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Medigram - February 21, 2008


CONTENTS

TOP STORY

NPI deadlines around the corner

Physicians are reminded that effective March 1, 2008, all Medicare fee-for-service claims must use an NPI as the primary identifier (ie, in the billing, pay-to, and rendering fields).

You may continue to submit NPI/legacy pairs in these fields, but claims without an NPI will be rejected or returned as unprocessable. Resubmission of a new claim will be required for claims that are rejected and returned as unprocessable for a missing NPI.

While the March 1 deadline is days away, physicians also need to look ahead to May 28. That’s when CMS will require an NPI in secondary fields, which means Medicare will not pay for referred or ordered services, or items, unless the name and NPI number of the ordering, referring, attending, operating, other, or service facility provider are on the claim. Medicare participation status of the provider is irrelevant.

If the ordering/referring provider does not directly furnish the NPI to the billing provider at the time of the order, the billing provider is to contact that ordering/referring provider for his/her NPI prior to delivery of the service or items. If after several attempts the billing provider is unable to obtain the information from the ordering/referring provider, the claim/bill submitter is to report their own name and NPI in these secondary fields.

CMS does not clarify the definition of “several attempts.” It is recommended that all attempts to obtain this information be documented and available if requested. Medicare defines the following four provider types as eligible to refer or order services for Medicare beneficiaries: Physicians (MD or DO), nurse practitioners (NP), clinical nurse specialists (CNS), physician assistants (PA) and certified nurse midwives (CNM). To read more about this requirement, click here.

For additional NPI Information including important updates, click here. To apply for an NPI on-line click here.


State has limited supply of free tamper-resistant prescription pads

In anticipation of the April 1, 2008 requirement that non-electronic prescriptions for Medicaid patients be written or printed on tamper-resistant prescription pads, the state's Department of Health and Family Services (DHFS) has announced that a limited supply of free pads are available upon request. A request form must be completed and submitted; to view the requirements visit the most recent DHFS bulletin on this issue.

As described in the September 20, 2007 Medigram, at least four companies are currently providing tamper-resistant pads in states where similar requirements already exist: The requirement was originally scheduled to go into effect October 1, 2007, but Congress pushed back the start date to April 1. For more information, contact Jeremy Levin or Mark Grapentine.

NEWS BRIEFS

Society discusses IPFCF lawsuit on radio

Continuing efforts to publicize the Society's lawsuit against the state regarding the raid on the Injured Patients and Families Compensation Fund (IPFCF), Society General Counsel Ruth Heitz and Senior Vice President of Government Relations Mark Grapentine appeared on WIBA-AM's "Outside the Box" program hosted by Mitch Henck.

Henck talked to Heitz and Grapentine for a half-hour Thursday morning about the various aspects of the lawsuit, the raid's potential effects on patients and their families and what citizens can do to help the Society's efforts in protecting the Fund.

You can listen to a podcast of the program here.


Leadership positions available

Decisions are being made today that will affect medical practice in the future, and a variety of leadership position are currently available to assure the voices of residents, fellows and young physicians are heard.

The Wisconsin Medical Society's Young Physician Section (YPS) includes physicians under age 40 or those who have been practicing for less than five years. On the YPS Governing Council, the positions of Chair Elect, Society YPS Delegate to the House of Delegates, and two positions for an AMA YPS Delegate will be elected at the YPS Annual Meeting.

The Society's Resident and Fellow Section (RFS) also has positions available on the RFS Governing Council. Section Chair, Society RFS Board of Director Seat, RFS Delegate to Wisconsin Medical Society, RFS Alternate Delegate to Wisconsin Medical Society, and four positions for an AMA RFS Delegate will be elected at the RFS Annual Meeting.

Applications for YPS leadership positions or RFS leadership positions will be accepted through April 3. Elections will be held at the YPS and RFS Annual Meetings on April 10, 2008 at the Wisconsin Medical Society headquarters in Madison. YPS elections will be at 4 p.m. and RFS elections will be at 4:30 p.m.

If you cannot attend the meeting in person but would like to participate, there will be a call-in number. If you are interested in casting a ballot but cannot be present please e-mail Melissa Breen by April 9 at 5 p.m. for voting information. For more information about YPS or RFS, contact Melissa Breen at 866.442.3800.


Wisconsin Medical Journal needs your expertise

The Wisconsin Medical Journal is seeking reviewers to add to our list of highly qualified reviewers for manuscripts. The Journal needs contributions from reviewers who can be objective, insightful, and respond in a timely manner. Manuscript review is an important collegial act and is essential to the integrity of the Journal.

Reviewers receive manuscripts electronically and are asked to review and return the manuscript with comments within four weeks. All reviews can be returned on-line.

Interested physicians should e-mail wmj@wismed.org with their name, e-mail address, speciality, at least three areas of expertise or interest, their current and previous practice location, and how often in 12 months they would be willing to serve as reviewers.

CAPITOL INSIDER

Mental Health Parity Action Day draws big crowd

Hundreds of Wisconsinites visited the Capitol yesterday as part of Mental Health Parity Action Day. They were there to voice their support for Senate Bill 375. Many members of the Wisconsin Medical Society and the Wisconsin Psychiatric Association came out in a strong show of force, including Society President Clarence Chou, MD; Molli Rolli, MD; Ken Casimir, MD; Laura Roberts, MD; Ronald Diamond, MD; Kenneth Robbins, MD; Peter Lake, MD; and Jerry Halverson, MD. Medical residents Rachel Molander, MD; Erin Curtis, MD; and Carrie Palmer, MD, and medical student Philip Zimmermann also joined the group.

Participants are hopeful Wisconsin will join 42 other states which have already enacted mental health parity. For more information, contact Jeremy Levin.


Update: Statewide Smoking Ban—Assembly public hearing

While discussion of the statewide smoking ban is not moving quickly in the Senate (Senate Bill 150), a bill has now developed in the Assembly (Assembly Bill 834). A hearing before the Assembly Public Health committee is set for noon on Wednesday, February 27, 2008. Supporters are encouraged to attend.

For more information, contact Jeremy Levin.


Citizens for Smoke-free Air to hold rally at the Capitol

Society members are encouraged to participate in a rally Tuesday, March 4 to support a smoke-free law for Wisconsin. Registration begins at 10:30 a.m. and the rally and group visits to legislative offices will wrap up around 3 p.m. Free buses are available for those traveling from Eau Claire, La Crosse, Wausau, Green Bay, and Milwaukee.

For more details, contact Jeremy Levin.


Mental Health Records Bill passes Committee

The Assembly Public Health Committee held a public hearing last week on Assembly Bill 793, which proposes changes to laws related to the confidentiality and disclosure of patient health care and mental health treatment records (specifically Wisconsin Statutes 51.30, 146.82, and 655.275). On Wednesday, the bill was passed out of the Assembly Public Health Committee and will be available to be scheduled for a floor vote.

AB 793 builds on the Legislature and Governor's efforts to encourage the implementation of health care information technology through incentives, such as tax credits for providers who invest in electronic medical record (EMR) systems and tax deductibility for bonds issued through the Wisconsin Health and Educational Facilities Authority.

Specifically, the bill makes changes regarding the disclosure of patient health care records and mental health treatment records to health care providers, or persons acting under the supervision of health care providers without patient consent. These provisions make Wisconsin law more consistent with federal HIPAA privacy laws and the patient protections inherent in them.

This bill is the result of work conducted under Wisconsin’s Health Information Security and Privacy Project, which involved numerous workgroups formulated by the eHealth Board and comprised of key advocacy and provider organizations who met regularly, including the Society.

The Society participated in the 51.30 workgroup that set the initial framework for AB 793. The representatives in the workgroup sought to balance patient privacy issues and the importance of access to limited, but key patient health care information in providing safe and complete care for the patient. The group identified a series of issues, including stigma and disclosure rights, related to mental health records. They also believed there were issues that warranted further discussion, including the need for education for health care professionals regarding the changes. Because of the broad range of issues raised by this workgroup, the group agreed on a delayed effective date for the changes related to mental health treatment records. The later effective date gives patients and health care professionals time to adjust and ensures the Department of Health and Family Services has time to address any outstanding issues.

The 51.30 workgroup included stakeholders representing consumers and providers of mental health, AODA, and developmental disability treatment services as well as individuals with expertise in health information administration and technology, privacy law, and data quality.

If you have questions, contact Jeremy Levin.

FYI: For your Insurance

You get what you pay for!

PIC WISCONSIN, a ProAssurance company, defends more claim allegations resulting in better outcomes than any other insurance company in Wisconsin. As part of the ProAssurance family, PIC WISCONSIN has the extra advantage of being part of a physician-focused company.

ProAssurance ended 2006 with more than 700 cases taken to trial, resulting in 86.3 percent favorable outcomes. Overall, the industry (which is defined as the Physicians Insurers Association of America) had favorable outcomes in approximately 70 percent of cases. In 2007, ProAssurance closed 397 claims in Wisconsin, which resulted in 88.2 percent favorable outcomes.

The company consistently spends more on defense costs than indemnity payments year after year. PIC/ProAssurance understands that a physician’s professional reputation is at stake when a lawsuit arises, and any payment made on his or her behalf becomes part of that physician’s permanent record.

To learn more about the PIC/ProAssurance promise to defend the practice of medicine, please complete Wisconsin Medical Society Insurance and Financial Services’ on-line contact form.


Congratulations

Wisconsin Medical Society Insurance & Financial Services, Inc. (WMSIFS) congratulates Dave Serena & The Heil Financial Group for outstanding sales achievements in 2007. Serena & The Heil Financial Group represent the professionalism and caring that have been the trademarks of the Society’s insurance agency for over 25 years. WMSIFS has highly qualified agents throughout the state to work with the insurance needs of Society members.

This year is one of opportunity for members to reap the benefits of such a focused sales force. WMSIFS will be kicking off a new member life insurance plan and a new member group disability insurance plan. Stay tuned for more details on these plans and all of the other types of coverage and services available. We look forward to serving your insurance needs in 2008.

QUALITY CORNER

Knowing what works in health care: A roadmap for the nation

Despite unprecedented advances in biomedical knowledge and the highest per capita health care expenditures in the world, the quality and outcomes of health care for Americans vary dramatically across the country. Improved knowledge about which treatments and procedures are effective could lead to less regional differences, stronger consensus on standards and guidelines, and lower costs. To this end, the Robert Wood Johnson Foundation asked the Institute of Medicine to convene a committee to recommend methods to better identify the most effective health care services. The resultant report provides a blueprint for a national clinical effective assessment program. To read more, click here.

FAQ

Question:
What can a physician expect to be paid as a professional witness?

Answer:
There is no fee schedule, guide, base fee or formula for expert witnesses. Expert witnesses negotiate fees in advance of providing testimony, travel or other services. When determining fees, it might be reasonable for the physician to ask, “How will my service as an expert affect my practice?” or “How much revenue will I lose if I serve as an expert witness?” The physician should also consider the impact of travel.

The Wisconsin State Public Defender’s (SPD) office hires various experts on its cases. The SPD has information on its Web site about the amount of money that the State will pay for various experts including physicians. (See links below.) Note that the SPD might be lower than law firms or others that might hire experts and the information on these sites may be outdated.

www.wisspd.org/html/ExpertsFAQ.asp
www.wisspd.org/html/ExpertGuidelines.pdf

For answers to other Frequently Asked Questions click here (members only).