December 29, 2008

 
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Gina L. Hobert Named Director of the Coding Center, Effective Jan 5, 2009

Following on the very successful efforts of Laurie Desjardins, CPC and Jana Purrell, Gina L. Hobert of Farmington has named Director of the Coding Center, effective Jan. 5, 2009.  Gina is a certified procedural coder and has worked for nearly twenty years at Franklin Memorial Hospital in Farmington.  The Coding Center will continue to offer a variety of coding and reimbursement-related services to MMA members and other physicians and hospitals throughout Maine, New Hampshire and Vermont.  Ms. Hobert is a candidate for an MBA from Thomas College this coming March.

The Coding Center will also continue to offer coding courses that allow a participant who completes the course successfully to sit for the CPC certification exam conducted by the American Association of Procedural Coders as well as chart audits and other educational services.

Coding Center services can continue to be accessed by calling, toll free, to 1-888-889-6597. 

MMA is very appreciative of the excellent services provided the last few years by Jana Purrell and offers her all the best wishes for her new career at Mid Coast Medical Center.  And we welcome Gina and hope for many good years as well.

Welcome to Northern Maine Medical Center Employed Physician Group

MMA welcomes the employed physician group at The Northern Maine Medical Center in Fort Kent as our latest group member.  Welcoming sixteen new members to MMA, MMA EVP Gordon Smith noted that this employed group represents the eighth hospital employed group to elect to become a group member of MMA, thus permitting a substantial discount on dues and other benefits.

If your employed group is ten or more physicians and would like to discuss a group membership with MMA, please contact Gordon Smith, Esq., MMA's EVP at 622-3374 ext. 212 or via e-mail to gsmith@mainemed.com.

Partially through the success of group  memberships, MMA closes 2008 with the most members ever, over 3,100. [return to top]

Update on MaineCare from Governor's Provider Advisory Committee

The MaineCare Provider's Advisory Group met on December 18th for its regular monthly meeting.  The Group has been meeting since early 2005 when the MECMS claims processing problem first came to light.  Certainly no one at that time would have predicted that the Group would still be meeting on a regular basis nearly four years after the MECMS system failed.  The new system being developed by Unisys is expected to be operational by Feb. 1, 2010.  The new system will be known as the Maine Integrated Health Management Solution (MIHMS).

In order to assure that the new system, MIHMS, contains accurate data and that claims are processed accurately at the onset, all providers must re-enroll in MaineCare.  Facilities, providers, organizations and groups must also re-enroll their servicing providers, where applicable.  This re-enrollment will begin in February 2009 and will be phased in throughout the year.  A provider will be able to enroll right from their desktop.  MIHMS enrollment will be based on the National Provider ID and Atypical Provider ID number.

MaineCare is soliciting practices to volunteer to be pilot sites as the new claims management system is rolled out early this year.  Any practices willing to be considered as pilots sites should communicate directly to Gordon Smith at MMA via e-mail to gsmith@mainemed.com to by calling 622-3374 ext. 212. [return to top]

Maine in Top 10 of Healthiest States

All six New England states score high on the latest ranking of the healthiest states issued by the United Health Foundation, the American Public Health Association and the Partnership for Prevention.  Vermont achieved the highest rank for the second year in a row. New Hampshire ranks third and Massachusetts is sixth.  Connecticut ranked seventh, followed by Maine at ninth  and Rhode Island at eleventh.  The report says Maine's strengths include a low crime rate, a low incidence of infectious disease, a low rate of uninsured population and ready access to primary care. It says the state's challenges include a high rate of cancer deaths and low immunization coverage of children.  Go here to see the entire report.  [return to top]

2009 Physician Quality Reporting Initiative Program Updates

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the release of the detailed specifications for the 2009 Physician Quality Reporting Initiative (PQRI) measures and the 2009 PQRI measures groups.  The following resources have been posted to the PQRI webpage on the CMS website:    

  • 2009 PQRI Quality Measure Specifications Manual and Release Notes
  • 2009 PQRI Implementation Guide
  • 2009 PQRI Measures Group Specifications Manual and Release Notes
  • Getting Started with 2009 PQRI Reporting of Measures Groups

To access the 2009 PQRI Quality Measure Specifications Manual and Release Notes, the 2009 PQRI Implementation Guide, the 2009 PQRI Measures Group Specifications Manual and Release Notes, or the Getting Started with 2009 PQRI Reporting of Measures Groups, visit http://www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage on the CMS website. Once on the Measure/Codes page, scroll down to the “Downloads” section and click on the appropriate link.

Please note that the 2009 PQRI quality measure specifications for any given quality measure may be different from specifications for the same quality measure used in 2008. Therefore, specifications for all 2009 PQRI quality measures, whether or not included in the 2008 PQRI program, must be obtained from the 2009 PQRI Quality Measure Specifications Manual. 

In addition, measures groups specifications are different from the specifications for individually reported measures that form the group.  Therefore, the specifications and reporting instructions for the 2009 PQRI measures groups must be obtained from the 2009 PQRI Measures Group Specifications Manual. 

Detailed information on the 2009 PQRI may be found in the 2009 Medicare Physician Fee Schedule final rule with comment period (73 FR 69817 through 69847) that was published in the Federal Register on November 19, 2008.  The final rule with comment period can be found in the “Related Links Outside of CMS” section of the Physician Quality Reporting Initiative website at: http://edocket.access.gpo.gov/2008/pdf/E8-26213.pdf  on the CMS website.

Reporting for the 2009 PQRI begins January 1, 2009. There is no need to sign up or pre-register in order to participate. [return to top]

A Big Thank You to MMA Members Completing Members Survey

Over six hundred (600) MMA members completed the recent member survey conducted by Enertrix, either on line or via a paper survey.  This nearly 34% return was the highest return of any of the state medical society surveys conducted by the firm.  The results will be available by late January and MMA staff and officers will make a series of presentations across the state at various settings describing the results.  Results will also be resported in an issue of Maine Medicine.

The survey asked a series of questions regarding the perceived value of MMA to its members and the types of benefits that members desired.

Thanks to all of you who responded. 

 

  [return to top]

Obama-Biden President-Elect Transition Team Health Care Community Discussion on December 30

Obama-Biden Transition Team Health Care Listening Session
Tuesday, December 30th 4pm - 6pm

Arnold/Howard Room, (North Wing) Augusta Civic Center, Augusta, Maine

Sponsored by:
Maine Medical Association (MMA), the Maine Osteopathic Association (MOA)
and the Downeast Association of Physician Assistants (DEAPA)

Host and Moderator:
Gordon Smith, Esq., EVP of MMA, Host and Joel Kase, D.O., MPH, President-elect of MOA, Moderator

As we work to revamp our health care system, we need to hear from you. There is no problem that we cannot solve together-and it is out of our collective wisdom and experience that we will identify potential solutions to the many health care challenges that we face. We need to hear your ideas and your stories so that we can report them to the President-elect. Your answers will guide our collective effort to reform the U.S. health system.

This session is one of nearly 5000 scheduled the last two weeks of December across the country.  Comments offered at the session will be recorded and forwarded to the transition team for its use in its effort to prepare health care reform legislation.

Download an advance copy of the five-page Participant Guide for Health Care Community Discussions here: http://change.gov/participantguide

Can't make it to the session but still want to participate?

Post your questions about health care policy at http://change.gov/newsroom/entry/open_for_questions

Submit your own personal health stories at http://change.gov/page/healthcare

Open to the public. Please RSVP to 622-3374 x219 or email RSVP@mainemed.com

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Physicians who bill for MaineCare Services under Section 90:Some Physician Fees Increased December 24, 2008

On December 24, 2008, MaineCare’s physician fees on certain procedure codes increased from 53% to 56.94% of Medicare’s 2008 rate.  A complete list of the codes receiving increases is available at http://www.maine.gov/dhhs/bms/member/innerthird/news_page.shtml(Click “Physician Fee Revision.”) 

The increase applies only to physicians billing for services under MaineCare Benefits Manual Section 90, Physician Services.  It does not apply to procedure codes billed under Section 55 Laboratory Services, Section 95 Podiatric Services, Section 101 Medical Imaging, or Section 75 Vision Services.   

Here is a summary of how the claims will be processed:  

  • The rate increase is retroactive to July 1, 2008. 
  • Claims billed for services provided December 24th and after will receive the new MaineCare rate. 
  • Claims yet to be filed for dates of service July 1, 2008 through December 23, 2008:  Please file them using your usual charges rate.  You will be paid the lower of your usual charges or the new MaineCare rate. 
  • Claims filed for dates of service July 1, 2008 through December 23, 2008:  If you filed using your usual charges rate, and that rate was higher than the old MaineCare rate, the claims system will automatically adjust the claim to the lower of your usual charges or the new MaineCare rate.  You will be paid the difference in one of your regular checks.  
  • We will issue another communication for claims for dates of service July 1, 2008 through December 23, 2008 that were billed using the old MaineCare rate or for services that required Prior Authorization.  

Feel free to contact Customer Service with questions at 1-800-321-5557 Option #8.  [return to top]

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