TOP STORY

No NPI = no pay after tomorrow

The National Provider Identifier (NPI) alone will be required for processing of all HIPAA Standard Transactions effective tomorrow, May 23. This means:

• For all primary and secondary provider fields, only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, DDE, 276/277, 270/271 and 835), paper claims (UB-04 and CMS-1500) and SPR remittance advice.
• The reporting of legacy identifiers in any primary or secondary provider fields will result in the rejection of the transaction.

The Centers for Medicare and Medicaid Services (CMS) hosted a national NPI Roundtable Q&A session May 19 to address last minute questions from the Medicare provider community in advance of the NPI implementation deadline. A replay of the call is accessible until 12:59 p.m. Saturday, May 24. To listen, call 800.642.1687 and enter passcode 46175614.

Meanwhile, the American Medical Association, the Medical Group Management Association and the American Hospital Association sent this letter to Department of Health and Human Services (HHS) Secretary Mike Leavitt urging HHS to extend the deadline, noting that failure to do so will result in enormous cash flow and claims processing interruptions.

For more information about the NPI, click here.

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NEWS BRIEFS

OCR releases HIPAA privacy consumer brochures in eight languages

The Office for Civil Rights (OCR) has posted two patient brochures on its health information privacy Web site. The brochures, Privacy and Your Health Information and Your Health Information Privacy Rights, are available in eight languages: Chinese, Korean, Polish, Russian, Spanish, Tagalog, Vietnamese and English. Previously the brochures were available in English and Spanish only.

These brochures educate patients about the HIPAA Privacy Rule.

• Privacy and Your Health Information describes the HIPAA Privacy Rule and explains who must comply, what information is protected, how this information can be shared, and what rights are granted to individuals under the Privacy Rule.
• Your Health Information Privacy Rights describes the individual rights granted by the Privacy Rule, including the right to access one’s medical records, the right to request an accounting of disclosures and the right to file a complaint for a potential violation of the Privacy Rule.

The brochures are high resolution, which allows printing of high-quality documents. In addition, OCR has posted information in these languages about how to file a privacy complaint, along with translated privacy complaint forms. Click here to access these resources.

Update: Workers’ Compensation Guidelines, intent

Payers are finding that most physicians and other health care professionals are unaware of the existence of new Workers’ Compensation Guidelines, and there is confusion regarding the intent of the guidelines. This feedback was the focus of a May 16 meeting of the Healthcare Provider Advisory Committee (HCPAC) of the Workers’ Compensation Advisory Council, which was attended by Society members Maja Jurisic, MD, Mary Jo Capodice, DO, MPH, Michael Lischak, MD, Sri Vasudevan, MD, Gina Buono, MD, MPH, and Ron Stark, MD.

Doctor Jurisic reported that e-mails to the Department of Workforce Development (DWD) indicate that some payers are interpreting the guidelines as “mandates” and that they are reviewing medical treatment for “compliance” with the guidelines, denying treatment that is not mandated.

DWD officials confirmed that the guidelines were intended to be used as “factors for an impartial health care services review organization and a member from an independent panel of experts established by the department to consider in rendering opinions to resolve necessity of treatment disputes.” They were not intended to expand or restrict a health care professionals’ scope of practice, or restrict a health care professionals’ obligation or right to do whatever he or she feels is necessary to treat a particular condition. Departure from the guidelines is acceptable, but it is prudent to document the reason for doing so to avoid challenges by payers.

To access the guidelines, click here, and watch future Medigrams for additional information and answers to frequently asked questions.

Resources available for people exposed to radiation

The Health Resources and Services Administration’s Radiation Exposure Screening and Education Program (RESEP) is launching a national outreach campaign to educate people who were exposed to radiation through nuclear arms testing or the uranium mining industry between 1942 and 1971 about available resources.

The RESEP program supports screening programs, medical referrals and the preparation of medical documentation related to radiogenic illnesses. RESEP also refers individuals diagnosed with radiogenic cancers and chronic disease to the Radiation Exposure Compensation Act (RECA) Program, administered by the Department of Justice, which provides payments of $50,000-$100,000.

It is important to identify individuals potentially adversely affected so that they are screened and evaluated by a health care professional. Many people have moved away from the site of their initial exposure and do not know that they are entitled to medical screening and financial compensation.

Many resources are availalbe including a brochure which explains who is eligible, what RESEP offers and how to receive benefits. To obtain printed copies free of charge call 1.888.ASK.HRSA, or download the resources from the HRSA Web site. Information about RESEP is also available.

For questions, please contact Vanessa Hooker, Public Health Analyst, HRSA’s Office of Rural Health Policy, at 301.594.5105.

Humana to post updated ‘physician effectiveness’ scores for patients

Humana updated its Physician Effectiveness Scores the week of May 12. Participating Milwaukee-area physicians have 45 days to review their scores and initiate an inquiry for correction or change before those scores become available to Humana Preferred members July 1.

The Physician Profile consumer tool displays effectiveness data based on claims and evidence-based medical standards. It compares an individual physician’s performance in treating a specific condition or providing preventive care to other physicians in the same market. Overall condition-level scores are provided to Humana Preferred health plan members only. Patient-level data are not shared with members.

The Physician Profile tool includes measure related to diabetes, heart disease measures, asthma/respiratory illness, and prevention, immunization and screening.

Questions should be directed to Humana Provider Relations at 800.626.2741.

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CAPITOL INSIDER

MEB to review licensure process

At its May meeting Wednesday, the Medical Examining Board (MEB) took up some issues beyond the usual discussions over individual discipline cases. Responding to concerns the Society and others have repeatedly raised regarding the length of time it often takes for a physician to obtain a license in Wisconsin, the MEB began a process to assess whether current law and administrative rules regarding licensing allow for a more efficient and streamlined process while still fulfilling the need to protect the public. Physician members of the MEB raised concerns similar to those the Society has heard from across the state—too often the licensing process is slow and unresponsive, leading to physician staffing delays and thus less patient access to care. While the MEB’s action is a sign of progress, results must follow. To that end, Society CEO/EVP Susan Turney, MD, and leadership from the Wisconsin Hospital Association have scheduled a meeting with Department of Regulation and Licensing Secretary Celia Jackson to get a report on progress the Department is making in its administration of the MEB.

Rep. Sheldon Wasserman, MD, (D-Milwaukee) appeared before the MEB regarding “expedited partner therapy” (EPT), which would allow a physician to write prescriptions or provide medications not only for patients with chlamydia or gonorrhea, but for the patient’s partner without the physician first examining the partner. Doctor Wasserman has authored legislation on EPT (most recently this past session as 2007 Assembly Bill 318), but those efforts have not resulted in a new law; his appearance before the MEB was to request willingness to explore potential rulemaking or policy statement solutions. The AMA has policy supporting EPT, citing a 2006 white paper on the topic from the Centers for Disease Control and Prevention. The Society has supported Dr. Wasserman’s legislative efforts. The MEB asked its legal counsel to research Wisconsin law to determine what actions it can take supporting EPT.

Also of note, MEB (and Society) member Sujatha Kailas, MD, MBA, was elected to the Federation of State Medical Board’s nominating committee at the 2008 FSMB annual meeting earlier this month. The two-year term bolsters Wisconsin’s national presence in a well-regarded organization.

For more information, contact Mark Grapentine.

Society councils taking on the tough issues

At the direction of the Executive Committee of the Society’s Board of Directors, the Society’s policy-making councils are tackling issues important to physicians and patients alike. The Executive Committee has asked the Council on Health Care Quality and Population Health to examine the issue of “adverse events,” a topic garnering much attention in Wisconsin and nationwide. The Health Care Access Council will study various aspects of health care reform proposals, including results from the survey recently mailed to 2,500 physicians statewide gauging physician attitudes about reform. Health Care Ethics is tackling physician discipline and impaired physician topics, including examining whether the state’s Medical Examining Board should return to independent status rather than remain a state-run entity. Finally, the Council on Legislation will continue its work on health care “transparency” issues that were such a hot topic in the State Capitol in 2008. These specific subjects are in addition to the councils’ typical policy deliberations.

If these or other topics affecting the practice of medicine interest you, consider joining a council or sitting in on one when you see an interesting topic. For more information on Society councils, contact Karen Carney, Mark Grapentine or Merry Earll.

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EDUCATION

CMS releases updates to the incident-to billing policy for Medicare

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QUALITY CORNER

CMS to host 2008 PQRI national provider conference call May 28

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the third in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 4:30 to 6 p.m., Wednesday, May 28.

The call will provide an overview of the alternative reporting periods and criteria for satisfactorily reporting quality measures for the 2008 PQRI as authorized by the Medicare, Medicaid and SCHIP Extension Act of 2007. CMS subject matter experts will also answer callers’ questions.

To receive call-in information, you must register by 4:30 p.m. May 27. Click here for more information and to register. A replay option will be available shortly following the call until 12:59 p.m. June 5. To listen to the replay, call 800.642.1687 and enter passcode 46870023.

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FAQ

Question:
What is Michelle’s Law (Wisconsin Act 36)?

Answer:
Michelle’s Law, which takes effect July 1, 2008, allows college students to take up to a 12-month Medical Leave of Absence from school and stay on their parent’s health insurance coverage. This applies to all plans except some self-insured and stand-alone plans like life, dental and vision that can be more generous in this regard. Eligibility for this coverage is gained with the attending physician sending a letter to the insurance carrier certifying the medical necessity for the leave of absence.

Check with your plan administrator or your Wisconsin Medical Society Insurance & Financial Services agent to learn more about your particular plan, or use the on-line contact form.