Medigram - September 25, 2008 | Wisconsin Medical Society

NEWS BRIEFS

New fact sheets available regarding reporting Medicare enrollment information changes

The Centers for Medicare & Medicaid Services (CMS) has posted three new Fact Sheets on its Medicare Provider Enrollment page.

The Fact Sheets list the types of changes that enrolled physicians, non-physician practitioners and group practices are required to report to Medicare and indicate the Medicare provider enrollment forms that must be used to report the changes. Not reporting changes may adversely affect claims processing, claims payment amounts and the eligibility of the physician, non-physician practitioner or group practice to participate in Medicare. The Fact Sheets also include information on where to go for assistance. You can view the Fact Sheets by enrollment type by clicking on the links below.

National Adult Immunization Awareness Week underway

This week, September 21-27, is National Adult Immunization Awareness Week. Held annually to promote the importance of adult and adolescent immunizations, the observance is spearheaded by the National Foundation for Infectious Diseases.

Each year, about 50,000 Americans, mostly adults, die from vaccine-preventable diseases or complications. Health care professionals are encouraged to talk to their patients about their risk for these diseases and steps they can take to help reduce those risks, including getting influenza, pneumococcal, and hepatitis B vaccines. Health care workers are also reminded to protect themselves.

For information about National Adult Immunization Awareness Week, please visit the National Foundation for Infectious Diseases at www.nfid.org/, or click here to download a toolkit that includes immunization schedules and fact sheets.

For information about Medicare’s coverage of adult immunizations and a list of related educational resources, click here to access CMS’s Medicare Learning Network Preventive Services Educational Products Web page.

Resolution deadline for 2009 Wisconsin Medical Society Annual Meeting

Editor's Note: Revised September 26

Actions or changes to Wisconsin Medical Society policy or organization are considered by the House of Delegates (HOD) during every annual meeting. Resolutions for action must be submitted in proper form by Monday, February 17, 2009, for consideration at the 2009 Annual Meeting, which begins Friday, April 17, 2009, at the Monona Terrace Convention Center in Madison.

Although the February deadline is months away, the Society would also like to remind members that issues/resolutions can be submitted for consideration year round. For time sensitive issues, this may be a better avenue. Please use the Member Communication Form which available on the Society Web site.

Also, if desired, assistance will be provided to develop a resolution that reflects a policy change you are possibly seeking. Ideas presented via the Member Communication Form can be referred to the Board of Directors, a specific Council or the HOD for further study and/or recommendations.

Click here to read more.

CMS releases revised guidelines for teaching future physicians

The revised Guidelines for Teaching Physicians, Interns, and Residents (July 2008) is now available for download from the Centers for Medicare & Medicaid Services Medicare Learning Network. These guidelines provide information about payment for physician services in teaching settings, general documentation guidelines, and evaluation and management documentation guidelines.

QUALITY & EFFICIENCY

McGlynn focuses on cost and performance measures at Efficiency Symposium

Elizabeth McGlynn, PhD, spoke about key considerations involving health care cost and performance measurement to nearly 100 attendees of last week’s “Efficiency Symposium: Methods, Measures and Policy Impact,” which was jointly sponsored by the Wisconsin Medical Society and the Wisconsin Collaborative for Healthcare Quality. Dr McGlynn is an associate director for RAND Health and holds its Distinguished Chair in Health Care Quality. She is currently leading the COMPARE initiative, which is developing a comprehensive method for evaluating options to improve the performance of the United States health care system.

Click here to read more about her presentation and to access last week’s article about speaker Mark Rattray, MD’s, presentation.

CAPITOL INSIDER

Congress close to passing mental health parity law

Ending discrimination for coverage of mental illness is close to becoming a federal law following federal legislative action Tuesday. Acting on two separate bills, both the House and Senate overwhelmingly approved provisions that would require private insurers to match mental health coverage with current coverage for physical illness.

The separate bills—the Renewable Energy and Job Creation Act of 2008 (H.R. 6049) and the Mental Health Parity and Addiction Equity Act (H.R. 6983)—have broad bipartisan support, evidenced by the lopsided votes: 376-47 in the House and 93-2 in the Senate. All 10 members of the Wisconsin Congressional delegation voted for passage; Wisconsin Medical Society President Steven Bergin, MD, faxed a letter of appreciation to each Wisconsin member.

That letter also points out that there is still critical work to be done: while each house approved separate bills, including parity provisions, the House and Senate must agree on a single bill in order for the language to get to the President’s desk for final approval. As this Washington Post story points out, getting anything through the Senate is a difficult task at this time. Therefore, it would be helpful if physicians across Wisconsin would follow Dr. Bergin’s lead and contact our members of Congress, urging them to not waste this opportunity. For a list of Congressional contacts, click here.

For more information, contact Mark Grapentine.

EDUCATIONAL PROGRAMS

Be prepared for Medicare in 2009 and Stark Law changes

Congress overrode a Presidential veto in July in favor of enacting the Medicare Improvements for Patient and Providers Act (H.R. 6331). This law supersedes the proposed physician fee schedule payment cuts for 2009 and instead provides for a 1.1 percent increase. This law also extends the Physician Quality Reporting Initiative (PQRI) reporting for two years and continues to provide a bonus payment for reporting, introduces financial incentives tied directly to e-prescribing, expands coverage of the “Welcome to Medicare” physical, provides an increase in payment for certain mental health services and more.

All of these changes, together with the Physician Fee Schedule proposed rule changes, will be discussed in a half-day seminar presented by the Wisconsin Medical Society in partnership with WPS Medicare Part B. Additional topics will include policy and coding changes related to Part B services and an update on National Provider Identifier implementation. Click here to learn more.

Another half-day session, which is being held in conjunction with the Medicare 2009 seminar, will focus on the many changes related to the Stark law, which go into effect October 1, 2008. Presented by the Health Law Group of Quarles and Brady, this seminar is a must-attend for physicians, compliance staff and group managers. Topics will include per click and percentage-based space and equipment leases, the final anti-markup rule, “stand in the shoes” rules and much more. Click here for more information about the seminar. To learn more about some of those changes, click here to read a column by Quarles and Brady’s Alyce Katayama, JD, one of the speakers for this seminar. The article was published in the latest issue of the Wisconsin Medical Journal.

QUALITY CORNER

eHealth initiative survey links health IT to lower costs and improved outcomes

The exchange of health information electronically between physicians, hospitals, health plans and patients is decreasing the cost of care and improving outcomes, according to a new survey recently released by the non-profit eHealth Initiative. The 2008 Fifth Annual Survey of Health Information Exchange at the State and Local Levels, which included responses from 130 community-based initiatives in 48 states, shows the significant impact fully operational initiatives are having on improving health care delivery and efficiency. To read the report, click here.

FAQ

Question:
The Screening Pelvic Examination service code has 11 elements of which seven have to be met. Does the service code (G0101) require the provider to perform the inspection and palpation of breasts as one of the seven required elements or can any combination of the 11 be performed to meet the required seven to bill G0101?

Answer:
The Centers for Medicaid & Medicare Transmittal 1541 released in June answers this question. Any combination of the 11 can be performed to meet the required seven to bill G0101. As provided in section 210.2 of the NCD manual, a screening pelvic exam should include seven of the 11 elements listed in the manual section. That is, the screening pelvic exam does not need to include the clinical breast examination to be considered a covered and reimbursable screening pelvic exam as long as seven of the remaining 10 elements are performed for the Medicare beneficiary.

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.