Medigram - November 6, 2008 | Wisconsin Medical Society

NEWS BRIEFS

Physicians may earn pay boost of up to 5.1% from MIPPA update plus e-prescribing and PQRI incentives

The Centers for Medicare & Medicaid Services (CMS) announced last week a new initiative for physicians to trade in their prescription pads and improve efficiency and safety when ordering drugs for patients with Medicare. The initiative is included in the Medicare Physician Fee Schedule (MPFS) final rule for calendar year 2009 and goes into effect January 1, 2009. (A copy of the final rule [CMS-1403-FC] is available here.)

Physicians and other eligible professionals who adopt and use qualified electronic prescribing (e-prescribing) systems to transmit prescriptions to pharmacies may earn an incentive payment of 2.0 percent of their total Medicare allowed charges during 2009. This incentive is in addition to a 2.0 percent incentive payment for 2009 for physicians who successfully report measures under the Physician Quality Reporting Initiative (PQRI), and both incentive payments are in addition to the 1.1 percent fee schedule update required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Thus, a physician who successfully reports under both the e-prescribing and PQRI initiatives could receive up to a 5.1 percent pay boost for 2009.

To participate in the e-prescribing incentive program, physicians will need to have a qualified e-prescribing system with certain required capabilities. And to earn the incentive payment, physicians must successfully report one of three codes for the e-prescribing measure when submitting claims for specified types of medical visits. Click here for more information.

As part of its e-prescribing incentive program, Medicare will be providing information and other educational resources to physicians and their offices about available e-prescribing systems.

New ‘how-to’ guide designed to help transition to e-prescribing

In an effort to help clinicians make informed decisions about how and when to transition from paper to electronic prescribing systems, A Clinician’s Guide to Electronic Prescribing was released recently in conjunction with the Centers for Medicare and Medicaid Services (CMS) National e-Prescribing Conference.

The first section of the guide targets office-based clinicians who are new to the concept of e-prescribing, and who seek a basic understanding of what e-prescribing is, how it works, what its benefits and challenges are, and the current environment impacting its widespread adoption. The second section of the guide targets office-based clinicians who are ready to move forward and bring e-prescribing into their practices. It presents fundamental questions and steps to follow in planning for, selecting and implementing an e-prescribing system.

The Guide was developed by a collaboration that includes the eHealth Initiative, the Center for Improving Medication Management (Center), the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, and the Medical Group Management Association, with the strategic guidance of a multi-stakeholder Steering Group comprised of clinicians, consumers, employers, health plans, and pharmacies. Click here for more information.

Medicare announces influenza, pneumococcal vaccine reimbursement rates

Medicare last week published updated payment allowances for influenza and and pneumoccal vaccines. The effective date for these rates is effective September 1, 2008. For more information, click here.

UnitedHealth Premium Physician Designation Program update

UnitedHealthcare has announced that it will mail the new and refreshed designation result letters for the UnitedHealth Premium Physician designation program to physicians in December. The new designations will be posted on UnitedHealthcare’s consumer Web site, myuhc.com in mid-first quarter 2009.

To help physicians and others understand the methodology used in the UnitedHealth Premium physician designation program, UnitedHealthcare has developed an on-line interactive course. To access the course, click here. Then click “Most Visited” followed by “UnitedHealth Premium® physician designation online course.”

For additional information, click here to read an August 28 Medigram article about the UnitedHealthcare program or call 866.270.5588.

Fact sheet now available for ICD-10

The Centers for Medicare & Medicaid Services Medicare Learning Network has released a new ICD-10-Clinical Modification/Procedure Coding System Fact Sheet. The fact sheet, which is available here, offers general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9¬CM and ICD-10-CM/PCS, and implementation planning recommendations.

Nominate a candidate for Physician Citizen of the Year

It’s quick and easy to nominate a fellow physician for the special honor bestowed by the Wisconsin Medical Society—the Physician Citizen of the Year Award. Just click here and complete the nomination process on-line. The deadline is January 15, 2009.

The award recognizes Wisconsin physicians who volunteer their time and talent to help better their community through cultural, civic or other activities. Last year the committee selected two winners, James Allen, MD, of Madison, who successfully lobbied Congress to help blind veterans and Scott Walker, MD, of Fennimore who serves as the medical director of a local free clinic. For the complete rules, click here.

QUALITY & EFFICIENCY

Society milestones in transparency

For the past four months, Medigram has featured weekly updates on the work of the Wisconsin Health Information Organization and the Wisconsin Medical Society’s role in these initiatives. But the Society’s work toward increased health care transparency is not limited to its involvement at the WHIO table. Click here for a brief overview of Society milestones over the past 12 months.

CAPITOL INSIDER

Tuesday elections wrap-up

The 2008-2009 biennium will feature Democratic Party control across the board, with the President, Wisconsin’s Governor, both houses of Congress and both houses of the Wisconsin Legislature all held by Democrats.

Democrats will control the State Assembly for the first time since Republicans gained a majority in 1994. A combination of defeating Republican incumbents and winning open seats gives Democrats a recount-pending 52-46-1 margin starting in 2009 (former Republican Jeff Wood is the first Independent to go to Madison in 62 years). Up next for both parties: selecting caucus leaders, establishing committee chairs and memberships. Democrats will select a Speaker and Majority Leader, whose powers rest in setting the agenda for Assembly floor sessions and managing floor procedure. Republicans will select a minority leader, who generally has two primary assignments: 1) be the voice of the opposition party on the floor and to the media, and 2) figure out a way to get back into the majority.

The departure of Society member Sheldon Wasserman, MD, (D-Milwaukee) from the Assembly (see Senate results below) leaves open the question of which Democrat will chair the Assembly Health Committee. That may not be decided until the next session of the legislature is organized in January. Wasserman’s departure leaves Society member Chuck Benedict, MD, (D-Beloit) as the lone physician in either house.

The State Senate will look much the same as it did last session, with Democrats maintaining an 18-15 majority in that house. Three Republican incumbents facing tough challengers kept their seats, with Sheila Harsdorf (R-River Falls), Dan Kapanke (R-La Crosse) and Alberta Darling (R-River Hills) returning for another four-year team. Darling, wife of Society member Bill Darling, MD, had to wait until Wednesday to declare victory in her race against Wasserman, as many absentee ballots in Milwaukee and Shorewood wards were outstanding until the day after election night. Republican Randy Hopper (R-Fond du Lac) and Democrat Jim Holperin (D-Conover) each won close open-seat races, maintaining their party’s control in each district. Hopper’s 180-vote win over Jessica King (D-Oshkosh) will likely undergo a recount.

Senate Democrats had originally scheduled a caucus today to elect a leader for the 2009-2010 session, but have postponed that election pending a recount in the Hopper-King race. Earlier today, Senate Republicans re-elected Scott Fitzgerald (R-Juneau) as minority leader.

Federally, all eight of Wisconsin’s incumbents in the U.S. House of Representatives won reelection to two-year terms, including Society member Steve Kagen, MD, (D-Appleton), who defeated former State Assembly Speaker John Gard (R-Suamico) by a 54-46 percent margin. Wisconsin’s eight House members are five Democrats (Tammy Baldwin, Ron Kind, Gwen Moore, Dave Obey and Kagen) and three Republicans (Paul Ryan, Tom Petri and F. James Sensenbrenner). Neither Wisconsin senator faced reelection on Tuesday; Russ Feingold (D-Middleton) will run again in 2010, while Herb Kohl (D-Milwaukee) next runs in 2012. Democrats increased their majority in both the Senate and the House.

Finally, Society lobbyist Jeremy Levin won election to the Dane County Board of Supervisors with a 53-46 percent win.

For more information, contact Mark Grapentine, JD, or Jeremy Levin.

EDUCATIONAL PROGRAMS

Medicaid—Preparing for changes now and in 2009

On November 10, 2008, Wisconsin Medicaid and its fiscal agent, EDS, will implement a new Web-based information system for all state programs called ForwardHealth interChange. Along with this new system, many changes will come related to billing and coding including the use of National Drug Codes (NDC), J code carve-outs for managed care organizations (MCO), new member ID cards and much more. Join EDS Provider Services Manager Dave Meiss and EDS Provider Relations Outreach Specialist Stacy Bernd for an informational session one week post-implementation to get the information you need for a seamless transition in November and into 2009.

This half-day face-to-face seminar being held in Eau Claire, Green Bay and Waukesha November 18, 19 and 20, respectively will conclude with an open Q&A forum providing you answers to any of your Medicaid questions. Click here for more information or to register.

Meanwhile, as the implementation deadline approaches, ForwardHealth encourages health care professionals to request a PIN and begin set-up of a ForwardHealth portal account now. The portal gives providers access to claims, prior authorization, member enrollment and other information through a secure Web-based system.

To request a PIN, visit www.forwardhealth.wi.gov and click on “Request portal access.” If you already received a PIN, you can begin account set up by going to www.forwardhealth.wi.gov and then clicking “Logging on for the first time.” For additional information, click here or refer to the Account Users Guide on the portal home page.

QUALITY CORNER

Medicare value-based purchasing program listening session December 9

The Center for Medicare and Medicaid Services (CMS) will hold a listening session from 9 a.m. to 3 p.m. December 9, 2008, as part of the development of a plan for the transition to a value-based purchasing program for physician and other professional services as required by section 131(d) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). This notice was published in the Federal Register on October 24, 2008.

The purpose of the listening session is to solicit comments on an issues paper that will present the range of issues being considered for plan development. Physicians, physician associations and all others interested in the pursuit of new payment approaches to enhance the quality and efficiency of physician and other professional services are invited to participate, in person or by calling in to the teleconference. The Issues Paper will be posted on the CMS Web site Physician Center Spotlights at this link no later than November 28, 2008. The issues identified and discussed during this meeting will assist CMS in developing options for the plan. The meeting is open to the public, but attendance is limited to space and teleconference lines available.

For further details, click here to view the notice.

FAQ

Question:
Where would I find the Healthcare Common Procedural Coding System (HCPCS) annual and quarterly updates?

Answer:
HCPCS codes are updated quarterly. As a result, changes may be made throughout the years and may not be included in your current HCPCS book. To find the quarterly HCPCS updates, you will need to access the general HCPCS release and code set data on the Centers for Medicare and Medicaid Services Web site. There you will find a section specific to the quarterly updates and a column within the file will indicate the effective date.

CMS released the 2009 HCPCS data set and its decision for coding skin substitute products on November 3, 2008. This information is also available using the above link.

If you have questions about this or other coding matters, click here to review our FAQ archives, or e-mail efaq@wismed.org.