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The West Virginia State Medical Association has scheduled a Physician Practice Management Conference for Thursday, May 14th, 2009, at the Charleston Marriott Hotel in Charleston, WV. The day long seminar will feature information on how to increase physician reimbursements, improve office personnel management, and obtain free tamper resistant prescription pads and/or paper. The afternoon session will feature a special Government Payors Workshop which will feature speakers from Medicaid, PEIA and Medicare. In addition to listening to presentations by speakers, attendees will be able to meet with officials from each payor and receive the most up to date information on policies and procedures regarding enrollment, billing, medical utilization and payment.
The WVSMA has secured a block of discounted rooms at the Marriott. For reservations, you may call 800-228-9290. For internet reservations, use code SMASMAA. The cutoff date for rooms is April 22, 2009.
The conference has been approved for 6 hours CME.
If you’ve attended a conference in the past, you know that it is an event that you don’t want to miss. Mark your calendars now and plan to attend this conference!
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If you’ve not yet ordered your free tamper resistant prescription pads or laser paper, you should do so now while there are still grant funds available. An order form is available online at the WVSMA website, www.wvsma.com or by contacting the WVSMA office.
If you have questions about the order form, you should contact Standard Register’s toll free prescription line (1-866-741-8488). If you have other questions about this grant program, please contact Barbara Good, WVSMA Physician Practice Advocate and Tamper Resistant Prescription Pad Project Manager, at (304) 925-0342, ext. 11, or via email (Barbara@wvsma.com).
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As of February 9, 2009, the parties involved in the protest of the Recovery Audit Contractor (RAC) contracts settled the protest, ending the stop work order. CMS will now continue implementation of the RAC program. Under the program, the RACs will contract with subcontractors to supplement their efforts.
The RAC for West Virginia (in Region C) is Connolly Consulting, Inc. VIant Payment Systems, Inc. will serve as a subcontractor to Connolly Consulting. Each subcontractor has negotiated different responsibilities in each region, including some claim review.
The RAC demonstration program has proven to be successful in returning dollars to the Medicare Trust Funds. They also identify monies that need to be returned to physicians and other providers.
If a physician receives a letter from a RAC that requests overpayments and believes it is incorrect, he/she may appeal. Physicians should first call within 15 days of the receipt date to discuss the overpayment and send any evidence to counter an offset. It is important to note that calling the RAC does not constitute a formal appeal.
If a physician continues to believe the request for overpayment is unjustified, he/she must file an appeal. If this is done within 30 days of receipt of the overpayment letter, he/she will avoid a Medicare recoupment action. Interest begins to accrue 31 days from the receipt of the overpayment letter regardless of whether or not an appeal is filed. No interest accrues if repayment is made within 30 days.
There are five levels of appeals, beginning with a “redetermination” first level appeal and ending at the fifth level with a Federal District Court review. The maximum time to file an initial appeal is 120 days.
Finally, if the appeal is upheld and making a repayment in full will cause a hardship to the physician, you should ask the RAC if you qualify for an extended repayment plan. Interest is waived if an overpayment has been returned within 30 days of the final determination.
For more information on the Limitation on Recoupment provision, go to:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6183.pdf.
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The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2009 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 2:30 p.m. – 4:30 p.m., EDT, on Wednesday, April 22, 2009.
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, but only authorized incentive payments through 2010. Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period. The 2009 PQRI consists of 153 quality measures and 7 measures groups.
The topics covered on this national provider call will include:
• An update on the prostate cancer measures-2008: Measure #101; 2008-2009: Measure #102, #104, and #105;
• Tips for satisfactorily participating in the 2009 PQRI; and
• Planning for the 2010 PQRI reporting options.
Following this presentation, the lines will be opened to allow participants to ask questions of CMS PQRI subject matter experts.
Educational products are available on the PQRI dedicated web page located at, http://www.cms.hhs.gov/PQRI , on the CMS website, in the Educational Resources section. Feel free to download the resources prior to the call so that you may ask questions of the CMS presenters.
Conference call details:
Date: April 22, 2009
Conference Title: 2009 Physician Quality Reporting Initiative - National Provider Call
Time: 2:30 p.m. EDT
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.
Registration will close at 2:30 p.m. EDT on April 21, 2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
1. To register for the call, participants need to go to: http://www2.eventsvc.com/palmettogba/042209
2. Fill in all required data.
3. Verify your time zone is displayed correctly the drop down box.
4. Click "Register".
5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails.
For those who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 3:30 p.m. EDT 4/22/2009 until 11:59 p.m. EDT 4/29/2009. The call in data for the replay is (800) 642-1687 and the passcode is 90578004.
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Federal drug officials have announced that many doctors may lose their ability to prescribe 24 popular narcotics as part of a new effort to reduce the deaths and injuries that result from the inappropriate use of these medicines.
A new control program will result in further restrictions on the prescribing, dispensing and distribution of Schedule II narcotics, including extended-release opioids like OxyContin, fentanyl patches, methadone tablets and some morphine tablets.
Hundreds of patients die and thousands are injured every year in the United States because they were inappropriately prescribed drugs like OxyContin or Duragesic or they took the medicines when they should not have or in ways that made the drugs dangerous. Although the agency has issued increasingly urgent warnings about the risks, the problem has worsened in recent years.
The blame for this is shared among doctors who prescribe poorly, patients who pay little attention to instructions or get access to the medicines inappropriately, and companies that have marketed their products illegally.
This year, the F.D.A. will hold meetings with manufacturers, patient and consumer advocates, and the public to ask for advice on how to carry out the new control program, officials announced.
The 24 medicines under review had 21 million prescriptions written for them in 2007, to 3.7 million patients. They are extremely effective in reducing pain, which many medical studies suggest is widely undertreated in patients suffering serious illness. (A complete list of the drugs may be found at www.fda.gov/cder.)
But many doctors prescribe the drugs far too cavalierly, say F.D.A. authorities. The F.D.A. has received reports of patients’ being prescribed such medicines to treat something as simple as a sprained ankle, he said. In such patients, the medicines can be dangerous.
Part of the problem is marketing. Several reports, for instance, have suggested that Purdue Pharma, the maker of OxyContin, helped fuel widespread abuse of the drug by aggressively promoting it. The company has denied such a connection, but a holding company connected with Purdue and three top Purdue executives pleaded guilty last year to criminal charges that the company had misled doctors and patients by claiming for five years that OxyContin was less prone to abuse because it was a long-acting narcotic.
A common reason for disciplinary actions at state medical boards is the use of narcotics in patients who show clear signs of addiction or for whom the drugs are obviously inappropriate.
Most of the drugs withdrawn over the last 20 years, however, were taken off the market because doctors continued to use the medicines in ways that the F.D.A. warned against.
The F.D.A. generally avoids interfering with the practice of medicine because doctor behavior is governed by state medical boards. Instead, the agency usually tries to provide doctors with the best and most current information, and then allows them to decide how to use it.
A law passed in 2007 has given the agency a new, intermediate weapon — Risk Evaluation and Mitigation Strategies. Known as REMS. These programs allow the F.D.A. to place strong restrictions on the distribution of certain drugs.
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To better accommodate physicians’ needs in the fast-changing world of health-care news, the American Medical Association’s (AMA) physician-focused newspaper, American Medical News, is expanding its online presence and capabilities. The print version of American Medical News is moving to a twice-a-month publishing schedule and will continue to provide in-depth coverage and practical advice for physician readers. The full content of the print edition will continue to be presented on www.amednews.com, which will also present fresh reporting and features every weekday throughout the year.
American Medical News’ convenient and easily accessible online news and resources can better help physicians with their day-to-day needs,” said AMA Board Chair Joseph M. Heyman, M.D. “The Web site contains tables, charts and useful links not found in the print edition, as well as multimedia presentations and a variety of digital conveniences. American Medical News will also offer greater access to a rich archive of practical advice on running a modern medical practice.”
To stay informed on the latest health care and health policy news at the click of a button, readers can sign up at www.amednews.com to receive email news alerts and RSS Feeds. American Medical News addresses issues that impact physicians on a daily basis, helping them to fully understand the trends and forces shaping a complex, ever-changing medical environment. Topics covered include national health policy issues and legislation, health care litigation, practice management concerns and health information technology.
As a leader in timely news for physicians, American Medical News remains committed to bringing its readers the award-winning, editorially balanced reporting on health-care news, along with the resources and tools they rely on. Features will be added and updated on an ongoing basis to help physicians with their evolving practice management and daily needs.
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The American Medical Association (AMA) has announced that it has filed a class action suit against WellPoint, Inc., the largest health insurer in the United States. The lawsuit is an expansion of the AMA’s ongoing effort to expose and prohibit insurer schemes that shift medical costs to physicians and patients.
The AMA filed the lawsuit on March 25, 2009, in Los Angeles federal court. The suit alleges that WellPoint colluded with others to underpay physicians for out-of-network medical services, resulting in patients paying an excessive portion of the medical bill.
“Physicians will not tolerate an apparent conspiracy that allows health insurers to play by their own rules without regard to patients, or the legitimate costs required to care for them,” said AMA President Nancy H. Nielsen, M.D.
The three AMA lawsuits claim that each insurance company conspired with Ingenix, a unit of United Health Group, on a price fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care. A year-long investigation by the New York attorney general confirmed that the Ingenix database is intentionally rigged to allow insurers to shortchange reimbursements.
“The AMA’s work to remove the cloak of secrecy from the Ingenix database promises to benefit patients and physicians by reforming the corrupt system for paying out-of-network medical bills,” said AMA President Nancy H. Nielsen, M.D. “Now that the underlying scheme has been exposed, health insurers are doing the right thing by cutting their ties with the flawed Ingenix database. However, serious damages resulting from prior use of the Ingenix database still need to be addressed.”
In addition to seeking reforms for the invalid payment systems used by Aetna, CIGNA and WellPoint, the AMA and partnered medical societies also seek relief for physicians who were seriously harmed by the insurers’ long-term use of the flawed Ingenix database.
The Litigation Center of the AMA and State Medical Societies is supporting the WellPoint lawsuit in partnership with the California Medical Association, Connecticut State Medical Society, Medical Association of Georgia and North Carolina Medical Society.
To view the individual legal complaints filed against Aetna, CIGNA or WellPoint, please visit the AMA Litigation Center website, http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.shtml
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The American Medical Association (AMA) and several state medical
associations, including the Medical Society of New Jersey, have joined with individual physicians in filing separate class-action lawsuits against Aetna Health, Inc. and CIGNA Corporation claiming the companies used rigged data to dramatically under-reimburse physicians.
The two lawsuits, filed on February 1, 2009, in New Jersey federal court, contend that for more than a decade the two health insurance companies used a corrupt system to underpay physicians for out-of-network medical services and forced patients to pay an excessive portion of the costs.
“We can no longer ignore the improper business practices of health insurers who decide to play by their own rules without regard to patients, or the legitimate costs required to care for them,” said AMA President Nancy H. Nielsen, M.D.
The complaints charge Aetna and CIGNA with relying on skewed data provided by UnitedHealth Group subsidiary Ingenix to set reimbursement rates for out-of-network care. Evidence from a recent investigation launched by New York Attorney General Andrew Cuomo found that the Ingenix data is intentionally manipulated to allow health plans to scam physicians by shortchanging reimbursements on medical bills.
“Through our lawsuits, the AMA and our partner medical societies seek to reform the payment systems used by Aetna and CIGNA by ending their dependence on the Ingenix database,” said Dr. Nielsen. “The lawsuits also seek relief for physicians who were seriously harmed by Aetna and CIGNA through the insurers’ long-term use of the flawed Ingenix database.”
The Litigation Center of the AMA and State Medical Societies is supporting the lawsuits in partnership with the Connecticut State Medical Society, Medical Society of New Jersey, Medical Society of the State of New York, North Carolina Medical Society and Texas Medical Association.
Please visit the AMA litigation website, http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.shtml to view the complaints filed against Aetna and CIGNA.
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Jane Marks, Executive Director for the WV Alzheimer’s Association, has provided the following information about new tools which are available for physicians who are treating Alzheimer’s patients.
Principles for a Dignified Diagnosis
The Alzheimer’s Association’s new, innovative Principles for a Dignified Diagnosis contains insights from people living with Alzheimer’s on how to improve the diagnosis experience. It evolved from the rich dialogue at Association Town Hall Meetings that identified diagnostic challenges and dissatisfying interactions with the medical community.
Dr. Steve Hume, a member of the Association’s Early Stage Advisory Group and a co-author of Principles for a Dignified Diagnosis, was diagnosed with younger-onset Alzheimer’s disease in May 2007 at the age of 61. Dr. Hume was a clinician, consultant and senior manager in the behavioral health field, but despite his professional health background, he struggled to secure a complete diagnosis. In fact, the first neurologist he visited told him he’d be fine if he just lost weight.
“The face of Alzheimer’s has changed in recent years, and Principles for a Dignified Diagnosis adds a voice to that face,” said Dr. Hume. “It is important that we not only tell clinicians we want a dignified diagnosis but also teach them what that means. There is a lot we can learn from each other.”
The Association has received welcome support from the American Medical Association (AMA) for this initiative. “Patients with Alzheimer’s disease face many challenges as they strive to maintain a normal life, and physicians are committed to helping ease the burden with high quality health care,” said AMA President Nancy Nielsen, M.D. “The AMA applauds the Alzheimer’s Association for bringing forward the patients’ perspective on compassionate care, as Alzheimer’s patients, their families and their physicians battle the disease together.”
This new tool and many other tools to assist physicians are available by calling our Chapter office at 1.800.491.2717 or by visiting our website at www.alz.org/wv. |
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March 31, 2009
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