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Medigram - July 26, 2007


TOP STORIES

Sign the petition - Stop the IPFCF raid

As the Legislature’s special conference committee begins its work, it is conceivable that some version of the Governor’s proposed $175 million raid on the Injured Patients and Families Compensation Fund could be part of the final package. To remind legislators of the Fund's importance as a stabilizing factor for Wisconsin's medical liability climate, the Society is collecting names for a petition opposing any raid from the Fund; the petition will be delivered to all conference committee members at the appropriate time.

To add your name to the petition, go to the Society’s home page and look for the “Sign the Petition!” box. Send the link to others, too—make sure medicine’s voice is heard in the Capitol!

For more information, contact Mark Grapentine or Jeremy Levin.


Proposed Medicare rule cuts physician reimbursements by 10 percent in 2008

The Centers for Medicare and Medicaid Services’ recently proposed physician payment rule for 2008 slashes physician reimbursements by nearly 10 percent in 2008. In Wisconsin, that means physicians stand to lose an estimated $93 million next year and $3.7 billion by 2016, according to the AMA.

Federal legislation to increase funding for the State Children's Health Insurance Program (SCHIP) could include a provision to prevent the cut, although the US House and Senate are proposing different bill versions. The House version - H.R. 3162 - would replace the cut with a 0.5 percent update in 2008 and 2009, while the Senate version holds no such provisions currently. The Society is in touch with members of the Wisconsin Congressional Delegation regarding these efforts.

The proposed CMS rule also identifies other Part B programs that may be affected. These include Independent Diagnostic Testing Facilities (IDTFs), the 2008 PQRI measure process, Anemia Quality Indicators when reporting Erythropoiesis stimulating agents (ESA), Physician Pathology Services and details on using the Physician Assistance and Quality Initiative Fund to extend voluntary quality reporting bonus payments into 2008. Click here for more information.

CMS is expecting comments related to the proposed rule. They must be received no later than 5 p.m. Friday, August 31, 2007. In commenting, refer to file code CMS-1385-P. To review the various ways to submit comments, see page 3 of the proposed rule.

In the past, Congress has adopted interim measures to stop payment reductions, but physicians need to stay in touch with their Representatives and Senators to stress the need to replace the flawed sustainable growth rate (SGR) formula used to calculate physician payment rates, as well as emphasizing the impact these cuts might have on patients under Medicare. Click here for legislators’ contact information or use the AMA’s Grassroots Hotline (800.833.6354). Tell them that
  • Medicare currently reimburses physicians about the same as it did in 2001.
  • Close to two-thirds of physicians plan to limit the number of new patients they treat if the 10 percent cut happens next year, according to an AMA survey.
  • Congress must repeal the flawed SGR formula used to calculate physician payment rates.
For more information, visit the AMA's Web site.


CMS proposes eliminating fax exemption for electronic prescribing

As part of the proposed rule setting the Medicare Physician Fee Schedule for 2008, the Centers for Medicare and Medicaid Services (CMS) has proposed eliminating the fax exemption to the SCRIPT e-prescribing standards it adopted in late 2005.

The exemption allowed providers and suppliers to send prescriptions via computer-generated faxes without use of the SCRIPT standard. CMS initially included the exemption, believing that entities using the computer-generated fax software would increasingly sign on to the SCRIPT e-prescribing standards. This has not happened.

As a result, CMS is proposing the elimination of the exception, believing this will prompt movement to standards-based e-prescribing. CMS anticipates the exemption going into effect one year after the effective date of the calendar year 2008 Physician Fee Schedule.

The proposed change was posted on the CMS Web site July 2 and was published in the Federal Register on July 12.

CMS is soliciting comments on the impact of the proposed elimination of this exemption. Specifically it is soliciting comments and information on (1) the total number of affected practices and pharmacies and the time required for them to implement SCRIPT-enabled software, (2) the number of practices currently using legacy versions of software that are not capable of generating SCRIPT transactions and the amount of lead time they would need to comply, and (3) the extent to which eliminating the exemption would cause entities using fax technology to revert to paper prescribing rather than update software.

CMS will accept comments on the proposed change until August 31, 2007. Comments can be submitted to CMS electronically here. You must provide your name to submit a comment. All comments submitted will become public information and may be published on the Internet.

NEWS BRIEFS

Doctors Without Borders coming to Milwaukee

Put your ideals into practice. Doctors Without Borders is holding a recruitment information session Saturday, September 15 at 3 p.m. in Milwaukee.

Every day, Doctors Without Borders field staff from around the world work alongside locally hired staff to assist people struggling to survive amid armed conflicts, nutritional crises, natural disasters and epidemics—regardless of political, religious or economic interests. You can learn more by attending this presentation and Q and A session. A human resources officer will be available to discuss requirements and applications.

Doctors Without Borders recruits physicians, nurses, surgeons, anesthesiologists, midwives, epidemiologists, laboratory scientists, technicians and more.

To register or learn more, click here.


Free clinic seeks volunteers

InHealth Community Wellness Clinic, a free health clinic scheduled to open in Boscobel as early as this September, needs volunteers, especially physicians.

The clinic will serve patients who cannot afford health care—those who have no health insurance but are not eligible for government-sponsored health care, such as Medicaid or Medicare—and will also address the special concern of women’s health by providing basic care for uninsured women such as prenatal care, mammograms and pap tests. Farmers, students without insurance, transient patients, and even those with health insurance but extremely high deductibles are among those that the clinic hopes to serve, according to Robin Transo, a Boscobel resident and retired art teacher who has been working since April to launch the clinic.

A number of nurses have volunteered their help, and Transo is hoping for more physician volunteers, including retired doctors. For those looking to help in other ways, the clinic is also seeking monetary contributions along with medical equipment and supplies. A sterilizing machine, procedure lamps and one more exam table are especially needed.

“I think that… people really admire doctors who do this,” Transo said. “By volunteering they are actually doing themselves a service by making themselves accessible to their community in a different way that makes them really, really respected.”

Tentatively, the clinic will be open two evenings and one day, with the possibility of a Saturday depending on the volunteer response. The clinic will be located in the lower level of the Associated Balance and Hearing Clinic in Boscobel, which is owned by Transo and her husband.

For more information on how to volunteer, or if you would like to make a donation to the InHealth Community Wellness Clinic, please contact Robin Transo at pertranso@mchsi.com, or call 608.375.4328 (Associated Balance and Hearing Clinic) or 608.485.1498.

Editor's Note: A physician should always check with the organization responsible for the operation of the free clinic or volunteer program to determine if the organization provides liability insurance for the health care services provided by the physician. If the organization does not provide liability insurance for the provision of such services, a physician should consult their risk management provider to determine the extent of their potential exposure and the sufficiency of their current medical liability insurance. If a physician is retired and no longer carries medical liability insurance, the physician should talk to their personal attorney about the extent of their potential exposure.


Society members in the news


Wertsch wins national medical teaching award
Society member Jacqueline J. Wertsch, MD, professor of physical medicine and rehabilitation (PM&R) at the Medical College of Wisconsin, received the University of Medicine and Dentistry of New Jersey’s New Jersey Medical School National Teaching Award in PM&R. The award was presented at the Kessler Institute for Rehabilitation in West Orange, NJ, in June.

Doctor Wertsch is the 20th recipient of the award since its creation in 1988 to recognize outstanding physical medicine and rehabilitation teaching at the national level. Dr. Wertsch also cares for patients at the VA Medical Center-Milwaukee. Her clinical specialties include hand rehabilitation, carpal tunnel syndrome, gait analysis, chronic musculoskeletal pain, electro diagnostic medicine and neuromuscular rehabilitation.


Chan to lead Wisconsin Psychiatric Association
Society member Carlyle H. Chan, MD, of Milwaukee, was recently installed as president of both the Wisconsin Psychiatric Association and the American Association for Technology in Psychiatry. Dr. Chan, who is professor and vice chair for professional development and educational outreach in the department of psychiatry and behavioral medicine at the Medical College of Wisconsin, will serve a two-year term for both organizations.

YOUR PRACTICE. YOUR FUTURE.

CMS publishes additional guidance on educational requirements under Deficit Reduction Act of 2005

The Centers for Medicare and Medicaid Services (CMS) published additional guidance on Section 6032 of the Deficit Reduction Act of 2005 (DRA) in March. DRA Section 6032 requires states to amend their Medicaid plans to require entities that receive or make at least $5 million in annual Medicaid payments to educate their employees, agents and contractors about federal and state false claims acts and whistleblower protections.

Covered entities include governmental agencies, organizations, units, corporations, partnerships, or other business arrangements (including any Medicaid managed care organization, irrespective of the form of business structure or arrangement by which it exists), whether for-profit or not-for-profit, that receive or make payments under a State Plan approved under title XIX or under any waiver of such plan, totaling at least $5 million annually.

Effective January 1, 2007, all Covered Entities are required to establish written policies and procedures informing employees, contractors and agents about the federal and state false claims and whistleblower laws as a condition of continued Medicaid payments. Such entities are encouraged to review the Initial Guidance, the FAQs and the “official description” of the False Claims Act and, if they have not already done so, immediately implement the requirements under Section 6032 of the DRA.

Click on the following links for more information:

EDUCATIONAL PROGRAMS

Evaluation and Management Services series offered

Because E/M coding and documentation can be very complex, the Wisconsin Medical Society Education Department is pleased to present a three-part teleconference series designed to give you the complete picture. Speaker Kerin Draak, CPC-EMS, APNP, is a practicing nurse practitioner and certified professional coder specializing in E/M reporting. She will present “The History,” “The Examination,” and “Medical Decision Making.”

The first step to understanding the key components of an E/M service is defining what constitutes the “history” portion. What’s the difference between “context” and “timing”? Are documentation shortcuts allowed? What services require a past medical, family and social history? This August 8 teleconference will help you gain a thorough understanding of what each element of the “history” represents.

The second step to understanding E/M services is defining the required documentation for an examination. CMS instructs you to use either the 1995 or 1997 documentation guidelines. This August 15 teleconference will help you understand the differences between the exam criteria for each set of guidelines.

And the third step to understanding the key components of an E/M service is defining what supports the medical necessity for services provided. The elements of Medical Decision Making will be thoroughly reviewed and discussed during this August 22 teleconference.

For more information, or to register for any of these teleconferences, click here.

FYI: FOR YOUR INSURANCE

Most homes are undervalued for insurance

In 2006, nearly 58 percent of homes were undervalued for insurance purposes, according to a survey by Marshall & Swift/Boeckh LLC, an industry leader in determining the building cost data necessary for real estate cost valuations. Of those dwellings, published reports say, the average homeowner can afford to rebuild just 80 percent of the structure following a disaster after drawing on their insurance. That isn’t much, especially considering how Americans have been beefing up their homes with elaborate additions, foyers and trendy landscaping.

Upgrade insurance limits
Most people who add on to their homes or upgrade their kitchens forget to upgrade their insurance coverage. It's important to conduct an insurance review at least every two years to be sure your policy covers current replacement costs. Verify those costs by videotaping each room of the home, and the items in it. Keep one copy of the tape, plus receipts for major appliances, fine art and jewelry, with your insurance agent and another in your safe deposit box.

For further information on upgrading insurance limits for insureds with Allied Insurance through Wisconsin Medical Society Insurance Services, Inc. please contact Diane Larson at 800.975.3418 or dianel@wismed.org. If you are not an Allied insured, please contact Larson to learn how to take advantage of Allied’s products and services.

Editor’s Note: This article is excerpted with permission from the Independent Insurance Agents-Newsletter, 2007, No. II.

FOUNDATION FOCUS

Society members encouraged to apply for Foundation grants

Physicians, medical students and residents are encouraged to submit grant applications on behalf of their organizations to the Wisconsin Medical Society Foundation for support of 2008 programs.

The Foundation will primarily support short-term, high-impact, high-visibility initiatives that support the Foundation’s mission of medical and health education. Preference will be given to initiatives that
  • focus on disease prevention through controllable (modifiable) lifestyle choices
  • have physician involvement and are community-based
  • are ultimately self-sustaining
  • promote collaborations/partnerships
  • incorporate principles of public health
“Physician involvement can be as simple as writing a letter of support noting the need for the project in the community and the ‘Good Housekeeping Seal of Approval’ for the individuals involved,” said Foundation Executive Director Renee Reback.

The application deadline for 2008 programs is October 15, 2007. To view or download application materials and information on past grants click here. For more information, contact Renee Reback at 608.442.3720 or e-mail reneer@wismed.org.

FAQ

Question:
If a patient is admitted to observation status on July 1 and then admitted to the hospital on July 3, how should the second day of observation be coded?

Answer:
For Commercial payers, CPT Assistant (January 2006, pp 46) states to report unlisted code 99499 for the second day of a three-day observation stay.

Medicare IOM 100-04, Chapter 12, 30.6.8 (B) states, “In the rare circumstance when a patient is held in observation status for more than two calendar dates, the physician must bill subsequent services furnished before the date of discharge using the outpatient/office visit codes.”

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

QUALITY CORNER

CMS: NPI being stripped from some electronic claims

The Centers for Medicare & Medicaid Services (CMS) is reporting it has learned that some Clearinghouses are stripping the National Provider Identifier (NPI) prior to submission of claims to Medicare. This will adversely affect physicians and other eligible professionals in that these claims will not count toward PQRI participation. CMS urges physicians who use clearinghouses to check to assure NPIs are not being stripped from claims. If the physician determines that their clearinghouse is stripping NPIs from the claim, they may want to consider other billing options.

A recent Special Edition MLN Matters article contains important information for Medicare providers and suppliers, including how to use the NPI correctly on Part A and Part B claims. You can view this article here.