May 21, 2007

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Mainecare/MECMS Update Provided to Appropriations Committee

The Legislature's Joint Standing Committee on Appropriations and Financial Affairs met on Friday and heard a report from DHHS Commissioner Brenda Harvey and Deputy Commissioner Kirsten Figuerora on the MaineCare FY 07 shortfall which has grown to $36 million.  Physicians and other providers paid off of the MaineCare fee schedule would face a potential 3 to 4 week delay in payment during June without remedial action being taken.  Fortunately, the state's Revenue Forecasting Commission met this past week and recognized an additional $17.7 million in revenue for the current fiscal year (07) which has been partially utilized to reduce the MaineCare shortfall to $20.2 million.  Physician practices still should plan for a delay in MaineCare payments as the state reaches the end of its fiscal year on June 30.  DHHS does intend to get caught up with the payments in July.

For the week ending May 4, 2007, the IPRT (Interim Payment Recovery Team) Weekly Snapshot report showed that physicians were still owed over $13 million in suspended claims and were holding almost $11 million in interim payments. 

The week's payment cycle totaled $46.0 million of which the state paid $35.2 million, thereby increasing the capped claims by $10.8 million.  As a result, the state is carrying approximately $56.8 million in claims due to capping cycles.  When DHHS caps a cycle, those claims held as a result of the cap are processed first in the next week's cycle, as long as there hasn't been more than a full cycle capped.  Once more than one week of claims is carried forward, the cap is determined day by day based on claims adjudication date.

Interim recoveries through May 11, 2007 total $351.7 million (67%), of which $111.1 million has been recovered in FY 07.

The Governor's MECMS Provider Advisory Committee (PAC) meets again on Friday, May 25.  On June 7, the PAC and the Technical Advisory Committee (TAC) will meet and have a facilitated "visioning" session, designed to elicit input from providers into the design of the new claims processing system that will be the subject of an RFP to be issued in December, 2007.  The RFP is expected to be responded to by one or more potential "Fiscal Agents" who would utilize a system in Maine that is similar to a system already in place in one or more states.  Among the states currently using a fiscal agent to process claims are New Hampshire, Massachusetts and Vermont.

MMA continues to advocate for a more meaningful Provider Advisory Committee that is chaired by a Provider representative and which is directed by providers rather than DHHS staff.

At the Appropriations Committee meeting on Friday, an editorial appearing in the Kennebec Journal on the previous day (May 17) was noted.  Entitled "Time to Crack the Whip", the editorial was particularly hard-hitting and drew the attention of committee members.  Commissioner Harvey indicated that she would be responding to the editorial but questioning by the committee members suggested that even they have reached the point where they recognize the colossal blunder and embarrassment that the MECMS project represents.  The following excerpt from the Kennebec Journal is representative of the entire piece:

Whatever you choose to call it, the state's failure to pay providers of Medicaid services years after they did the work now amounts to stealing.  If the state was a private individual, they'd have been taken to the collection agency and small claims court long ago.  If the state was a private insurance company, it would have been shut down by now - by the state bureau of insurance.

The editorial went on to state that the three year fix that the state was now talking about was hard to swallow. 

MMA has consistently expressed its concern to state officials, including Governor Baldacci, of the seemingly lack of urgency in fixing the problem.  For the RFP for a fiscal agent to be not even released until December, sets up a timetable for transition to a new system that may not be complete for two to three years.  Such a timetable is simply unacceptable to physician practices who have waiting since Jan. 2005 for a system that will electronically process cross-over claims for patients covered by both MaineCare and Medicare, that is HIPAA complaint and that allows providers to void a claim.

Please continue to access the Weekly Update to learn the latest on the MECMS problem.

Mount Desert Island Hospital Receives National Rural Health Association Award

This past week, Mount Desert Island Hospital received the National Rural Health Association's Outstanding Rural Health Organization of the Year Award at its 30th Annual Conference in Anchorage, Alaska.  The award is presented  to recognize any group or entire organization that has improved access to health services and information for rural people through innovative, comprehensive approaches.  Factors considered include outreach, preventive health and education, quality and efficiency of care and strong community support and involvement. 

Congratulations to CEO Art Blank, the MDI Hospital Medical Staff and all of the hospital employees and board members for this recognition. [return to top]

Single-Payer Health Care May be On November 2008 Maine Ballot

Organizers of a newly formed ballot initiative will attempt to gather the required number of signatures to place on the Maine ballot  a question regarding whether the state should adopt a single-payer health-care system.

The group is being led by Jonathan Carter and Pat LaMarche, both of whom have run for Governor as Green Independents candidates and Chris Miller, who challenged Gov. Baldacci in last year's Democratic primary.

To get on the ballot, the organizers need to gather signatures from 55,000 voters.  Leaders of the signature drive said they are seeking "privately delivered and publicly financed" health care, comparing their initiative to the Canadian health-care system.  They are now in the process of drafting proposed language that will be sent to the Secretary of State's Office, which must approve ballot language before it's sent to voters. [return to top]

Insurance and Financial Services Committee Hears Dirigo 2.0 Legislation (L.D. 1890)

L.D. 1890, An Act to Make Health Care Affordable, Accessible and Effective for All, which embodies Governor Baldacci's proposed changes to the Dirigo Health Program, was the subject of a public hearing on this past Wednesday before the Joint Standing Committee on Insurance and Financial Services.  Testimony presented, included that presented by MMA, can be accessed through the MMA website at

MMA's testimony in favor of the changes emphasized the Association's support for the individual mandate and the effort to cover all Mainer's with some form of health insurance.  Testimony of the Maine Hospital Association emphasized its support for expanding coverage, as well, but expressed opposition to the financing mechanism which represents a surcharge of hospital bills.  Both business interests and consumer interests testified against the legislation, with the business community opposing the employer "pay or play" provision and the consumers opposing the changes to the community rating bands (which business interests support).

MMA also opposed the hospital bill surcharge as the new primary financing vehicle, and instead noted its support for the recommendations of the Blue Ribbon Commission on Dirigo which recommended financing the costs through taxes on snacks, cigarettes, sweetened beverages and alcohol.

A work session has been scheduled on the bill for this coming Tuesday (May 22).    MMA representatives will attend. [return to top]

Sunbury Medical Associates Seeks Family Practice Physician

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Taxation Committee Drops Proposal to Tax "Elective Cosmetic Medical Procedures"

In last week's edition of Maine Medicine Weekly Update, the MMA reported that the Taxation Committee was considering an extension of the sales/use tax to "elective cosmetic medical procedures" during its "tax reform" discussions.  Based upon conversations with key members of the committee last week, the MMA believes that the committee no longer is pursuing this proposal.  Thanks to all members who contacted committee members to express your concerns about it.  As previously reported, Maine Revenue Services is auditing two Bangor practices under current law and is claiming sales or use tax is due on some drugs, such as Botox, and prosthetic devices.  The state's plastic surgeons have retained legal counsel through the MMA to oppose this action.
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HHS & IFS Committees Consider Bill on Hospital Rate Regulation

Last week, the Legislature's Health & Human Services and Insurance & Financial Services Committees jointly held a public hearing and work session on L.D. 1849, An Act to Protect Consumers from Rising Health Care Costs, sponsored by Senator Philip Bartlett (D-Cumberland).  The first part of the bill proposes to re-establish  a system to regulate hospital rates in Maine, using language from the enabling legislation creating the Maine Health Care Finance Commission.  The second part proposes a commission to develop such a system.  Despite the sponsor stating his intention to address health care costs more broadly than just hospital costs, the sponsors' and proponents' testimony certainly focused on hospital costs. 

Proponents of the bill included the Maine Council of Senior Citizens, Consumers for Affordable Health Care, Maine Equal Justice Partners, the Disability Rights Center, the Maine Center for Economic Policy, and the Maine State Employees Association.  MaineHealth, the MHA, the MMA, Anthem, and the Maine State Chamber of Commerce all spoke in opposition to the bill.  The MMA's testimony focused on the likely negative effect such a proposal would have on recruitment and retention of physicians who might see this as a sign that Maine policymakers have a regulatory attitude that is contrary to the advancement of medicine.

At a work session last Thursday afternoon, it became clear that the Democratic majority on the two committees intend to pursue some legislative response to the continuing concern about high health care costs in Maine.  HHS Committee Chair Anne Perry (D-Calais) proposed in concept a permanent entity under the Dirigo Health Agency (either the Advisory Council on Health Systems Development or a new body) to review the recommendations of the various health care reform study groups established during the past decade and to seek ways to address health care costs without resorting to rate regulation. 

The Committees have scheduled another work session on the bill for this Thursday, May 24, 2007 at 3 p.m. in the HHS Committee room, Room 209 of the Cross State Office Building.

If you would like to express your concerns about L.D. 1849, you can find contact information for members of the two committees as follows:

IFS Committee:
HHS Committee: [return to top]

CON Program is Subject of Two Bills Before the HHS Committee

The state certificate-of-need (CON) program continues to attract the interest of health care policymakers in Augusta with key individuals in the Baldacci Administration and advocacy groups like Consumers for Affordable Health Care pushing to extend the reach of the CON program at every opportunity.  Rep. Lisa Miller (D-Somerville) has sponsored a study bill, L.D. 1535, Resolve, to Establish the Work Group to Review and Recommend Improvements for the Certificate of Need Program, a bill similar to one she submitted on behalf of Consumers for Affordable Health Care in the 122nd Legislature.   Rep. Miller also has sponsored L.D. 1763, An Act to Amend the Maine Certificate of Need Act of 2002 on behalf of the Department of Health & Human Services.  Much of L.D. 1763 is technical, but the MMA, Ambulatory Surgical Center Coalition, MHA, and other interested parties have objected to some parts of the bill that might extend the scope of the program.  The principal areas of contention are proposals to require CON review for replacement of medical equipment when the original acquisition did not require review, to establish a different methodology for determining whether projects are "related" for purposes of CON review, and to permit the Department to review projects for 3 years following issuance of a letter stating that CON review is not necessary.  

The MMA met with representatives of the Department and the other stakeholders last week before a scheduled work session to negotiate a resolution to these issues.  The group is re-drafting portions of the bill and both bills will have another work session in the HHS Committee on Thursday, May 24th at 1 p.m.  [return to top]

REMINDER: Legislative Committee Conference Call Thursday at 7:30 p.m.

The MMA Legislative Committee will hold its next conference call this Thursday, May 24, 2007 at 7:30 p.m.  The conference call number is 1-800-989-2842 and the access code is 6223374#.  There is no published agenda for these calls, but Mr. MacLean and/or Mr. Smith will update participants on the current legislative activities and issues.  Any interested member is welcome to participate and this is your opportunity to ask a question or to make a comment about the MMA's legislative advocacy work. [return to top]

AMA & 86 Other Medical Groups Recommend Medicare SGR Replacement

In a letter to every member of Congress dated May 17, 2007, the American Medical Association and other medical groups urged the U.S. Congress to replace the Medicare SGR physician payment methodology with a system like the one used to determine rates for hospitals, nursing homes, and other Part A providers.  The process would begin with the Medicare Payment Advisory Commission (MedPAC) forecasting the increase in medical practice costs and then Congress would act upon the MedPAC recommendations.  Under the SGR, Medicare physician payment rates are scheduled to be cut by 9.9% in 2008.

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Milliman Study Cites $14,500 Average 2007 Medical Cost for Family of 4

According to a study released by Milliman, Inc. on May 15, 2007, the total medical costs for a family of 4 will average $14,500 in 2007, an increase of $1118 or 8.4% from 2006.  The average increase is lower than the 9.3% annual increase over the last several years, but Milliman does not expect the downward trend to continue because of a variety of factors, including a faster rise in prescription drug inflation.  The study projects physician costs to rise at the slowest rate.

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June 1 First Friday CME Program Features Coding Issues with Jana Purrell

On Friday morning, June 1, MMA will present its fifth "First Friday" educational offering of the year with a program entitled, "Jazzing Up Your Coding Skills" presented by Jana Purrell, CPC, Director of The Coding Center.

Jana will answer your questions and address Common Coding Issues - How to prevent costly coding errors.  Topics will include:

  • Evaluation and Management Services
  • Global Surgical package
  • Use of Modifiers - E/M and surgical

Jana will also present information regarding reporting quality measures, including what physicians and staff need to know about the CMS PQRI (Physician Quality Reporting Initiative).  Attendees are encouraged to bring any coding questions with them for discussion.

Jana Purrell has over twenty years experience in medical offices, management companies, hospital, and emergency medicine settings including both clinical and administrative roles.  Prior to joining the Coding Center, Jana worked for Maine Cardiology Associates for eleven years in the role of Business Office Manager.  She received her Certified Professional Coder Certification in 1999 and her CPC Instructor Certification in 2001.

Persons interested in registering for the program may call MMA at 622-3374 and Press O to be assisted and you may register on the MMA website at  There is a $60 fee which covers breakfast and all materials. [return to top]

Register Today for June 20 Practice Education Seminar in Auburn

Register today for the Association's 16th Annual Practice Education Seminar to be held on Wednesday, June 20th at the Hilton Garden Inn in Auburn.  The all-day program, featuring plenary sessions in the morning and a choice of twelve break-out sessions in the afternoon, will run from 8:30am to 4:00p.m.  The keynote presenter is Erik Steele, D.O. of Eastern Maine Healthcare  System, a well known columnist for the Bangor Daily News and a health administrator for the EMHS.  An update will also be provided by the new MaineCare Director.  Federal officials will present information on the new CMS Physician Quality Reporting Initiative, which begins on July 1.

The Annual Practice Education Seminar, which regularly attracts about one hundred attendees, presents the Association with an annual opportunity to share with practice managers and members the major issues affecting medical practice in Maine.

Call the MMA office at 622-3374 to register or register online at the MMA website at [return to top]

One Week Left for Physicians to Obtain National Provider Identifier Number

Beginning May 23, physicians nationwide who bill Medicare will be required to use their new National Provider Identifier (NPI) number in lieu of their old identifier numbers on claims and other transactions.  CMS will permit physicians and others required to use the NPI to enact contingency plans that permit the continued use of legacy identifier numbers on claims and other transactions so long as they are making good faith efforts to work toward NPI compliance. Getting an NPI number prior to the deadline is seen as a key step in moving toward compliance.  The maximum allowed time for a contingency plan to be in effect is through May 23, 2008. After that, no legacy identifiers may be used on claims or other transactions. Medicare as a payer has decided to enact a contingency plan that is expected to end when a “sufficient number” of claims contain the NPI.

Physicians are strongly encouraged to do the following:

  • Get an NPI prior to May 23.
  • Contact each payer to determine what, if any, NPI contingency plan they have and how long it will last.
  • Establish a line of credit that can be used to avert unanticipated cash flow interruptions beginning May 23 during the transition to use of the NPI.

Visit for more information. [return to top]

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