 2006 at the Eastland Park Hotel in Portland, ME.

One conference track addresses the multitude of issues surrounding the appropriate uses, misuse and alternatives to benzodiazepines, a class of medications used to treat anxiety, stress and insomnia, and other prescription drugs. Pertinent health safety and improved medication prescribing practices will be considered.
A second track focuses on the environmental and social impact of unused prescription drugs stored in homes and flushed or otherwise discarded into the environment. Innovative return and disposal policy and program responses will be illustrated.

Conference registration instructions, sessions topics and speakers, and hotel reservation information are now available on our website www.mainebenzo.org or you may click directly to registration files below:

We look forward to seeing you in October!
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CMS Hosts Provider Town Hall Conference Call, September 20, 2-4pm

CMS is hosting a Provider Town Hall conference call on Wed., Sept. 20, 2006 from 2pm-4pm. The meeting is intended to serve as a venue for interaction between CMS and physicians, providers and suppliers and to obtain feedback. Issues schedule for discussion include but will not be limited to:

  •  Implementation of the National Provider Identifier (NPI)
  •  Pay for Performance initiative
  •  Part D Compliance
  •  Durable Medical Equipment (DME) Accreditation, and
  •  Medicare Contracting

Participating via Conference line: 877–357–7851 Identification #: 2323964

For more information please contact Colette Shatto at CMS at 410–786–6932. E-mail inquiries may also be directed to meeting to MFG@cms.hhs.gov [return to top]

CMS National Provider Identifier (NPI) Roundtable Conference Call, September 26

CMS National Provider Identifier (NPI) Roundtable conference call scheduled for Tues., Sept. 26th from 2pm – 3:30pm. Send questions in advance of the meeting to: NPIQuestionsfromCarrierBillers@cms.hhs.gov.  The NPI will be required for all physicians who conducts claims and other HIPAA transactions electronically, beginning May 23, 2007. NPI questions / concerns should be directed to Mari Johnson at mari.johnson@ama-assn.org or (202) 789-7414.

It is important to note that while the Health Insurance Portability and Accountability Act (HIPAA) only requires physicians who conduct one or more HIPAA transactions electronically to begin using the NPI, some payers may make the business decision to require paper billers to also obtain an NPI. Medicare has recently announced it will require paper billers to obtain an NPI. More information on the requirements for Medicare paper billers is forthcoming from CMS.

-CMS 1500 Claim Form: CMS is implementing use of the revised 1500 claim form to accommodate the use of the NPI. Transition to the new form will begin on January 2, 2007. Go to: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5060.pdf for more information.

-More information about the use of the NPI through electronic data interchange, Direct Data Entry, and on paper claims forms can be found at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4023.pdf [return to top]

The Coding Center's Coding Tip of the Week

“Nurse Visits”—What is different about 99211?

  • Only visit code that does not require a practitioner (physician, PA, NP) to be present
  • Physician’s can use this code, however
  • CMS “incident to” criteria should be met
  • Must be an employee or have contractual relationship, who is trained and competent to render the service
  • Physician/PA/NP MUST be immediately available in the office if required must review and sign the chart
  • Orders for service should be in patient’s chart
  • Staff must document who order is from and who is “supervising” to bill for service

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