May 5, 2008

 
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The Coding Center Begins Two New E/M Chart Auditing Classes this Week

The Maine Medical Association's Coding Center begins two E/M Chart Auditing Classes this coming week.   The classes will be held in Portsmouth, New Hampshire and Manchester, Maine with the N.H. course beginning on Tuesday, May 6 and the Manchester course beginning on Wednesday, May 7.  Both classes run for five weeks and are held from 3:00 pm to 7:00 pm.

Both courses will be taught by The Coding Center Director Jana Purrell, CPC and offer 20 CEU's for certified coders.  However, coding certification is not required in order to take the class.

Topics covered in the class include:

  • Understand the elements of an audit
  • Issues surrounding documentation
  • Step-by-step auditing:  the key components
  • Helpful information about a variety of visit codes
  • Develop a template for an audit program

The cost of the five-week course is $600 and registration is available by calling the Maine Medical Association at 622-3374 (ask for Lisa Dennison or dial extension 219).

MMA Committee on Physician Quality Meets on Thursday, May 8 at 4:30 pm

MMA's Committee on Physician Quality (CPQ) will meet on Thursday, May 8 at 4:30 pm at the offices of the Association in Manchester.  Included on the agenda are the following items:

  • A review of the major portions of the recently released State Health Plan which relate to the quality of medical care provided to Maine's citizens;
  • An update on the Voluntary Practice Assessment Initiative (VPAI), which has been expanded recently to include more enhanced reporting;
  • A review of the agenda for the Sept. 4th joint program with the Maine Hospital Association;
  • Further discussion of that portion of the MMA Professionalism Initiative which focuses on quality improvement and patient safety.

The Committee is chaired by David McDermott, M.D., M.P.H., a family physician and emergency room director at Mayo Regional Hospital in Dover-Foxcroft. [return to top]

Report on Saturday (May 3) Meeting of New England Delegates to the AMA

Four representatives from Maine journeyed to Connecticut on this past Saturday to discuss resolutions and conduct other business in preparation for the AMA's Annual Meeting in June in Chicago.  Attending from Maine were AMA Delegates David Simmons, M.D. and Richard Evans, M.D., alternate delegate Maroulla Gleaton, M.D. and MMA EVP Gordon Smith.

Among the resolutions considered and approved for support of the New England delegation were the following:

  • Health Care Costs of Violence & Abuse Across the Lifespan (introduced from Maine);
  • AMA Model Agreement with Advanced Practice Nurse Clinicians (APRN's), Nurse Practitioners (NP's), and or Clinical Nurse Specialists (CNSs);
  • Optional Use of Social Security Numbers during the CAQH Credentialing Process;
  • Studying the Ethical Implications of creating "cytoplasmic" human-animal hybrids.

Attendees also received updates of AMA Councils and Task Forces from New England physicians who are on them.

Earlier in the morning, the participants assembled as the Council of New England State Medical Societies and heard reports from each New England state medical society.  Dr. David Simmons reported from Maine and spoke of the recent struggle in the legislature with lay midwives, the enactment of the new financing package for Dirigo Health, and the public health initiatives enacted by the 123rd Legislature, including the bill to prohibit smoking in vehicles with children under the age of 16 as passengers. [return to top]

17th Annual Practice Education Seminar being held in Augusta, Wed., May 28

MMA will hold its 17th Annual Practice Education Seminar on Wednesday, May 28 from 8:30 am to 4:30 pm at the Augusta Civic Center in Augusta.  More than 100 physicians and practice managers are expected to attend and benefit from morning plenary sessions and from four tracks of educational programs in the afternoon.  The afternoon tracks feature the topics of technology, compliance, practice management, and "hot topics."

Featured speakers include U.S. Attorney for the District of Maine Paula Silsby, forensic anthropologist Marcella Sorg, recuitment specialist Kurt Mosley, and a panel consisting of leaders of several of the quality improvement initiatives in Maine.

Updates will also be provided by MaineCare Director Tony Marple and MaineCare Medical Director Roderick Prior, M.D.

Registration for the program is available on the MMA website at www.mainemed.com or by callling the MMA office at 622-3374 (ext. 219). [return to top]

2008 Physician's Guide to Maine Law Available this Summer

The May "First Fridays" program featured the MMA's 2008 Physician's Guide to Maine Law which will be available this summer to MMA members and corporate affiliates.  The Guide also will be placed on the MMA website in the member's only section.  A pre-publication edition is available currently but has not yet been updated for the actions of the 123rd Legislature.  That work will be done this summer and the Guide then will be released on CDs and in three-ring binders.

For one of the pre-publication editions, either in a three-ring binder or on a CD, call Gail Begin at MMA at 622-3374 (ext. 210). [return to top]

In-Office Consultations Available on Prescribing for Chronic Pain

Through the generosity of the Board of Licensure in Medicine, in-office consultations are available on the subject of prescribing for chronic pain.  For more information on the availability of these consultations, at  no cost to the practice, call Gordon Smith, Esq. at MMA at 622-3374 (ext 212) or via e-mail to gsmith@mainemed.com.

These consultations are part of a contract between MMA and the BOLM which includes funding for placing resources on the MMA website, development of a home study course, and the in-office consultations.

This contract complements the contract MMA has with the Office of Substance Abuse (OSA) to educate physicians and other prescribers on the Prescription Monitoring Program and other means of preventing diversion of narcotics.  The Association has presented 18 of these programs.  If your hospital medical staff, specialty society, or group practice is interested in one of these programs, contact Gordon Smith (contact information above).  These programs are offered in one, two, three, and four hour increments. [return to top]

May 7th Marks CMS One Day Testing of NPI's

Testing of NPI Set for May 7

The Centers for Medicare and Medicaid Services (CMS) has requested that providers submit claims with the National Provider Identifier (NPI) number only in all provider identifier fields on May 7, 2008, as part of a one-day test exercise.  Clearing houses are instructed to submit claims using only NPI numbers without the legacy identifiers (e.g, PIN), which providers are permitted to use until May 23, 2008.  CMS believes this exercise will help providers assess their readiness prior to the May 23 deadline. 

In response to this deadline, the AMA has written to Health and Human Services Secretary Michael Leavitt expressing apprehension and and has requested that physician practices and others be allowed to continue to submit transactions that contain both legacy and NPI numbers for a minimum of six additional months after May 23rd.  This would allow for CMS to review and assess the rate of claims and other transactions being submitted successfully with just the NPI by Medicare, commercial payers, and other public payers (and the rate of claims sent with the NPI only which are rejected) during the six month period following May 23rd.

If your claims with NPI-only identifiers are being rejected, CMS recommends checking the National Plan and Provider Enumeration System (NPPES) data to see if your information is correct, and to check your Medicare enrollment status and record. 

Further information may be obtained from the  CMS Web site  - http://www.cms.hhs.gov/NationalProvidentStand/02_WhatsNew.asp# [return to top]

MMA Public Health Committee Meeting May 28th 4-6pm

The upcoming Public Health Committee meeting is scheduled for May 28, 2008, from 4-6 pm at the Maine Medical Association.  Committee Chair Dr. Charles Danielson has requested committee members to submit public health resolution concepts for consideration in preparation for the MMA Annual Session General Membership Meeting in September.  The meeting will focus on the following: 1) a review of the 80 public health bills tracked by staff during the 123rd Legislative Session; 2) Public Health Resolution Concepts; 3) Health Policy Partners of Maine's "Policy Change Campaign to Reduce Obesity"; 4) Collaborative data gathering effort for a report to the New England Governors Conference involving the six New England States to help guide future policy and action on Healthy Weight initiatives in the clinical setting; 5) recommendations for moving forward in our immunization educational efforts to reach the State Health Plan goal of 90% by end of 2009; and 6) Determine the Toxic Chemical (Environmental Health) workgroup charge/tasks.

All meetings are accessible via conference call or videoconference at the MaineHealth Board Room location in Portland.  For more information on PHC meeting activities, contact MMA staff Kellie Miller at kmiller@mainemed.com or (207) 622-3374, ext 229.  We certainly appreciate the involvement of any MMA member and welcome your participation.  All meeting agendas and minutes are posted on the MMA website. [return to top]

All Members Invited to 1st District Congressional Forum, May 13, 2008

Six of the eight First District Congressional candidates have responded positively to an invitation by MMA to participate in a Forum at MMA on Tuesday evening, May 13.  All MMA members are invited to attend and participate in a discussion about health care reform with candidates vying to succeed Tom Allen as Maine's First District Member of Congress.

MMA's Legislative Committee will host a candidate's night for 1st Congressional District candidates at the MMA offices in Manchester on Tuesday evening, May 13.  Refreshments will be available at 5:30 pm with the event beginning at 6:00 pm.  Six of the eight candidates have responded that they will attend, including front runners Chellie Pingree, Ethan Strimling, and Adam Cote, along with Steven Meister, M.D., Michael Brennan, and Dean Scontras.

After presenting five minute opening statements, each candidate has been asked to "discuss 3 steps you would take to improve the health care system of the United States. "  Following that, candidates will answer questions from physicians in the audience.

Representatives of the Maine Physicians Action Fund, a state-registered political action committee, and of the American Medical Association Political Action Committee (AMPAC) also will be in attendance, and following the forum will discuss potential endorsements and contributions.

All MMA members are invited to attend.  Please RSVP to the receptionist at the MMA at 622-3374. [return to top]

New Dirigo Funding Plan May be Subject to "People's Veto"

Since enactment of a bill amending the funding for the Dirigo Health Program late in the session, several trade groups affected by the bill have been discussing the prospect of pursuing a so-called "People's Veto" of the bill.  L.D. 2247, An Act to Continue Maine's Leadership in Covering the Uninsured replaces the controversial "savings offset payment" (SOP) with a 1.8% "health access surcharge" and increased taxes on beer, wine, and soda.  The MMA has always supported the Dirigo Health Program as part of Maine's pluralistic approach to universal coverage.  The DirigoChoice product reimburses physicians at market rates for their services and this was the key to MMA's support of the Dirigo bill in 2003.  The amended funding in L.D. 2247 is consistent with the recommendations of the Blue Ribbon Commission on the Dirigo Health Program issued in early 2007.  MMA EVP Gordon Smith was a member of the Blue Ribbon Commission and recently wrote an op-ed in the Kennebec Journal in support of L.D. 2247.  On Friday, May 2, 2008, Newell Augur, an industry lobbyist and director of a new coalition called Fed Up With Taxes, filed a "People's Veto" application with the Secretary of State's office.  Secretary of State Matthew Dunlap has 10 business days to accept or reject the application.  In order to get the question on the November ballot, coalition organizers would have to collect 55.087 signatures by July 17, 2008. [return to top]

Workers' Compensation Board Proposes Facility Fee Schedule

Following several years of advocacy by the business community about medical costs in the workers' compensation system, the Workers' Compensation Board last year issued a RFP for consulting assistance to develop a fee schedule for health care facilities such as hospitals and ambulatory surgical facilities.  Professional services have been governed by WCB Rule Chapter 5 for many years.  The Board worked with Eric Anderson with Ingenix to develop the background for a facility fee schedule and then convened a so-called "consensus-based" rulemaking group to determine if consensus can be achieved on the methodology for a fee schedule.  The MMA and the ambulatory surgical facilities are participating in the group.  At the first meeting on April 22, 2008, the WCB staff provided copies of the following draft amendment to Rule Chapter 5.

Section 1.  Definitions.

            (a)  Acute care hospital

            (b)  Ambulatory Payment Classification System

            (c)  Ambulatory Surgical Center (ASC)

            (d)  Critical Access Hospital

            (e)  Durable Medical Equipment

            (f)  Implantable

            (g)  Inpatient services

            (h)  MS-DRG

            (i) Outpatient services

 

Section 2.  Inpatient

            (a)  Billing for inpatient services must be submitted on a CMS Uniform Billing (UB-04) form.

            (b)  A critical access hospital shall be reimbursed at 95% of its usual and customary charge.

 

            (c)  Payments for inpatient services in an acute care hospital are based on the MS-DRG system.  The payment must be calculated by multiplying the base rate times the current MS-DRG weight.  The base rate for inpatient services at acute care hospitals is $8923.00.

 

            (d)  Except as provided in subsections (e) and (f), acute care hospitals shall be paid the maximum allowable payment established in Appendix IV or its usual and customary charge, whichever is less, for inpatient services. 

 

            (e)  The threshold for outlier payments is $50,000.00 plus the maximum allowable charge established in Appendix IV If the outlier threshold is met, the outlier payment must be the maximum allowable charge plus the charges above the sum of the threshold and the maximum allowable charge multiplied by 75%.  The total payment for the services is the outlier payment plus the maximum allowable charge. 

            (f)  Where an implantable exceeds $10,000 in cost, acute care hospitals may seek additional reimbursement beyond the maximum allowable charge.  For invoiced items, reimbursement is set at the actual amount paid plus 20%.  If an item is not invoiced, the payment must be 75% of charges.  When a hospital seeks additional reimbursement pursuant to this rule, the implantable charge is excluded from any calculation for an outlier payment.  Handling and freight charges must be included in the facility's invoiced cost and are not to be reimbursed separately.

 

            (g)  All services provided during an uninterrupted patient encounter leading to an inpatient admittance must be included in the inpatient stay.

 

            (h)  The following applies to facility transfers when a patient is transferred for continuation of medical treatment between two acute care hospitals:

            (1)  A hospital transferring a patient is paid as follows:  The MS-DRG reimbursement amount is divided by the number of days duration listed for the DRG; the resultant per diem amount is then multiplied by two for the first day of stay at the transferring hospital; the per diem amount is multiplied by one for each subsequent day of stay at the transferring hospital; and the amounts for each day of stay at the transferring hospital are totaled.  If the result is greater than the MS-DRG reimbursement amount, the transferring hospital is paid the MS-DRG reimbursement amount.  Associated outliers and add-ons are then added to the payment.

            (2)  A hospital discharging a patient is paid the full MS-DRG payment plus any appropriate outliers and add-ons.

            (3)  Facility transfers do not include costs related to transportation of a patient to obtain medical care. 

 

            (h)  Services provided by an acute care hospital that do not have a maximum charge in Appendix IV shall be paid at 75% of the acute care hospital’s usual and customary charge.

            (i)  Services provided by an inpatient rehabilitation facility shall be paid at 75% of the inpatient rehabilitation facility’s usual and customary charge.

            (j)  Individual medical providers who furnish professional services in a hospital, ASC, or other facility setting must bill insurers directly and must be reimbursed using the maximum fees set forth in Appendix III.  The individual medical provider’s charges are excluded from any calculation of outlier payments.

 

Section 3.  Outpatient and ambulatory surgical care centers 

            (a)  Billing for outpatient services must be submitted on a CMS Uniform Billing (UB-04) form.

            (b)  The base rate for outpatient services at acute care hospitals is $108.42.

            (c)  The base rate for inpatient services at ambulatory surgical care centers is $81.32.

            (d)  Outpatient services include observation in an outpatient status.

            (e)  Except as provided in subsections (g) and (h), acute care hospitals and ambulatory surgical care centers shall be paid the maximum allowable payment established in Appendix V or its usual and customary charge, whichever is less, for outpatient services. 

            (f)  Payments for outpatient services in an acute care hospital or an ambulatory surgical care centers are based on the APC system.  The payment must be calculated by multiplying the base rate times the APC weight. 

            (1) If the APC weight is not listed or if the APC weight is listed as null for items with status codes A, B, C, D, E, F, K, L, M, Q, S, T, V, X, Y then  reimbursement must be paid at 75 percent of usual and customary charges. For items with status code of N or items with no CPT/HCPCS code, there is no separate payment.

            (2)  When two or more T status code items are on the same claim, the highest weighted code is paid at 100 percent of the APC payment and subsequent T status code items are paid at 50 percent of the APC payment. 

            (3)  “Q” status indicator codes will not be discounted.

            (g)  The threshold for outlier payments is $2,500 per CPT code plus the maximum allowable charge as defined in paragraph (e).  If the outlier threshold is met, the outlier payment must be the maximum allowable charge as defined in paragraph (e), plus the charges above the threshold multiplied by 75 percent.

            (h)  Where an implantable exceeds $5,000.00 in cost, hospitals or ambulatory surgical care centers may seek additional reimbursement.  For invoiced items, reimbursement is set at the actual amount paid plus 20 percent.  If an item is not invoiced, the payment must be 75 percent of charges.  When an ambulatory surgical care center or hospital seeks additional reimbursement pursuant to this rule, the implantable charge is excluded from any calculation for an outlier payment.  Handling and freight charges must be included in the facility's invoiced cost and are not to be reimbursed separately.

            (i)  The following applies to patient transfers from an acute care hospital or ambulatory surgical care center to an acute care hospital:

            (1)  An acute care hospital or ambulatory surgical care center transferring a patient is paid the maximum allowable charge established in this section.

            (2)  The acute care hospital to which the patient is transferred is paid the maximum allowable charge established in section 2.

            (3)  Facility transfers do not include costs related to transportation of a patient to obtain medical care.

            (j)  Individual medical providers who furnish professional services in a hospital, ASC, or other facility setting must bill insurers directly and must be reimbursed using the maximum fees set forth in Appendix III.  The individual medical provider’s charges are excluded from any calculation of outlier payments.

A second and final meeting of the "consensus-based" rulemaking group has been scheduled for Tuesday, May 13, 2008 and the WCB staff is likely to provide a new version of the proposed rule based upon comments made at the last meeting.  Then, the rule will enter the formal Administrative Procedures Act rulemaking process. 

If you have comments about this proposal, please contact Andrew MacLean, Deputy EVP at amaclean@mainemed.com or by phone at 622-3374, ext. 214 before the 13th.

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