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Medigram - September 4, 2008


NEWS

FEATURES



NEWS BRIEFS

Reminder: Tamper-resistant prescription requirement effective October 1

Effective October 1, federal law requires that prescriptions for patients covered by Medicaid and BadgerCare Plus that are not telephoned, faxed or electronically transferred to a pharmacy must include three tamper-resistant features. To be considered tamper-resistant, each of the following is required:
  • One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form.
  • One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber.
  • One or more industry-recognized features designed to prevent the use of counterfeit prescription forms.
This requirement follows enactment of legislation April 1 requiring that prescriptions comply with one of the above-listed criteria rather than all three. (See Medigram from March 13 for more information.)

To assist physicians with implementation of this mandate, the Wisconsin Department of Health Services (DHS) is offering a limited supply of free tamper-resistant prescription pads and computer paper to Medicaid-certified prescribers, available on a limited basis until the end of 2008. (Health care professionals are not required to use state-supplied prescription pads to be compliant with the new requirement.)

For more information visit the DHS Web site or contact Jeremy Levin.


CMS to host national e-prescribing conference next month

The Centers for Medicare and Medicaid Services (CMS), along with industry partners from health and technology, is hosting a national e-prescribing conference October 6-7 at the Sheraton Boston Hotel in Boston, Mass. The conference is meant to educate professionals and beneficiary constituencies on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) e-prescribing program and help promote the adoption of e-prescribing throughout the health care community. Wisconsin Medical Society staff will be tracking this e-prescribing initiative and assisting our members in understanding its impact on their practice.

At the conference, attendees will learn how to earn incentives from Medicare; learn how e-prescribing can work for your practice; and get answers to questions about privacy, security and risk management. The conference is free, but space is limited. Click here to learn more.


Wisconsin physicians invited to ‘Reading Retreat in the Medical Humanities’

The Iowa Medical Society is hosting a “Reading Retreat in the Medical Humanities” October 3-5 and has invited interested Wisconsin Medical Society members to participate in the weekend seminar at a reduced member rate. Participants receive a packet of materials to read through in advance, which includes passages from literature, essays, or other writings about medicine and healing. During the retreat, participants discuss the materials similar to a book club. Spouses are invited to register as well. (Click here to access a pdf of the retreat brochure.)

For more information including access to an on-line registration form, click here.

QUALITY & EFFICIENCY

Physician feedback sought as WHIO finalizes Data Use Guidelines

The Wisconsin Health Information Organization (WHIO) Board of Directors will be holding its next meeting Friday, September 19. Topics on the agenda for this critical meeting include discussion and possibly finalization of Data Use Guidelines and the First Quarter 2009 Study Period. As illustrated in this recent article from the Milwaukee Journal Sentinel, there is increasing demand to rate physicians on quality and cost efficiency and WHIO’s Data Mart is expected to impact these efforts.

To learn more WHIO, click here to read a series of articles from previous issues of Medigram. Society members are urged to direct any questions, concerns or positions you have regarding WHIO and the use of administrative claims data to define quality and cost-efficiency in health care to qande@wismed.org. We will aggregate this feedback to represent the voice of physicians at this and future WHIO meetings.

CAPITOL INSIDER

Primary elections Tuesday

The Fall primary election will be held Tuesday, September 9 and will finalize the ballot for the November partisan elections. Below is a quick summary of the upcoming races:

Congressional seats
In one primary of note, long-time Republican incumbent Rep. James Sensenbrenner of the 5th Congressional District is being challenged by Jim Burkee (R-Cedarburg), a professor at Concordia University. The district is considered Republican, and the winner will not face a general election opponent. Another primary of note is the Democratic primary in the 1st Congressional District, where three Democrats are vying for the right to challenge five-term incumbent Paul Ryan (R-Janesville). Click here for a local news summary of the Democratic primary.

State Senate and Assembly
Primaries are being held across the state. (For a list by district click here.) Republicans currently control the Assembly 52-47, and this close margin will mean even more contested primaries. All seats are technically up in November, and a few incumbents do not face a general election opponent. Eleven of the Assembly seats will have new representation due to retirements and other vacancies; six of those seats are currently under GOP control. The State Senate is under Democratic control by an 18-15 margin. About half of the chamber’s 33 seats are up this November, but because there are no contested primaries the November ballot has already been set.

Get Involved!
It is critical that physicians get involved in the political process, including joining the Wisconsin Medical Society’s political giving efforts. Through WISMedPAC and WISMedDirect, physicians can make the most of their political donations and take an active role in the state political process and the future of health care in Wisconsin.

Because a crucial new state budget cycle begins in 2009 and the candidates elected this November will have a tremendous impact on that budget and what it means for medicine in Wisconsin, your involvement is more important than ever. To join WISMedPAC, contact Jeremy Levin, Beth Alvin or Mark Grapentine, JD.

EDUCATIONAL PROGRAMS

You still have 1 day to save $80–don’t wait!

The 9th Annual Midwest Coding and Practice Management Symposium is only two weeks away and this year’s event is packed full of informational sessions you don’t want to miss. E/M coding represents approximately 80 percent of primary care services billed. Join Christine Wahmhoff, MD, as she discusses, “History, Exam, Medical Decision Making... Where Should You Begin?” This session will offer a different approach to breaking down the elements of E/M codes and will provide the much sought after physician perspective.

Additionally, Jeannie Cagle of the Coker Group will teach attendees how to “Audit for Compliance.” This hands-on session is geared toward the intermediate to advanced coder and will highlight how to effectively assess risk, perform a successful audit and best practices for packaging the results.

You also won’t want to miss “Federal Government Investigations, Are You on the Radar?” Join Mark Cameli, Esq. and David Frank, Esq. of Reinhart, Boerner Van Deuren, S.C. as they share strategies for minimizing compliance-related risks to your practice. This session will include information on current law enforcement initiatives and what to do if in fact you find yourself on the radar.

For more information on all of the break-out sessions at this year’s Symposium along with the full Symposium agenda and registration information, click here.

QUALITY CORNER

2008 PQRI national provider conference call with Q&A Session

The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the seventh in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 2:30–4 p.m., Thursday, September 18.

The call will focus on registry reporting for 2008; information on the E-prescribing measure for 2008 PQRI (measure #125) and proposed measures for 2009 PQRI; incentives for electronic prescribing; 2007 PQRI feedback reports and incentive payments, and will include a question and answer session.

To register, click here. Although the call is free, you must register for the call by 2:30 p.m. September 17 to receive call-in information. Additionally, a PowerPoint slide presentation will be posted here to download prior to the call so that participants can follow along with the presenters, Michael Rapp, MD, and Daniel Green, MD.

FAQ

Question:
A physician I work with admitted a patient to observation status on August 31, but did not physically see the patient until September 1 and the patient was ultimately discharged the same day. Should I report CPT 99234-92236 (same day admit/discharge) for this service?

Answer:
CPT guidelines are different from Medicare’s for this situation, so it will most likely depend on the payer. The June 2002 CPT Assistant states, “Codes 99234-99236, Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, may be reported only when the patient is actually admitted and discharged on the same date of service. The physician should not report these codes when the patient is admitted one day and discharged the next day. In this case, the patient is in the hospital for two dates of service, so the physician should report the discharge services performed on the second day of admission, which is also the date of discharge.”

Medicare guidelines clearly state they do not pay for nursing observation and outline the following documentation requirements. Medicare requires documentation identifying that:

  • the billing physician was present and personally performed the services
  • the admission and discharge notes were written by the billing physician.

In this scenario, it should be clear that the patient was not just receiving nursing observation and the physician was personally observing the patient. For coding purposes, there would be no billable services for August 31 and a code from the initial observation services, CPT 99218-99220 would be reported for September 1. No discharge would be billed in this scenario. Since payment is based on the work of the physician actually performing the observation services, the face-to-face visit must occur in order for a service to be billed.

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