Medigram - December 4, 2008 | Wisconsin Medical Society

NEWS BRIEFS

ForwardHealth to hold meetings for interChange implementation questions

ForwardHealth is meeting with physicians and other health care professionals in December to share updates and additional information on the implementation of ForwardHealth interChange and the provider portal. These sessions will:

Answer common questions ForwardHealth has received from providers post-implementation.
Provide the latest information on the implementation of the new processing system.
Review the format of new Remittance Advices and how to read the information contained in the report.
Share information and tips for use of the provider portal including account set-up and maintenance, enrollment verification, claims research and submitting prior authorizations.
Give providers the opportunity to ask questions about the new system and the functionality of the provider portal.

For dates and locations of the sessions, click here.

Reports predict Medicare Part A trust may be exhausted by 2016

The Associated Press recently reported that the Medicare Part A trust fund may be depleted one to three years sooner than expected because of the struggling economy, according to federal health officials. "The economy will likely generate less revenue through payroll taxes than the trustees had projected" last March when they announced that "the trust fund for Medicare Part A would become insolvent in 2019,” according to Richard Foster, the chief actuary for the Centers for Medicare and Medicaid Services (CMS). Click here to read more.

Nominating Committee solicits nominees

The House of Delegates Nominating Committee is requesting nominations for the following Society offices:

President-Elect for 2009-2010
Speaker of the House for 2010 and 2011 to succeed Kevin Flaherty, MD: (Doctor Flaherty has served the maximum number of terms as Speaker and is not eligible for re-election.) Please note, based on the outcome of the election process, the position of Vice Speaker may become vacant this year. Therefore, please mention in your cover letter whether you want the Nominating Committee to consider you solely for the position of Speaker or whether the Nominating Committee may also consider you for the position of Vice Speaker, in the event that the position of Speaker is filled and the Vice Speaker position becomes available.
AMA Delegate for calendar years 2009 and 2010: Vacancy
AMA Delegates for calendar years 2010 and 2011:

Timothy McAvoy, MD, of Waukesha (incumbent)
Michael Miller, MD, of Madison (incumbent)
Richard Roberts, MD, of Belleville (incumbent)

AMA Alternate Delegate for calendar year 2009 and 2010: Vacancy
AMA Alternate Delegate for calendar years 2010-2011:

George Lange, MD, of River Hills (incumbent)
Charles Rainey, MD, of River Hills (incumbent)
Paul Wertsch, MD, of Madison (incumbent)
Tosha Wetterneck, MD, of Madison (incumbent)

All candidates must submit a curriculum vitae not to exceed three pages, a cover letter not to exceed one page in length and a completed candidate questionnaire for the office that you are seeking by Friday, January 23, so that it can be provided to the Nominating Committee members. Click here for the President-Elect candidate questionnaire, here for the Speaker and Vice Speaker candidate questionnaire and here for the AMA Delegate and Alternate Delegate candidate questionnaire. NOTE: The completed candidate questionnaire and cover letter will be posted on the Society’s web site in the “members only” section, in accordance with 2008 Resolution 8.

Communications to the Nominating Committee should be addressed to: Susan L. Turney, MD, Executive Vice President/CEO, Wisconsin Medical Society, P.O. Box 1109, Madison, WI 53701. Communications can also be sent via e-mail to Noreen Krueger.

Click here for Nominating Committee meeting and member information.

Resolution deadline date for 2009 Wisconsin Medical Society Annual Meeting

Society members can submit issues/resolutions year around. For time sensitive issues, this may be a better avenue. Please use the Member Communication Form, which is available on the Society Web site.

Issues presented are referred to the Board, a specific Council or the House for further study and recommendations. Also, if desired, assistance will be provided to develop a resolution that reflects a policy change you are possibly seeking.

The 2009 Annual Meeting of the Wisconsin Medical Society will convene Friday, April 17, 2009, at the Monona Terrace Convention Center in Madison.

The deadline for receipt of resolutions you wish submitted to the House of Delegates, is Monday, February 17, 2009. Resolutions must be submitted, in proper form, to the Chief Executive Officer’s office no later than two months prior to the opening session of the House of Delegates.

To read more, click here.

IN MEMORIAM

Paul S. Robinson, PA-C

Paul S. Robinson, PA-C, passed away unexpectedly November 12 at the age of 55. Robinson, of River Falls, was president-elect of the American Academy of Physician Assistants and had served as an observer in the AMA’s House of Delegates. He also served two terms as president of the Wisconsin Academy of Physician Assistants, and as speaker of the AAPA House of Delegates. Click here to read more.

QUALITY & EFFICIENCY

WHIO Data Mart ready for participating organization access

Over the last several months, the Wisconsin Medical Society (Society) has worked to keep members and the physician community aware of the activities of the Wisconsin Health Information Organization (WHIO). As a founding member of WHIO, the Society is proud to announce that the first version of the WHIO Data Mart was delivered to the WHIO Executive Director on Tuesday, December 2—one day ahead of schedule. (For more information about the Data Mart, read this article from the October 23 Medigram.) This first version of the Data Mart included the following inputs:

1.6 million unique members (or patient lives)
25,000 providers (physicians and other medical professionals)
56 million individual claims
6 million treatment episodes

Click here to read more.

YOUR PRACTICE. YOUR FUTURE.

Employer-sponsored parties: What is your liability?

This time of year many employers host holiday parties to show appreciation for their employees and to provide employees a chance to socialize with their colleagues. While such holiday gatherings bring cheer to many employers and employees, they can also bring unexpected liability to the employer.

Liability to the employer can come from a variety of sources, including, but not limited to, excessive alcohol consumption, workers’ compensation claims, harassment and other improper conduct. This does not mean the employer should not host such a party, just that the employer should be aware of the risks and plan the party to minimize such potential risks.

To read more, click here.

Court rejects CMS policy allowing contractors to pay least costly alternative for Part B drugs administered in physicians' offices

A recent ruling from the U.S. District Court for the District of Columbia stated that a Centers for Medicare & Medicaid Services (CMS) policy allowing Medicare claims contractors to limit payment for Part B drugs administered in a physician’s office to the least costly alternative is not authorized by Federal law. The decision in this case, Ilene Hays v. Michael O. Leavitt, stated that payment rates are set by statutory formulas, and neither CMS nor the contractors are authorized to redefine those rates.

In the case, a physician prescribed an inhalation medication to his patient to treat her chronic obstructive pulmonary disease, but four Medicare contractors changed the basis of the payment for the medication from the average sales price of that drug to the price of the least costly alternative, which in this case was separate doses of the medication’s two active ingredients.

The Department of Health and Human Services unsuccessfully argued that it was okay for CMS and its contractors to limit payments in this manor because the Medicare statutes prohibit payments for services that are not “reasonable and necessary” for treatment. However, the court, in ruling against CMS, stated that once coverage is approved for a medication, payments are set in preexisting, explicit formulas in the Medicare statutes, which neither CMS nor contractors have the authority to ignore or change.

While it is not certain whether this case will have any effect on other uses of the least-costly-alternative policy, if the decision stands, it could discourage claims contractors from using it in Part B drug coverage determinations.

CMS has stated that it is disappointed in the ruling and is determining how it should proceed.

EDUCATIONAL PROGRAMS

Upcoming teleconferences target successful reporting for Medicare PQRI and E-prescribing incentives

The 2009 Medicare Physician Final Rule outlines incentives tied to the Physician Quality Reporting Initiative (PQRI) and E-prescribing. Together these incentives could bring you an additional 4 percent of Medicare revenue in 2009. The Centers for Medicare and Medicaid (CMS) has many helpful resources on these programs, but it can be overwhelming knowing how to begin. The Wisconsin Medical Society is offering two teleconferences to help you report PQRI and e-prescribing measures by optimizing your current workflow.

On December 16, let us guide you into PQRI claims-based reporting for 2009. We will provide tips for picking your measures, walk through some “real-clinic” scenarios, discuss short cuts to implementation and direct you to the resources you really need. On December 17, assess your readiness for reporting the e-prescribing measure to capture the 2 percent incentive payment. We will define a qualified system, explain submission requirements to earn the incentive payments and provide guidance on e-prescribing system selection.

Currently the e-prescribing program is voluntary but there will be a penalty in 2012 for not prescribing electronically. Register today for one or both sessions to learn how to incorporate performance measure reporting in your practice. If you can’t join us in December, join us in January when we repeat both teleconferences.

QUALITY CORNER

CMS Special Open Door Forum: Electronic Prescribing—Recording now available

The CMS Special Open Door Forum on Electronic Prescribing recording and transcript are now available. CMS staff presented information on the following topics: Overview of Part D E-Prescribing Standards, E-Prescribing Resources, E-Prescribing Incentives and E-Prescribing Measures. To access the audio recording and transcript, click here, and select the November 19 listing.

FAQ

Question:
Does the e-prescribing incentive for 2009 include reporting on medication refills that are phoned into the office?

Answer:
The 2009 Electronic Prescribing Incentive Program for Medicare beneficiaries does not include reporting on phone requests for medication refills. In order to successfully report the e-prescribing measure, a provider must first adopt a qualified e-prescribing system. When reporting the measure, both a denominator (CPT 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, G0101, G0108, G0109) and a numerator must appear on the claim. There is no required diagnosis associated with reporting this measure. The denominator CPT codes listed above are all reflective of face-to-face visits in the ambulatory setting and therefore, a request for a medication refill via the phone is not a reportable instance for the e-prescribing incentive program.

For additional educational opportunities on e-prescribing and PQRI, join us in December for two separate teleconferences that will focus on the implementation of performance measurement reporting.

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