July 6, 2010

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8th Annual Hanley Leadership Forum Tackles Youth Obesity

The Daniel Hanley Center for Health Leadership presented its 8th Annual Hanley Leadership Forum on June 30th at the Hilton Garden Inn in Auburn.  Entitled, What Goes Up Must Come Down:  Reducing Youth Obesity in Maine, the program focused on the epidemic of obesity among Maine's youth.  The afternoon session was interactive and explored opportunities for collaboration among the many organizations and individuals interested in working on this important public health issue.

According to the Maine Center for Disease Control and Prevention, the prevalence of obesity in Maine has nearly doubled since 1992.  Currently, nearly two-thirds of Maine adults are overweight or obese (38% overweight; 25% obese).  More than one in four of Maine's middle and high school youth and one of three kindergartners are overweight or obese, placing these students at much greater risk of chronic disease from high blood pressure, high cholesterol, heart disease, stroke, type 2 diabetes, gall bladder disease, osteoarthritis, sleep apnea, and respiratory problems.

The day-long program explored the problem and potential solutions with much of the groundwork performed by the participants in the Hanley Center's Health Leadership Development class.  A smaller group will follow up on the suggestions presented and MMA will be one of the collaborating organizations.

The Harvard Pilgrim Health Care Foundation was a partner and lead sponsor of the event.  Other sponsors included ONPOINT Health Data, Hannaford Brothers, and the Maine Association of Health Plans.  The Forum was presented in cooperation with Health Policy Partners (formerly the Maine Coalition on Smoking OR Health).

The Hanley Center is named for Dr. Dan Hanley (1916-2001) who served as Executive Director of MMA for 24 years and was the physician at Bowdoin College for more than three decades.  He was a pioneer in the fields of sports medicine and the use of data to improve the quality of care and patient outcomes.



Medical Mutual Practice Managers Educational Workshop Attracts Record Crowd

Nearly 150 practice administrators attended the annual Educational Workshop presented by Medical Mutual Insurance Company of Maine last Tuesday, June 29th.  Medical Mutual is the largest professional liability carrier in the state and also writes policies for physicians and hospitals in New Hampshire and Vermont.  The workshop, which gets more popular each year, was presented at the Marriott Sable Oaks in South Portland.

Presenters on the topics of test tracking and appointment management system and liability and the electronic medical record included Karen Waycott, CPC, Quality Manager for Physician Services for SMMC PrimeCare, Louise Beaulieu, FNP, Clinical Quality Coordinator, SMMC PrimeCare, and the following staff from Medical Mutual.

Terrance J. Sheehan, M.D., President/CEO

Cheryl Peaslee, Asst. VP, Risk Management

Sue Boisvert, Sr. Risk Manager

Nancy Brandow, Sr. Risk Manager

Mary-Elizabeth Knox, Asst. VP, Claims

Jim Bilodeau, Sr. Claims Rep.

Ted Westerfield, Sr., Claims Rep

Of particular interest was the last presentation of the afternoon by Ms. Knox regarding the relatively new Medicare requirements regarding the reporting of write-offs.  These requirements come from Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (42 U.S.C. 1395Y(B)(2)(A).  For purposes of Section 111, risk management write-offs or payments (i.e., actions taken because of an adverse medical incident), are considered liability self-insurance. 


When a provider knows they want to reduce a charge or write-off some portion of a charge BEFORE sending the bill to Medicare, they must submit a claim to Medicare reflecting the unreduced, permissible charges and showing the amount of the reduction or write-off as a payment.  In this situation, the provider does not need to report the reduction or write-off to CMS.  However, if there is any evidence, or a reasonable expectation , that the patient has sought or may seek additional medical treatment from any other healthcare provider as a consequence of the underlying incident, the provider shall report the write-off, payment, reimbursement or property of value (one example would be a gift card), as a TPOC (Total Payment Obligation to the Claimant) from self-insurance.  However, if the value of the write-off or payment is less than the following TPOC reporting threshold, it does not need to be reported:

  • 10/01/2010 through 01/01/2012    $5,000
  • 01/01/2012 through 12/31/12         $2,000
  • 01/01/13 through 12/31/13              $600
  • After 12/31/13                                      zero threshold

This obligation to report begins with any write-off or payment made to a Medicare beneficiary on or after Oct. 1, 2010.  Non-compliance with Section 111 reporting will result in a penalty of $1000 for each day of noncompliance with respect to each Medicare beneficiary.


If a practice has any expectation that it may be in the position of deciding to write-off bills, reimburse money or even provide property of value (such as a gift certificate) to a Medicare beneficiary as a consequence of an adverse medical incident, the practice should:

  • Educate itself by reviewing the provisions set forth at www.cms.hhs.gov/MandatoryInsRep
  • Consider consulting your corporate counsel
  • Register as a reporting entity with CMS
  • Become familiar with the Direct Data Entry (DDE) option for small reporters

Practices insured by Medical Mutual are always free to call the company and discuss the situation with staff in the claims department. 

MMA thanks Medical Mutual and Mary Elizabeth Knox for permission to reprint materials on this topic.

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DHHS Moves MIHMS "Go-LIve" Date to 9/1/10 to Enable More Testing

Maine's DHHS provided an update on the implementation status for the Maine Integrated Health Management System (MIHMS) as of June 28th.  As of that date, 87 providers of all types have volunteered to be pilot sites and the Department has begun testing the system from beginning to end.  This work will provide assurance that the system will operate effectively and with high quality when used by all providers.  The Department has determined that it needs more time to complete testing, evaluate results, and make any changes necessary.Accordingly, the Department has moved the Prior Authorization go-live date to August 9th and the Claims go-live date has been moved to process claims with a date of service of September 1st.  Department staff and consultants believe this testing validation is critical to ensure that the system can meet the high quality standards set last year.  The additional time also will give staff an opportunity to work with the providers who have not yet enrolled in MIHMS. [return to top]

Proposed Medicare Physician Payment Regulation

As mentioned in last week's Maine Medicine Weekly Update, CMS released a proposed rule governing Medicare physician payments in 2011 on June 25th and it will be published in the Federal Register on July 13th.  The rule proposes several potentially helpful provisions, particularly a plan advocated by the AMA to examine whether the Medicare Economic Index (MEI) accurately reflects all the costs of a current medical practice.  The rule projects a 6.1% cut in the conversion factor.  This would come on top of a budget neutrality adjustment tied to rebasing the MEI and the expiration of legislation averting a 21.3% cut, leading to a conversion factor of $26.76 in 2011.  The 1250-page rule also implements provisions of PPACA, including reduced out-of-pocket costs for preventive services, bonus payments to some general surgeons and primary care physicians, changes in the geographic practice cost indexes, and cuts in payments for advanced imaging services.  In addition, CMS is proposing to expand its current 50% reduction in advanced imaging services performed on contiguous body parts in the same session to include therapy services performed on the same day and imaging of the same modality in the same session.  The rule also would make a number of significant changes in the Physician Quality Reporting Initiative (PQRI), including reducing the reporting sample for claims-based reporting of individual measures from 80% to 50% as had also been advocated by the AMA. [return to top]

Update on Medicare Enrollment (PECOS) Issue & July 6th Deadline

As reported in last week's Maine Medicine Weekly Update, the new federal health care reform law (PPACA) establishes a new Medicare enrollment deadline for referring/ordering physicians of July 6th.  This applies to any physician who has not submitted an updated enrollment application to Medicare in the last 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.

The AMA has been working with CMS in an effort to modify the aggressive compliance schedule.  On June 30th, CMS issued a press release indicating that it will not implement the automatic claims rejection function for those not enrolled in PECOS by the July 6th deadline.  CMS has not indicated when it might implement that function, but the AMA has urged a delay of at least 6 more months.

You can find more information in the CMS press release here:  http://www.cms.gov/apps/media/press/release.asp?Counter=3774&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.

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

Latest AMA "Therapeutic Insights" Newsletter Focuses on Management of HIV in Primary Care

The topic for this quarter's edition of the AMA Therapeutic Insights newsletter is "Management of HIV in Primary Care."  You can find the newsletter on the AMA web site at:  http://www.ama-assn.org/ama/pub/education-careers/continuing-medical-education/cme-credit-offerings/therapeutic-insights.shtml.  You can also find past newsletters on Hypertension, Alzheimer's Disease, and Type 2 Diabetes on the site. [return to top]

Article in "Health Affairs" Addresses Options for Congress on Medicare SGR Issue

On June 25th, the Robert Wood Johnson Foundation and the journal Health Affairs released a policy brief entitled, Paying Physicians for Medicare Services.  The policy brief discusses various long-term options for payment reform.  You can find the policy brief on the web at:  http://www.healthaffairs.org/healthpolicybriefs/.

The most recent short-term SGR "fix" expires on December 1, 2010. [return to top]

FTC Finalizes Agreement on Temporary Exemption from "Red Flags" Rule for Physicians

On June 25th, the Federal Trade Commission (FTC) finalized an agreement with the AMA and other health care organizations that exempts physicians from enforcement action under the so-called "red flags" rule on identity theft until the U.S. Court of Appeals for the District of Columbia resolves litigation initiated by the AMA, the American Osteopathic Association, and the Medical Society of D.C. in May.  The FTC once again has delayed the compliance deadline for the rule from June 1st to December 1st. [return to top]

Fact Sheet on Prevention Aspects of Federal Health Care Reform Available

Maine CDC Director Dora Mills, M.D., M.P.H. has pointed out a new overview of the prevention efforts in the federal health care reform law, including:

  • Improving community and clinical prevention efforts (focused on chronic diseases of cardiovascular disease, cancer, and diabetes);
  • Strengthening public health infrastructure;
  • Improving research and data collection; and
  • Bolstering the training of public health and primary care professionals.

 You can find the fact sheet on the web at:  http://www.healthreform.gov/newsroom/preventioncouncil.html. [return to top]

Update on 2010 PQRI

It is not too late to start participating in the 2010 PQRI program and potentially qualify for incentive payments.  The new six-month reporting period began on July 1st and extends through December 31, 2010.  Eligible professionals who satisfactorily report PQRI measures for the six-month reporting period will become eligible to receive a PQRI incentive payment equal to 2% of their total Medicare Part B allowed charges for services performed during that time.

Those who have not participated in the PQRI program can begin by reporting data using:

  • claims-based reporting of individual measures;
  • claims-based reporting of one measures group;
  • registry-based reporting for individual PQRI measures; or
  • registry-based reporting for a measures group (with a minimum of 8 patients).

Although there is no requirement to register prior to submitting data, there are some preparatory steps that physicians should take prior to undertaking PQRI reporting. 

You can find more information about the Physician Quality Reporting Initiative (PQRI) on the CMS web site at:  https://www.cms.gov/pqri/.

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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]

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