April 30, 2012

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Let MMA Train Your Staff on HIPAA, June 1, 2012

The Maine Medical Association will present its Annual HIPAA Update on Friday morning, June 1st from 9:00am to noon at the Frank O. Stred Building in Manchester with the program also offered remotely through WebEx.  With the final HITECH regulations due before June 1, this year's update is particularly important from a compliance standpoint.  And don't forget that the federal HHS will now be auditing a sample group of practices for HIPAA compliance.  Previously, offices were only reviewed if there was a complaint filed.

The Annual HIPAA Update is traditionally MMA's most popular First Fridays'  program.  The faculty this year includes Stacey Mondschein Katz, J.D., of SMK Consulting Services, LLC, and MMA's three in-house attorneys, Andrew MacLean, Jessa Barnard and Gordon Smith.

The agenda for the morning follows:

8:30am   Breakfast and Networking

9:00am    Welcome, Introduction and Overview of State and Federal Privacy Law and HIPAA Regulations, Gordon Smith, JD

9:30am    HITECH Regulations, Mental Health Rules and Preparing for an HHS Audit, Stacey Mondschein Katz, JD

10:30am  Break

10:45am  Special Privacy Rules:  Minors and HIV, Jessa Barnard, JD and Andrew MacLean, JD

11:30am   Summation and Q & A,  All presenters, moderated by Mr. MacLean

MMA's sample Notice of Privacy Practices document, consent forms and release forms are currently being updated to comply with the HITECH regulations and will be made available to program participants.

This program is ideal for your annual HIPAA staff education or for training new staff.  There is a $65 fee and registration is available on the MMA website at www.mainemed.com.  A HIPAA Training Certificate will be presented to each participant and CME has been applied for.

Members and practice managers are also reminded that MMA attorneys are available to come to the practice site to provide this program.  Normally, a $200 fee is charged for an on-site program which can be one hour or more if the practice is able to commit that much time to the education.

Any questions about the MMA's educational offerings can be directed to either Gordon Smith, EVP at gsmith@mainemed.com or Gail Begin via e-mail to gbegin@mainemed.com.

Political Pulse: Legislature on Break, Appropriations Committee Continues Work

The Legislature has recessed until May 15th following enactment of the second FY 2012 - 2013 supplemental budget (L.D. 1903) several weeks ago.  

The Joint Standing Committee on Appropriations & Financial Affairs met each day last week to continue work on non-budget bills, including bond issues, and have been in disagreement with the Governor over requiring voter approval for all bonds issued by the State.  

The Committee heard from DHHS staff last Friday regarding the DHHS MaineCare eligibility system/claims management system incompatibility problem.   DHHS Commissioner Mary Mayhew reported that around 7,700 individuals - out of an estimated 24,000 whose eligibility was improperly continued - used their cards for services.  This led to $6.8 million in improper payments of state funds and $3.7 million in improper payments from federal funds.  Taking into account repaying the $3.7 in federal funds, DHHS is now projecting shortfall of $82.5 million for fiscal year 2013, down from an original $89 million. This reflects a reduction in $5.3 million because DHHS overestimated their spending needs to cover services for the individuals who were ultimately not eligible for benefits.  In response to questioning, Commissioner Mayhew confirmed that providers would not be expected to repay the state for any services provided to these ineligible individuals.     

The Committee met again this afternoon to hear an updated revenue forecast for 2013 taking into account $14 million in revenue from January that was not property accounted for and April tax filings.  The Revenue Forecasting Committee has now forecast an increase in total revenues by $42,147,750 for fiscal year 2012 and $6,711,283 for fiscal year 2013.  This Committee was waiting for this update to proceed with budget negotiations and met in partisian caucuses immediately after the announcement.  They will still have significant work to do to close the remaining budget gap and plan to meet again tomorrow. 

NOTE:  THERE WILL BE NO LEGISLATIVE COMMITTEE CONFERENCE CALL THIS WEEK.  Please check the Weekly Update next week for news on whether there will be a call on Tuesday evening.

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MeCDC Hosts Successful Immunization Conference - New Tools for Physician Practices

Last Monday, the Maine CDC held its very successful Annual Immunization Conference at the Augusta Civic Center.  It was attended by several hundred health professionals who are responsible for managing or staffing child and adult immunization programs, health program administrators, nurses, physician assistants, and physicians.  A number of national speakers addressed the attendees, including: Kristine Sheedy, PhD, Associate Director of Communication Science at the US CDC, Jon Kim Andrus, MD, Deputy Director of the Pan American Health Organization, Andrew Terrannella, MD, MPH, Epidemic Intelligence Service Officer at the US CDC and Mark Grabowsky, MD, MPH, at the US Department of Health and Human Services who spoke about health care personnel flu vaccination requirements.  Maine immunization experts and MMA members Sidney Sewall, MD, and Larry Losey, MD, spoke about vaccinating children new to the US and catch up vaccine schedules. 

Of particular interest to physician practices, Ms. Sheedy from the CDC shared a new set of materials for primary care practices to use in educating families about the safety and importance of vaccines.  Materials include communication strategies for having more productive conversations about immunizations; current vaccine safety information, including answers to common questions and summaries of research; and disease-specific fact sheets.  You can download the free materials here: www.cdc.gov/vaccines/conversations.  

 The Maine Immunization Program at the MeCDC also distributed a new Provider Resource Manual for practices.  It is intended as a day-to-day reference tool for activities such as vaccine storage and handling, vaccine administration and ordering.   The Manual replaces the Desktop Reference Guide that has previously been offered by the Immunization Program.  If your practice has not received one or did not pick one up from the conference, you can contact the Immunization Program at 207-287-3746.  One Manual will be available per practice. 

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Summary of MMA Board Meeting, April 25, 2012

The MMA Board of Directors met for a regularly scheduled meeting last Wednesday, April 25th.  The Board consists of 23 voting members and is chaired by Kenneth Christian, M.D. of Holden. 

Highlights of the meeting included:

1.  Consideration of the Resolutions approved by the general membership at the Annual Meeting last September.  All of the Resolutions were adopted as MMA policy following a new procedure voted by the Board last meeting in the face of bylaw amendments approved at the Annual Meeting.

2.  A request by the AMA for state societies to endorse a document entitled Guidelines for Reporting Physician Data  was referred to the Executive Committee with direction to the Committee to obtain more information and meet via conference call to discuss prior to responding to the AMA or endorsing the document.

3.  A request by the organization, Maine United for Marriage, for the Association to endorse the ballot question legalizing same-sex marriage was denied, following discussion largely focused on the questions of whether or not there was a sufficient medical interest involved and whether or not taking a position was consistent with MMA's mission.  MMA will be neutral on the ballot question.

 4.  The need to appoint an audit committee to work with the Finance Director and the Budget and Investment Committee was noted.  The new Nominating Committee is charged with the task of recommending members for the audit committee which was established in the new bylaws approved last September.

The Board meets again on June 6th, at 4:00pm at the Frank O. Stred Building in Manchester.

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MMA Meets with Congressional Delegation to Urge Reform of Chemical Safety Laws

A U.S. Senate Committee vote on the Safe Chemicals Act, a bill that would fix the outdated Toxic Substances Control Act of 1976 (TSCA),  is imminent.  Momentum to reform the nation’s broken chemical safety laws is picking up speed as evidenced last month when all of Maine’s major newspapers ran editorials in support of national reforms.

The momentum kept on growing in April when the Maine legislature passed a joint resolution urging Congress to fix TSCA.  With this bipartisan resolution, Maine lawmakers sent a clear message to Congress that Mainers want laws that adequately protect health and safety.

With that message in hand, representatives of the Maine Medical Association (Gordon Smith, MMA EVP), Roman Catholic Diocese of Portland, Environmental Health Strategy Center, and Learning Disabilities Association of Maine flew to Washington, DC on April 18th to ask the members of Maine's Congressional delegation to support the Safe Chemicals Act of 2011.  They met with Congressman Mike Michaud and key staff for Senators Olympia Snowe and Susan Collins, and Congresswoman Chellie Pingree.  Maine's entire delegation agrees that the outdated and ineffective Toxic Substances Control Act must be reformed.  Leadership is especially needed now from Maine's Senators to move reform of TSCA forward this year.

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CMS Issues Final Rule on Ordering and Referring Provider Enrollment

In 2010, Congress passed a statutory provision to require physicians who order or refer to enroll in Medicare and to list their National Provider Identifier (NPI) on all such claims.  Later that year, CMS again proposed instituting edits to reject claims if ordering and referring physicians did not have an enrollment record in PECOS and meet the other statutory requirements.  At that time, the AMA argued successfully that many physicians did not have enrollment records in PECOS and cited other operational concerns, leading CMS to delay the edit implementation.

In direct response to ongoing AMA advocacy and comments submitted by the AMA and 42 medical specialty societies, CMS has now published a final rule on these requirements that makes significant improvements to CMS’ prior interim final rule and proposals on the subject, namely:

  • Physicians who order or certify imaging or clinical laboratory services, DMEPOS, or home health services who are enrolled in PECOS or the legacy Medicare system will satisfy the enrollment requirement.

  • Referrals to physician specialists have been excluded from the final rule.

  • If a state allows a medical resident who has a provisional license, or is otherwise permitted by state law to practice or order and certify services, CMS will permit the resident to enroll in Medicare to order and certify, at the discretion of their institution.

  • CMS will provide a 60 day notice to physicians prior to turning on the edits to deny claims due to lack of an enrollment record.

What Physicians Need to Know

Physicians who order or certify imaging or clinical laboratory services, DMEPOS, or home health services for Medicare beneficiaries need to:

  • Enroll or verify enrollment in Medicare now to avoid claim denials.  While CMS will give 60 days advance notice to the physician community prior to turning on the edits that will deny a claim, it is the AMA’s understanding that this date will be announced in the near future.  Physicians who seek to enroll for ordering or certifying only may do so via PECOS or by submitting the CMS 855-0, a paper enrollment application. Note that this requirement does not extend to physicians who have validly opted-out of Medicare.

  • Retain records related to orders or certifications for 7 years.  There is no requirement regarding the manner of record retention (i.e. electronic or paper).

  • Use their Type I individual NPI when certifying or ordering, even if they are being reimbursed under a Type II NPI.  For example, if Dr. Smith orders home health services and uses his Type II NPI for John Smith, MD LLC instead of his personal, Type I NPI, the claim may be denied (even if Dr. Smith has reassigned Medicare reimbursement to John Smith, MD LLC).

See the AMA’s Medicare enrollment website for more information.

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Announcing J14 A/B MAC Web Site Enhancements (From NHIC)

NHIC, Corp. J14 A/B MAC is committed to ensuring that our Web site www.medicarenhic.com meets the needs of our users.  We continually strive to improve our offerings based on the information and feedback we receive from you, which also helps us to respond more effectively to your individual support needs.  

NHIC, Corp.  Part B Web Site Enhancements: 

Are you prepared for ICD-10?  The ICD-10 Webpage was developed to provide you with essential resources to assist you in this transition.  On this page, you will find links to the most recent ICD-10 News from CMS, CMS Resources, ICD-10 Myths & Facts, and Part B teleconferences and presentation materials.  Please visit this page for the tools and resources you need to ensure a smooth transition to ICD-10.

The Centers for Medicare & Medicaid Services (CMS) implemented the Comprehensive Error Rate Testing (CERT) program in 2003 to measure improper payments in the Medicare fee-for-service (FFS) program.  NHIC, Corp established the Comprehensive Error Rate Testing (CERT) Center for you to easily locate CERT Guidelines, Documentation Requirements, Signature Guidelines, CERT Educational Articles and CERT Resources. Within the CERT Center you will also find links to the CMS CERT Web site, the CERT Provider Center, and CERT related MLN Articles.

NHIC, Corp. understands that the frequency of updates and changes to the Medicare program can create many questions for our provider community.  Recently, a new feature, The FAQ Quick Hit, was added to each contract's home page.  This feature will randomly select and display individual FAQ's from our database.  Each time you visit the home page, a new FAQ will be displayed.  This feature will allow you to view some of the questions we received that may interest you, and provide you with the answer you were looking for.

We want to make sure you have all of the resources available to keep you updated and informed of the latest information.  One of the tools we offer is line of business specific Frequently Asked Questions (FAQ's).  FAQ's include questions and answers for specific categories such as:  Provider Enrollment, Billing and Coding, Medical Review/Policy, and Customer Service.  We encourage you to use this resource for your common FAQ's that are available at Part B

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Receive Two Hours of Category One CME for Completing Pain Management Home Study Course

The Home Study Course on the Management of Pain has recently been updated and is available on the MMA website.  Many thanks to primary author Noel Genova, PA-C and a physician advisory committee that reviewed and edited several drafts of this important material.  It can be taken, at no cost, for two hours of CME if the pre-test and post-test questions are taken and the evaluation form completed.  Thank you also to the Maine Board of Licensure in Medicine which has funded this work and the consultations that Noel has performed out in the practices.

The link to the course follows:  http://www.mainemed.com/painMgt/cme.php. [return to top]

Maine Health Policy Study Group and Maine AllCare Presents May 11 Program on Universal Coverage

The Maine Health Policy Study Group and Maine AllCare present, Beyond Patient Care:  Defining the Doctor's Role in Health Care Policy, on Friday morning, May 11, 2012 from 8:30 a.m. to 10:30 a.m. at the Maine Medical Association in Manchester.  Please join us for a dialogue with physicians about efforts to bring accessible, high quality, affordable health care to all of the people of Maine.

Guest Speaker:  Margaret Flowers, M.D., Congressional Fellow, Physicians for a National Health Program

Reaction Panel will include:

 Jeffrey Barkin, M.D., Associate Medical Director, Goold Health Systems, Co-Chair Maine Health Policy Study Group;

Linda Sanborn, M.D., State Representative, House District 130, part of Gorham; and

Philip Caper, M.D., Vice-Chairman of Maine AllCare Board and Member of Health Policy Study Group.

There is no charge to attend but space is limited and advance registration is requested.  To register, please e-mail Julie Pease, M.D. at jpease@maineallcare.org

Coffee and on-site registration opens at 8:00 a.m. and the program will begin at 8:30 a.m.



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Join Practice Managers at Regional Conference in Rockport, May 15-17, 2012

For details, click on Upcoming Events and Conferences article, below. [return to top]

Portland Gastroenterology Center Seeking Nurse Practitioner

Are you looking to maximize your professional career? Portland Gastroenterology Center is one of the leading providers of G.I. health care in Maine and Northern New England and we are looking for a dedicated Nurse Practitioner to join our team!

Our Nurse Practitioners are an integral part of our practice; performing patient follow up and consultative clinical evaluation, conducting physical exams, preparing treatment plans, and providing patients with health and disease prevention information.

Candidates should have advanced knowledge and skills in conducting physical examinations and treating patients in an expanded practice model with minimal direction. An advanced knowledge of nursing theory and practice, and additional specialized training acquired through completion of a concentrated study and clinical internship leading to a Master’s Degree. Applicants should have or be eligible to obtain a current license and registration to practice as a certified Advanced Practice Nurse in the State of Maine.

We offer a competitive salary and benefits packet.

If you have always wanted to live in a vibrant city that offers affordable housing, excellent schools, and an energetic arts community, then Portland, Maine is for you!

Resumes should be sent to: TABERA@mmc.org


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Upcoming Events & Conferences


11th Annual Obesity Workshop 

Price Matters: Sugar Sweetened Beverages, Taxes & Obesity - The Evidence 

May 3, 2012

8:00 am - 3:00 pm 

Maple Hill Farm, Hallowell

The annual obesity workshop is an event not-to-miss for all people interested in public health and the health of our children.  Three nationally known speakers will present the latest research and information about sugar sweetened beverages, how they impact obesity rates and how purchase price influences our choices.

For more information or to register, click here


The Maine Society of Eye Physicians and Surgeons Spring Meeting

May 4, 2012 

12:00pm - 4:45pm

Harraseeket Inn, Freeport

The Spring Meeting will include lunch, educational presentations and a business meeting.  The educational talks include Trexler M. Topping, MD presenting on Lessons Learned from Malpractice Claims and Bradford Shingleton, MD presenting on Pseudoexfoliation:  IOP, Cataract Surgery and Postoperative IOL Issues.

For more information or to register, contact Shirley Goggin at sgoggin@mainemed.com or 207-445-2260.


Back to School: Pediatric and Adolescent Hot Topics and School Based Health

May 5-6, 2012

Harborside Hotel, Bar Harbor 

Approved for 10.5 Hours of Category 1 CME 

For more information or to register, go to www.maineaap.org 


Maine Association Medical Staff Services Biennial Education Conference: The Many Spokes of the Wheel

 May 9-11, 2012

 Residence Inn Hotel and Conference Center, Portland, ME

The conference welcomes physicians and other health professionals with an interest in medical staff activities, including credentialing and quality improvement.  Category I CME is offered for physicians.

An agenda and registration materials are available at www.meamss.org


Perspectives on Wellness in Aging 

May 10, 2012

8:00 am - 4:00 pm

Hilton Garden Inn, Bangor, ME

This conference will begin an important discussion about aging, new insights and ideas to help promote wellness for elders in Maine. 

For more information or to register, click here


2012 New England Medical Group Management Association Regional Conference 

Practice Management - A Changing Landscape 

May 15-17, 2012

Samoset Resort, Rockland, ME 

In the face of the changing healthcare landscape, you need to understand the challenges and opportunities your practice is facing. The 2012 New England MGMA Regional Conference features a wide range of speakers who will provide you with the insight and tools you need to help your practice thrive.

For more information or registration, visit: http://newenglandmgma.com/

Members of the Maine Chapter MGMA now receive a $50 registration reimbursement. 


22nd Annual Maine GERIATRICS Conference - Save the Date

June 7-8, 2012 

Harborside Hotel & Marina, Bar Harbor, ME

Registration Open.  CME Available. 

 For more information or to register visit http://www.une.edu/com/cme/


Save the Date: 

Medical Mutual Practice Manager Seminar: 

Caring for our Seniors - Complex medical & liability issues

June 13, 2012

DoubleTree by Hilton Hotel, South Portland, ME 


Save the Date: 

Emergency Ultrasound Course

October 25-26, 2012

MaineGeneral Medical Center, Waterville, ME 

Primarily geared to emergency and intensivist physicians and mid-levels.  Expected 14 Category 1 CME Credits.  Course Director: John Joseph, MD, FACEP 

To reserve your spot: 626-1303 or sharon.judkins@mainegeneral.org

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CMS Has Paid $4.5 Billion in EHR Incentives

Through the end of March 2012, CMS has paid almost $4.5 billion to more than 76,000 providers for "meaningful use" of electronic health records through the Medicare and Medicaid EHR incentive programs.  More than 225,700 providers now have enrolled in the incentive programs, up from 211,600 in late February.  CMS says it paid almost $340 million to more than 8700 physicians and hospitals through the Medicare incentive program in March.  Medicaid incentive programs paid approximately $267 million to 5400 providers in March.

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Opportunity to Further Expand Maine PCMH Pilot - Application Process Re-Opened!

We are writing to notify the Maine primary care community of a potential opportunity to increase the planned expansion of the multi-payer Maine PCMH Pilot to include up to 50 qualified adult primary care practices.  It should be noted that several issues must be addressed before this opportunity can be finalized.

Maine’s participation in the CMS MAPCP demo currently brings in approximately $2.5M per year in new Medicare payments to the 22 adult Pilot practices ($1.7M) and the 8 Community Care Teams (CCTs) ($720K).  Bringing in the planned 20 new practices is expected to bring in approximately $2.5M of additional Medicare payments to practices and CCTs (i.e. nearly doubling that revenue).  Bringing in an additional 30 new practices could be expected to bring in an additional $3.4M in new Medicare payments to these new practices and CCTs.

In order to proceed, CMS requires that the other payers agree to participate, and that Pilot Conveners offer the same level of practice transformation support for all practices in the Pilot.  While we fully recognize the importance of this opportunity, resources do not currently exist to provide this practice transformation support for an additional 50 practices, and we do not have sufficient time to secure additional grant resources  in the  required timeframe.  Given that, we are proposing that new practices selected for the Pilot contribute a modest per member per month (pmpm) payment to support these required practice improvement activities.

While final approval of this additional expansion of the Pilot is contingent upon these additional steps and subject to CMS approval, we feel that it is highly possible that we will be allowed to proceed.  Given that, we are re-opening the online application process for the Maine PCMH Pilot and the MaineCare Health Homes initiative for a 2 week period, from Friday, April 20 through 5PM on Friday, May 4.  

For more information or questions about eligibility, please contact Dr. Lisa Letourneau at tel. 415.4043 or Lletourneau@mainequalitycounts.org or Nancy Grenier at tel. 240.8768, or ngrenier@mainequalitycounts.org

We appreciate your interest in and support for the Maine PCMH Pilot.

Maine PCMH Pilot Conveners,

Karlynee Harrington, DHA’s Maine Quality Forum

Lisa M. Letourneau MD, MPH, Maine Quality Counts

Elizabeth Mitchell, Maine Health Management Coalition


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