October 22, 2007

 
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U.S. House of Representatives Fails to Override President's Veto of SCHIP Expansion

On a vote of 273 to 156, the House failed this past week by 13 votes to override the veto of President Bush of the compromised version of the State Children's Health Insurance Program (H.R. 976).  A two-thirds vote was required.  Forty-four Republicans voted to override, while two Democrats voted to sustain the President's veto.  Because both the House and Senate would need to override the veto for the legislation to become law, a Senate vote to override will not be scheduled. 

The AMA, the American Academy of Pediatrics and numerous other medical and child advocate groups have lobbied for months encouraging the Congress to not only re-authorize the program but to expand it.  H.R. 976 would have provided an additional $35 billion to the program over the next five years.  The President had supported a $5 billion expansion.

The bill would have strengthened outreach and enrollment efforts to target children in families of the lowest income, provided assistance to allow SCHIP program and employers to enroll children in employer sponsored private insurance plans, retained the current law for eligibility coverage of 200% of the federal poverty level for children up to 19 years of age, and prohibited federal funding for coverage of illegal aliens.

All four members of Maine's Congressional delegation have supported an expansion of the SCHIP program and both Congressman Allen and Michaud voted to override the President's veto. 

The SCHIP program has been extended, with current funding levels, through Nov. 16.  It is hoped that the President and Congressional leaders will now compromise on a more limited SCHIP package, but nonetheless one that will continue to provide health insurance coverage to more children.

Dirigo Health Agency Board of Trustees to Meet Tuesday (Oct. 23)

The Dirigo Health Agency Board of Trustees will meet this coming Tuesday to consider the proposed contract with Harvard Pilgrim Health Care, the potential new carrier for the DirigoChoice insurance product. The meeting will be held at 1:00pm in the Boardroom of the Dirigo Health Agency at 211 Water St., Augusta.  Although funding has been more limited than expected because of the recent decision on the Savings Offset Payment (SOP) by Acting Superintendent of Insurance Eric Cioppa, and further because of the Legislature's failure to establish an alternative funding source, the product will be available to existing insureds throughout 2008 and hopefully beyond.  Enrollment has been frozen at current levels until the financing matter is resolved.  Approximately 15,000 persons are currently insured through the program. [return to top]

October is National Breast Cancer Awareness Month

The American Cancer Society is encouraging everyone to do something to fight the disease which will affect about 179,000 women in the nation this year. 

Every woman age 40 or older is encouraged to get a mammogram every year.  Getting regular mammograms is the best way to find breast cancer early, when treatment is more effective. 

Learn more about what the American Cancer Society is doing to fight breast cancer and what you can do to help.  Call 1-800-ACS-2345 or visit www.cancer.org/breastcancer.

 

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Attention Again Focused on Second-Hand Smoke: Autos and Rental Properties

Weekend newspaper articles featured the upcoming debate on proposals to prohibit smoking in automobiles when children are in the vehicle and a voluntary effort to persuade private lanlords and housing authorities around Maine to prohibit smoking inside hundreds of dwellings.

The recently formed Smoke-Free Housing Coalition is spearheading the effort relative to apartments.  Currently, 1800 apartments are listed as smoke-free on the coalition's online registry.

On Monday (today), a report is being released by the University of Maine stating that the treatment of children for problems related to secondhand smoke comes with a price tag of at least $8 million a year.  The research was conducted by the report's author, University of Maine economist Mary Davis.  The report was prepared at the request of Dr. Jonathan Shenkin, a pediatric dentist in Bangor who was the driving force behind the City of Bangor ordinance prohibiting smoking in cars when children are in the vehicle. Legislation is expected to be introduced in the 2008 session of the Maine legislature which would impose the Bangor ordinance on a state-wide basis.

MMA members endorsed a resolution at the Sept. Annual Meeting on the topic of second-hand smoke and children in motor vehicles.  The resolution can be viewed on the MMA website at www.mainemed.com[return to top]

State Forums on Health Care Issues Continue this Week

State officials from the Governor's Office of Health Policy and Finance and the Maine CDC/DHHS continue their forums around the state this coming week and next week with programs in Wells, Portland, Auburn and Rockland.  Members of the public and providers are invited to attend and discuss priorities for the upcoming state health plan, the emerging public health infrastructure, and revitalization of the local health officer system.

The remaining four programs are as follows:

Oct. 24       am    Wells  (Village by the Sea)

Oct. 24       pm    Portland (Holiday Inn By the Bay)

Oct. 29      pm    Auburn (Hilton Garden Inn)

Oct. 30      am    Rockland (Samoset Resort)

The morning sessions are from 8:30am to noon.  The afternoon sessions are from 12:30pm to 4:00pm.

For more information, see www.mainepublichealth.gov or call Elaine Lovejoy at 287-3266. [return to top]

MeCMS RFP issued

The Request for Proposals (RFP) to redesign Maine’s beleaguered Medicaid claims system, known as MeCMS, were made public last week.

Four companies are expected to bid on the project: EDS , Unisys , ACS , and First Health Services Corp.  

According to potential contractors, the RFP has a shorter turnaround, less than 30 days, than most such requests.  And the RFP is asking for a true fixed price, which is likely to raise the amount of the bids, as contractors try to prevent any losses considering all that is unknown about the project.  Both points were inconsistent with conversations with the state in bidders’ meetings, potential bidders said.

Also, it appears that the scope of the outsourcing to run the claims system is bigger than the state employees and their union had expected.  In other words, more state workers would lose their jobs.  This has concerned the Medicaid/Department of Health and Human Services staff, resulting in several meetings. [return to top]

Senate Finance Panel Begins Meetings On Payment Fix for Doctors, Other Changes

Senate Finance Committee members met Oct. 17 to begin the process of crafting a Medicare bill that will include a provision canceling a scheduled 10 percent cut in physician pay for 2008. 

Committee members emerged from a 90-minute meeting saying they discussed Medicare options and the process for getting a bill through the Senate, but no final decisions were made.

The committee is examining whether to provide a one-year or two-year payment fix for physicians, as well as several other provisions in a package with a price tag of about $30 billion, Sen. Gordon Smith (R-Ore.) told reporters.

Committee members said whether to do a one- or two-year fix for doctors likely will depend on how much money can be found to pay for the package. Funding options include cutting Medicare Advantage managed care payments, payments to oxygen providers, and payments to other providers, they told reporters.

Increasing doctors' pay likely will be expensive, with a two-year fix estimated at about $20 billion.

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The Coding Center Announces Two Fall Classes for New Billers

Don't miss these fall classes from the Coding Center, November 9 in Portland and November 12 in Concord, New Hampshire:

Learning the Language of ICD-9-CM
8:00am-noon
Objective: To gain a working knowledge of diagnosis coding rules as they apply in the physician billing environment.
This workshop will introduce the new medical biller to the principles of ICD-9 coding for physician services. After this session, the student will have:

  • Understanding of the purpose of diagnosis coding using ICD-9
  • Familiarity with layout of ICD-9 - Volumes 1 & 2 including Tables
  • The ability to interpret the coding rules & guidelines
  • Understanding of the importance of coding to highest specificity and sequencing
  • An initial introduction to specific coding situation (Burns, Late effects, Poisoning)
  • Knowledge of V & E codes

Deciphering the Code of CPT
1:00-5:00pm
Objective: Initial introduction to Current Procedural Terminology (CPT)
This workshop is geared to the new medical biller. We will explore the basic layout of the CPT book and discuss general coding principles as they relate to coding for services provided by physicians. After completing the session, the student will have:

  • Understanding of what CPT means and why it is used
  • The ability to navigate the CPT book including Index, Sections, and Appendices
  • Understanding of CPT coding rules
  • Introduction to modifiers
  • Basic knowledge of Evaluation and Management (E/M) services
  • Brief overview of contents of each Subsection

Register today! [pdf] [return to top]

'Wage and Hour Issues For Businesses' Brown Bag Lunch Offered, November 6, Lewiston

The Androscoggin Chamber of Commerce is sponsoring a brown bag lunch meeting on federal wage and hour issues for all sizes of businesses November 6, 2007. Even if you believe you aren't involved in the interstate "stream of commerce," all you need is an employee using a credit card machine for at least that employee to be covered. The lunch will take place at the Chamber's offices at The Business Service Center at KeyBank Plaza. George Rioux, District Director of the federal Department of Labor, will be one of the speakers, along with Rebecca Webber, an employment attorney at the Auburn law firm of Linnell, Choate & Webber. Mr. Rioux will address exemptions, compensable hours of work, on call time, travel time, independent contractors, salespeople, tip credit, and common violations to watch out for.  Call 207-783-2249 to register. [return to top]

A Message for MaineCare Providers on Void Functionality

During the first two weeks of October, more than 800 providers attended training on use of the void functionality in MeCMS.  The Powerpoint presentations used for the training have now been posted to the MaineCare Services web site.  These can be accessed at the link here under the “Void Functionality to be implemented in MeCMS” headline.

http://www.maine.gov/dhhs/bms/member/innerthird/mecms_portal_news.html

Providers can begin to submit voided claims not intended for re-billing on Monday, October 22.
Providers can initiate voided claims intended for re-billing on Monday, October 29.
Providers may submit re-bills once the voided claim appears on a Remittance Advice (RA).

Reminders:

What providers CAN do with Void functionality: 

B Void an original paid claim document or paid claim line for which a void was not previously submitted and approved

A general rule of thumb is that if claims are currently paying correctly, a Void followed by a Re-bill should result in a proper payment.  If a claim is NOT paying correctly due to a known issue, VOIDS AND RE-BILLS SHOULD NOT BE SUBMITTED because the claim will encounter the same issue.  Examples of these are limits, edits processing failures (EPF) and co-pays. 

Nursing, Custodial Care and Residential Care Facilities cannot void paid claim lines on documents with cost of care; spend downs, room and board or TPL.  Please contact your Adjustment Specialist for instructions on how to handle these. 

Hospitals and Psychiatric Hospitals cannot void paid claim lines on documents that include spend downs or TPL, and cannot void a line that has a revenue code of room and board unless the room and board line is the only line in the entire claim document.  Please contact your Adjustment Specialist for instructions to handle these.

B  Re-bill a Voided claim document or claim line once the Void appears on an RA

B  Void multiple claim lines within a billing cycle 

Each claim line must be submitted as a separate Void document

What Providers CANNOT do:

D   . . .Void a DENIED claim document or claim line

D   . . .Void an ADJUSTMENT claim document or claim line

D   . . .Void a VOID claim document or claim line

D   . . . Void a mixed DENIED and PAID claim document (must VOID individual paid claim lines)

D   . . . Void a SUSPENDED claim

D   . . . Void a claim held in Edits Processing Failure

D   . . . Void a claim held in Fund Allocation Failure

D   . . . Resolve a current outstanding billing issue by voiding and re-billing

D   . . . Adjust a claim document or claim line (using Submission Reason/Frequency of 7)

 

Contacts for Questions:

Billing and Information 1-800-321-5557, Option 8

Adjustment Unit Contacts

Providers Billing on CMS1500 or Dental Forms:

            Provider names
            beginning with:                        Contact Person:                      Phone:

                  A-E                                    Debbie Ladd                            207-287-1780
                  F-N                                    Jaime Hall                               207-287-1778
                  O-Z                                    Debbie or Jaime                     

Providers Billing on UB Forms:

            Provider names
            beginning with:                        Contact Person:                      Phone:

            A-E                                          Linda Harrington                      207-287-1777
            F-L + All MR Waivers              Shavon Smith                         207-287-6284
            M-Z                                          Nancy Haskell                         207-287-1779 [return to top]

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