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Medigram - June 12, 2008


BREAKING NEWS

Medicare bill support needed: Contact Senators Kohl, Feingold now

Late Tuesday afternoon, the U.S. Senate began floor consideration of S. 3101, which prevents a 10.6 physician reimbursement for Medicare cut from taking effect on July 1. Sen. Max Baucus (D-MT), the ranking member of the Senate Finance Committee, introduced the bill last Friday; it would continue current reimbursement rates through the end of the year and schedule a 1.1 percent increase for 2009. The Society urges all members to phone, e-mail or fax your support to our Senators before they vote at 2 p.m. today. There may be a later opportunity to urge final passage of the bill, but we need calls to the senators today on cloture. Sen. Baucus has summarized the payment update provisions in this press release.

The Senate is scheduled to take action on the bill this morning—with a vote for “cloture,” which is a filibuster-preventing procedural vote. This requires 60 votes, so it is very important Senators Kohl and Feingold know that physicians are paying attention to what’s happening in Washington, D.C. Your direct contact with the senators’ offices can signal physician strength and help prevent a draconian cut. When you contact the senators, ask for a “yes” vote allowing debate on the bill and a “yes” vote for passing the bill.

To reach the senators, call the AMA’s hotline: 800.833.6354 to be connected with the senators’ offices. Fax Senator Kohl at 202.224.9787 and Senator Feingold at 202.224.2725. E-mails can be sent via the Senators’ web sites: kohl.senate.gov and feingold.senate.gov. Click here to view a copy of the AMA’s letter of support.

No bill is perfect; there are more than 300 sections in the legislation. It also is not a permanent fix to the physician reimbursement problem. But with July 1 looming, S. 3101 is currently the best chance physicians and their patients have to prevent a Medicare access crisis. For more information, contact Mark Grapentine.

TOP STORY

Society seeks summary judgment in lawsuit

The Wisconsin Medical Society last week filed a motion for summary judgment in its lawsuit to restore $200 million to the Wisconsin Injured Patients and Families Compensation Fund.

“The Fund must be restored or we jeopardize a key component of Wisconsin’s excellent health care system,” said Society President Steven Bergin, MD.

The Society’s motion asks the Court to declare that
  • The raid of the Fund was an unconstitutional taking of health care providers’ property rights without just compensation,
  • An unconstitutional impairment of health care providers’ contractual rights,
  • A disguised tax on health care providers and injured patients and families; and,
  • An unconstitutional denial of health care providers’ rights to equal protection.
The Society has also asked the Court to order the State to replace all money removed from the Fund, including lost investment earnings and interest.

The Society has prepared a five-minute informational video about the issue. Click here to watch it. More information about the lawsuit and the Fund, including frequently asked questions, court documents and press releases are available on the Society’s Web site: www.wisconsinmedicalsociety.org/initiatives/lawsuit.

Additionally, a series of meetings is being scheduled around the state this summer to provide updates about the lawsuit along with tips for educating patients, community members and local media about the issue. The first meeting is scheduled Tuesday, June 24 in Wausau. Click here to view an invitation to the event.

NEWS BRIEFS

Prevention Summit July 17-18 in Appleton

In health care, prevention is the name of the game. And on July 17 and 18, the Wisconsin Prevention Summit in Appleton will be the place to hear the latest from a variety of experts.

Thursday’s keynote speaker June Simmons will discuss Sustainability for Living Well with Chronic Conditions: Engaging Community Participants and Partnerships; Program Fidelity and Sustainability. Simmons is CEO of Partners in Care Foundation, San Fernando, Cal.

The Summit is sponsored through the Administration on Aging grant awarded to the Division of Long Term Care in collaboration with the Division of Public Health. The purpose of the grant is to expand evidence-based programs statewide, including Living Well with Chronic Diseases, a chronic disease self-management program, and Stepping On, a falls prevention program.

The cost to attend the two-day Summit is $50 and includes lunches and materials. The registration deadline is Tuesday, July 1. Click here to view a Summit agenda, and click here to register on-line. For more information, e-mail Jill Ballard, Statewide Coordinator for Evidence-Based Prevention Programming, AgeAdvantAge, or call 608.224.6307.


CMS starts program to confirm NPPES data

In an effort to ensure that the data submitted to the National Plan and Provider Enumeration System (NPPES) for organization health care providers is accurate, CMS has initiated an NPPES-IRS data match to ensure that the legal business name (LBN) and employer identification number (EIN) in NPPES are consistent with IRS data.

This week, CMS will mail out letters to organization health care providers that have an EIN/LBN combination in NPPES that is different from the information maintained by the IRS. These letters ask the health care providers to review and update their LBN and/or EIN in NPPES. If health care providers cannot furnish data consistent with the IRS, CMS will deactivate the National Provider Identifier in NPPES. CMS will continue to match these health care provider data in NPPES against IRS data to ensure the accuracy of NPPES data. For more information, click here.


Reminder: National survey gives physician a voice

The Physicians’ Foundation for Health Systems Excellence is conducting a national survey designed to give physicians a voice. The survey has been mailed to over 300,000 physicians and could be in your mailbox or on your desk today. It offers physicians the opportunity to comment on the current state of medical practice in America. If you are concerned about your profession and your practice, please take a few moments to complete the survey and let your voice be heard. Responses to are due back by Wednesday, June 25.

Please note that this national survey is a separate project from the survey of Wisconsin physicians currently being conducted by the Wisconsin Medical Society and the University of Wisconsin School of Medicine and Public Health (UWSMPH), which was outlined in this May 8 Medigram article.

QUALITY & EFFICIENCY

For the next several weeks, Medigram will feature a series of articles about the Wisconsin Health Information Organization (WHIO) and its role in health care transparency efforts underway in Wisconsin. In this week’s installment, “WHIO Q&A: Who, what and why?” Society CEO Susan Turney, MD, addresses several key questions about WHIO. Click here to read more.

EDUCATION

Medicaid training: Sign up today!

The Department of Health and Family Services, together with EDS, will be offering information and training to all providers on the new ForwardHealth interChange system beginning in July. This new system will replace the existing Medicaid Management Information System (MMIS) in October 2008. EDS, the state’s fiscal agent, will support this system, which will support multiple state programs including Wisconsin Medicaid, BadgerCare Plus, the Wisconsin Chronic Disease Program, SeniorCare, and the Wisconsin Well Woman’s Program.

Training sessions will focus on the many details involved with using the new system for prior authorizations, claims detail, eligibility verification and more. Both billing staff and management should attend. There is no fee, but participants are required to pre-register. For a list of current training locations available, please see the April 2008 ForwardHeath Update.

QUALITY CORNER

Embracing accountability: Physician leadership, public reporting, and teamwork in the Wisconsin Collaborative for Healthcare Quality

A new Commonwealth Fund report features a case study of the Wisconsin Collaborative for Healthcare Quality (WCHQ). WCHQ has achieved voluntary public reporting of comparative performance information in both ambulatory and hospital settings. Tenets crucial to the observed success in physician engagement include (1) an unrelenting focus on quality of care as the goal of reporting; (2) performance data that meet scientific standards of validity and reliability; (3) creation of standard measures to assure applicability to all sites; and (4) mutual sharing of best practices.

To access the report, click here.

FAQ

Question:
The WPS Medicare PSYCH-014 policy states CPT code 90801 and 90802 can be used once per provider, per discipline. What is the definition of discipline and does membership in the same group affect the billing of these codes?

Answer:
Discipline is defined as area of specialty. For example, a clinical social worker is a different discipline than a clinical psychologist. However, WPS Medicare would not intend to pay for a 90801 billed by both a clinical social worker and a clinical psychologist that were members in the same group for the same episode of mental illness. There may be an occasional situation when it is medically necessary for both disciplines within the same group to bill for a 90801 or 90802 and documentation must be available to support this.

For answers to other Frequently Asked Questions about coding matters and more, click here to review our Education Department’s FAQ archive, or e-mail efaq@wismed.org.