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Medigram - September 20, 2007


TOP STORY

Tamper-resistant Rx pads required October 1

As reported in a previous issue of Medigram, effective October 1 all hand-written or computer-generated prescriptions paid for by Medicaid, SeniorCare or BadgerCare fee-for-service must be written or printed on tamper-resistant prescription pads or computer paper. This requirement, which is for prescriptions given to patients to take to a pharmacy, applies to both controlled and non-controlled substances.

The Society, along with other state and federal health care organizations, are working to delay the implementation date and seeking to limit the requirement to Schedule II drugs, as these drugs see the most fraud and abuse. However, physicians are urged to be prepared for October 1 implementation.

Required features
To be considered tamper-resistant, prescription pads/computer paper must contain at least one of these characteristics:
  • One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form.
  • One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber.
  • One or more industry-recognized features designed to prevent the use of counterfeit prescription forms.
(Note: As of October 1, 2008, all three of these characteristics will be required.)

Exclusions
Following are exclusions to the tamper-resistant prescription pad requirement:
  • Refills of prescriptions presented at a pharmacy before October 1, 2007.
  • Prescriptions faxed directly from the prescriber to the pharmacy.
  • Prescriptions electronically transmitted directly from the prescriber to the pharmacy.
  • Prescriptions telephoned directly from the prescriber to the pharmacy.
  • Prescriptions paid for by a Medicaid Managed Care Organization (MCO).
  • Prescriptions provided to recipients in nursing facilities, intermediate care facilities for the mentally retarded, and other specified institutional and clinical settings to the extent that drugs are part of their overall rate. However, written prescriptions filled by a pharmacy outside the walls of the facility are subject to the tamper-resistant requirement.
Grace period
Prescriptions presented by patients on non-tamper proof pads or paper may be dispensed and considered compliant if the pharmacy receives a compliant prescription order within 72 hours.

Obtaining Tamper-Resistant Prescription Pads and Paper
These following companies have supplied tamper-resistant prescription pads to some of the 12 states that currently require them. If you have any questions, please contact Mark Grapentine or Jeremy Levin in the Society’s Government Relations Department, or call 866.442.3800.

NEWS BRIEFS

Upcoming legislative forums offer chance to share your views

Assembly Health and Healthcare Reform committee chair Representative Leah Vukmir (R- Wauwatosa) and committee member Representative John Nygren (R-Marinette), with Representative Phil Montgomery (R- Ashwaubenon) and Representative Van Roy (R- Howard), are hosting forums in Marinette, Oconto and Green Bay Wednesday, September 26, 2007 to discuss the health care reform proposals being debated in Madison. These forums will give Society members an opportunity to discuss health care reform proposals with members of the Health Committee. The forums will be held at the following locations:

Marinette: 11:30 - 1 p.m., Marinette City Hall, Council Chambers, 1905 Hall Ave.

Oconto: 2-3:30 p.m., Oconto City Hall, Council Chambers, 1210 Main St.

Green Bay: 5:30-7 p.m., Rock Garden and Comfort Suites- Grand Ballroom, 1951 Bond St.

Society members are urged to find the time to attend one of these meetings, as this is a tremendous opportunity to interact with important members of this committee and local legislators. Please contact Hillary Conley at 866.442.3800 ext. 3764 if you plan to attend or if you have any questions.


Wisconsin site of Midwest Healthcare IT conference

Leaders in health care information technology are invited to participate in the Midwest Healthcare Information and Management Systems Society 2007 fall conference: "Technology for Tomorrow & Beyond: A Healthcare IT Odyssey." The conference is November 5-6 at the Osthoff Resort in Elkhart Lake. Click here to learn more.


The check could be in the mail

The Wisconsin Health Liability Insurance Company (WHCLIP) has been issuing checks for the distribution of excess surplus related to policies issued from 1975 to 2000. WHCLIP is an insurance company that writes the primary level medical malpractice for WI healthcare providers. Many providers entitled to these distribution checks have not been located. If you or someone you know thinks that they may be entitled to these distributions from WHCLIP, please call WHCLIP at 715.842.6412 or e-mail whclip@wausau.com.

YOUR PRACTICE. YOUR FUTURE.

Litigation efforts yield nearly $7 million for Wisconsin physicians

Financial support from the Wisconsin Medical Society to the AMA Litigation Center has paid off handsomely for hundreds of Wisconsin physicians and practices to the tune of $6.7 million.

More than 900,000 physicians nationwide were represented by the AMA, state and county medical societies and other medical groups in the class action lawsuit against some of the nation’s largest for-profit health plans, including CIGNA, Aetna and Wellpoint. The suit, which is the largest class action health care lawsuit filed in the United States, alleged civil violations of federal anti-racketeering laws.

To date, physicians and clinics in Wisconsin have received substantial reimbursements, including a payment of $1.2 million to one medical group. In addition to these retrospective reimbursements, the settlements also stipulate that the health care plans change the way they do business, as well as make contributions to physician-controlled foundations. An example is the Physicians’ Foundation, which provides grants to nonprofit organizations for practice-based, innovative projects that provide physician education or address quality or patient safety issues.

“This successful litigation is yet another example of a valuable benefit physicians receive through their Wisconsin Medical Society membership,” said Susan Turney, MD, Society CEO/EVP. “With a strong membership base, the Wisconsin Medical Society is able to support efforts like this as yet another form of advocacy for the profession.”

For more details about the HMO settlements, visit the AMA web site or visit www.hmosettlements.com.

EDUCATIONAL PROGRAMS

Coding changes: Are you prepared?

Did you know that there is a new special screening code for human papillomavirus? Or that there are 54 new codes for the lymphoma diagnoses? Beginning October 1, 144 new codes, 17 deleted codes and 5 revised codes will take effect. And there is no grace period for implementing these changes, so it is imperative that encounter forms, charge tickets, computer systems and edits are up-to-date.

To make sure you know what’s coming, you won’t want to miss the Wisconsin Medical Society’s September 27 webcast: “The ICD-9-CM Changes.” Our speaker will go through the changes and explain why they occurred to give you the insight you need to better understand and code correctly. Click here for more information or to register!

FYI: FOR YOUR INSURANCE

Life Insurance: Taking care of personal AND professional needs

September is life insurance awareness month, and there's no better time to evaluate whether or not you have sufficient coverage. When most people think about life insurance, they automatically think about their personal coverage. However, one of the first things any business owner should consider is how to protect the business against events that may threaten its future, such as the death of a proprietor, partner or key employee. Business continuation plans can protect family and partners from unwanted debts and responsibilities when an owner dies.

Whether you are a sole-proprietor, a partner or a member of a corporation you need to protect yourself and others around you. Please give Wisconsin Medicial Society Insurance and Financial Services a call at 866.442.3810 or complete our on-line contact form to request more information about individual life insurance coverage, buy-sell agreements or key person insurance. One of our knowledgeable representatives will be happy to assist you.

FOUNDATION FOCUS

2008 Foundation event to feature the real ‘Rain Man’



The Wisconsin Medical Society Foundation’s 2008 fundraising event April 10 will feature a unique opportunity to meet one of the world’s few identified prodigious savants, Kim Peek. Peek has read over 7600 books, and he has 98 percent recall of each one—not to mention a storehouse of facts on subjects ranging from music to history to sports. He’s also developmentally disabled. Although it does not depict his actual life story, Peek inspired the 1988 Oscar winning film, Rain Man.

Kim Peek and his father, Fran, accepted a personal invitation from Wisconsin Medical Society member and Past-President Darold Treffert, MD, to include the Foundation’s event on their 2008 itinerary; they have already presented their message of diversity and acceptance to over 2 million people in national and international audiences. In addition to Kim’s extraordinary abilities, their story is also an inspirational and touching example of unconditional love, which is such a powerful shaping force in all savants. Kim sums it up this way: “My Dad and I share the same shadow.”

Doctor Treffert developed a friendship with the Peeks when, as an internationally recognized expert on savant syndrome, he served as a consultant on the movie Rain Man. Since that time, Dr. Treffert has been the essential expert behind the Foundation’s Savant Syndrome Web site. He was instrumental in securing a grant from the Brinson Foundation to significantly upgrade the Web pages, which have evolved into a world-renowned resource on savant syndrome for parents, educators and the medical community.

Doctor Treffert believes that savant syndrome may point toward untapped abilities in everyone. Be sure to mark your calendar for this exceptional opportunity to explore the mysteries of savant syndrome and consider the possibility that we may all have such abilities just waiting to be developed.

For more information on savant syndrome and Kim Peek, click here.

FAQ

Question:
If documentation for a colonoscopy says, “polyp removed in piecemeal fashion using biopsy ‘forceps’” is the correct code 45380, 45385 or 45383?

Answer:
According to the AMA, it is appropriate to use 45383 if the physician is using forceps to remove a polyp in piecemeal fashion taking “bites” of the polyp. Use of 45385 is not appropriate as it refers to “snare technique,” which is not indicated in the example above.

If you have questions about this or other coding matters, click here to review our FAQ archives, or e-mail efaq@wismed.org.

Quality Corner

AHRQ Effective Health Care Program

Patients, health care professionals, and policymakers all share an interest in making the best health decisions. One of the greatest challenges is finding reliable and practical data that can inform these decisions. Dedicated to fulfilling this need, the Effective Health Care Program follows three approaches to research in order to provide current, unbiased evidence on health care interventions.
  • Review and synthesize published and unpublished scientific evidence.
  • Promote and generate new scientific evidence and analytic tools in an accelerated and practical format.
  • Compile the findings and translate them into a variety of useful formats for stakeholders.
To learn more, click here.


CMS to host PQRI call September 26

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the seventh in a series of national provider conference calls on the 2007 Physician Quality Reporting Initiative (PQRI) Wednesday, Sept. 26 from 12:30–2:30 p.m., CDT.

Physicians and other eligible professionals started submitting claims with PQRI quality data codes on them July 1, 2007. This toll-free question and answer teleconference will provide eligible professionals the opportunity to ask questions of presenter Susan Nedza, MD, MBA, FACEP.

To receive the call-in information, you must register by 12:30 p.m. CDT September 25. Space is limited. To register, click here.

For those unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 5:30 p.m. EDT September 26 until 11:59 p.m. EDT October 3.