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Medicare Physician Access Crisis---Congress Must Act Now!
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(Information supplied by the AMA)
On June 24, 2010, Congress passed a six-month Medicare patch providing a 2.2 percent positive update and a temporary reprieve for seniors and the physicians who care for them. In December, without action by Congress, the Medicare physician payment cut will be a whopping 23 percent, increasing to nearly 30 percent in January 2011.
With baby boomers beginning to enter into Medicare in just six months, the physician payment problem must be addressed or these new Medicare patients won’t be able to find a doctor to treat them. Congress must act to replace the broken physician payment system before the cost to fix it grows even larger.
West Virginia seniors may soon face significant challenges obtaining access to physicians.These challenges will get much worse unless Congress acts very soon to prevent steep cuts in Medicare payment rates. With just 12 practicing physicians per 1,000 Medicare beneficiaries, West Virginia ranks 49th in the country and is far below the national average. Nearly one in ten West Virginia residents is living in a primary care shortage area, and 33 percent of the state’s Medicare beneficiaries are living below 150 percent of the federal poverty level. With 652 emergency department visits per 1,000 population, West Virginia also has one of the highest rates of emergency room use of any state.
Combining cuts that will occur on Dec. 1, 2010 and Jan. 1, 2011, West Virginia Medicare physician services face an across-the-board pay cut of nearly 30 percent, due to a flawed payment formula, the Sustainable Growth Rate (SGR), created by Congress.
By taking quick action during its lame duck session in November, Congress can avert these cuts. During the 13 months from Dec. 1, 2010 through Dec. 31, 2011, SGR legislation would prevent a loss of $140 million for the care of elderly and disabled patients in West Virginia.
19,183 employees of medical practices, 379,457 Medicare patients and 37,554 Tricare patients in West Virginia will be helped by the legislation that averts these cuts.
Compared to the rest of the country, West Virginia, at 21 percent, has the highest proportion of Medicare patients in the country.
45 percent of West Virginia’s practicing physicians are over 50, an age at which surveys have shown many physicians consider reducing their patient care activities.
What can you do?
Physicians have several means of expressing their concerns over this potential crisis. When the WVSMA sends out email alerts urging you to contact our congressional representation, please participate. Every call or email counts!
You may also go ahead and call your members of Congress at (800) 833-6354 to demand they fix the problem once and for all.
Remember----we’re all in this together!
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Save the Date for a Special Conference!
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The WVSMA has scheduled a special conference for prescribers and practice managers on Thursday, December 2, 2010, at the Embassy Suites in Charleston. The conference, entitled “Prescribing in a World of Drug Diversion and Substance Abuse: Dealing with Key Issues Affecting Your Patient” will feature a variety of sessions presented by guest clinicians. The conference is designed to enable physicians of all specialties to be more knowledgeable about the substance abuse crisis in our state. CME credit will be available.
More information will be coming soon via email, on the WVSMA website and in the West Virginia Medical Journal. Mark your calendar now!
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Special Pricing Arrangment for Coding Bookx
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The WVSMA has made arrangements with Contexo Media for special pricing on coding books (both general and specific), practice management handbooks, software and data files, Medicare billing, compliance and other books. To receive the special pricing, please see the WVSMA website for available products and the Contexo contact, Cody Erickson. |
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Confusion About Copays
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We’ve had some calls from physician offices about patients complaining to them that they shouldn’t have a copay/coinsurance, etc. due on preventive medicine visits. Apparently, there was a piece on MSNBC that patients saw, which stated that there were to be no more copays for preventive services. This is only partially correct. Per the government website, that only applies to certain plans. Here is the information posted on the healthcare reform website:
http://www.healthcare.gov/law/provisions/preventive/index.html
The advice from the WVSMA and AMA has been to verify benefits online when possible and if the health plan website is still showing a copay, the patient will have to address the issue directly with his/her plan.
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Mountain State Blue Cross Blue Shield Update
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Mountain State’s Charleston Provider Training Session will be held on Tuesday, October 19, 2010 at the Charleston House Holiday Inn. Registration is scheduled from 7:30 AM-8:00 AM. You may also register online at www.msbcbs.com. This will be the last of the plan's 2010 statewide provider training sessions.
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Palmetto GBA News
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Ask the Contractor Teleconferences and Webinars
Palmetto GBA will host “Ask the Contractor Teleconferences” (ACTs) and webinars on various topics throughout the year. Mark your calendars now so that you don’t miss a chance to learn valuable information about how Medicare guidelines affect your practice!
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8A5KMZ0673?opendocument
Part B Redetermination Requests Can Be Accepted Via Fax: Ohio & West Virginia
Effective October 1, 2010, Palmetto GBA will begin accepting Part B redetermination requests via fax. No special preparation is necessary for redetermination requests submitted this way. The redetermination form can serve as the fax cover sheet. All current required elements remain in effect for any requests sent via fax.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8A5LS21446?opendocument
PQRI Update
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that incentive payments for the 2009 Electronic Prescribing (eRx) Incentive Program are being made to eligible professionals who met the criteria for successful reporting. The 2009 eRx incentive payments are currently being processed and distributed by Carriers and Medicare Administrative Contractors (MACs). Distribution of the 2009 eRx incentive payments are scheduled to be completed by October 22, 2010.
Special Open Door Forum: Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (eRx) Incentive Program Updates
The Centers for Medicare & Medicaid Services (CMS) will host a special open door forum on the 2010 PQRI and Electronic Prescribing eRx Incentive Program updates on October 19, 2010 from 2 p.m. to 3 p.m. EDT. During this special open door forum, CMS will discuss: 2009 PQRI and eRx Incentive Program payment distribution and provide instructions for understanding these payments; an overview of the 2009 Feedback Report user guides for PQRI and the eRx Incentive Program; changes to the electronic remittance advice for eligible professionals receiving PQRI and eRx incentive payments in 2010; and participation in the 2010 eRX Incentive Program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~89ZJ6G5867?opendocument
E-prescribing incentives earned by individual participating physicians and other eligible professionals are paid as a lump-sum to the Taxpayer Identification Number (TIN) under which the EP’s claims were submitted. It is then up to the physicians with the TIN to decide how to distribute the incentive within the practice.
EHR: 33 New Products Certified
The Certification Commission for Health Information Technology (CCHIT®) recently announced that it has tested and certified 33 Electronic Health Record (EHR) products under the Commission’s ONC-ATCB program, which certifies that the EHRs are capable of meeting the 2011/2012 criteria supporting Stage 1 meaningful use as approved by the Secretary of Health and Human Services (HHS). Certification is required to qualify eligible providers and hospitals for funding under the American Recovery and Reinvestment Act (ARRA). The certifications include 19 Complete EHRs, which meet all of the 2011/2012 criteria for either eligible provider or hospital technology, and 14 EHR Modules, which meet one or more – but not all – of the criteria.
To learn more about the EHR certifications, see http://www.cchit.org/media/news/2010/10/commission-announces-first-onc-atcb-20112012-certifications
2010 Reminder for Roster Billing and Centralized Billing for Influenza and Pneumococcal Vaccinations
This article, which is based on Change Request (CR) 7124, includes important reminders for the Medicare provider community regarding the requirements for roster billing and centralized billing for influenza and pneumococcal immunizations. Please be sure billing staffs know of these requirements.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~89RKN40381?opendocument
Teleconference: Medicare Part B Update and Open Forum
Join Palmetto GBA on October 21, 2010, to learn about the most recent Medicare changes, receive updates on current Medicare initiatives, and find out what resources are available to help with the top problems that affect health care providers.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~89QQLZ3810?opendocument
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Unicare News
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UniCare invites provider offices to attend some upcoming webinars to learn about upcoming system enhancements that the plan is implementing in October. Other topics include added benefits for UniCare patients and changes in the 2011 membership population.
System Enhancements ~ New Managed Care Benefits ~
Supplemental Security Income PopulationLo
cation Dates and Times (Eastern)
Web Conference* Thursday, October 14, 2010, 12– 1 p.m.
Web Conference* Tuesday, October 19, 2010, 12– 1 p.m.
Web Conference* Thursday, October 21, 2010, 12– 1 p.m.
Registration is required. Registration automatically enters the provider
office into our “door prize” drawing – the winner will be announced at the end of the Webinar. We will have one drawing per session.
For online registration, go to www.unicare.com and click “Information for Providers” on the bottom right. Select “State Sponsored Plans” in the middle of the page, choose “West Virginia-Medicaid Managed Care” link, then select “Register Today”.
If you have questions, please contact the Community Resource Center at 1-888-611-9958.
Also, UniCare will be going through a system conversion October 28, 2010. Member ID numbers will change to include a "W" prefix in front of the existing UniCare member ID. Members will receive new ID cards in October to reflect this change. It is important to ask your patients for their new ID so you can update your patient records.
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UnitedHealthcare Update
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Social Security Numbers to be Masked on Printed EOBs and PRAs
Effective Nov. 16, 2010, UnitedHealthcare will mask a portion of the provider Social Security Number (SSN) on printed Explanation of Benefits (EOB) and Provider Remittance Advice (PRA) statements for claims processed on the UNET (commercial products) and COSMOS (government products) platforms. The purpose of this activity is to ensure compliance with American Recovery and Reinvestment Act (ARRA) and Health Insurance Portability and Accountability Act (HIPAA) privacy requirements. This change only affects printed provider statements; electronic EOB (835) transmissions and member communications are not affected.
Information about this change will be included in the November 2010 Network Bulletin and posted on UnitedHealthcareOnline.com and on the clearinghouse website.
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Farewell to a Good Friend!
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Melissa Prescott, Provider Relations Consultant, West Virginia Medicare Products for Humana, has announced her retirement as of October 7, 2010. Melissa has been a friend to physician offices and will be greatly missed. We wish her great enjoyment in her retirement!
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October 13, 2010
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