Controversy over MaineCare RAC Audits is Deja Vu for MMA
The current media attention on MaineCare audits of dentists under the so-called RAC provisions of the Affordable Care Act has shown a spotlight on the unfairness of recovery efforts conducted by contractors paid on the basis of contingent fees. These contingent fees were prohibited by legislation introduced at the request of MMA back in 2001.
P.L. 2001, Chapter 464, An Act to Ensure Appropriate Audit Procedures was introduced into the 120th Legislature and MMA testified on the proposal on March 1, 2001. We noted in our testimony that the L.D. was the highest priority of the eleven bills MMA prepared that session. In our testimony, we quoted then Commissioner Kevin Concannon who stated to the Appropriations Committee that, "if he had it to do over again, he would not go down that road," referring to the practice of Medicaid contracting with private firms on a contingent fee basis. The Legislature agreed that this practice created an inherent bias in the audit and recovery process and enacted the legislation prohibiting the practice. That legislation was signed into law by then Governor Angus King.
While the federal Affordable Care Act required states to put similar programs into place, states with prohibitions on contingent fees had the opportunity to file State Plan Amendments asking CMS to waive the requirement of paying the contractor on such a basis. Unfortunately, in protracted negotiations in the winter of 2012, the current administration declined to ask for the exception and filed legislation, L.D. 1629 which expressly allowed for the payment of contingent fees in MaineCare audits. Fortunately, several other protections for providers were agreed to. MMA representatives will be meeting with Maine Dental Association staff this week to discuss whether the procedural protections in the law and rules are being applied.
In both 2012 and this year, MMA has provided educational resources to members and their billing staffs on the Medicaid Recovery Audit Contractor Program. The educational presentations were presented as part of the First Fridays educational series, which are available both live and through webex. Please see the accompanying article in this week's update announcing the First Friday programs for 2014.
If your practice has already heard from Health Management Systems, Inc. (HMS), the private contractor conducting the RAC audits, please let MMA staff now so that we track the experiences of our members. Contact Gordon Smith, Esq. via e-mail to firstname.lastname@example.org if you are already being audited or have had an audit completed under the provisions of the ACA.
2014 First Friday Educational Program Line-up
Announcing the Maine Medical Association's
2014 First Fridays Educational Programs
8:30 AM – Registration and Breakfast; All Programs 9:00 AM to Noon
All sessions take place at the Maine Medical Association Building in Manchester, Maine or remotely via WebEx, unless otherwise noted. Please look for a registration flyer in the upcoming edition of the Maine Medicine newsletter.
February 7 Payment Reform Readiness
Presented by Benjamin Townsend, Esq., Kozak and Gayer, P.A.
April 4 Annual Coding Seminar/Transitioning to ICD 10
Presented by Laurie Desjardins, PCS, CPC-I, Coding Strategies, Inc.
May 2 New Laws from the 126th Legislature
June 6 Annual HIPAA Update
June 18 Annual Practice Education Seminar, Augusta Civic Center, Augusta, Maine
August 1 Ethical Issues in Contemporary Medicine
October 3 Risk Management Seminar
Presented by Medical Mutual Insurance Company of Maine
December 5 Annual Compliance Seminar [return to top]
Reception Tonight for MMA President Guy Raymond, M.D. and AHA Board Member Kris Doody
The Eureka House Restaurant in Stockholm, Maine will be the site of a reception tonight honoring MMA President Guy G. Raymond, M.D. and Cary Hospital President and CEO Kris Doody, RN. Ms. Doody was recently elected to the Board of Directors of the American Hospital Association, one of the first hospital administrators from Maine to ever achieve this honor.
All MMA members are invited to attend the reception which will be held from 4:00 to 6:00pm. Guests are welcome as well. Refreshments and a cash bar will be available.
Several area Legislators will be attending along with MMA EVP Gordon Smith and Vanessa Santarelli, CEO of the Maine Primary Care Association.
Both Dr. Raymond and Ms. Doody are natives of Aroostook County and both returned to The County to serve the needs of county residents and their families. [return to top]
New Payment Reform Committee Holds Inaugural Meeting Tonight
MMA's new Payment Reform Committee will meet tonight at the Association offices in Manchester, Maine to begin the work of the Committee. Dinner will be available at 5:30pm with the meeting commencing at 6:00pm and scheduled to conclude no later than 8:00pm.
Executive Committee chair Brian Pierce, M.D. will chair the Committee, at least initially and the Committee will be staffed by MMA attorneys Andrew MacLean, Jessa Barnard and Gordon Smith, assisted by Jennifer Reck who is the project manager for the current payment reform grant the Association has received from the Maine Health Access Foundation.
All MMA committee meetings are open to any MMA member who may be interested in the work of the committee. Feel free to attend the meeting and if you are interested in the work, please volunteer to serve on the committee.
5:30 - Dinner available
6:00 - Meeting begins
Introduction to MeHAF Payment Reform grant
- Jennifer Reck
Purpose/scope of committee
- Brian Pierce, MD, Chairperson
SIM grant overview
- Noah Nesin, MD
Payment Reform Readiness: A Legal Toolkit for Physicians
- Jessa Barnard
- Provider survey
- MeHAF grant work plan for 2014
- MaineCare Accountable Communities proposed quality framework
- 2014 Committee Meeting dates
8:00pm - Meeting adjourns [return to top]
Sign up to be Doctor of the Day
During the 1996 legislative session, the Maine Legislature asked the Maine Medical Association and the Maine Osteopathic Association to furnish a physician for each day of the legislative session to assist in the event of a medical emergency. Now the “Doctor of the Day” program is well established and respected, and legislators are enthusiastic about it. This is a unique opportunity to observe the legislative process in action and to interact with the lawmakers. We need your help to continue our presence and to ensure the continued success of this program.
The scheduling of volunteers for the second year of the 126th Legislative Session has already begun. We would like to invite you to participate in the upcoming session that is scheduled to convene in January and is expected to run through April.
Upon receipt of your registration, MMA staff will contact you to arrange and/or confirm the most convenient date for you to serve. The House Clerk’s office staff then will mail you a packet with a legislative parking pass and confirmation letter informing you about your scheduled date. On the day of your participation, a Maine Medical Association or Maine Osteopathic Association staff representative will meet you at the State House and will be available to guide you throughout the State House.
This is an effective grassroots contact program for organized medicine in Maine and it has established substantial "good will" for organized medicine at the State House. The “Doctor of the Day” program gives you the unique opportunity to observe the process in which your legislators make decisions affecting you as a physician and as a citizen of the State of Maine.
If you have any questions regarding the “Doctor of the Day” program, please feel free to contact the MMA at email@example.com. You can submit your registration on line. We hope to see you at the State House for what is expected to be a very interesting session for the medical community. [return to top]
MMA Webinar: Payment Reform Readiness for the Independent Physician, Nov 21
Webinar: Payment Reform Readiness for the Independent Physician
Nov. 21, 12:00-1:00 pm
Ben Townsend, JD, Shareholder, Kozak & Gayer
Beverly Neugebauer, Executive Director, Coastal Women’s Healthcare
Attorney Ben Townsend of Kozak & Gayer will discuss the publication he recently authored for the MMA entitled “Payment Reform Readiness: A Legal Toolkit for Physicians”. He will provide an overview of current payment reform initiatives as well as the sometimes unexpectedly complicated business, legal and compliance issues that such initiatives may raise, particularly for independent physicians.
Beverly Neugebauer, Executive Director for Coastal Women’s Healthcare in Scarborough, will give a first hand account of how Coastal Women’s Healthcare has navigated many challenges of the changing healthcare payment environment, remaining a viable, independent practice owned by eight physicians.
To join this webinar, please email Jennifer Reck at firstname.lastname@example.org. The legal toolkit document and other payment reform resources are available at: https://www.mainemed.com/cme-education-info/payment-reform. The webinars and resources are made possible through a generous grant from the Maine Health Access Foundation. [return to top]
MICIS Can Help Physicians Save Time and Practice More Effectively
The Maine Independent Clinical Information Service (MICIS), the academic detailing program of the Maine Medical Association, has been helping busy physicians keep up with medical literature since 2009. MICIS provides high-quality, rigorous and independent modules on a range of topics that are offered to you by trained clinicians at your convenience, at your work site, at no cost. CME is available.
Currently available topics are:
- Obesity Management (NEW!)
Upcoming topics are:
Contact Program Manager Jennifer Reck today at email@example.com for more information or to schedule a visit. [return to top]
- Antibiotic Stewardship (Nov. 2013)
- COPD (Jan. 2014)
Save the Date: MMA Legislative Committee Meeting, Dec. 9
The MMA Legislative Committee, chaired by Amy Madden, M.D., will hold an organizational meeting in anticipation of the Second Regular Session of the 126th Maine Legislature on Monday, December 9th from 6:00 p.m. to 8:30 p.m. at the MMA office in Manchester. Dinner will be available at 6:00 p.m. Any MMA member or practice management staff person who is interested in our advocacy work is welcome to attend. Medical specialty societies are strongly encouraged to have a representative at the meeting to ensure their members are aware of policy initiatives that may affect their specialty. For our meal planning, please RSVP to Ashley Bernier (firstname.lastname@example.org; 622-3374, ext. 213) if you plan to attend.
MMA is not planning to hold a Physicians' Day at the Legislature this year. However, the Cover Maine Now! (CMN) Coalition, (www.covermainenow.com), a broad based group of health care and consumer advocacy organizations supporting the acceptance of federal funds to provide health coverage for low income Mainers, plans a rally at the State House in support of that initiative on January 8th, the opening day of the second session. The MMA is a member of the Steering Committee of the Coalition and encourages physicians to attend on the 8th. The MMA will publish more information about the CMN rally in the Maine Medicine Weekly Update as it becomes available.
The MMA is also seeking physicians who are willing to serve as "Doc of the Day" for the Legislature in 2014. To learn more about the program or sign up, please visit: http://www.mainemed.com/doctor-day. [return to top]
MMA Advocates for Improved Health Care Coverage for Maine Veterans
In honor of Veterans Day, please consider joining the MMA in advocating for health coverage for Maine veterans.
Approximately 2,700 uninsured Maine veterans who do not have health insurance today could be covered in 2014 if Maine accepts federal funds that have already been set aside for Maine’s uninsured. It’s estimated that about 1000 family members of veterans could also gain coverage.
Here are 5 key facts about veterans and health coverage:
1. Not all veterans are eligible for health care services through the Department of Veterans Affairs. The Department of Veterans Affairs (“VA”) considers a veteran’s active duty status, condition of discharge, and length of service in determining eligibility for health care services. In addition, the VA uses a priority enrollment system to facilitate the management and delivery of health care services. There are eight priority groups that determine a veteran’s eligibility and priority for using health care services. Priority status is based on several factors, such as service-related disabilities and income-level. Depending on the VA’s medical care budget, veterans in lower priority groups may face restrictions on new enrollment or lose their eligibility.
2. Uninsured veterans have substantial medical needs. Uninsured veterans have a disproportionate amount and complexity of health issues. Over 40 percent of uninsured veterans report having unmet medical needs. About one third of uninsured veterans have at least one chronic health condition, while over 15 percent have physical, mental, or emotional health problems.
3. Nearly half of today’s uninsured veterans would get the coverage they need with additional Medicaid coverage. There are approximately 1.3 million uninsured veterans nationwide. Nearly half of the uninsured veteran population reports family income below 138% of the federal poverty level, and would get coverage if states accept federal funding to expand Medicaid. Only 10% of these veterans appear eligible for Medicaid under current law.
4. Rural veterans often have no VA facilities near them. Veterans eligible for VA health care services usually receive those services at facilities operated and staffed by the Veterans Health Administration. Proximity to VA facilities may impact the likelihood of veterans seeking health care services. This is particularly true for those in rural communities located far from VA facilities. If these veterans had additional coverage through Medicaid, they could access local providers and get regular care.
5. For some veterans availability of Medicaid coverage automatically improves their standing in the VA’s priority system. Veterans eligible for Medicaid benefits may be placed in a higher priority group in the VA’s priority enrollment system. Therefore, if a state expands Medicaid, in addition to receiving Medicaid coverage, many veterans will also automatically have improved access to health care through the national VA system. [return to top]
Obama Administration Releases Mental Health Parity Final Rule
On November 8th, the Obama Administration released a final rule requiring most health plans to treat physical and mental health benefits equally. The rule carries out the 2008 mental health parity law known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. It requires health plans offering mental health or substance abuse disorder benefits to treat them in the same way as medical and surgical benefits in terms of costs and access to care. The law does not apply to private employers with fewer than 50 workers. An interim final rule was published in 2010.
The rule is published jointly by the departments of Health and Human Services, Labor, and the Treasury and is effective for plan years beginning on or after July 1, 2014. The rule is scheduled for publication in the Federal Register on November 13th. [return to top]
Ambulatory Surgery Center Manager
Central Maine Orthopaedics (CMO) is recruiting for a full-time Manager for our ASC. The foremost duty of this position is to ensure the day-to-day operations and management of the ASC run smoothly and efficiently. This position requires a professional with strong leadership characteristics with an associated broad skill set who will serve as role model, mentor, and coach/facilitator.
This position is responsible for delivery on the organization's strategic plans, benchmarks, and critical success factors and therefore must demonstrate accountability and responsibility for own work and expected outcomes for those supervised. This position is responsible for maintaining requirements for State licensure, Medicare certification, and accreditation by the Accreditation Association for Ambulatory Health Care (AAAHC).
AAAHC/JCAHO experience in an ASC or hospital free-standing outpatient surgery setting, required.
Please see the full listing for this opportunity on the Careers section of our website www.cmogroup.org.
Interested candidates, please send cover letter, résumé, and salary requirements to: Janine Valliere, HR Manager, Central Maine Orthopaedics, 690 Minot Ave, Auburn, ME 04210 or e-mail to email@example.com.
Chief Medical Officer at Portland Community Health Center
The Portland Community Health Center, located in the heart of Portland Maine, is seeking an experienced physician leader/chief medical officer to join our mission driven team. As a Federally Qualified Health Center, we offer a great opportunity to provide patient centered holistic care to a highly diverse patient population. An interest in teaching and international medicine is preferred. Position is full time, extended hours, outpatient only and no call.
The Chief Medical Officer is responsible to the CEO. She/he also makes direct reports to the monthly Board of Directors meeting and the quarterly Board Quality Management Committee. The Chief Medical Officer is accountable for the delivery and quality of all PCHC’s health care clinical services.
Portland Community Health Center, 180 Park Avenue, Portland, ME 04102 http://portlandcommunityhealthcenter.org
Submit resume and letter of intent to: Leslie Brancato, CEO: Lbrancato@portlandchc.org or 207.874.2141 Ext: 5028.
Practice Administrator at Maine Nephrology Associates in Portland, Maine
Maine Nephrology Associates (MNA), an independent
physician practice located in Portland, Maine,
is seeking a Practice Administrator. MNA
is comprised of eleven nephrologists and two physician extenders supported by
approximately 25 employed staff. We provide specialist care for kidney disease
and hypertension in a single private office location that includes its own
laboratory, in four area hospitals and in five dialysis centers. MNA Physicians hold Tufts University School
of Medicine faculty positions to teach trainees at Maine Medical Center. MNA physicians also serve as principal investigators
on numerous research grants.
The Practice Administrator’s oversight responsibilities
include all aspects of practice management: planning, implementing,
controlling, contracting, financial, legal and regulatory compliance,
administrative services, physician credentialing, human resource policies and
benefits, organizational design, supervising, training, billing, scheduling and
medical records functions.
The Practice Administrator reports to the Managing Partner
and this pair in turn works with the Physician Steering Committee to implement
the strategic goals of the group. The
ideal candidate is an experienced healthcare management professional with
competence to lead this medical practice through organizational change to
ensure efficient, effective and safe operations of all aspects of clinical and
Interested candidates are invited to forward a resume or
CV along with a cover letter detailing how your experience meets the
expectations of this position along with salary requirements to firstname.lastname@example.org.
Department of Psychiatry Faculty
The Geisel School of Medicine at Dartmouth,
Department of Psychiatry, in a productive collaboration with the State of
Maine, is seeking a psychiatrist to join our faculty for inpatient
responsibilities at the Riverview Psychiatric Center.
Riverview Psychiatric Center is a
92-bed acute psychiatric facility located in Augusta, ME and is the flagship inpatient
treatment center for Maine’s public mental health system. Psychiatrists with expertise in general inpatient psychiatry or
forensic psychiatry are encouraged to apply.
Academic duties can include teaching
and supervision of medical students and residents. Research opportunities
available and encouraged.
Candidates should be board certified or
eligible in Psychiatry. This position will include a faculty appointment at The
Geisel School of Medicine at Dartmouth at a rank and salary commensurate with
experience. Curriculum vitae and three letters of reference, addressed to Dr.
William Torrey, Search Chair, should be e-mailed to email@example.com. Please reference search number PS1013D.
The Geisel School of Medicine at
Dartmouth is an Equal Opportunity/Affirmative Action Employer and encourages
applications from women and members of minority groups.
Family Medicine Physicians
[return to top]
Katahdin Valley Health Center is recruiting dedicated Family Medicine Physicians that are committed to providing quality health care services to the people in Central/Northern Maine. Join our practice in one of the newly expanded facilities. We are seeking physicians for our Millinocket and Houlton locations. KVHC is a fully electronic medical record site and offers a competitive salary ($170,000 to $190,000 annual) and benefit package which includes: a 10% of first year salary sign on bonus, generous amounts of paid time off, $2500 annually toward CME as well as a completely outpatient site. The call schedule is 1 in 8 with additional coverage from the Open Access Clinic. Physicians who join KVHC are eligible to apply for NHSC Loan Repayment.
Physicians that join KVHC will be providing quality care in a dynamic, cutting edge environment, within a patient focused team of 10 Providers and 90 Staff Members. As one of New England’s highest performing Federally Qualified Health Centers (FQHC), KVHC has a mission to provide community accessible, quality healthcare with compassion and dignity.
To learn more about KVHC and Practitioner Opportunities, please contact Michelle LeFay at firstname.lastname@example.org or visit our website at www.kvhc.org. KVHC is an equal opportunity employer.
Maine School Administration District No. 75 seeks a Nurse Practitioner
for our School Based Health Center at Mt. Ararat High
School. The position is a Part time (.5 FTE) salaried
position with a flexible schedule.
Nurse Practitioner will provide
administrative and supervisory oversight of our School Based Health Center and administration of the funding grant. Responsibilities include providing
comprehensive primary health care services to enrolled High School students and
coordination of care with their Primary Care Clinicians. This position works collaboratively
with the School Nurses, Medical Director and SBHC Advisory Committee.
have State of Maine Nurse Practitioner license and be certified in Family Practice of
Pediatrics. At least two years Nurse Practitioner and Supervisory experience
Please forward a MSAD # 75 Professional
employment application, cover letter, resume and copy of license to: Human Resources, M.S.A.D. No. 75, 50 Republic Avenue, Topsham, Maine 04086. Applications
can be found at: www.link75.org. (Departments/Human
MaineHealth Director of Government Affairs
The Director of Government Affairs reports directly to the
Senior Vice President of Government and Employer Relations; and under the
supervision of the SVP, will research and coordinate MaineHealth’s position on
state and federal legislation and communicate with policymakers on behalf of
candidates with excellent written and verbal communication skills; strong
analytic capacity; and background in
legislative process. The position requires the ability to accommodate a
flexible work schedule (some nights and weekends). Working knowledge of health
care policy preferred.
The position requires a
thoughtful and keen individual to execute the following:
- Research, monitor and analyze
federal and state legislation and regulation;
- Work with internal advocacy
and clinical advocacy committees to coordinate development of positions on
- Attend committee hearings and
work sessions and maintain written summaries;
- Maintain files for bills,
including handouts and testimony;
- Draft testimony and supporting
materials. Occasionally testify on legislation;
- Develop and maintain strong
relationships with legislators and their staff;
- Work collaboratively with
other organizations to promote MaineHealth’s interests;
- Participate in Maine Hospital
Association’s advocacy calls;
- Work with contract lobbyists
to ensure the effective coordination of legislative activities;
- Distribute regular internal
communications on legislative activities and issues of concern.
To apply, please contact Shawn-Elise
Lapomarda, Executive Recruiter, at email@example.com or
Additional information regarding MaineHealth and its members
can be found at: www.careersatmainehealth.org or www.mainehealth.org
Equal opportunity employer.
2013 Division of Infectious Disease Annual Conference
November 13, 2013
Augusta Civic Center
Sponsored by the Maine Center for Disease Control & Prevention
Since 1983, the Maine Center for Disease Control and Prevention, Division of Infectious Disease, Department of Health and Human Services has organized an annual infectious disease conference targeting public health issues of emerging concern to medical practitioners throughout the State. Presentation topics will focus on a range of infectious diseases and immunizations. This year’s conference includes aspects from the Division of Infectious Disease’s Epidemiology, Immunization, HIV, STD and Viral Hepatitis Programs.
For more information or to register, click here.
Medical Group Management Association of Maine Presents:
MGMA Seminar: Generational Differences in the Workplace & Advanced Excel 2010 Tips and Tricks
Wednesday, November 13, 2013
8:30 a.m. - 4:00 p.m.
Fireside Inn & Suites, 81 Riverside Street, Portland
For more information or to register, visit: http://www.memgma.com/site/events-calendar.htm
Muskie School Health Policy Colloquium
The Future of Medicaid: Building Sustainability through Program Innovation
Friday, November 22, 2013
8:30 am - 12:30 pm
Augusta Civic Center
Speaker: Diane Rowland, Executive Vice President, Henry J. Kaiser Family Foundation; Additional program details and speakers coming soon.
To register, click here.
MaineGeneral Medical Center
2013 Fall Coding & Compliance Conference: Precision and Quality with Surgical and E & M Coding
Waterville Elks Banquet & Conference Center
Friday, December 6, 2013
7:30 a.m. – 3:00 p.m.
Cost: $75 (includes continental breakfast, lunch and breaks) CEUS: 6
For more information or to register, contact Cindy Sturtevant, Physician Office Relations Liaison, (207) 872-4058 or firstname.lastname@example.org [return to top]