TOP STORY

New drug warning announced, available immediately via HCNN

Yesterday a new FDA-mandated warning was sent to physicians specializing in internal medicine, family medicine, obstetrics and gynecology, and emergency medicine via the Health Care Notification Network (HCNN).

Paper-based versions of these time-sensitive warnings are sent by U.S. mail but typically arrive days or weeks later and often buried in mounds of administrative correspondence and junk mail.

You can prevent this delay and stay up-to-date by registering for HCNN Web alerts, including drug warnings, drug recall announcements and public health emergency notifications, here. If you are already registered for HCNN, view the new drug warning here immediately. Unregistered members can also enroll to view this alert at any time but will continue to receive paper-based alerts until they register for the HCNN.

HCNN alerts are free for all Wisconsin Medical Society members and fulfill the new FDA guidance promoting electronic delivery of drug warnings. They are also supported by medical liability insurance carriers because they reduce professional liability by eliminating delays to accessing information that is crucial to providing safe, high-quality patient care.

Find more information about HCNN here, or contact HCNN directly at 866.925.5155.

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NEWS BRIEFS

May 19 Quality Forum to address coordination of care

This biennium, the state is working to address a projected $415 million shortfall in funding for its Medicaid program. On the bright side, many inefficiencies and coordination-of-care issues have been acknowledged and can be corrected.

In an effort to improve quality while mitigating costs, Jason Helgerson, Medicaid Director at the Wisconsin Department of Health Services (DHS), has asked the Wisconsin Medical Society to highlight smart experiments in patient-care coordination. Helgerson will open the Society's next Quality Forum May 19 with some brief comments on this project.

Afterwards, a sharing summit will take place, during which there will be presentations on four different Wisconsin initiatives that demonstrate the ideals of patient-centered medical care. Speakers from several different care-delivery platforms will discuss innovative models for achieving these goals.

A risk-management program will be presented following the summit. Click here for details.

This Forum is open to all interested Society members. If you would like to participate, receive additional information or to be notified about future Quality Forum events, contact Stephanie Taylor to be added to the mailing list.

CIGNA lifts administrative burden in response to physician groups’ concerns

The CIGNA HealthCare settlement agreement is designed to promote greater transparency in the company’s claims-processing and payment practices. At the same time, it has led CIGNA to require supporting documentation for certain procedures, a move that would create a great administrative burden for many health care professionals.

Thankfully, CIGNA has listened to the concerns of the American College of Cardiology, the American Medical Association and other physician organizations and revised its policy to be more manageable for practice managers and other administrative workers at medical offices.

Specifically, the company has agreed to loosen its requirement that services and procedures appended with a CPT modifier of 25 or 29 must include supporting documentation. Without this negotiation, medical practices would have had to provide additional documentation on 17,000 NCCI code pairs, a task that cannot be completed electronically at the present time.

Until the details of this agreement are finalized, practice staff should check Box 19/Loop 3200 when submitting claims to indicate that supporting documentation has been filed. A revised list of which code pairs require supporting documentation will be updated regularly at www.cignaforhcp.com, and tips on navigating the documentation process are available in the Claim Editing Procedures area of this Web site, located in the Resources section.

For more details on the CIGNA settlement and how it affects medical practices, click here or here.

To access a related list of codes and for CPT modifier 25, click here, and for CPT modifier 29, click here.

Learn about hypertension and sleep apnea via free webinar

Two free Web-based seminars are being offered to educate Wisconsin physicians about the connections among cardiovascular disease, chronic kidney disease and obstructive sleep apnea.

A seminar titled “Hypertension and Obstructive Sleep Apnea” will be offered from 12 to 1 p.m. on June 17, and a seminar on hypertension and chronic kidney disease will follow in July.

Geared toward primary-care physicians and those with an interest in hypertension, the seminars will address these issues from two perspectives: the patient-centered medical home model and the chronic disease model.

The Wisconsin Academy of Family Physicians, which is collaborating with the National Kidney Foundation of Wisconsin and the Wisconsin Heart Disease and Stroke Prevention Program to offer the series, has applied for CME credit. If approved, these credits may be translated into AMA Category 1 credits as well.

Each of these educational opportunities requires advance registration. A call-in option will also be offered. To register for the June seminar, click here. For more information about either event, contact Rose White at the Wisconsin Department of Health Services.

RAs receive makeover under ForwardHealth

When BadgerCare, Medicaid and other state-run health care programs became part of the new ForwardHealth interChange system last July, providers were asked to give feedback about how claim information should be sorted on Remittance Advice (RA) documents.

In response to your feedback, on May 1 ForwardHealth began sorting claim information by provider name. In addition, data on RAs now appears in the following order:

• claim type
• claim status
• member last name, first name and middle initial
• member identification number
• internal control number.

When ForwardHealth providers submit a claim, adjustment request or financial transaction for processing, they should expect to receive an RA from the appropriate ForwardHealth program, just as they did under the Medicaid Management Information System (MMIS).

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QUALITY & EFFICIENCY

WHIO extends data-study activities

The first version of the Wisconsin Health Information Organization (WHIO) Data Mart was delivered in December 2008 and contained 1.5 million members, 55 million medical and pharmacy claims lines totaling $11.8 billion in billed charges, 5.9 million episodes of care and 122,000 Wisconsin-based medical professional, facility and allied providers. The next step was to evaluate the aggregated data for accuracy and completeness for use in physician performance measurement and other business analytics.

The WHIO Data Study Period was from January 2, 2009 to March 31, 2009, and a full report on findings and recommendations was presented to the WHIO Board at an April meeting. Physicians should be aware of the following three recommendations:

• WHIO members will continue to observe limited use of Data Mart Version 1 (extension of Data Study activities; members refrained from using data for any production purposes).
• Data Mart Version 2 is anticipated for delivery in August 2009 and should be considered the first “production” version of the WHIO Data Mart. (A 30-day “curing” period will occur allowing for members to access the data to ensure that recommended improvements to the data and software have been properly installed).
• A Provider Rollout Plan will be created and implemented to include more sites in each reporting cycle. (The goal is to generate awareness, education and support of WHIO, the Data Mart, reporting methodology and data utility).

On behalf of our physician members, the Society continues to advocate for a thoughtful, disciplined and productive process with regard to data transparency. Please stay tuned to Medigram for further updates on the WHIO Data Mart and contact your Q&E staff with any questions, concerns or comments by e-mailing QandE@wismed.org.

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CAPITOL INSIDER

State deficit reportedly growing; Medicaid reimbursement cuts coming?

Legislative work on the state’s 2009-2011 biennial budget ground to a halt this week upon news that tax collections are substantially behind levels predicted when the budget was first submitted in February.

While the numbers won’t be released until early next week, the shortfall is expected to add another $750 million to $1.25 billion to the $5.7 billion deficit. Joint Committee on Finance Co-Chair Senator Mark Miller (D-Monona) has said that the committee may be forced to revisit actions it has taken so far on the budget to address the additional shortfall. To view his statement, click here.

This afternoon, Governor Jim Doyle announced potential cuts to state government—including employee furloughs and potential cuts to Medicaid reimbursements—as a way to address the larger deficit without raising taxes.

The deficit news only exacerbates a looming $415 million deficit in the state’s Medicaid program. The Society continues to collaborate with different health care groups statewide to educate state officials and legislators on how “easier” solutions to this deficit, such as reimbursement cuts, could affect access to Medicaid services. The Society also continues to press the Wisconsin Department of Health Services for additional collaboration on the Medicaid program overall.

For more information, contact Mark Grapentine, JD.

Legislators reach statewide smoking-ban deal

It appears that Wisconsin may join the list of states with a statewide smoking ban before Memorial Day. When that ban would go into effect is another matter.

Following committee public hearings on draft companion bills—Senate Bill 181 on Tuesday and Assembly Bill 253 yesterday—it was announced Wednesday afternoon that all sides have agreed to terms on legislative language. While the legislation still needs a bit of work, final passage of the bills next week appears more likely than ever before.

Society members Michael Miller, MD, and Alan Schwartzstein, MD, provided vital personal testimony about the real-world effects of secondhand smoke at the committee hearings this week. Society Government Relations staff have also been very involved, working with Smoke Free Wisconsin, the American Cancer Society and the Capitol to ensure that the political environment is ideal for the proposal to become law. Society President Robert Jaeger released a statement today applauding these efforts.

Under the agreement, a substitute amendment to the proposal will include, among other provisions, a start date of July 5, 2010. It will also allow for smoking on certain outdoor patios, adjust certain fines for noncompliance and permit tobacco-only establishments such as cigar bars.

While yesterday’s announcement is promising, the bills still must be amended and approved in both the Senate and Assembly. The bills must also contain identical language if they are to reach the Governor after action in both houses next week. Contact your state senator and state assembly representative and ask them to support the agreed-upon smoke-free legislation. Your legislators’ contact information is available here.

For more information, contact Mark Grapentine, JD.

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YOUR PRACTICE. YOUR FUTURE.

HIPAA privacy rules go high-tech: Are you ready?

The privacy rules of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) have been expanded significantly, and your practice may be required to implement a variety of new information-security procedures.

Part of the economic stimulus package that President Obama signed into law in February, the Health Information Technology for Economic and Clinical Health Act (HITECH Act), gives HIPAA a boost by changing the way covered entities and their business associates use, disclose and maintain protected health information.

Most of these changes will not apply until February 2010, but one important provision—breach notification—will take effect before the end of this year. Covered entities and their business associates will be required to report to the U.S. Department of Health and Human Services (HHS) breaches of protected health information not secured via an HHS-specified technology or methodology.

To meet this requirement, many practices will need to create and implement policies and procedures that identify, track and report this type of breach. Plus, many of the other provisions of the HITECH Act will require a substantial amount of time and resources to implement.

To help you comply with these changes, Choua L. Vang, JD, an attorney with the law firm Godfrey & Kahn, has prepared a helpful checklist of due dates and action items. Click here to access the list and learn more about the HITECH Act.

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F.Y.I. FOR YOUR INSURANCE

May 19 seminar features CME, potential for premium discount