MSD Continues to fight the "Clawback" of 20% of Medicaid Payments Made to Physicians in 2011

     In a transmittal dated February 2, 2012, the Department of Health Care Finance announced its intent to implement a 20% rate reduction effective March 1, 2012.  All Medicaid claims submitted on or after that date are being processed with a Medicaid fee schedule paying 80% of the Medicare rate.  This is consistent with the FY 2011 Budget Act passed by the Council in spring of 2010. The Medicaid payment reduction contained in that budget was strongly opposed by the Medical Society at the time, citing its effect of placing our City's most vulnerable citizens at greater risk of losing access to much-needed medical care.

     However, the DC Department of Health Care Finance also plans to implement a physician payment recovery program affecting all physicians who have accepted Medicaid payments from January 1, 2011 through February 29, 2012.  This "Medicaid Clawback" program requires physicians to refund the DC Medicaid program 20% of all payments received during that time frame, and represents a terrible threat to Medicaid's relationship with District physicians that puts DC patients' access to health care in jeopardy.

     While the DC Council approved the Medicaid rate change, it did not approve this Medicaid Clawback program. If a private health insurance plan attempted such a recoupment program, they would be in violation of current District law addressing health insurance plans.  Currently, MSDC is exploring legal options to prevent the implementation of the Medicaid Clawback program, but continues to work with the Department of Health Care Finance and CMS to address the issue.  Additionally, we have been in constant communication with several coalition partners, including the AMA, DCHA, GW MFA and MedStar Health, to engage the proper regulatory and legislative authorities in an effort to stop the clawback effort and avoid the negative consequences that would occur for the District's Medicaid patients.

For a copy of the February 2nd transmittal, click here.

Continuing to push for the Medicare Patient Empowerment Act

    The AMA and MSDC continue to educate members of Congress about HR 1700, "The Medicare Patient Empowerment Act."  This bill is based largely on policy supported by MSDC at the AMA House of Delegates meeting in 2010, and allows Medicare patients and their physicians to enter into private contracts without penalty to either party. 

March 28 Webinar

How to  Avoid An EHR Data Breach with a Detailed Privacy & Security Risk Assessment & Mitigation Plan

April 11 Webinar

Social Media & Website Design to Increase Revenue, Thought Leadership and Develop Relationships Among Existing & Future Patients

Location: Web Meeting via Go To Meeting

RSVP: Contact Chris Lee at lee@msdc.org by 4:30pm tomorrow.

AMA offers physician practices updated EFT resource

     The key to matching the electronic funds transfer (EFT) payment with the electronic remittance advice (ERA) is the TRN-Reassociation Trace Number (TRN) that is passed from the payer to the payer's bank and to the practice's bank and to the practice. The Health Insurance Portability and Accountability Act (HIPAA) Transaction and Code Set regulation requires the payer to place the same TRN in both the ERA and in the associated HIPAA-mandated EFT format (ACH CCD+ Addenda Record) that it forwards to the bank. The NACHA Operating Rules then require that the bank provide the TRN to the practice, when requested. The practice and its bank should discuss the best way to deliver the addenda record information.

     When choosing to participate in EFT, a physician practice should advise its bank where to send the ACH CCD+ Addenda record information that includes the TRN key and discuss options for delivering the addenda record informationand any associated fees. Those considering transitioning from paper explanation of benefits (EOB) to accepting ERAs, and/or from accepting checks to accepting EFTs, should access the AMA's Electronic Remittance Advice Toolkit or AMA's Electronic Funds Transfer Toolkit, which includes the "ACH Primer for Healthcare: A Guide to Understanding EFT Payment Processing" developed by NACHA - The Electronic Payments Association. The EFT toolkit also includes a recently updated resource, "Questions to ask a bank before signing an EFT agreement."

Hear what doctors have to say about:

• Cardiac Health in the District of Columbia
• Technology's role in Preventive Care Services
• Quality Improvement and Engagement of Patient and families

Time: 9:00 am-12:30 pm

Location: Howard University Hospital

Featured Speaker:

Janet S. Wright, MD, FACC,

Executive Director, Million Hearts

Guest Speakers:

Bryan H. Curry, MD, Assistant Director, Echocardiography Lab and Nuclear Cardiology,    Howard University Hospital  

Debra White-Coleman, MD, Interim Chief, Division of General Internal Medicine and Director of Continuing Medical Education, Howard University Hospital

To register, contact: Caron Craig at IHPC@Dfmc.org or 888-301-7894

     Atlantic Health Partners offers MSDC members the overall best purchasing terms for Sanofi's Fluzone, Merck's Afluria, and MedImmune's Flumist.  As the leading vaccine buying group in the country, Atlantic can assist your practice with reserving flu doses for the upcoming flu season, including Sanofi's High-Dose and Intradermal Fluzone.

     Furthermore, Atlantic provides our members with the lowest costs for the complete spectrum of Sanofi and Merck vaccines.  Thousands of physicians nationwide have seen how Atlantic can improve the financial and operational practice performance of providing immunizations to your patients.

      In addition Atlantic offers a unique program that enables physicians to provide vaccines like Zostavax to Medicare Part D patients with fair and timely reimbursement.

     We encourage you to contact Atlantic to determine how their program can be of benefit to your practice.  You can reach Jeff or Cindy at 1-800-741-2044 or at info@atlantichealthpartners.com

     Early voting in DC is currently underway and continues through March 31. You can vote at any of the satellite locations, regardless of where you live.

     Remember, for the first time this year the primary is on April 3. Additionally, DCPS is on spring break on April 3 so many families may not realize they are out of town. If you plan to be out of town your can vote early at any of these locations or request an absentee ballot. 

Early Voting Locations and Times:

Today - March 31, 2012

One Judiciary Square

441 4th Street NW 8:30 AM-7:00 PM

Columbia Heights Community Center
1480 Girard Street, NW

Chevy Chase Community Center 
5601 Connecticut Avenue, NW  

Takoma Community Center
300 Van Buren Street, NW

Turkey Thicket Recreation Center
1100 Michigan Avenue, NE

King Greenleaf Recreation Center 
201 N Street, SW  

Dorothy Height/Benning Library
3935 Benning Rd. NE

Southeast Tennis and Learning Center
701 Mississippi Avenue, SE