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Medigram - May 1, 2008


TOP STORY

Enforcement of state law restricting use of DEA numbers expected to begin May 23

As previously reported in Medigram, it will soon be illegal under Wisconsin law for health plans, pharmacies or anyone else to use or disclose physician’s Drug Enforcement Administration (DEA) registration numbers for purposes other than prescribing controlled substances. Specifically, Wisconsin Statute § 146.87 makes it unlawful in Wisconsin for any person to do the following:
  • Require a physician to include his or her DEA number on a prescription that is not a controlled substance.
  • Disclose a physician’s or other registrant’s DEA number without that person’s consent, for any purpose other than complying with or enforcing federal or state law related to controlled substances.
  • Use a DEA number to identify or monitor the prescribing practices of a physician or other DEA registrant.
The Wisconsin Medical Society expects that the Wisconsin Attorney General’s office will begin to prosecute violations of the statute occurring after May 23, 2008. Violators may be subject to a fine of up to $10,000 per violation.

NEWS BRIEFS

Value of both quit-smoking counseling and medications confirmed in new guideline

Smoking-cessation counseling is effective, according to the latest research on how best to help smokers quit. An updated clinical practice guideline, scheduled for release May 7, finds even stronger evidence that demonstrates the effectiveness of counseling.

“Of particular note are findings that counseling adds significantly to the effectiveness of tobacco cessation medications, quitline counseling is an effective intervention with a broad reach and counseling increases abstinence among adolescent smokers,” according to the executive summary.

The guideline is an update of the “U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence.” Society member Michael Fiore, MD, of the University of Wisconsin Center for Tobacco Research and Intervention, chaired a panel of 24 of the nation’s premier tobacco treatment experts to produce the updated guideline.

Besides stronger evidence in favor of smoking-cessation counseling, the updated guideline also finds a greater number of effective medicines and strong evidence that health policies significantly improve the odds of quitting for smokers.

The guideline and its related materials, including a clinician’s quick reference guide, will be posted at this link on May 7.


CMS urges testing NPI-only claims now; deadline for implementation is May 23

May 23 is just a few weeks away, and it’s important to make sure physician offices are prepared. That’s when claims with NPI/legacy pairs in the primary identifier fields will no longer be accepted. Instead, claims with NPI only will be required.

CMS continues to be concerned about the low percentage of NPI-only claims being submitted and encourages health care professionals that have successfully submitted claims with NPI/legacy pairs to begin sending small batches of NPI-only claims for testing. If the claim is processed and you are paid, continue to increase the volume of claims sent with NPI only. If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will be rejected. If that happens, CMS suggests going into your NPPES record to validate that the information you are sending on the claim is consistent with your NPPES information. If it is different, update the NPPES and resend a small batch of claims three to four days later. If your claims are still being rejected, you may need to update your Medicare enrollment information to correct this problem. Testing claims now will allow time for any needed corrections prior to the May 23 deadline.

Additionally, May 7 has been deemed “Legacy Free” Day. CMS, in collaboration with the Healthcare Information and Management Systems Society (HIMSS), has asked clearinghouses that submit claims to FFS Medicare to participate in a one-day NPI preparation exercise. On May 7 these clearinghouses are being asked to submit Medicare claims with NPI-only in all provider identifier fields for which a provider currently uses NPI/legacy pairs. On May 8, the clearinghouses will revert back to sending Medicare NPI/legacy pairs as received from the providers. This exercise will also help Medicare providers evaluate their NPI readiness prior to the May 23 deadline.

CMS NPI Roundtable May 14
To address questions from the Medicare provider community regarding Medicare’s NPI implementation, CMS will host a free national NPI Roundtable May 14 from 1-2:30 p.m. Health care professionals will be able to submit questions through the on-line registration system when they sign up for the call. For registration details, click here. And for more information about NPI, click here.


Newly revised ABN must be implemented by September 1

Physicians, other health care professionals and laboratories were able to start using the newly revised Advance Beneficiary Notice (ABN) form March 3. The Centers for Medicare and Medicaid Services (CMS), which has allowed a six-month implementation period for the new form, will require its use by September 1, 2008. The new form merges the old forms (ABN-G [CMS-R131-G], ABN-L [CMS-R131-L] and the NEMB [CMS-2007]) into one document, which is currently available in English and Spanish. For additional information on the revised form or for information on its use, click here.


New long-term disability plan features guarantee issue for members who enroll early

Wisconsin Medical Society Insurance and Financial Services introduced last month a new long-term group disability insurance plan from Epic Life Insurance exclusively for Society members. The plan is designed to protect Society members’ future incomes in the event they are unable to work as a result of a disability. And there is a special introductory offer for Guarantee Issue* when you enroll before October 1, 2008.

To read more about this coverage click here to review the plan flyer. For additional information, contact a Wisconsin Medical Society Insurance and Financial Services agent at 866.442.3810 or complete our on-line contact form.

*Requirements for Guarantee Issue are explained on the plan flyer.


DMEPOS accreditation may impact your office

Do you supply durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) to Medicare beneficiaries? If so, are you aware that you must be accredited no later than September 30, 2009? All suppliers of DMEPOS are required to obtain accreditation to assure compliance with quality standards and to receive Medicare Part B payment. Medical supplies furnished by Home Health Agencies, drugs used with durable medical equipment and certain other Part B drugs (i.e., immunosuppressives, anti-emetics) are excluded.

CMS has deemed 10 accrediting organizations (AO) to meet quality standards. (A list of these can be found on the CMS provider enrollment Web site.) The AO will assist suppliers in conforming to the accreditation standards, as some changes may be required. The AO will decide whether to accredit the supplier based on review of data and an on-site survey. The entire process may take four to six months, so suppliers are encouraged to become familiar with this process early. For additional information, click here.

The Wisconsin Medical Society Education Department will host a teleconference May 13 that will focus on what physicians need to know to assist Medicare beneficiaries in a seamless process of obtaining DMEPOS. Speaker Sara Hicklin from the Wisconsin Association of Medical Equipment Services will also touch on the accreditation process. Click here to register.

NEWSMAKERS

Madison physician to discuss lesbian health care needs at June AMA meeting

Family physician Kathy Oriel, MD, from Madison, will speak at the AMA House of Delegates meeting June 13 in Chicago. Her presentation, titled “Lesbian Health Care: What You Don't Know is Harming Them” will be held at the Hyatt from 5:30 – 7 p.m.

“This event, which is accompanied by a reception, also serves as an opportunity for GLBT and all AMA members to network in a welcoming and comfortable setting,” said Madison physician Paul Wertsch, MD, Chair, AMA Advisory Committee on Gay, Lesbian, Bisexual and Transgender Issues.

Doctor Wertsch encourages Wisconsin physicians attending the AMA meeting to participate in this event. If you would like to attend, please contact Michael Kutnick at the AMA at 312.464.4335 by May 9.

EDUCATIONAL PROGRAMS

AMA to host EMR/EHR web conference

With an increasing number of hospitals, health systems and health plans donating health information technology (HIT) to physician practices, physicians and practice managers need to understand the complexities of HIT donation agreements and Stark law and Anti-Kickback Statute requirements. To help, the American Medical Association will host “Financing electronic health record (EHR/EMR) systems: Should your practice accept a donation?” a live Web conference from 1 to 2 p.m. on May 14. The conference will help participants learn more about whether or not accepting these donations is the right move for their practices, and how to comply with subsidized EHR regulations, recognize regular components of donation agreements, and prepare more effectively for any HIT selection. The program is open for all physicians and their staff and offers continuing medical education credit. Registration is $95 for AMA members and $150 for nonmembers. Click here for more information.

QUALITY CORNER

BadgerCare Plus Healthy Living Update

This month’s Commonwealth Fund States in Action newsletter features Wisconsin’s BadgerCare Plus Healthy Living initiative. Wisconsin’s BadgerCare Plus, an expansion of its State Children’s Health Insurance Program (SCHIP) launched February 1, 2008, extends health coverage and at the same time emphasizes individuals’ responsibility for improving their own health. This is expected to achieve better health outcomes and value for each health care dollar spent. The program expands state-sponsored health insurance coverage to all children and greater numbers of pregnant women, adult caretaker relatives, and parents by increasing the income level for eligibility. BadgerCare Plus members are encouraged to take responsibility for their own health through three strategies: individual incentives, a member pledge, and health literacy campaigns. To read the BadgerCare Plus Healthy Living Update and learn about initiatives in other states, click here.

FAQ

Question:
Is a National Provider Identifier (NPI) required in box 32 of the CMS-1500 claim form?

Answer:
No, according to the Centers for Medicare and Medicaid Services (CMS), but claim form instructions located in IOM 100-04, Chapter 26, Section 10.4 may be confusing. They state: “Enter the NPI of the service facility as soon as it is available. The NPI may be reported on the Form CMS-1500 as early as January 1, 2007 and must be reported May 23, 2007.” CMS clarified that you are not required to submit an NPI in box 32; however, if you choose to enter a facility identifier in this box, it must be an NPI on or after May 23, 2008. (See related article on NPI under "News Briefs.")

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.