June 28, 2010

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House Passes, President Signs Short-Term Medicare Physician Payment Fix

Shortly after 7:00 p.m. Eastern time last Thursday, June 24th, the House passed H.R. 3962, which provides a 2.2 percent Medicare fee schedule update for physician services through November 2010.  The bill passed by a bipartisan vote of 417 to 1.  Since the same legislation passed the Senate last week, the President signed the bill into law.

The 2.2 percent update provided by H.R. 3962 would replace the 21 percent Medicare cut currently in effect, and be applied retroactively to claims for services provided on or after June 1st.  

The MMA thanks physicians who communicated with Maine's Congressional delegation to help reach this result.  We will keep you posted about the MMA's and the AMA's continuing efforts to pass a permanent, or at least a longer-term, SGR fix.


Last Friday, June 25th, President Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.  This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010.  The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems.  Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates.  CMS expects to begin processing claims at the new rates no later than July 1, 2010.  Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.

Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible.  Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount.  Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed.  Affected physicians who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment.  Submitted charges on claims cannot be altered without a request from the physician/provider.  Physicians/providers should not resubmit claims already submitted to their Medicare contractor.

Kellie Slate Miller Named Director of Continuing Medical Education at UNECOM

Kellie Slate Miller, MS, who has served MMA and its members well as Director of Public Health Policy, was recently named the Director of Continuing Medical Education at the University of New England College of Osteopathic Medicine.  Kellie will be re-locating to the Southern Maine area and her last day at MMA will be July 2nd.  The Association wishes Kellie all the best as she embarks on this new path.

Kellie joined MMA in January of 2008 and has been responsible for the administrative contract with the Downeast Association of Physician Assistants (DEAPA) and for the Association's academic detailing program, as well as handling all of the public health activities and staffing the Committee on Public Health.  Previous to her work at MMA, Kellie had served for twelve years as the Executive Director for the Maine Osteopathic Association and for one year as the Director of Emergency Preparedness for the Maine Primary Care Association.  Prior to coming to Maine, Kellie had served for ten years with the American Lung Association of Indiana.

Kellie received her Bachelor of Science Degree in Health Education at Ball State University and her Master of Science Degree from Purdue University.   

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Recent Overdose Death Prompts "Wake Up Call" about Prescription Drug Abuse and Diversion

The recent death of an Auburn man has prompted local DEA agents to again highlight how problematical abuse of prescription drugs has become.  Kyle Tyburski, age 24, was found dead on June 14, 2010 with several prescription drug bottles nearby.  Although the specific drug involved was not identified, Maine Drug Enforcement Agency Supervisor Gerry Baril said the death is another indication of the serious problem prescription drug abuse has become.  "Which untimely and unexpected death is going to be the wake-up call?", Baril stated two days after the death was discovered.

Between 1999 and 2006, the number of accidental overdose deaths in Maine tripled.  In 2005, the number of deaths from overdoses for the first time exceeded deaths from automobile accidents.  Preliminary statistics from 2009 noted 179 overdose deaths, 92% of which were tied to prescription drugs.  In addition, over 400 infants born in the state last year showed signs of withdrawal from narcotics or other illicit drugs.

Between 2007 and 2008, the number of drivers found inpaired by hydrocodone - the generic form of Vicoden, rose by 750%.  The number of impairment cases involving oxycodone rose by 450% and cases involving methodone, 150%.

Baril made the following observations, as reported in the June 17, 2010 issue of the Lewiston Sun Journal:

    A lot of these folks became dependent on these opioids because they took them long term for an underlying health problem, then they developed a tolerance.

MMA, through the support of the Maine Office of Substance Abuse and the Board of Licensure in Medicine, has conducted more than thirty workshops across the state educating physicians and other prescribers about this problem and pointing out the tools the state has provided to assist prescribers.  Among these tools is the Prescription Monitoring Program and the new Chapter 21 rules of the licensing boards, effective June 13, 2010.

If your practice would like a CME program or an in-office consultation focusing on narcotic prescribing for chronic pain, contact Gordon Smith at 622-3374, ext. 212 or via e-mail to gsmith@mainemed.com.  Because of the generous support of the state agencies, there is no charge for these programs.



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President Unveils Interim Final Rules on PPACA's Insurance Protections

On June 22nd, President Obama held a press event in which he unveiled proposed rules providing new consumer protections in health insurance authorized by the health care reform law, PPACA.  He called the new rules a Patients' Bill of Rights and they are to be published in the June 28th issue of the Federal Register.  The proposed rules, most of which take effect September 23rd, address:

  • pre-existing condition exclusions;
  • lifetime and annual limits on benefits;
  • limits on rescission of coverage; and
  • other patient protections, such as network standards, that some states like Maine already have in place.

You can read the President's press release on the web at:  http://www.whitehouse.gov/the-press-office/background-and-fact-sheet-presidents-event-today-affordable-care-act-and-new-patien.

You can read a fact sheet on these proposed rules on the web at:  http://www.whitehouse.gov/sites/default/files/Consumer%20reg%20Fact%20Sheet.pdf. [return to top]

ACGME Publishes New Work Standards for Medical Residents

On June 23rd, the Accreditation Council on Graduate Medical Education (ACGME) published revised draft work standards for medical residents that would shorten the standard for first-year residents or interns from a maximum of 24 hours in a shift to 16 hours.  The 24 hour shift limit, however, would remain for second-year residents.  The proposed changes also amend the requirements for supervision, workloads, moonlighting, and other aspects of residents' work.  Representatives of medical education favored the changes, while some consumer and patient safety advocacy groups claimed the changes don't go far enough.

You can find the proposed changes on the web at:  http://acgme-2010standards.org/pdf/Proposed_Standards.pdf. [return to top]

ACHSD Unanimously Approves New State Health Plan

http://www.maine.gov/tools/whatsnew/attach.php?id=101749&an=1At its regular meeting last Friday, June 25th, the Advisory Council on Health Systems Development (ACHSD) approved unanimously the 2010-2012 Maine State Health Plan entitled, Making Us Better:  Improving Health & Lowering Costs.  The Governor's Office of Health Policy & Finance (GOHPF) and its consultants drafted the Plan under the review and guidance of the ACHSD.  The GOHPF and the ACHSD sought public input throughout the process of development and many stakeholders, including the MMA, commented on it.  The MMA, and most stakeholders, spoke favorably about the most recent Plan.

You can find the final draft version of the Plan on the web at:  http://www.maine.gov/tools/whatsnew/attach.php?id=101750&an=1.

You can find the summary of public comments and responses on the web at:  http://www.maine.gov/tools/whatsnew/attach.php?id=101749&an=1.

Maroulla Gleaton, M.D. and Lani Graham, M.D., M.P.H. are physician representatives on the ACHSD.  Arthur J. Blank, President & CEO of MDI Hospital, and Nona O. Boyink, an executive with MaineGeneral Health & HealthReach Network represent hospitals on the ACHSD. [return to top]

MMA Operations Committee to Meet Tuesday Night, June 29th

MMA's Operations Committee will meet, via conference call, on Tuesday evening, June 29th at 8:00 p.m.  The Operations committee consists of the President (David McDermott, M.D., MPH), the President-elect (Jo Linder, M.D.), the immediate Past President (Stephanie Lash, M.D.), the chair of the Executive Committee (Nancy Cummings, M.D.), the Treasurer (Michael Parker, M.D.), and two members at-large from the Executive Committee (Kenneth Christian, M.D. and Jennifer Charity, M.D.)

Tuesday's agenda includes reviewing a proposed budget for 2011 prepared by Finance Director Heidi Lukas, CPA and Budget Committee Chair Kevin Flanigan, M.D and consideration of a report from the Nominations Committee.  Both the Budget and the Nominations Committee report will be presented at the Annual Meeting in September.  Additional items include updates on staffing, the transition of the Coding Center and current activities of the Medical Professionals Health Committee.

The Committee will also consider some current maintenance items relative to the Frank O. Stred Building.

Nancy Cummings, M.D., chairs the Committee in her capacity as chair of the Executive Committee. [return to top]

REMINDER: July 6th Medicare Enrollment Deadline for Ordering/Referring Physicians

WHAT:  New Medicare enrollment deadline for referring/ordering physicians.  This includes any physician who has not submitted an updated enrollment application to Medicare in the past 6 years or has had a change to their enrollment information during this time but has not reported the change.  All physicians must list the legal name and NPI of the physician or provider who referred/ordered to them on their claims.  If the referring/ordering physician is not enrolled in PECOS, the physician or provider who accepted the referral could see their claims rejected.  This change stems from Section 6405 of the new HSR law known as PPACA.

WHEN:  Compliance deadline is July 6, 2010

WHO:  Physicians or health care providers who refer or order the following services for Medicare patients to other physicians or health care providers:

  • Durable medical equipment, prosthetics, and supplies (DMEPOS);
  • Home health;
  • Specialist services (not defined by CMS);
  • Laboratory; or
  • Imaging services.
  • INCLUDES:  Any physician/provider including those who do not traditionally bill Medicare (dentists, pediatricians, and physicians in the VA/DOD/Public Health Service);
  • EXCLUDES:  Physicians who have opted out of Medicare.  Physicians are encouraged to call their Medicare contractor to determine whether the contractor has them officially listed as opted out.

WHY:  Prior to the passage of PPACA, CMS announced that all physicians/providers who order and refer services to other health care providers must be enrolled by January 3, 2011.  CMS originally was going to require these same physicians/providers to be enrolled by the end of 2009, but the AMA succeeded in securing an extra year to become enrolled.  While the AMA continues to lobby for more time to comply, we recommend that physicians begin the enrollment process.

You can find more information about this process on the AMA web site at:  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/medicare-enrollment-process.shtml.

You also can find more information about this process on the CMS web site at:  http://www.cms.gov/medicareprovidersupenroll/01_overview.asp??. [return to top]

CMS Creates New Web Site for EHR Incentive Programs

On June 18th, CMS announced its new web site for current, detailed information about the Medicare & Medicaid Electronic Health Record (EHR) Incentive Programs.  The programs begin in 2011 and the web site will provide information on:

  • steps for providers beginning the process of implementing EHRs;
  • eligibility for the Medicare or Medicaid incentive funding, including requirements for hospitals, eligible professionals, and Medicare Advantage eligible professionals;
  • certification requirements for EHR technology;
  • how to register for the incentive funding; and
  • documentation for states so that they can create the health information technology necessary to facilitate the EHR incentive programs.

The web site also links to CMS' webinar series on meaningful use, other funding programs available through the Office of the National Coordinator for HIT, and additional funding available under the HITECH portion of the ARRA.  Please go to:  http://www.cms.gov/ehrincentiveprograms/01_overview.asp??.

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MMA Offering CME Programs on HIPAA, the Federal Health Reform Bill (PPACA) and Medicinal Marijuana

MMA is now offering CME presentations on the following topics:

  • HIPAA Update;
  • Treating Chronic Pain While Preventing Diversion of Narcotics (offered in conjunction with the Maine Office of Substance Abuse);
  • Federal Health Care Reform Law; and
  • Medicinal Marijuana Law
  • Health Care Highlights of the 124 Legislature

MMA offers these programs to various audiences, including medical staffs, specialty societies, office staff, and other interested groups.  A fee of $200 is normally charged to cover travel and copying costs for the materials.  If your practice or group is interested in a presentation, contact Gail Begin at 622-3374, ext. 210 or via e-mail to gbegin@mainemed.com. [return to top]

2010 MMA Annual Session Registration Materials are in Your Mail

Watch for MMA Annual Session registration materials in your mail.  The materials were mailed last week for the meeting which will be held September 10-12, 2010 at the Harborside Hotel & Marina in Bar Harbor, with the Friday educational sessions being held at Jackson Laboratories.

Registration is also available on the MMA website at www.mainemed.com.

Don't miss the opportunity this year to visit with your colleagues, pick up some quality CME, and learn about the activities of your professional association.

Any questions regarding the meeting should be directed to Diane McMahon at MMA at 622-3374, ext. 216 or via e-mail to dmcmahon@mainemed.com. [return to top]

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