Medigram - April 2, 2009 | Wisconsin Medical Society

TOP STORY

Medicaid reimbursement: How would cuts affect your practice?

Wisconsin’s Medicaid program is anticipating a shortfall of more than $415 million this biennium. The Department of Health Services knows physician and other health professional reimbursements are already strained. In an effort to illustrate this problem to policymakers and show what a large impact this could have on access to health care in our state, the Wisconsin Medical Society would like to hear from you. How would further reimbursement cuts affect your practice? How will this impact your patients?

Click here to send your response to Tim Bartholow, MD, Wisconsin Medical Society senior vice president of Member Services, Policy Planning and Physician Professional Development. All replies will be kept confidential.

NEWS BRIEFS

Free symposium April 22 focuses on healthy classrooms

A free seminar at the University of Wisconsin School of Medicine and Public Health April 22 will explore such issues as sex education in schools, bullying and school nutrition. The program, “Healthy Classrooms: A Public Health in Education Symposium,” will include a keynote address by Society member Jeffrey Lamont, MD, FAAP. Doctor Lamont is president of the Wisconsin Chapter of the American Academy of Pediatrics. His presentation is titled “Heroes prevail where systems fail: The role of communities and schools in promoting lifelong health.”

Health professionals, educators and community members are encouraged to attend this second annual symposium, which begins at 5:30 p.m. Attendance may qualify for PAC/CEU Student Teacher Credit. Sponsors include the Dane County Medical Society and the Wisconsin Medical Society Foundation.

Registration is available on-line. Click here for more information.

CMS to host special RAC Open Door Forum April 14

The Centers for Medicare and Medicaid Services (CMS) is hosting a Special Open Door Forum for Part B provider recovery audit contractors (RACs) April 14 from 1-3:30 p.m. The goal of the forum is to introduce providers to the new contractors and provide more information about the RAC program.

Section 302 of the Tax Relief and Health Care Act of 2006 makes the RAC Program permanent and requires the Secretary to expand the program to all 50 states no later than 2010. Last October, CMS announced awards for the four permanent RACs. Each RAC will be responsible for identifying overpayments and underpayments in approximately one-fourth of the country. CMS has planned a gradual expansion to all 50 states. For further details, click here.

To participate, call 800.837.1935 and enter Reference Conference ID number 92489480. Capacity is limited so dial in early. TTY communications relay services will be available for the hearing impaired by dialing 711 or 800.855.2880. For Internet Relay services, click here.

Beginning April 22, an audio recording of the forum will be posted at this link and will be available for 30 days.

Changes in UnitedHealthcare PDP designations may mean notification exemptions

Physicians who take part in UnitedHealthcare’s Premium® Designation Program (PDP) may be exempt from its radiology notification process if they have received a two-star designation for quality and cost efficiency. These designations have changed recently and now may be viewed via UnitedHealthcare’s member Web site, myuhc.com.

Physicians who meet the program’s quality criteria receive one star, while those who meet both quality and cost-efficiency criteria receive two stars. This designation information applies to some UnitedHealthcare programs such as the Radiology Notification Program, which includes a mandatory notification process for selective outpatient advanced imaging procedures (e.g., CT, MRI, PET, Nuclear Medicine/Cardiology) prior to performance, with administrative claim denial for non-compliance. Physicians with a two-star designation are exempt from this notification requirement.

A quick reference guide to the Radiology Notification Program is available here, and an FAQ on the program is available here. Past issues of Medigram that address the PDP’s rating system may be found here, here and here.

To determine if a physician has received a two-star quality and cost efficiency designation from the PDP, click here and choose “Search for a UnitedHealth Premium® Physician.”

OIG posts Open Letter to health care professionals

The Office of Inspector General (OIG) last week posted an open letter to health care professionals that refines its Self-Disclosure Protocol (SDP) to better allocate resources. In a 2006 open letter, the OIG “promoted the use of the SDP to resolve matters giving rise to civil monetary penalty (CMP) liability under both the anti-kickback statute and the physician self-referral (‘Stark’) law.” Last week’s open letter explains how the OIG will be narrowing the scope of the SDP regarding the physician self-referral law and implementing a minimum settlement amount for addressing kickback issues. To read the letter, click here.

EDUCATIONAL PROGRAMS

Compliance with the new ‘Red Flag’ Rules: Protecting physicians and their patients from identity theft

Medical identity theft is becoming a huge national problem. The Federal Trade Commission (FTC) decided that the “Red Flag” Rules, part of the Fair and Accurate Credit Transactions Act of 2003, require physicians to have a written Identity Theft Prevention Program in place by May 1, 2009. If physicians do not comply with the rules, the FTC can impose civil penalties of up to $2,500 per violation.

The Wisconsin Medical Society is sponsoring a teleconference April 28 to provide physicians with a Red Flag Rules toolkit. Join the call as Bruce G. Arnold and Mark Garsombke from the law firm Whyte Hirschboeck and Dudek S.C. describe the four basic requirements for the Red Flag Rules. These include procedures for verifying identity, identification of typical red flags that arise when identity theft might occur, a procedure for investigating identity-theft red flags, and a procedure for mitigating the damages associated with identity theft.

To register for the teleconference, click here.

Additional Medical Records and the Law seminar to be offered

You asked, and we’re answering. Due to popular demand, we’re adding another date to our Medical Records and the Law seminar in June. This face-to-face seminar will now also be available June 4 in Eau Claire, in addition to the three dates and locations previously announced. For more information or to register for the seminar, click here.

QUALITY CORNER

New Commonwealth Fund Report available on-line

Changing how the nation pays for health care is critical to improve value, achieve better quality and slow cost growth. A new report from the Commonwealth Fund, titled “Reforming Provider Payment: Essential Building Block for Health Reform,” examines in greater detail key payment reform recommendations made by the Commonwealth Fund Commission on a High Performance Health System in a previous report. The authors explore bundling payments to cover care over a specified period, revising fees to increase compensation for primary care and offering providers financial incentives to serve as patient-centered medical homes. These strategies seek to encourage more collaboration among providers, accountability for patient outcomes and efficient use of resources than exist in our current fragmented system of care. Built on a foundation of universal health insurance coverage and new systems to promote better decision-making and improve population health, these payment reforms could slow the growth of health spending by $1 trillion through 2020, as compared with current projections. To read the report, click here.

FAQ

Question:
As of January 2009, Medicare has been denying claims submitted for the administration of Albuterol and Levalbuterol provided in the office when submitted with HCPCS codes J7611- J7614. There does not appear to be another HCPCS code that applies for Albuterol and Levalbuterol in the 2009 HCPCS book. Which code(s) should we use to report these services to Medicare for 2009?

Answer:
The HCPCS codes J7611-J7614 appear to have been given a status of “I” in the Medicare Physician Fee Schedule Database (MPFSDB) for the first quarter of 2009. Change request 6397 (Transmittal 1691) was issued by CMS on March 4, 2009. The status of HCPCS codes J7611-J7614 are changed from “I” (invalid) to “E” (excluded from physician fee schedule by regulation and typically reimbursed on reasonable charge) in this transmittal. The effective date of the change is January 1, 2009, with an implementation date of April 6, 2009. You may submit claims for reprocessing using HCPCS codes J7611-J7614 beginning April 6, 2009.

For answers to other Frequently Asked Questions about coding matters and more, click here or e-mail efaq@wismed.org.