January 4, 2010

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124th Maine Legislature Returns to Augusta this Wednesday

The 186 members of the 124th Maine Legislature will return to the State House in Augusta to begin their Second Regular Session on Wednesday, January 6th.  The legislature's Appropriations Committee will begin hearings on the Governor's proposed supplemental budget (L.D. 1671) to close a $438 million budget gap on January 7th.  During the Second Regular Session, the legislature also will address 88 bills carried over from the first session and bills of an "emergency" nature approved for consideration by the legislative leadership.  MMA President David McDermott, M.D., M.P.H. and Maine Osteopathic Association President Joel Kase, M.D., M.P.H. are scheduled to be co-Doctors of the Day for the opening session on January 6th.  Retired ophthalmologist Jan Berlin, M.D. will sing the national anthem in the House as Doctor of the Day on January 7th.  While the Appropriations Committee holds hearings on the supplemental budget, the other committees will get right to work because they must meet a January 22nd deadline to vote out their carry over bills.  Senate President Elizabeth Mitchell and Speaker of the House Hannah Pingree are targeting an early April adjournment of the second session, somewhat earlier than the usual mid-April statutory adjournment deadline.

The Governor's proposed supplemental budget (L.D. 1671) will be the focus of the legislature's attention immediately with public hearings in the Appropriations Committee beginning on the second day of the session.  The Appropriations and HHS Committees will hold hearings on the DHHS portions of the budget on Monday through Wednesday of the week of January 11th.  The Committee will hear comments on the following budget provisions of most interest to physicians on Monday, January 11th:

  • Reductions in reimbursement to critical access hospitals from 109% of costs to 101%.  CAH reimbursement was reduced from 117% to 109% of costs in the biennial budget last session.
  • Reductions in hospital inpatient reimbursement of $4.1 million (state and federal).
  • Reductions in hospital outpatient reimbursement of $3.2 million.
  • Increase in the hospital tax through re-basing the tax to 2008, thereby increasing revenue by $10.7 million.
  • Reduces funding for psychiatric hospitals by reducing reimbursement by $500 per discharge for a total cut of $1.2 million in FY 2011.
  • Cuts mental health and substance abuse outpatient hospital services by $3.1 million in FY 2011.
  • Reductions to non-hospital-based physicians by $5 million, state and federal.  MMA understands this cut to affect non-employed, hospital-based physicians providing imaging and related services.
  • Limits MaineCare hospital outpatient visits to 15 per year with the exception of HIV, cancer, prenatal, kidney failure, and transplant services.
  • Limits MaineCare hospital inpatient services to 5 per year.
  • Limits MaineCare lab and x-ray services to 15 per year.
  • Limits MaineCare mental health outpatient visits to 18 per year.
  • Institutes an across-the-board 10% reduction in reimbursement for MaineCare providers, except for hospitals, physicians, dentists, and pharmacies.
  • The budget eliminates 22 state positions, including 12 that are currently filled.  Among these positions are 2.5 psychiatric physician positions within DHHS.

You can find supplemental budget materials on the legislature's web site at:  http://www.maine.gov/legis/ofpr/current_legislature/budget_summaries/index.htm.

You can find lots of information about the Maine legislative process on the web at:  http://janus.state.me.us/legis/.

MMA President David McDermott, M.D., M.P.H. will present the MMA's comments on the supplemental budget on the afternoon of Monday, January 11th.

Best Wishes for the New Year from the Maine Medical Association

The officers and staff of the Maine Medical Association wish all of our members, corporate affiliates, and office staff good health and happiness in 2010.  We appreciate your support of the Association and its activities throughout the year.  We have completed a very successful year with 3356 members, nearly 2000 of whom are in a dues-paying category (the remaining members are retirees, students, residents, and fellows).  This represents the most members the Association has ever had in its 157 year history.

In 2009, the Association also added staff and client agencies for the Medical Professional Health Program, established a part time Development Office, and initiated a new program involving academic detailing.  We were thrilled on December 4th to hold an event commemorating the opening of the John C. Dalco House that will house the staff of the Medical Professional Health Program.  This program, which has been helpful to physicians, dentists, PA's and pharmacists in the past, will now be available to nurses, courtesy of a contract with the Maine State Board of Nursing.  We also continued the operation of the Coding Center under the direction of Gina Hobert, CPC, MBA.

MMA has even more exciting plans for the upcoming year.  We will be rolling out our new Web-ex capabilities for long-distance learning and governance enhancement and promoting our social networking presence on Linked-in and Twitter.  A new interactive website will be available to complement our existing content oriented site at www.mainemed.com.  We have scheduled seven First Friday CME programs and will hold the Annual Practice Education Seminar on Wednesday, May 19th at the Augusta Civic Center.  Off-site educational programs will also continue in the areas of Prescribing for Chronic Pain,  Academic Detailing, and HIPAA staff training.  The 2010 Annual Session will be held September 10-12 at the Harborside Hotel & Marina.  The Jackson Laboratory again will be assisting with the educational programming for the annual session.

In addition to our educational and hands-on services, our advocacy for Maine's physicians and their patients will continue in Augusta and Washington.  We expect a busy year.  From time to time, we will also be reaching out to the membership for your thoughts and opinions on a host of issues.  In the meantime, we are always glad to hear from you and seek new and more effective means of communication.  Please forward your thoughts to President David McDermott, M.D., M.P.H. at president@mainemed.com, or connect with him on LinkedIn and follow his tweets @mmapresident.  Feel free also to communicate directly with EVP Gordon Smith, Esq. at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com.

And again, a Happy New Year to all our readers. [return to top]

SAVE THE DATE: May 19, 2010 for MMA's Annual Practice Education Seminar

The 2010 version of the Association's popular Annual Practice Education Seminar will be held on Wednesday, May 19, 2010 at the Augusta Civic Center from 8:00 am to 4:00 pm.   Plenary sessions are planned for the morning with three tracks of breakout sessions in the afternoon.  Maine Insurance Superintendent Mila Kofman, J.D. has again been asked to speak on the current status of Maine's commercial health insurance market and the impact of federal reform.  We also anticipate sessions on workforce issues (shortages and recruitment strategies), regulatory compliance, and quality improvement.  Watch the update for further information and registration materials will be included in upcoming issues of Maine Medicine. [return to top]

AMA Presents Analysis of 2010 Medicare Participation Options for Physicians

As reported in last week's Maine Medicine Weekly Update, Congress and the President have acted to delay the projected 21.2% Medicare physician payment cut from January 1st to March 1st through the DOD appropriations bill (H.R. 3326).  This will give the Congress an opportunity to address the Medicare SGR issue either in the health care reform conference or through a stand alone bill. 

CMS will hold claims for the first 10 business days of January (January 1 through January 15) for 2010 dates of service to allow its contractors time to update their systems and pay claims based on the updated rates.  CMS also has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010 to March 17, 2010.  You can find the AMA's analysis of your participation options on the web at:  http://www.ama-assn.org/ama1/pub/upload/mm/399/med-par-options.pdf. [return to top]

More on Medicare RAC Audits

In 2009, the Centers for Medicare and Medicaid Services (CMS) launched its recovery audit program in the northeast states.  The program uses recovery audit contractors (RAC's) to review paid Medicare fee-for-service claims in an effort to identify and recoup overpayments.  Any person or entity billing Medicare for services (physicians, hospitals, nursing homes, etc.) may be subject to a Medicare audit.

 When a clear cut discrepancy is identified, a notice will be sent to the billing entity.  The RAC's decision may be challenged and physicians have 45 days to respond to the demand letter and an additional 60 days for a "level two" appeal once the RAC has issued its decision.

In most cases, the RAC will request copies of records.  While a single record can be requested, many times the RAC may request multiple records.

How to prepare

Documentation should always match the level of billed services, particularly with E & M codes.

  • Review any past experience with carrier-noted errors or overpayments.
  • If payor-noted deficiencies are found, how were they resolved?
  • Are there any "patterns" to the error messages?
  • Review any previous error rate testing program notifications that identified any documentation problems.  How were those problems resolved?
  • Review documentation requirement from CMS and other carriers for provided medical services. 

Watch the Maine Medicine Weekly Update for further information on the RAC audits as we begin to see more audits across the state. [return to top]

Maine WIC Nutrition Program Announces Policy Changes

The Maine WIC Nutrition Program recently implemented major changes in food benefits for participants, as required by the U.S. Department of Agriculture Food and Nutrition Service (USDA FNS).  A final piece of this required change involving medical formulas and foods will be take place beginning in January 2010.  For WIC participants who receive medical coverage through MaineCare (all WIC children are MaineCare eligible), the USDA is now requiring that Medicaid (instead of WIC) pay for food and formula needed by children to serve their health needs. This includes all formula for children with food allergies, special metabolic needs (PKU…) and special caloric needs (premies).

A clinical resource guide for health care providers has been developed and is available on the Maine WIC website: http://www.maine.gov/dhhs/wic/crg/index.shtml.  The guide provides information on the process for prescribing formulas, including the form needed, clinical guidance for specific medical conditions, and a formulary of covered items. 

Please note that:

·         The prescription form includes both the information needed by MaineWIC and the MaineCare prior authorization (PA) form.  Both must be completed and sent to the local WIC office (fax, mail or send with parent).

·         Maine WIC staff will review the prescription and provide the first 30 days of benefits upon approval.  The prior authorization (PA) form will then be forwarded to the pharmacy and MaineCare by the WIC staff.

·         Only qualifying medical conditions will be accepted as justification for medical formula prescriptions.  Symptoms (such as colic or fussy baby) will no longer be accepted.

Hard copies of the guidance will be provided to health care provider offices soon.  Until these are available, please refer to the online documents at the above website address.

For More Information Contact Karen Gallagher, MS., RD, Nutrition Coordinator or Stephen Meister, MD, MHSA, FAAP, Medical Director, Maine WIC Nutrition Program, Family Health Division, Maine CDC at  207-287-4622 [return to top]

2010 H1N1 Update from the Maine CDC

An H1N1 Update from the Maine Centers for Disease Control and Prevention:

If a health care provider does not have H1N1 vaccine and would like to offer it to his or her patients, the Maine CDC asks that he or she fill out the one page registration form located at http://www.maine.gov/dhhs/boh/maineflu/h1n1/provider-agreement-2009-2010.shtml .  Once given a PIN number from the Maine CDC’s Immunization Program, he or she must then order vaccine. The ordering form can be found on the health care provider web page at www.maineflu.gov , which is: http://www.maine.gov/DHHS/boh/maineflu/h1n1/health-care-providers.shtml .  The Maine CDC encourages all appropriately licensed health care providers to register for, order, and offer H1N1 vaccine to their patients, including those health care providers in non-traditional settings for vaccine, such as specialists and those providing care for populations who may not seek vaccine, such as those with serious mental illness. Vaccination is the best way to protect patients and to slow down the circulation of the virus.

If a health care provider is running low on H1N1 vaccine, he or she should:

    • Make sure he or she has placed sufficient orders of vaccine from Maine CDC.  The order form may be found on the health care provider web page of www.maineflu.gov or directly at:

http://www.maine.gov/dhhs/boh/maineflu/h1n1/hc-providers/h1n1-vaccine-orderform.shtml .

    • Email flu.questions@maine.gov to inform Maine CDC of any acute vaccine needs. 

The Maine CDC has and expects sufficient supplies to meet the demand for vaccine on a weekly basis, but it does often take 7-10 days to replenish a health care provider’s vaccine supply.  In the meantime, if vaccine supplies are not sufficient, we recommend focusing the limited supply on those patients in the five high risk groups (pregnant women, people ages 6 months through 24 years old, people 25 through 64 years old with an underlying medical condition, caregivers and household contacts of those under 6 months, and health care workers).  Patients can also be referred to public clinics, which there are an increasing number available. They can be found by calling 211 or checking www.maineflu.gov .

The health care provider website on www.maineflu.gov also has information on billing, consent forms, etc.

http://www.maine.gov/DHHS/boh/maineflu/h1n1/health-care-providers.shtml .

The most recent recall of vaccine is a voluntary and non-safety one of some nasal spray distributed in October. These recalled lots may run low on their potency if given in the future.  There are about 90 health care providers in Maine who received a total of about 27,000 doses of these recalled lots in October.  It is doubtful there is much of this vaccine that has not been already administered.  

The Maine CDC is extremely grateful for the thousands of Maine health care providers who have been offering vaccine to their patients and volunteering with many of these vaccination efforts.  The Maine CDC hopes to continue and even increase these efforts now that more vaccine is flowing into the state, since this is our window of opportunity to protect our patients before the next wave and as H1N1 continues to circulate.  The first priority is to make sure traditional health care providers (hospitals, private practices, health centers, home health agencies, municipal health departments) have sufficient vaccine.  The Maine CDC is increasingly also distributing vaccine to other health care providers such as those in employment and in retail settings.  Offering vaccine in these other settings will help serve many people who may have difficulty seeking vaccine in traditional health care settings and will help reduce the burden on traditional health care providers. [return to top]

CMS & ONC Issue Regulations Proposing a Definition of "Meaningful Use" and Setting Standards for EHR Incentive Program

Last week, the Obama Administration posted two proposed HIT regulations in the Federal Register.  CMS issued the first proposed rule that outlines the provisions governing the EHR incentive programs including the definition of "meaningful use."  The second rule is an interim final regulation issued by the Office of the National Coordinator (ONC) for DHHS that describes the standards that must be met by certified EHR technology to exchange health care information.  The Administration reached out to the American Medical Association prior to the publication of the rules to emphasize that these are proposed rules and that the Administration is very interested in receiving comments.  Both rules have a 60-day comment period that is expected to begin on the anticipated publication date, January 16th.  The AMA will be working with state medical societies and other medical societies to develop comments on these rules.

 You can find the CMS press release on the two rules with links to them on the web at:  http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3561.
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American College of Cardiology Files Suit on 2010 Medicare Physician Fee Schedule

On December 28, 2009, the American College of Cardiology filed a civil action in federal court in Miami challenging CMS on its proposed cuts in reimbursement for cardiology services in the 2010 Medicare physician payment schedule (American College of Cardiology, Inc. v. Sebelius, S.D. Fla., No. 09-CV-62034-Dimitrouleas-Snow, filed 12/28/09).  The College says that the cuts for cardiology services could be as much as 42% for 2010.  The ACC criticizes a Physician Practice Information Survey (PPIS) used by CMS to collect data on which to base the new reimbursement rates.  It says that the data is unreliable because the survey sample was too small. 

You can find more information about the ACC suit on the web at:  http://www.campaignforpatientaccess.org/Legal.
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For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association