Wisconsin Medical Journal
109 #4
109 #4
Medigram - May 14, 2009
TOP STORY
Society files appellate brief in effort to restore $200 million to Fund
In its next step of legal action disputing the raid of $200 million from the Wisconsin Injured Patients and Families Compensation Fund (Fund), the Society yesterday filed its appellate brief with the Court of Appeals. Because the issues in the lawsuit involve questions of law, the Court of Appeals is not required to give the trial court's decision any weight. Instead, the Court of Appeals may take a fresh look at the issues and arguments.The Society’s brief outlines several reasons why the Court of Appeals should reverse the trial court's decision.
Click here to read more...
NEWS BRIEFS
Quality Forum Tuesday: Learn about patient-centered care and risk management from experts in the field
The next Quality Forum, scheduled for Tuesday, May 19, is packed with presentations to help make your practice more efficient and effective, especially when it comes to patient care.The Forum will feature presentations on four different state initiatives that demonstrate the patient-centered care model at its best. A CME opportunity afterwards, entitled “And You Think You’ve Had a Bad Day,” will cover risk management topics such as drug-seeking patients, patient noncompliance and patients who can’t pay. The post-Forum seminar will take place from 11:45 a.m. to 12:45 p.m., with lunch included, and will be repeated as a teleconference on July 15.
The Quality Forum and risk management seminar are open to all physician members of the Wisconsin Medical Society. If you, or another representative from your practice, are interested in participating in-person or via teleconference or would like more information, contact Stephanie Taylor at 608.442.3796.
Click here to read more…
Medicare provider enrollment changes: Are you current and correct?
Several changes have been made to the Medicare provider enrollment requirements. These changes could affect your practice, especially if you have a new owner or location.The Center for Medicare and Medicaid Services’ (CMS) 2009 Physician Fee Schedule Final Rule (CMS-1403-FC) outlines these changes, which went into effect January 1, 2009.
In particular, the Final Rule establishes the effective date of billing for physicians and other health care professionals as: (1) the date of filing of a Medicare enrollment application that was subsequently approved by a Medicare contractor, or (2) the date an enrolled physician or non-physician health care professional first started furnishing services at a new practice location. The later of these two dates will be considered the effective date.
During a CMS teleconference April 30, officials stated they will not penalize physicians for failing to make an address change by retrospectively revoking billing privileges. They did not specifically address changes in ownership or final adverse action. CMS emphasized that changes should be reported as soon as possible. The best practice would be to adhere to these guidelines in a timely fashion to avoid enrollment-related billing issues down the road. Additional information related to enrollment changes that went into effect January 1, 2009 can be found here.
Blue Cross Blue Shield settlement in effect: Be sure you are being paid correctly
The class action lawsuits brought against for-profit health insurers by several medical societies and physicians resulted in settlements requiring the insurers to significantly change the way they do business.As of April 21, all provisions in the Blue Cross Blue Shield Settlement Agreement were effective. This means settling Blue Cross Blue Shield plans:
- may not seek overpayment recovery beyond 18 months.
- must use a clinically based definition of medical necessity.
- must adhere to most CPT© coding rules including payment for E/M codes appended with a 25 modifier and payment for add-on codes.
- must provide 90 days advance notice of material adverse change.
- may not require physicians to participate in all products.
- must disclose their methodology for determining UCR amounts.
Physicians have used the compliance dispute process in other settlements to collect millions of dollars. For example, physicians collected more than $12 million for previously denied CAD mammography and myocardial perfusion add-on codes.
Settlements with Anthem/WellPoint, HealthNet and Humana are also in effect. For more information, visit www.ama-assn.org/go/settlements or click here.
Tell us about your problems with health insurers
The American Medical Association and the Wisconsin Medical Society invite you to participate in a survey on claims denial management and health insurer business practices. This 10-minute survey, which is open to physicians and their practice staff, will help determine how to best equip your practice for private payer and practice management issues. Click here to take this survey. Thank you for your participation.NEWSMAKERS
Remington named associate dean of UW School of Medicine and Public Health
Patrick L. Remington, MD, director of the University of Wisconsin Population Health Institute, has been appointed associate dean of the University of Wisconsin-Madison’s School of Medicine and Public Health (SMPH). He will begin his new post July 1.A recent recipient of the Wisconsin Public Health Association’s Researcher of the Year award, Dr. Remington has spent his entire career exploring the nexus between medicine and public health and will help SMPH—the nation’s first school of both medicine and public health—marry these two disciplines as well.
Doctor Remington is also a professor of population health sciences at SMPH and founded the school’s Master of Public Health (MPH) degree program. Before joining SMPH in 1997, he served as chief medical officer at the Wisconsin Division of Health.
YOUR PRACTICE. YOUR FUTURE.
Sixth Circuit rules that third parties may sue for damages under EMTALA
On April 6, 2009, the U.S. Court of Appeals for the Sixth Circuit (Sixth Circuit) ruled that a third party who suffers harm because of a hospital’s failure to screen or stabilize a patient with an emergency medical condition has standing to sue a hospital under the Emergency Medical Treatment and Active Labor Act (EMTALA). (Moses v. Providence Hospital and Medical Centers, Inc., 6th Cir. No. 07-2111 4/6/09). EMTALA is a federal statute that imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC) regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs.Click here to read more...
CAPITOL INSIDER
Workplace smoking-ban bill heads to governor’s desk
After more than 10 hours of debate in both houses of the State Legislature yesterday, a workplace smoking ban bill, Senate Bill 181, is now headed to the governor’s desk for his signature.Following last week’s announcement of an agreement among legislators, public health advocates (including the Society) and the Tavern League of Wisconsin, the greatest threat to the bill becoming law was the possibility that a slew of amendments could upend that compromise. Seventeen separate amendments were proposed in the Senate, and 30 more were proposed in the Assembly. While some votes were extremely close, the bill ultimately passed along the lines of the compromise. The final vote was 25-8 in the State Senate and 61-38 in the Assembly.
The bill now goes to Governor Jim Doyle, who has indicated he will sign the bill into law. If signed, it will go into effect July 5, 2010.
Society members should send their thanks to Sen. Fred Risser (D-Madison), Rep. Jon Richards (D-Milwaukee), Sen. Jon Erpenbach (D-Waunakee) and Rep. Al Ott (R-Forest Junction), who all worked many hours in the last several weeks to convince a majority of their colleagues to vote for the bill. Special thanks should also go to Society Key Contacts who reached out to their Assembly and Senate representatives.
For more information, contact Mark Grapentine, JD.
EDUCATIONAL PROGRAMS
Medical Records & the Law coming to a city near you
The Medical Records & the Law seminar is a great opportunity for physicians, practice administrators, medical records personnel, health information managers, business and office managers, compliance directors and attorneys to come together and learn about the laws surrounding the creation, maintenance, release and retention of medical records.
During this seminar, a panel of experienced professionals will provide participants with an overview of federal and Wisconsin laws as they relate to medical records. Presentations will cover topics such as HIPAA, state medical records laws, documentation and electronic health records. All attendees will receive a supplementary resource manual on CD prepared by the Wisconsin Medical Society.
Questions to be addressed at this seminar include:
- Who owns medical records and who can have access to them?
- What needs to be documented in the medical record?
- When can a health care provider/facility release medical records?
- How long do medical records have to be retained?
- Are there special rules for medical records of minors?
Eau Claire—June 4*
Green Bay—June 9
Madison—June 10
Waukesha—June 11
*The Eau Claire session will include a special breakout session on Minnesota law, which will be presented by Briar A. Andresen, a Minneapolis attorney with the law firm Fredrickson & Byron, P.A. Ms. Andresen will join the other speakers in an “Ask the Panel” segment immediately following the Minnesota breakout session.
Click here for more information or to register.
QUALITY CORNER
Plain-language guides to osteoarthritis of the knee now available
The Agency for Healthcare Research and Quality (AHRQ) recently released plain-language guides for consumers and clinicians that examine the effectiveness, safety and adverse effects of various treatments for osteoarthritis of the knee.The consumer guide, Osteoarthritis of the Knee—A Guide for Adults, defines the condition and is written to assist patients who seek answers to basic questions and to guide them when they discuss treatment options with their clinicians. The clinician guide, Three Treatments for Osteoarthritis of the Knee: Evidence Shows Lack of Benefit, features additional information, including a confidence scale that rates the available evidence.
The guides were produced through the AHRQ Effective Health Care Program dedicated to facilitating decision making by providing findings from high-quality research in formats for different audiences. To learn more about the program, click here.
FAQ
Question:How can I find out if a procedure may be quantity-billed to Medicare Part B?
Answer:
Certain procedures may be limited by the number of services that can be reported on each line of a claim. However, you may now determine if a CPT code can be quantity billed and how many services (units) are allowed per claim line.
WPS Medicare recently added a quantity-billed list, by procedure code, to its Web site. The list will be updated quarterly but does not include Medically Unlikely Edits (MUEs), which may impact the number of units that are allowed per line, per day. You may also continue to contact Medicare Customer Service directly for assistance.
To view the electronic list and additional information related to MUEs, click here.
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