August 23, 2010

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MIHMS: New MaineCare Claims Management System Scheduled to "Go Live" on September 1st

In pilot testing, DHHS officials report 96.3% adjudication accuracy and 95% pricing accuracy.  Top 3 errors identified are invalid or missing service location, multiple service location error, and "pay to" affiliation error.  The MIHMS PA and referral functions now are operational.  You can find more information about the upcoming transition on the MIHMS Provider Portal on the DHHS web site:

MaineCare Claims Notice

MIHMS Claims:  Claims for dates of service (DOS) beginning September 1, 2010 and later must be submitted to MIHMS using new billing instructions.  These instructions are located under "Provider Documents" on the MIHMS Health PAS Portal on the web site mentioned above.  Companion Guides for electronic claims submissions are also located here under "Claims Submission Manuals."  If you need further assistance, Provider Services will be available beginning on September 1, 2010 at (866) 690-5585 or by email at

MeCMS Claims:  Claims for DOS through August 31, 2010 must be submitted to MeCMS.  Billing instructions are located at:  For assistance on these claims, please call (207) 624-7539 or (800) 321-5557.

Split Claims:  Claims that span dates of service August 31, 2010 and September 1, 2010 must be split-billed.  The portion of the claim with dates of service through August 31, 2010 must be billed to MeCMS and the portion with dates of service on or after September 1, 2010 must be billed to MIHMS following the instructions above.

MeCMS Decommissioning

MeCMS will stop accepting claims, voids, and adjustments on January 31, 2011.  Providers are strongly encouraged to submit claims to MeCMS as quickly as possible.  Final details are still being evaluated.

During the most recent meeting of the Governor's Provider Advisory Group and Technical Advisory Group on Friday, August 20th, the DHHS staff and consultants presented an update on the MIHMS project and provider pilot testing in particular.  The Department has identified the following four top PA and referral errors:

  • Date of service (DOS):  remember that August DOS must go to MeCMS);

  • Fax cover sheets:  each paper claim submitted by fax must have its own cover sheet;

  • Lacks supporting documentation; and

  • Referral errors:  group v. rendering provider or provider not enrolled.

A "tip sheet" for billing claims in MIHMS should be posted on the web site this week.

Today MMA Welcomes Jessa Barnard, J.D., MMA Director of Public Health Policy

MMA's new Director of Public Health Policy Jessa Barnard, J.D. begins employment with MMA today, August 23rd.  Jessa is a 2008 graduate of Stanford Law School and is returning to the East Coast.  She is a native of Vermont and a graduate of Dartmouth College.  Between Dartmouth and Stanford Law School, Jessa worked at the Vermont Medical Society where she focused on special projects and advocacy. 

Jessa's husband Justin Barnard has begun a judicial clerkship with the Honorable Kermit Lipez on the U.S. Court of Appeals for the First Circuit which includes the District of Maine. 

We welcome Jessa to MMA.  Many members will be able to meet Jessa at the upcoming Annual Meeting in Bar Harbor.  In addition to directing MMA's activities in the area of Public Health, Jessa will be responsible for the Committee on Public Health, working with co-chairs Norma Dreyfus, M.D. and Lani Graham, M.D., M.P.H.  She also will work with Andy and Gordon in MMA's advocacy activities.  Other assignments, which may be related to DEAPA, specialty societies, or grant responsibilities, will be announced as MMA staff assignments are completed early this Fall.  Jessa also will have some responsibility for the updated Physicians' Guide to Maine Law. [return to top]

Make Reservations Now for 157th Annual Session in Bar Harbor, September 10-12

It is not too late to register for the Association's 157th Annual Session being held this year from September 10-12 in downtown Bar Harbor (note:  Friday's activities are at the Jackson Laboratory).  While the Harborside Hotel and Marina is sold out, there are many other alternative rooming options, some within walking distance of the meeting.  Contact Diane McMahon at MMA for the list of alternate housing (622-3374, ext. 216 or via e-mail to

Registration materials are on the MMA website at or you may call Diane or Maureen Elwell (622-3374, ext. 219) for a registration form.

Six and one-half hours of CME are available.  Other highlights of the meeting include a gubernatorial forum on public health (most of the candidates have confirmed their participation), presentations by AMA President Cecil Wilson, M.D. and Congresswoman Chellie Pingree, the presentation of the Cushman Award for Humanitarian Service, and the installation of officers on Saturday evening.  On Sunday morning, Medical Mutual Insurance Company of Maine and MMA will sponsor the 30th Annual Edmund Hardy Road Race. 

A silent auction will be held on Saturday at the Bar Harbor Club, with bids taken for a variety of items from 7:30 a.m. to 7:00 p.m.  If you have something you would like to donate to the auction (which will benefit the Maine Medical Education Trust), contact Dee DeHaas  or Gordon Smith.

The Annual Session provides an opportunity once a year for Maine's medical community to come together for professional and social activities.  Give yourself a break, enjoy the beauty of Mount Desert Island, and support your professional association by joining your professional colleagues in Bar Harbor.  Daily rates are available for those members not attending the entire meeting. [return to top]

National Association of Insurance Commissioners Act on Medical Loss Ratio

Last Tuesday, August 17th, the National Association of Insurance Commissioners (NAIC) approved a preliminary outline of what health insurers will be able to count as medical costs, a document known at a "blank," required by the health reform law's provision that insurers spend at least 85% of subscribers' premiums on medical costs in the large group market and 80% for small groups and individual plans.  Significantly, the vote on the controversial measure was unanimous.

The Commissioners also approved 10 of 11 amendments presented that narrow inclusions of utilization review in the calculation and expand the definition of wellness and health promotion activities to include public health promotion and marketing activities that are performed in conjunction with state or local health departments.  The insurance industry criticized the votes while consumer groups and public health groups praised the work.

The vote came at the end of the NAIC's recent annual meeting in Seattle that focused on health reform.  Fourteen different health groups within the NAIC have been created specifically to focus on implementation of the new federal law.

Maine Insurance Superintendent Mila Kofman, J.D. serves on the Executive Committee of the NAIC and was very influential in the work that was done on the medical loss ratio provision.


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Medical Mutual Alerts Insureds to CMS Notice on Risk Management Write-Offs

Medical Mutual Insurance Company of Maine recently sent a letter to its insureds with the following message about risk management write-offs.

As part of the implementation of the Medicare Secondary Payer Mandatory Reporting Provisions in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (See 42 U.S.C. 1395y(b)(7)&(8)), CMS has recently formalized its opinion regarding how write-offs or the provision of something of value to Medicare beneficiaries must be handled and reported by healthcare providers.  A copy of the CMS Alert is attached for your review.

If you are engaged in “writing-off” or reducing a bill, or if you provide something of value (e.g. cash, gift card, etc) to a Medicare beneficiary outside a formal claims process reported to Medical Mutual Insurance Company of Maine, then according to CMS you are “self-insured” for that activity, if it is in response to either a medical incident or patient dissatisfaction.

This new reporting obligation begins with any write-off or payment made to a Medicare beneficiary on or after October 1, 2010.

Non-compliance with Section 111 reporting will result in a penalty of $1,000 for each day of non-compliance with respect to each incident involving each Medicare beneficiary.   

The only way in which a healthcare provider can fall outside the reporting requirement is to submit a claim to Medicare reflecting the unreduced permissible charges and also showing the amount of the reduction provided or write-off as a payment from self-insurance.  If you confine your write-offs for Medicare beneficiaries to this specific billing procedure, then you do not have to separately report this write-off or payment.

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 healthcare provider must report the write-off, payment, reimbursement or property of value (like a gift card), as a TPOC (Total Payment Obligation to the Claimant) from self-insurance. 

For the next several years, if the value of the write-off or payment is less than the TPOC reporting threshold listed below, it does not need to be reported.

Present TPOC Reporting Thresholds.

•          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                                              No threshold applies

Therefore, for almost all of our insureds, there is a reasonable time period to develop procedures necessary to comply with Section 111, as I believe most write-offs or payments undertaken by our insureds outside their policy with Medical Mutual would be well within the initial reporting threshold of $5,000.

If you have any expectation that your practice may be in the position of deciding to write-off bills, reimburse money or even provide property of value (like a gift card) to a Medicare beneficiary as a consequence of a medical incident, you need to:

•           Educate yourself:

•           Consider consulting your corporate counsel or the medical or hospital association in your state for further advice.

•           Register as a reporting entity (RRE) with CMS.

•           Become familiar with the Direct Data Entry (DDE) option for small reporters.                                            

Our policyholders can always discuss these situations with Medical Mutual’s Claims Department.  However, remember that liability    insurance is not “no-fault” insurance and Medical Mutual’s decision on whether or not to make a payment to any claimant will be based on a review of the medicine, including negligence and causation.  Also, if Medical Mutual agrees to make such a payment to a claimant, it is possible that the involved physician will need to be reported to the National Practitioners Data Bank.

I am hopeful that all of you will be hearing directly from CMS regarding this new reporting obligation.  However, since to my knowledge this has not yet occurred, I felt it necessary to give all of you a heads-up regarding this issue.  If you would like to discuss this issue further with someone from Medical Mutual, please feel free to contact either our Claims or Risk Management Departments. 

The MMA thanks Medical Mutual for alerting us to this issue.
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Medical Director Opening on Vinalhaven Island

ENJOY MAINE ISLAND LIFE!  Seeking  experienced family practitioner to lead well-established FQHC health center on year-round, unbridged island community. Penobscot Bay area. New K-12 school, working waterfront, vibrant Arts community.  Rewarding primary care practice, excellent benefits, NHSC Site.  Contact:, 207 863 4109. [return to top]

Report on First Maine Telemedicine Summit, August 17, 2010

Telemedicine is already playing an expanded role in Maine's health care system, according to presenters at the first Maine Telemedicine Summit held last Tuesday at the University of Maine in Orono.  Nearly 150 physicians, health care providers, administrators, and policy makers attended the conference which featured a keynote presentation by Dale Alverson, M.D., President of the American Telemedicine Association.

Maine was identified as a leader in the use of telemedicine with one of the first grant funded projects in the nation originating at the medical center in Lubec in 2001. 

Several current uses of the technology were described at the conference, including:

  • teletrauma program at Eastern Maine Medical Center, assisting physicians in rural hospitals in northern and eastern Maine;

  • the use of telemedicine units in home health settings, that allow health professionals to monitor patient status remotely;

  • Intensive Care Unit support from Maine Health, supporting ICU's in nine smaller hospitals in Southern and Coastal Maine.

Despite obvious advantages in terms of access to care, many public and private payors have been slow to embrace payment for medical services delivered remotely through technology.  National speakers noted that a Maine law requiring health insurers to pay for services delivered through telemedicine if they would have paid for the same service delivered on site was unique.  It was enacted in 2009 and took effect last September.  It should help speed the development of additional telemedicine services in the state.

The summit was sponsored by the Maine Telehealth Collaborative, a project of the Maine CDC, Office of Rural Health and Primary Care, and the Muskie School of Public Service at the University of Southern Maine. [return to top]

Athenahealth Offers Webinar on Improving Patient Communication on September 9th

Boosting Schedule Density While Reducing Cost and Hassle With Patient Communication Technologies 

Thursday, September 9, 2010, 12:15 PM EDT 

Patients today expect 24/7 access to your practice—and their health care information—through a range of communication technologies.  But if your practice is like most, it’s overwhelmed with frustrating phone traffic and unwieldy, often paper-driven, administrative tasks.  Patients are just as fed up playing phone tag as your staff. But it doesn’t have to be that way. 

Industries such as banking and finance have eased communication and access for customers with the widespread use of web portals and email.  Health care providers need to catch up. Now you can. 

Learn how a web-based system can reach beyond just medical scheduling software to improve all your patient interactions outside the office, leading to better access, care and practice profitability.  Key to achieving a more efficient practice that’s integrated with an electronic health record and a practice management system are:

·          Automated Messaging;

·          Patient Web Portal;

·          Operator Services; and

·          Self-Pay Reminders.

With the guidance provided in this webinar and the accompanying white paper, you’ll learn how the right communication solution can make your practice competitive through increased schedule density, enhanced patient engagement, elimination of costly administration and more. 

Join athenahealth on Thursday, September 9th at 12:15 PM ET for a live Webinar, and bring your own questions as athenahealth has set aside a lot of time for Q&A. Register today! 
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Fall Political Campaigns Ramping Up as Labor Day Approaches

News of the five gubernatorial candidates seems to be on the front pages of the state's newspapers more frequently now and the races for the U.S. House of Representatives, Governor, all 186 seats in the legislature, and county and local offices will gain momentum after Labor Day.  You can find the most recent list of candidates on the Secretary of State's web site:  The MMA PAC, the Maine Physicians Action Fund (MPAF), encourages you to introduce yourself to the candidates for your House and Senate seats.  If you have any questions about the races, or if you have feedback from your contact with candidates, please contact Andrew MacLean, Deputy EVP at 622-3374, ext. 214 or [return to top]

CMS Provides Update on PQRI, eRx Incentive Payments

During a conference call with the provider community last week, CMS officials told participants that they could expect payments for the 2009 PQRI and eRx incentive programs this fall after delays caused by technical problems.  CMS expects that participants in the 2009 eRx program will receive payments between September 21st and October 22nd.  Participants in the 2009 PQRI program will receive payments between October 25th and November 12th.  CMS anticipates sending 2009 feedback reports in November.  The agency also announced that 889 additional participants have been declared eligible under the 2008 program following these technical adjustments.  Those individuals can expect payments between August 25th and September 17th. [return to top]

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