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On July 1, 2009, CMS released the 2010 Medicare physician payment schedule proposed rule, including an announcement that the Obama Administration will change the definition of physician services under the SGR to exclude physician-administered drugs. The drug costs will be removed retroactive to the 1996/97 base year of the SGR formula, which will greatly lessen the forecast SGR cuts in future years, although there is still a 21.5% cut scheduled for 2010. This action will substantially reduce the legislative cost of congressional proposals to reform physician payments making a permanent solution to SGR disaster much more feasible.
In addition to the new practice expense data, these impacts reflect a CMS proposal to eliminate Medicare coverage for consultations and redistribute the relative values to visits, as well as changes in the methodology for professional liability insurance relative values. Other changes in the rule include revisions to the e-prescribing incentive program intended to simplify reporting requirements, and addition of measures and more measures groups for the Physician Quality Reporting Initiative (PQRI).
The rule proposes to eliminate Medicare payment for consultations and use the money from these services to increase payments for visits. CMS states that the impacts of this change should be fairly minimal since the combination of the new practice expense data, the updated PLI values, and the redistribution of the consult values means that visit payments will be pretty close to what consult payments have been in the past.
The proposed rule is available online at: http://www.federalregister.gov/inspection.aspx#special. Comments on the rule will be accepted until August 31, 2009.
Physicians are urged to contact their congressional representatives to express concerns regarding the proposed rule. You may do so either by contacting the American Medical Association's Physicians’ Grassroots Hotline at (800) 833-6354 or by contacting the West Virginia legislators as listed below.
United States House of Representatives
Alan B. Mollohan (D – 1st district)
2346 Rayburn House Office Building
Independence & S. Capitol St., S.W.
Washington, D.C. 20515
Phone: (202) 225-4172
Fax: (202) 225-7564
Web page: www.house.gov/mollohan
Health Legislative Assistant- Ryan Costello
Email – ryan.costello@mail.house.gov
Shelley Moore Capito (R-2nd district)
1431 Longworth House Office Building
Independence & New Jersey Avenues, S.E.
Washington, D.C. 20515
Phone: (202) 225-2711
Fax: (202) 225-7856
Web page: www.house.gov/capito
Legislative Director- Aaron Sporck
Email: aaron.sporck@mail.house.gov
Executive Assistant/Office Manager- Alison Bibbee
Nick J. Rahall II (D-3rd district)
2307 Rayburn House Office Building
Independence & S. Capitol St., S.W.
Washington, D.C. 20515
Phone: (202) 225-3452
Fax: (202) 225-9061
E-mail: nrahall@mail.house.gov
Web page: www.house.gov/rahall
Health Legislative Assistant- Kate Denman
Email: kate.denman@mail.house.gov
United States Senate
Robert C. Byrd (D)
Senate Hart Office Building, Room 311
2nd and C Streets, N.E.
Washington, D.C. 20510
Phone: (202) 224-3954
Fax: (202) 228-0002
E-mail: senator_byrd@byrd.senate.gov
Web page: www.senate.gov/~byrd
Health Legislative Assistant: Chris Gould
Email: chris_gould@byrd.senate.gov
Fax - 202-228-0002
John D. Rockefeller, IV (D)
Hart Building, Room 531
2nd and C Streets, N.E.
Washington, D.C. 20510
Phone: (202) 224-6472
Fax: (202) 224-7665
E-mail: senator@rockefeller.senate.gov
Web page: www.senate.gov/~rockefeller
Health Legislative Assistant: Jocelyn Moore
Email: Jocelyn_moore@rockefeller.senate.gov
Email - Sheila_kennett@rockefeller.senate.gov
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Identity theft is becoming a huge problem nationally. A recent presentation on Identity Theft by AdvanceMed highlighted how easily some people are able to defraud health care providers or Medicare and how physician offices can help prevent this fraud.
Identity theft becomes health care fraud when it involves healthcare providers or Medicare. Imposters have devised numerous ways of committing identity theft fraud, including posing as Medicare representatives or placing fraudulent ads in papers and magazine, seeking medical directors.
AdvanceMed reports that a group of unknown individuals is soliciting (and often obtaining) personal identification information from physician practices through various schemes. Once obtained, the personal information can be used to complete fraudulent Medicare provider applications for new practice locations. Once a new provider number is established, these individuals can very rapidly submit a large volume of claims to the Medicare carrier for payment.
Another means of identity fraud that is occurring more frequently in offices involves an attempt to obtain physicians’ personal ID information via fax. Imposters send faxes, complete with logo of a Medicare carrier, and request that you “re-enroll” in the Medicare program. There is a phone number (generally bogus) and a fax number given on the request form. Often, pages from the CMS 855 application will be included, in order to make the request look more legitimate. Once you complete the paperwork and fax it to the number, the imposters have your complete information, including your social security number.
If you receive a phone call, letter or fax from the Affiliated Contractor or Medicare representative (Palmetto GBA for West Virginia), confirm the identity of the source. Palmetto GBA does not generally make phone calls and will not fax requests for information. No one from Medicare should be contacting you to verify Medicare numbers since they already have this information.
If you receive what appears to be a fraudulent inquiry, or you are suspicious of a request for information, you should call Palmetto GBA’s Provider Enrollment at 1-866-308-5439. You should also call Palmetto GBA if you receive inquiries or complaints from individuals who are not your patients, particularly if these inquiries are in regard to services you supposedly performed.
Identity theft can have a devastating effect on people’s lives. We must all be diligent about safeguarding all personal information, particularly when it comes to healthcare and financial information.
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The Centers for Medicare & Medicaid Services (CMS) will host a national provider conference call on the 2009 Physician Quality Reporting Initiative (PQRI) on Thursday, August 20, 2009 from 2:30 p.m. – 4:30 p.m. EDT.
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:
• Status of the 2007 re-run and 2008 PQRI Incentive payments and feedback reports;
• How to access the 2007 re-run and 2008 PQRI feedback reports; and
• Resources to assist eligible professionals.
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, section, as well as educational products are available on the e-prescribing dedicated web page located at http://www.cms.hhs.gov/ERxIncentive. Interested participants may download the resources prior to the call in order to be able to ask questions of the CMS presenters.
You must register for the call before you receive call-in information. 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.
Registration will close at 2:30 p.m. EDT on 8/19/2009, 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, go to: http://www2.eventsvc.com/palmettogba/082009
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. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
For those who are unable to attend, a transcript of the call will be available at least one week after the call at http://www.cms.hhs.gov/pqri on the CMS website.
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This information has been supplied by the CDC.
On August 5, 2009, CDC changed its recommendation related to the amount of time people with influenza-like illness should stay away from others (the exclusion period). New guidance indicates that people with influenza-like illness should stay home for at least 24 hours after their fever is gone (without the use of fever-reducing medicine). A fever is defined as having a temperature of 100° Fahrenheit or 37.8° Celsius or greater.
This is a change from the previous recommendation that ill persons stay home for 7 days after illness onset or until 24 hours after the resolution of symptoms, whichever was longer.
The new recommendation applies to camps, schools, businesses, mass gatherings, and other community settings where the majority of people are not at increased risk for influenza complications. CDC recommends this exclusion period regardless of whether or not antiviral medications are used. This guidance does not apply to health care settings where the exclusion period continues to be for 7 days from symptom onset or until 24 hours after the resolution of symptoms, whichever is longer. (See http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm for guidance on infection control in health care settings.)
Decisions about extending the exclusion period should be made at the community level, in conjunction with local and state health officials. More stringent guidelines and longer periods of exclusion – for example, until complete resolution of all symptoms – may be considered for people returning to a setting where high numbers of high-risk people may be exposed.
This exclusion period guidance for the community setting is based on epidemiologic data about the overall risk of severe illness and death. The new recommendation attempts to balance the risks of acquiring illness from influenza and the potential benefits of decreasing transmission through the exclusion of ill persons with the goal of minimizing social disruption. This guidance will continue to be updated as more information becomes available.
To read the complete revised guidance see: http://www.cdc.gov/h1n1flu/guidance/exclusion.htm
This change in our recommendation has affected content on a number of other pages, including the following:
Visit http://www.cdc.gov/h1n1flu/guidance_homecare.htm for more information on caring for sick persons in the home.
Visit http://www.cdc.gov/h1n1flu/qa.htm questions and answers about H1N1 influenza.
For more general information on H1N1, go to http://www.cdc.gov/h1n1flu/.
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10. Give your fax machine a rest.
9. Impress the kids with your use of e-mail.
8. Save trees and "go green:'
7. Increase your personal comfort with technology.
6. Get information in a quick-read, timesaving format.
5. Share news with staff just by clicking "Forward".
4. Help the WVSMA maximize your dues dollars.
3. Know what your colleagues know at the same time they know it.
2. Protect your patients with access to immediate updates from the CDC and other healthcare bulletins.
AND the TOP reason to ensure the WVSMA has your e-mail address:
1. Learn news of importance to physicians as soon it is available.
To make sure you, like your colleagues, are getting e-mail news and bulletins of importance to West Virginia physicians, send an e-mail message to mona@wvsma.com. If your e-mail has changed -or whenever it changes -make sure you send your new address to the WVSMA.
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Many offices have questioned the requirement for billing a secondary insurance for a patient. This issue is generally addressed in either your contract with the payor or in the payor’s provider manual.
The general rule is that if you are a contracted provider with a payor, you must bill the insurance, regardless as to whether it is the primary or secondary payor. It all depends on your contract and your contract status.
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Connolly Consulting and the WVSMA are partnering to ensure that our physicians receive any new information about the RAC in an expeditious manner. Connolly has committed to notifying the WVSMA prior to any new initiatives with the RAC program. As of this date, Connolly has not yet initiated the RAC program in West Virginia. We will keep you informed and updated on changes or additions to the RAC program.
For more information about the RAC, please visit the CMS and Connolly websites,
www.cms.hhs.gov/RAC and www.connollyhealthcare.com/RAC
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On July 13, 2009, Aetna Inc. announced that the U. S. Department of Defense had awarded the TRICARE managed care support contract for the North Region to their company. Under the five-year administrative services contract, Aetna Government Health Plans will support health care delivery to approximately 2.8 million eligible beneficiaries who are active duty service members, retirees and family members based in the 21 states of TRICARE’s North Region.
Later in the month, Health Net Inc. filed a protest over the decision made by the Department of Defense to not renew its TRICARE contract for the North Region. In an earlier protest, the health insurer alleged that Aetna Inc., which was awarded the contract, had an unfair advantage in the bidding process because the Department of Defense posted Health Net’s pricing on the Internet. The new five-year contract is slated to begin on April 1, 2010.
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The West Virginia Medical Group Managers Association will hold its 2009 Fall Conference on Thursday and Friday, September 17th and 18th, at the Stonewall Jackson Resort in Roanoke, West Virginia. An exciting agenda has been planned for the conference. This is a great time to learn about the latest changes in healthcare. Attendees also are able to obtain new tools and resources to better manage their medical groups.
For more information about the WVMGMA membership and the conference, you may contact Diana Williamson, WVMGMA President (diana@wvneuro.com).
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The 2009 West Virginia Office Managers Association State Conference will be held on Thursday, October 22 and Friday, October 23 at the Pullman Plaza in Huntington, West Virginia. This conference is always a great educational opportunity for office managers. Not only are the sessions jam packed with outstanding speakers, but the networking opportunities are abundant. Managers are able to share experiences and assistance with others who may be experiencing the same issues. This is also a good place for new managers to form mentoring relationships with more seasoned managers.
Physicians and their practices can benefit greatly from the knowledge and practical information that their office managers gain at a conference such as the OMA meeting.
For additional information, please contact Toni Charlton, OMA President (Antoinette.Charlton@sw-rmc.com) or your local chapter of the OMA.
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August 14, 2009
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