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Medigram - October 30, 2008


TOP STORY

Society, pharmacy group alert Attorney General about DEA number issue

The Society, joining forces with the Pharmacy Society of Wisconsin (PSW), has alerted the state’s Attorney General about a company offering to sell access to Drug Enforcement Administration (DEA) registration numbers on the Internet. In a joint letter to Deputy Attorney General Ray Taffora, the two groups ask the Department of Justice to “take action to stop the sale of DEA numbers in Wisconsin,” citing a Wisconsin State Statute that specifically bars use of DEA numbers without the health care professional’s consent.

“Despite the vigilance of the health care community, we need the assistance of law enforcement to protect physicians’ DEA number,” the letter reads, “thereby reducing the potential for prescription fraud and abuse.” This situation serves as another reminder that physicians should zealously protect their DEA number from misuse.

For more information, contact Ruth Heitz, JD, or Mark Grapentine, JD.

NEWS BRIEFS

Medicaid reporting of NDCs and the Managed Care J-Code Carve out project—What you need to know before November 10!

When ForwardHealth interChange goes into effect November 10, physicians will be required to indicate National Drug Codes (NDCs) along with the appropriate HCFA Common Procedural Coding System (HCPCS) code for physician-administered drugs in the office or outpatient setting. Immunizations and radiopharmaceuticals will be excluded from this requirement, and reimbursement will still be determined based on the HCPCS codes submitted. Drugs for which there is no rebate available to the state will not be reimbursed (see Medigram August 23, 2007).

In addition, beginning January 1, 2009 physicians will be required to “carve out” all physician-administered drugs, including the administration fee, from Medicaid managed care organizations (MCO) and submit them to Fee-For-Service Medicaid. A ForwardHealth interChange Provider Update will be coming soon, but you can click here for more information from ForwardHealth. If you have questions, e-mail Carrie Gray at ForwardHealth or call 608.266.3901.


AMA declares November ‘Heal that Claim Month’ and offers on-line tools to assist physicians

As part of its campaign to save the health system billions of dollars by improving the accuracy and efficiency of medical claims processing, the American Medical Association (AMA) issued this release yesterday declaring November the first national Heal that Claim Month.

Because many physician practices often experience an increase in claim denials from health insurers during the last quarter of the year, AMA calls November an ideal time to appeal inappropriately underpaid and denied claims. An estimated 90 percent of claim denials are preventable and 67 percent of denials are recoverable, according to the Advisory Board Company, a Washington-based research organization. Based on those estimates, physicians collectively lose billions of dollars a year of revenue to health insurers.

As part of this initiative, the AMA has developed several resources to help physician practices review their claims-management process and also offer tips and advice for appealing claims. Click here to access the tools, which are available to all physicians at no charge.


Physician nominees sought for $100,000 Kanter Prize

The Wisconsin Medical Society has the opportunity to nominate one physician for The Kanter Prize, which for the first time honors an MD or DO for helping to find ways to overcome healthcare disparities. The $100,000 cash prize is sponsored by The Health Legacy Partnership, a public-private partnership between the Agency for Healthcare Research & Quality (AHRQ) and the Joseph H. Kanter Family Foundation.

“It was established to recognize and to celebrate the talent, dedication and creativity of a practicing physician who has contributed significantly to enhancing the delivery of health care by minimizing healthcare disparities,” according to the Kanter Prize Web site.

The Society must receive all nominations by December 21, 2008, so it can complete the selection process and nominate the physician by February 6, 2009. If you are interested in nominating a physician, please e-mail or mail a letter of recommendation to Dana Jansen at 330 East Lakeside Street, Madison, WI 53715. For more information about the award, click here.

IN MEMORIAM

Frank Urban, MD

Society member and former state Representative Frank Urban, MD, died Saturday, October 25 while traveling with his wife in Egypt. He was 78.

Doctor Urban, a Republican from Brookfield, spent 13 years in the Assembly, rising to the post of chairman of the chamber’s Committee on Public Health. When he was chosen in a special election in 1989, Urban was the first physician in more than 50 years to be elected to the Legislature.

Urban co-sponsored legislation creating a tax exemption for medical savings accounts, and he listed his work on bioterrorism preparedness and small-business health insurance among his accomplishments.

Click here to read the obituary published Monday.

QUALITY & EFFICIENCY

Are we up for the tipping point?

When the WHIO Data Mart launches in December, it will provide a new opportunity for physicians to utilize data to drive quality improvement initiatives. Family physician Tim Bartholow, MD, calls this a “tipping point” moment and encourages fellow physicians to lead the charge toward improving our health care delivery system. Click here to read more.

CAPITOL INSIDER

November elections finally imminent

Next Tuesday Wisconsin voters will join those around the country in casting ballots for federal, state and local elections. Besides the race for President, 35 U.S. Senate seats are up for grabs, with Republicans facing the daunting task of protecting 23 of those seats. (Wisconsin’s U.S. Senators are not up for reelection this cycle; Senator Russ Feingold’s six-year term expires in 2010, and Senator Herb Kohl faces reelection in 2012). All 435 U.S. House of Representatives seats are up for another two-year term; the most competitive race in the state is in the 8th Congressional District, with Rep. Steve Kagen, MD (D-Appleton) facing former Wisconsin Assembly Speaker John Gard (R-Suamico) in a rematch of the 2006 race.

State Democrats hope to gain seats in both the State Senate and State Assembly. Democrats control the Senate by an 18-15 margin and look to increase that spread with five seats in play: incumbent Republicans face stiff challenges in three races and two seats are open (see previous Medigram articles on those contests). Republicans hold the Assembly on a razor-thin 51-47-1 margin, with all 99 Assembly seats in play for 2009-2010.

If you have any questions about Tuesday’s elections, contact Mark Grapentine, JD, Jeremy Levin or Beth Alvin.


State Commerce Secretary: Budget deficit could be $4 billion

In remarks at a recent economic development conference, Wisconsin Department of Commerce Secretary Richard Leinenkugel warned that Governor Jim Doyle’s statement earlier this month of a possible $3 billion state biennial budget deficit could actually underestimate the size of the funding hole. According to Wisbusiness.com, Leinenkugel told the conference that with state tax receipts continuing to lag, Doyle “easily could have said $4 billion.”

A deficit of that size will force Capitol policymakers to make difficult taxing and spending decisions, regardless of which political parties control the State Assembly and State Senate. Making budgeting more difficult: the vast majority of state general fund spending (primarily income and sales tax-supported) lies in just five areas: Elementary and School Aids (37.9 percent of the 2007-2009 biennial budget), Medical Assistance (11.9 percent), the University of Wisconsin system (7.8 percent), Shared Revenue payments to local government (6.7 percent) and Corrections (6.7 percent). The Legislative Fiscal Bureau’s “top 10” chart from the last budget shows the 10 programs making up about 80 percent of this general fund spending; none are in areas where cuts are likely to engender warm and fuzzy political sentiment.

For more information, contact Mark Grapentine, JD.

YOUR PRACTICE. YOUR FUTURE.

Pulling a ‘Favre’: Lessons in employee relations

In week four of the National Football League season, Brett Favre threw a record six touchdowns for the New York Jets while Aaron Rodgers, the Packers quarterback, was sacked, threw three interceptions and was taken out of the game with a shoulder injury. Favre played for the Packers for 17 years, amassed virtually every record a quarterback could achieve, and had one of his most productive years and was one completion away from the Super Bowl in 2007. But with all that, some thought he had become a distraction and did not represent the long-term interests of the Green Bay Packers. The two previous seasons he teased the Packers’ management and Packers’ fans with rumors of retirement, not retirement, and allegedly made suggestions/demands that the team acquire or trade for certain players, or sign other players to long-term contracts with the Packers. Following his very successful 2007 season, Brett Favre announced in March that he would retire.

Click here to read an article by Thomas Godar, JD, that outlines how your organization can avoid a Favre-like situation.

F.Y.I. FOR YOUR INSURANCE

Umbrella coverage may prevent financial ruin

Too often, people with major assets either do not buy the extra coverage afforded by an umbrella policy or do not buy enough because they may not be familiar with umbrella coverage or they may not realize its potential benefits. Umbrella and excess coverage are extensions of home and auto insurance. They cover you and your assets and can also pay for attorney fees and other legal expenses if an accident occurs on your property or you are deemed liable for an accident.

While financial institutions require that people buy home insurance to get mortgages and states require drivers to buy auto insurance, no one mandates buying a policy that could turn out to be the most important part of your insurance package. Umbrella coverage usually costs a fraction of the price of a typical home and auto insurance package.

It’s important to review your current coverage to ensure you are protected adequately. Contact Diane Larson, Wisconsin Medical Society Insurance and Financial Services Personal Lines Agent, at 800.975.3418 for more information.

QUALITY CORNER

Help desks available for obtaining 2007 PQRI reports

Three separate Help Desks are available for assistance with IACS Accounts, Feedback Reports Access and General Information and Payment Issues:

  • External User Services (EUS) Help Desk: 866.484.8049 or TTY 866.523.4759 (6 a.m.-6 p.m.); : This help desk addresses how to register for an IACS Account; how to access an IACS account; how to change an IACS account; assistance with User Profile update; approval of Security Official Roles; and general IACS access questions.
  • QualityNet Help Desk: 866.288.8912 (7 a.m.-7 p.m.); qnetsupport@ifmc@sdps.org: Physician Offices tab PQRI. This help desk answers questions related to PQRI portal access within IACS; inability to access feedback reports; feedback reports were not generated; feedback reports are not reflecting data submitted; processing issues; and detailing information not answered elsewhere.
  • Provider Call Center (Carrier or A/B MAC): See call center directory on CMS Web site. These call centers provide general information on feedback reports; incentive payments, and claims data submitted.


FAQ

Question:
How do I log in to the “Members-only” section of the Society Web site?

Answer:
If you are a Society member and you’ve forgotten your username and password, you’ll need to reset your password. To do so, follow these simple steps:

  1. From the left menu bar, click “Log in”
  2. Click the “Request New Password” tab
  3. Enter your e-mail address
  4. Click “E-mail new password”
  5. You will receive an e-mail message from it@wismed.org
  6. Click the link in that e-mail message. (Your username is on the first line and in the subject)
  7. Click “Log in”
  8. Enter new Password (twice)
  9. Click “Submit”
To confirm the new password is working:
  1. Click “Sign Out”
  2. Click “Log in”
  3. Enter your username (NOT your e-mail address) and password
  4. Click “Log in”
If you have questions about this, e-mail communications@wismed.org.