Welcome Guest, if you have an account you may login

Medigram - July 17, 2008


TOP STORY

Medicare victory in Congress provides both short- and long-term lessons

Congress voted Tuesday to override a veto by President Bush, and effectively avoid the planned 10.6 Medicare cut. H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008, extends the June 2008 Medicare rates through Dec. 31, 2008, and provides an additional 1.1 percent increase in Medicare payments for 2009. For a synopsis of the passage of H.R. 6331, its veto by the President, and the subsequent Congressional override, review previous Medigrams or read this Washington Post article.

“Action taken by both Houses to soundly override the presidential veto represents a victory for patients and physicians alike,” said Wisconsin Medical Society President Steven Bergin, MD. “The advocacy voices of the AMA, state medical societies and health care organizations nationally have been heard. More importantly, for the next 18 months health care access for our seniors will be maintained. However, this is a short term solution as the bigger problem of the flawed SGR has failed to be addressed.”

All Senators and Representatives from Wisconsin voted to override the presidential veto, with the exception of Rep. Jim Sensenbrenner (R-Menomonee Falls). Please take the time this week to call Senators Kohl and Feingold and your Representative in the House (unless you live in Rep. Sensenbrenner’s district) and thank them for their vote for physicians and Medicare patients. Members of Congress typically field calls for action, but do not often field calls of thanks for action. To find office numbers, click here.

What this means for your practice now, and in the near future
Under instruction from Health and Human Services Secretary Michael Leavitt, the Centers for Medicare and Medicaid Services (CMS) did not process any claims for the first 10 business days in July, or before July 15. This means most claims that would have qualified for the 10.6 percent cut after July 1 were not processed. CMS will automatically reprocess any claims paid at the reduced rate and provide any balances due to physician practices, most likely in one check. For more information, click here for an update from the American Medical Association (AMA), and click here to access a CMS fact sheet on the issue.

While H.R. 6331 avoids Medicare cuts this month, it is only a temporary fix. As Society President Bergin stated above, the underlying federal formula that causes these rolling crises, the Sustainable Growth Rate (SGR) formula, cannot be fixed through tinkering or continued “kick the can” Congressional actions. Rather, we must find a new way for calculating Medicare payments. To join the Society in efforts to improve health care at the state and national level, physicians are encouraged to participate in WISMedPAC and WISMedDIRECT. The AMA was able to influence many members of Congress through grassroots and other political pressure; Wisconsin physicians can do the same in our state.

For more information, contact Mark Grapentine.

NEWS BRIEFS

CMS pilot program saving nearly $700 million in improper Medicare payments—How will the RACs affect your office?

The Centers for Medicare & Medicaid Services (CMS) released a new report Friday, July 11 verifying that the recovery audit contractors (RACs) pilot program is successfully identifying improper payments. The evaluation report shows that $693.6 million in improper Medicare payments was returned to the Medicare Trust Fund between 2005 and March 2008. The findings will also help the agency improve the program as it is expands nationwide within two years.

The RAC program was created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) to find and correct improper Medicare payments paid to health care providers participating in fee-for-service Medicare. The RAC demonstration was required by Congress to be a permanent part of Medicare in the Tax Relief and Healthcare Act of 2006, and the national program must be implemented by Jan. 1, 2010. For more information on the RAC program and to view the evaluation report, click here.

Most of the improper payments that the RACs identified occurred when health care professionals submitted claims that did not comply with Medicare’s coverage or coding rules. The types of inadvertent errors leading to improper payments found by the RACs include billing for a procedure multiple times, incorrectly coded procedures, and submission of duplicate claims resulting in two payments to a provider.

To learn how your organization can prepare for the RAC implementation, plan to attend the Wisconsin Medical Society the 2009 Midwest Coding and Practice Management Symposium breakout session, “Documentation Critical—Facing the RAC.” This session will teach you how to develop an internal audit response system to track and monitor the RAC requests. For more information on the Symposium click here.


2009 Joint Commission Standards available on-line; revised and enhanced for ease of use

The Joint Commission’s revised standards, rationales and elements of performance for 2009 are now available on-line. The standards will take effect January 1, 2009 but are posted now to give all health care organizations time to become familiar with the new language, ordering and numbering.

The changes are part of the Standards Improvement Initiative (SII), launched in 2006 as part of The Joint Commission’s ongoing quality improvement efforts. SII focuses on clarifying standards language, ensuring that standards are program-specific, deleting redundant and nonessential standards, and consolidating similar standards. While no new requirements were added, chapter overviews, standards, introductions, rationales, and elements of performance were designed for ease of use. In the standards reorganization, requirements were split or consolidated. Standards have been renumbered and reordered to allow electronic sorting and to allow the addition of new requirements in the future.

Click here for more details and to view to standards.


New educational product available for 2008 PQRI

The Centers for Medicare & Medicaid Services (CMS) has posted a new educational resource to the PQRI Web page on the CMS Web site. The 2008 PQRI Reporting Options Quick Reference Chart gives eligible professionals and practice staff a quick reference to the new reporting options available for 2008 PQRI with their corresponding alternative reporting periods.

To access this new educational resource, click here. To order a two-sided, laminated version of this reference chart, visit the CMS Web site and click on the 2008 Physician Quality Reporting Initiative (PQRI) Reporting Quick Option Reference Chart (ICN# 900843)(May 2008) link. For this and additional educational resources, visit the PQRI section of the CMS Web site and click on the “Educational Resources” tab. Once on the Educational Resources page, scroll down to the “Downloads” section and click the desired link.

YOUR PRACTICE. YOUR FUTURE.

Dealing with the loss of patient medical records in a disaster

While physicians and clinics have a duty to maintain the physical safety of medical records, sometimes records are unavoidably destroyed prematurely due to fire, flood, terrorist attack, or some other natural or man-made disaster. There are a number of steps physicians can take when patient medical records are damaged or destroyed by disaster.

The affected physician or clinic should consider contacting a document recovery or restoration company for assistance. These services may be able to salvage some or all of the records. A contract should be in place with the recovery company that protects the confidentiality of the records. General liability insurance may include coverage for the cost of salvaging records.

The physician or clinic should create a permanent record of the disaster event. For records that cannot be salvaged, the physician or clinic should create a log of all destroyed records, the circumstances that caused the loss and the date of loss. When creating a new chart, other treating physicians and facilities can assist in recreating the chart through referral letters, discharge summaries, lab reports, etc. The patient should be informed of the circumstances why a new chart needs to be created, and the patient may also be a good source for replacing lost information. The new chart should document the reasons why a new chart was created and how information was reconstructed. When records are disclosed that would have normally contained information that was destroyed, the disclosed record should include the entry documenting the loss of that information.

The Comprehensive Error Rate Testing (CERT) program requests records from Medicare providers to calculate paid claims error rates. When a disaster causes damages of sufficient severity and magnitude to partially or completely destroy or delay access to medical records requested by CERT, the Medicare provider must fill out a form attesting under penalty of perjury to that fact. Click here to access the CERT Attestation Letter.

QUALITY & EFFICIENCY

Society and WCHQ partnering on efficiency symposium

As part of Medigram’s continuing series of articles about the Wisconsin Health Information Organization (WHIO) and its role in health care transparency efforts underway in Wisconsin, this week's installment previews the Methods, Measures and Policy Impact symposium. Previous installments include topics addressed at the Wisconsin Medical Society’s June 24 Quality Forum along with insight from Society CEO Susan Turney, MD, and Society members John Hartman, MD, and Tim Bartholow, MD, about different aspects of WHIO, and the state of Wisconsin's involvement in WHIO. Click here to read more.

F.Y.I. FOR YOUR INSURANCE

Voluntary benefits—are they right for your practice?

With many employers experiencing increases in their health insurance premiums, cost-sharing has become a necessity for some when it comes to employee benefits. Fortunately, voluntary benefits are a way to attract and retain employees without breaking the budget.

Here are a few ideas to help you build flexible designs to meet the various needs of your employees:
  • Offer life coverage. Offering additional life insurance is a great way to help employees protect their financial well-being at affordable rates.
  • Offer disability coverage. Additional disability insurance protects the employee’s ability to earn an income and pay bills when he or she cannot work.
  • Offer long-term care coverage. Long-term care insurance protects the employee’s assets if an injury or illness strikes and they need nursing home or home health care.
  • Offer dental benefits. Dental care is important because it contributes to employees’ overall health and encourages regular check-ups.
Your employees can select the coverage that work best for their lifestyle. Voluntary benefits can provide the flexibility and cost-sharing that employers and employees need.

To learn more about voluntary benefits and to work with one of our agents, please complete our on-line contact form or call the Wisconsin Medical Society Insurance & Financial Services, Inc. at 866.442.3810.

QUALITY CORNER

Wheaton Franciscan Medical Group: A case study of patient- and family-centered primary care practice

The Spring Street site of the Wheaton Franciscan Medical Group is one of 12 primary care practices featured in Commonwealth Fund case studies of high-performing patient-centered primary care practices. Practices were selected from a sample of over 2,000 sites on the basis of their exceptional scores across multiple domains on patient experience surveys. The purpose of the case studies is to document models of high-quality, patient-centered care and to extract lessons regarding the organizational factors and specific processes used by these practices to achieve favorable patient experiences. To read the case study or listen to the podcast, click here.

FAQ

Question:
How do I log in to the “Members-only” section of the Society Web site?

Answer:
If you are a Society member and you’ve forgotten your username and password, you’ll need to reset your password. To do so, follow these simple steps:
  1. From the left menu bar, click “Log in”
  2. Click the “Request New Password” tab
  3. Enter your e-mail address
  4. Click “E-mail new password”
  5. You will receive an e-mail message from it@wismed.org
  6. Click the link in that e-mail message. (Your username is on the first line and in the subject)
  7. Click “Log in”
  8. Enter new Password (twice)
  9. Click “Submit”

To confirm the new password is working:
  1. Click “Sign Out”
  2. Click “Log in”
  3. Enter your username (NOT your e-mail address) and password
  4. Click “Log in”
If you have questions about this, e-mail communications@wismed.org.