There has been an on-going debate over how to resolve the problem of Medicare sustainability that does not limit patients' access to needed medical care.  In the beginning of the letter, MSDC emphasizes the severity of Medicare's future to physicians and patients by stating, "the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (P.L. 111-192) stabilized Medicare physician payments only until November 30, 2010.  After that, Medicare payments for physician services will be slashed by more than 23 percent.  To make matters worse, an additional cut of 6.5 percent will follow on January 1, 2011.  Physician practices simply cannot absorb cuts of this magnitude in a program as important as Medicare."

 

The letter will be sent to Congressional offices this week.  Once a finalized letter is complete, we will share the contents with you.

 

Use the November Elections to Address Medicare Reform with your Senators and Representatives

     "On the Waterfront" Annual Meeting  - Registration Closing Soon!
 
When: October 20, 2010 from 6:00pm to 9:00pm
Where: Phillip's Restaurant at 900 Water Street, SW, Washington, DC, overlooking the Washington Channel off the Potomac River.
Register: Contact Barbara Allen at (202) 355-9403 or allen@msdc.orgto join the crew.  Price: $60 for members, $105 for members and spouses, $50 for students/residents, and $80 for non-members, Tables of 8 for $425
    Hurry and register soon - if you don't make the Captain's Log before Sail Date, registration at the door will increase to $80 for members and $100 for non-members.

   Joanne Grossi, will attend our Annual Meeting, "On the Waterfront," as the evening's featured speaker.  This past April, Ms. Grossi was appointed as the Regional Director of the U.S. Department of Health and Human Services for Region III, which includes the states of Pennsylvania, Delaware, Maryland, Virginia, West Virginia and the District of Columbia.  As Regional Director, Ms. Grossi serves as the key representative in this region in working with federal, state, local and tribal officials on a wide range of health and social services issues.
     Prior to this appointment, Ms. Grossi served for seven years in the administration of Governor Edward G. Rendell, first as Deputy Secretary of Health and later as the first- ever Director of the Office of Women's Services.


Annual Meeting Sponsors
  

     In a recent posting to their website, Highmark Medicare Services (Highmark) announced the initiation of a new review focusing on these E&M codes given preliminary evidence that widespread problems were present with current billings.  The problems cited by Highmark extended beyond the issue of support for the code selection and included a variety of citations such as signature and plan of care requirements.  Highmark will be conducting a limited review of these billings.  The scope of the review will be much less intensive, and therefore less intrusive, than implied by the article.  Claims will be randomly selected for review on a daily basis from their entire Jurisdiction 12 area.  While the specific impact cannot be precisely estimated, it is believed that this endeavor will place only relatively minor demands on the membership.

 

     This year has certainly been one for the books relative to the roller coaster ride otherwise known as the Medicare Physician Fee Schedule (MPFS).  The highlight of activity (so far) occurred in June when first the 21% reduction fee schedule was installed followed shortly by its replacement schedule that contained a 2.2% increase.  The 21% reductions only affected three days of processing by Highmark Medicare Services (Highmark).  Services that were paid per this fee schedule were automatically adjusted and this activity was completed on July 9th.

     The installation of the fee schedule that contained the 2.2% increase occurred on June 28th.  Claims finalized on and after this date reflect the 2.2% fee schedule amounts for dates of service on and after June 1, 2010.  Unlike the earlier situation, the Center for Medicare did not instruct their contractors to automatically adjust claims (in either an up or down manner).  Information on this matter was published on the CMS website as part of the Medicare Learning Network Matters article number MM6973 which also contains a link to the formal Change Request document.  Providers may seek recovery for fee schedule differentials by filing a petition or request for a reopening with Highmark if so inclined.

 

     Due to scheduled maintenance, the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will be unavailable from Wed Sep 29 through Sun Oct 3.  Internet-based PECOS allows physicians, non-physician practitioners, providers, and other suppliers to enroll or make a change to their existing Medicare enrollment information over the Internet.
     If you would like to enroll or make a change to your existing Medicare enrollment record, you can do either of the following:
1.  Use Internet-based PECOS prior to Wed Sep 29 or after Sun Oct 3.  For more information about Internet-based PECOS, see the appropriate "Getting Started" guide available in the Downloads section .  There is a "Getting Started" guide for physicians and non-physician practitioners and one for provider and supplier organizations.
2.  Complete and submit the paper Medicare provider enrollment applications(s) (CMS-855) along with any required supporting documentation and mail the application(s) to the appropriate Medicare carrier, fiscal intermediary, or A/B MAC.  The CMS-855 forms are downloadable from the CMS forms page:  www.cms.hhs.gov/cmsforms.

     High-Risk Pool Opens Enrollment for DC

     The District of Columbia's Department of Health Care Finance (DHCF) announced the availability of the Pre-Existing Condition Insurance Plan (PCIP) through the US Department of Health and Human Services (DHHS).  The program provides affordable health insurance for District residents unable to purchase health coverage in the commercial marketplace because of a pre-existing medical condition.  
     After exploring the feasibility of a District-run program, DHCF informed DHHS that it would join the 23 participating states utilizing the federal option.  The program is administered by GEHA, a health insurance carrier under contract with the DHHS.  
     The PCIP was established by the federal health reform legislation, the Affordable Care Act (ACA), it is a transitional program that provides coverage until the health insurance exchanges are launched in 2014.  The health insurance exchanges will offer subsidized health coverage in all states to residents without insurance coverage, regardless of their medical condition.  Through the ACA, states were offered the option of administering a PCIP program using federal funds or allowing the federal government to run a program.  
     As of September 15, 2010, District residents can apply for the program, with coverage starting as soon as October 1, 2010 for applications submitted and approved prior to September 30, 2010.  Information on the application process and monthly premium rates for DC can be found at www.pciplan.com. 

 

     According to Surescripts LLC, a company that operates the nation's largest e-prescribing network, and their annual Safe-Rx Awards, the District ranks 49th out of 51 states/districts in the United States in use of electronic prescribing for prescriptions.  The only two states falling below the District are Alaska and North Dakota.  E-prescribing has been identified as one of the measures of the "meaningful use" requirement for Electronic Medical Record to qualify for the financial incentives for Health IT implementation through Medicare.

From the Congressional Health Care Caucus: Understanding the Medical Loss Ratio

     Work is on-going within the District to successfully implement the changes occuring to our health care system under the Affordable Care Act.  MSDC continues to participate with the Mayor's Health Reform Implementation Committee, and is working to serve on the Delivery System Subcommittee.

     The DC RHIO's Governance and Sustainability Workgroup, under DCPCA, has just finalized its planning sessions and will be submitting a progress report to the Office of the National Coordinator for Health IT this week.

     The Department of Health Care Finance is overseeing the development of the District's Health Information Exchange.  MSDC continues to serve on their Steering Committee, which is entering its second month of operation.

10/13/2010 - "Tax Law Changes: What They Mean for Business Owners and High Income Earners" - Tim Grace Regan, Grace & Kerley, LLC
10/27/2010 - "Reducing Healthcare and Group Benefits Costs" - William MacCartee, Monument Benfits
11/10/2010 - "Controlling Downside Risk in a Rising Interest Rate Environment" - Dave Mengden, Genworth Wealth Management
12/8/2010 - "Business, Property & Casualty Insurance- Liability Protection or Business Owners and High Income Earners" - Andrew Howard, Howard insurance Agency

     The Office of the National Coordinator for Health Information Technology (ONC) named InfoGard Laboratories, Inc., San Luis Obispo, Calif. as an ONC-Authorized Testing and Certification Body (ONC-ATCB). The addition of InfoGard Laboratories, Inc. as an ONC-ATCB provides more options for EHR vendors to have their products tested and certified for compliance with the standards and certification criteria that were issued by the U. S. Department of Health and Human Services earlier this year. 
     Certification of EHRs is part of a broad initiative undertaken by Congress and President Obama under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009.  HITECH created new incentive payment programs to help health providers as they transition from paper-based medical records to EHRs.  Incentive payments totaling as much as $27 billion may be made under the program.  Individual physicians and other eligible professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid.  Hospitals can receive millions.
     To qualify for the incentive payments offered by the Centers for Medicare & Medicaid Services (CMS) providers must not only adopt, but also demonstrate the meaningful use of, certified EHR systems.   
     ONC authorized the first two ONC-ATCBs in late August, 2010.  Additional applications are under review.  
     For more information about the ONC certification programs visit http://healthit.hhs.gov/certification.
     To learn more about InfoGard Laboratories, Inc. visit www.infogard.com

     Information about the Medicare & Medicaid EHR Incentive Programs, may be found here.