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Medigram - January 10, 2008


TOP STORY

Medicare participation deadline extended

The Medicare, Medicaid and SCHIP Extension Act of 2007 made several changes affecting payments to physicians, including a 0.5 percent increase to the Medicare Physician Fee Schedule for dates of service from January 1 through June 30, 2008. This increase temporarily replaces the 10.1 percent cut that had been planned. However, after July 1, 2008, the cut is still scheduled to go into effect.

Meanwhile, Medicare contractors will begin processing claims with January 2008 dates of service with the new fees on January 7. The new fees are expected to be posted under the “Medicare Physician Fee Schedule Look-Up” link on the CMS Web site the week of January 21. Carrier specific public use files are available now for the new 2008 MPFS rates at this link.

Although Congress stopped the 10 percent across-the-board payment cut, physician reimbursement for many services will be lower in 2008 than in 2007 because of adjustments to the practice expense and work RVUs and geographic payment formula. And because of changes to the 2008 Medicare Physician Fee Schedule rates, CMS has extended the Participation Decision Period until February 15, 2008. All participating status changes will be effective January 1, 2008, and CMS has indicated that participation decisions will be binding throughout 2008.

To become a participating physician, you must complete the CMS-460 form, which can be found on the CD that was mailed to physicians in November. You can also request the form from your local contractor, WPS. The form must be completed, signed, mailed to WPS and postmarked by February 15, 2008. If you are changing your participation status to non-participating, please send your request to WPS in a letter, postmarked by February 15, 2008.

For more information on Medicare participation options for physicians, the American Medical Association has prepared this document.

NEWS BRIEFS

Still time to participate in 2008 Medicare Part B Drug CAP

The Medicare Part B Drug Competitive Acquisition Program (CAP) is a voluntary program that offers physicians the option to acquire many injectable and infused drugs they use in their practice from an Approved CAP Vendor, thus reducing the time and cost of buying and billing for drugs.

An additional election period for the 2008 CAP will occur January 15–February 15, 2008 because recent changes make the program more flexible for physicians. Changes include:
  • CAP drug administration claims may now be filed up to 30 days after administering CAP drugs;
  • Participating CAP physicians may now request to leave the CAP within the first 60 days of election if program participation results in a burden to a practice (i.e. difficulty meeting CAP drug ordering or billing requirements);
  • After 60 days, a participating CAP physician may request to leave the CAP if an unexpected change in circumstance causes CAP participation to become a burden to a practice (i.e. a change in patient population or practice personnel).
Effective participation for physicians who elect to join the CAP during this additional election period will be April 1, 2008 to December 31, 2008. The additional election period is for physicians who have not already elected to participate in the CAP for 2008.

Noridian Administrative Services (NAS), the designated CAP carrier, will hold a teleconference on January 23 at 2 p.m. to provide more information and answer questions. To participate in the teleconference call 888.830.6260 and enter passcode: 463742. A PowerPoint slide presentation to accompany the teleconference will be posted at this link no later than January 22.

For additional information about the CAP, including a downloadable list of drugs supplied by the CAP vendor and the physician election form, click here.


Family Planning Waiver Program changes detailed in latest ‘Update’

Changes to the Family Planning Waiver Program (FPWP) are explained in the December Badger Care Plus Update published by the Wisconsin Department of Health and Family Services.

The Update features new information regarding coverage and non-coverage under the FPWP, which provides limited services to low-income women who are otherwise not eligible for BadgerCare Plus. Providers should pay special attention to Attachment 1, which lists procedure codes that must be billed with a diagnosis code in the V25 range in the primary diagnosis field and those for which a V25 series diagnosis code can be a secondary or other diagnosis. It also identifies in bold all newly covered FPWP services. Note that Implanon is now an FPWP covered service. Special billing instructions for the implant are included.

The Update also lists services that will no longer be an FPWP benefit effective January 1, 2008. In particular, non-emergency transportation (specialized medical vehicle and common carrier) is no longer an FPWP benefit.

Questions may be directed to Provider Services at 800.947.9627.


Join a Wisconsin Medical Society Strategic Council

The Wisconsin Medical Society is seeking members for the following Strategic Councils:
  • Health Care Ethics (formerly Ethics and Judicial Affairs)—Issues include physician professionalism, pharmaceutical gifts, interprofessional code for physicians and attorneys, cloning/embryonic research and end-of-life care.
  • Health Care Access (formerly Health Care Access and Financing)—Issues include review of health system reform proposals, increasing access to health care, Medicare and Medicaid reimbursement, medical malpractice issues and administrative costs.
  • Health Care Quality and Population Health (formerly Health of the Public)—Issues include patient-centered medical care, public/patient safety, population health and occupational health.
  • Policy Panel—This panel reviews existing five-year policies for germaneness and continued alignment with the Society’s Strategic Plan. The council will craft new policies based on referrals by the Board of Directors and House of Delegates and recommendations from the Strategic Councils.
  • Legislation—This council plans, organizes, and implements programs to protect and preserve the legislative, socioeconomic and political interests of Society members. Please note: Membership on this council is limited to the number deemed sufficient to execute its responsibilities by the Board of Directors. It also includes a representative from each of the Society’s specialty sections, subject to Board approval.
Council members are appointed to three, three-year terms (or a total of nine years). At the end of each three-year term, members have the option of continuing. Society members may also participate in Council discussions on a topic-by-topic basis. These opportunities will be published in Medigram. Non-member experts may be invited to participate depending on the topic, but will not be able to vote on Council matters. To promote continuity and history, no ad hoc members will be included on the Policy Panel.

If you are interested in being appointed to a Council, please contact Merry Earll at 866.442.3800 or 608.442.3766 by March 7, 2008.


Mental Health Parity Action Day set for Feb. 20

Lt. Governor Barbara Lawton announced this week that February 20, 2008, will be Mental Health Parity Action Day, a day for employers and workers, health care professionals and advocates, and all citizens to make the case for mental health parity legislation in Wisconsin. Wisconsin is one of only eight states in the nation without mental health parity.

“Our coalition has an excellent bill drafted, an impressive list of sponsors, and now we invite all who understand the importance of this legislation—to Wisconsin’s economy and to our families—to be part of Mental Health Parity Action Day,” Lawton said. Senate Bill 375 requires that insurance policies provide the same coverage for mental health and mental illness as they do for physical health, illness or injury.

For more information, visit http://ltgov.wisconsin.gov and click on the “Mental Health” button, or call 608.266.3516. The day will include advocacy training, a networking lunch and appointments arranged with legislators.


AMA steps up advertising campaign for the uninsured as elections approach

The American Medical Association kicked off the second phase of its “Voice For The Uninsured” campaign this week, with new television and print advertising. Over the course of 2008, the AMA will invest millions in advertising and events surrounding the upcoming presidential election to spur action to cover the uninsured.

“One in seven Americans doesn’t have insurance, but we all have a voice and a vote,” said AMA Board Member and Boston pediatrician Samantha Rosman, MD. “We know that if Americans make this a priority in the coming election, together we can cover the uninsured.”

Launched in August 2007, the first phase of the AMA’s “Voice For The Uninsured” campaign reached millions of voters through advertising and event sponsorship in Washington, DC and the early primary states. Uninsured patients shared their personal stories with the AMA through this Web site, and many signed a petition supporting the AMA’s proposal.


Still time to nominate doctors for Physician Citizen of the Year

It’s easier than ever to nominate a dedicated physician for the special honor bestowed by the Wisconsin Medical Society—the Physician Citizen of the Year Award. Just click here and complete the nomination process on-line. The deadline is January 15, 2008.

The award recognizes Wisconsin physicians who volunteer their time and talent to help better their community through cultural, civic or other activities. Last year’s winner was Patrick Wolf, DO, of Marshfield, who established and operates a free clinic there. For the complete rules, click here.

YOUR PRACTICE. YOUR FUTURE.

Submitting influenza and pneumonia vaccinations to Medicaid—are you getting paid correctly?

During periods of non-vaccine shortage, there are two fees set for influenza and pneumonia vaccines through the Wisconsin Medicaid program. When submitting claims for Wisconsin Medicaid patients receiving influenza and/or pneumonia vaccinations outside of the Vaccines for Children (VFC) program, you may append a U1 modifier. Appending this modifier to the service will result in increased payment.

The 2007-2008 fee for the influenza vaccine under VFC = $3.28 The 2007-2008 fee for the influenza vaccine outside of VFC = $14.25

If you have claims that have been paid under the VFC fee, you will need to request an adjustment. During periods of vaccine shortage, the non-VFC fee will be paid for all claims submitted.

E-mail Penny Osmon with questions or call 608.442.3781.

EDUCATIONAL PROGRAMS

BadgerCare Plus to be implemented Feb. 1

BadgerCare Plus, the new state-sponsored health care program that merges family Medicaid, BadgerCare and Healthy Start into one new program, will be implemented February 1, 2008. The Department of Health and Family Services (DHFS) has scheduled free training sessions to provide health care professionals with an overview of the program, including:
  • Presumptive eligibility for children
  • ID card changes
  • Enrollment verification
  • Billing certain members for covered and noncovered services
The first session was held January 9, but additional sessions are scheduled for January 15, 17 and 24 in Milwaukee, Stevens Point and Madison, respectively. For an overview of these sessions or to register, please click here.

FYI: FOR YOUR INSURANCE

Starnes, PIC WISCONSIN prepared for your defense

PIC WISCONSIN is a top choice among Wisconsin physicians for professional liability insurance. Started by the Wisconsin Medical Society more than 20 years ago and now a ProAssurance Group company, PIC WISCONSIN continues to provide first-rate professional liability insurance coverage with unmatched success in claims defense.

Stan Starnes, CEO of ProAssurance, discussed the companies’ commitment to Wisconsin physicians in terms of claims defense and the strong ties between them and the medical community in an article in the latest issue of the Wisconsin Medical Journal.

For more information, contact Wisconsin Medical Society Insurance & Financial Services, Inc. at insurance@wismed.org, 866.442.3810 or our on-line contact form.

FOUNDATION FOCUS

Foundation announces 2008 grant awards

“The Wisconsin Medical Society Foundation is especially pleased with the variety of initiatives that both statewide and local community organizations are undertaking to improve the health of the people of Wisconsin,” said John Petersen, MD, Chair of the Foundation’s Grants Committee. The Foundation Board of Trustees met in November to approve the 2008 award recipients.

“Each project has been developed with the unique needs of a specific population or community and with emphasis on developing strategies to implement programs focused on prevention,” Petersen added.

The Trustees approved the following 2008 awards:
  • Allied Wellness Center, Madison; Community Cookbook Project—$2,200
  • Ashland County Health Department, Ashland; Printing of material produced by Holly Grunst through the 2007 Summer Fellowship in Government and Community Service project to reduce childhood obesity—$2,500
  • St. Adalbert School, Milwaukee; Every Child and Every Year Preventive Care Project—$2,000
  • Community Memorial Hospital, Oconto Falls; Metabolic Syndrome Awareness and Prevention Program—$9,065
  • Safe Communities, Dane County; Reducing Falls in Dane County Through Community/Medical Partnerships, Year 2—$15,000
  • St. Clare Health Mission, La Crosse; Preventive Care Clinic—$2,500
  • University of Wisconsin School of Medicine and Public Health; Madison Medical Students for Minority Concerns, 21st Annual Health Fair—$2,500
  • Wisconsin Medical Society Alliance; Underage Drinking Public Service Announcements—$2,500
  • Wisconsin Women’s Health Foundation; Spanish Women’s Health Guide—$10,000

FAQ

Question:
Is it truly the intention of CPT to require a separate, signed, written and retrievable report for EKG interpretation? If so, does this requirement apply to all codes that have interpretation and report in the verbiage (for example: an X-ray performed in the office)?

Answer:
In the 2007 CPT codebook, instructions were added to each CPT section with guidelines to clarify (1) the meaning and relationship of a report to other services provided and (2) the intent of the inclusion of the term report in many descriptors and guidelines.

In the 2008 CPT codebook, these instructions have been removed from the individual sections and a revised definition has been placed in the “Instructions for Use of the CPT Codebook”, found in the codebook’s “Introduction,” because this definition is relevant to all instances of these terms in the CPT codebook. The definition has been expanded to clarify the relationship of results and interpretation of the results to procedures that have a technical component requiring interpretation.

Therefore, from a CPT coding perspective, the following definition of results, testing, interpretation and report apply wherever these terms appear in the CPT codebook, according to the instructions in the codebook: “Results are the technical component of a service. Testing leads to results; results lead to interpretation. Reports are the work product of the interpretation of test results. Certain procedures or services described in the CPT codebook involve a technical component (eg, tests), which produce results (eg, data, images, slides). For clinical use, some of these results require interpretation. Some CPT descriptors specifically require interpretation and reporting to report that code.”

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

Physician Quality Reporting Initiative (PQRI) tools available

For the second year in a row the Centers for Medicare & Medicaid Services (CMS) has announced a quality reporting program (PQRI) where eligible professionals may earn a 1.5 percent bonus by successfully reporting at least three quality measures.

To assist physicians and other eligible professionals, the American Medical Association, in collaboration with CMS, the Mathematica Policy Research, Inc, and the National Committee for Quality Assurance has developed participation tools. The tools are designed to:
  • aid physicians and other eligible professionals wishing to participate in the program to identify measures relevant to their practice
  • facilitate the data collection required to report clinical performance data

Click here for the list of 119 quality measures, sorted by specialty, included in the 2008 PQRI program. To the right of each measure, you will find links to the Measure Description, Data Collection Worksheet, and Coding Specification. For additional information please refer to the PQRI Web site or contact Cindy Helstad at the Society at 608.442.3751.