| Upcoming Events | |
Protecting Senior Patients from Medicare Fraud
May 16
CME Event
Medstar Washington Hospital Center
True Auditorium
MSDC 2012 Annual Meeting & Reception
October 24
Metropolitan Club
Washington, DC
More info to come.
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2011-2012 Board of Directors
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Catherine S. May, MD
At-Large; Chair of the Board
James C. Cobey, MD
President
Daniel I. Perlin, MD
President-Elect
Joseph Gutierrez, MD
Treasurer; AMA Delegation Chair
Reginald Robinson,MD
Secretary; At-Large
Peter E. Lavine, MD
AMA Delegate
J. Desiree Pineda, MD
AMA Alternate-Delegate
Laura L. Tosi, MD
AMA Alternate Delegate
Julian R. Craig, MD
Frederick C. Finelli, MD
John W. Larsen, MD
Joan B. Loveland, MD
Carla Sandy, MD
At-Large
Stuart F. Seides, MD
At-Large
K. Edward Shanbacker
Executive Vice President
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| We're on Facebook! | |
The Medical Society of DC is on Facebook!
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Contact the MSDC Office
| 1250 23rd Street, NW
Suite 270
Washington, DC 20037
(202) 466-1800 (phone)
(202) 452-1542 (fax)
info@msdc.org
www.msdc.org |
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| UnitedHealthcare Community Plan joins with City to Rescind Medicaid Clawback Order |
MSDC's action against the Medicaid "clawback" saves DC physicians $11 million
MSDC has spoken with Karen M. Johnson, the Executive Director at UnitedHealthcare Community Plan about the status of the Medicaid fee schedule recoveries.
Ms. Johnson said:
"We value our partnerships with the medical community and recognize that the recent events related to the changes in the District's Medicaid Fee Schedule have caused frustration for many. We apologize for any difficulty this has caused and effective April 25, 2012, UnitedHealthcare Community Plan ("United") suspended recoveries for claims United overpaid due to the 20% reduction in the District's Medicaid fee schedule. If you have already paid United based on a letter and 1/1/11-10/31/11 claims detail you received from its Recovery Services, United will refund these payments to you within the next thirty (30) to 45 business days. United is planning a Provider Town Hall here in the District for the week of May 21 to discuss the status of its Medicaid fee schedule implementation. You will receive a invitation directly from United in the very near future."
This message will be posted today to UHC's website at www.unitedhealthcarecommunityplan.com. If you have questions regarding UnitedHealthcare Community Plan, please call their recovery team at 1-800- 727-6735 ext. 77376.
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| Spotting Medicare Fraud: A CME Event for Member Physicians |
Seniors lose almost $3 billion each year to fraud. When your patients lose enough to have to choose between paying for out-of-pocket health care costs and basic living costs, this can become a clinical issue. Attend this free CME course on how to spot the "red flags" your older patients may have that place them at high risk of financial exploitation. You will hear from geriatrician Namirah Jamshed, MD, at the Washington Hospital and Tony Miles, JD, Associate Commissioner of the District of Columbia Department of Insurance, Securities and Banking tell you about the neurobiological basis for why some seniors fall prey to financial scams that rob them of having a good old age.
Location: Washington Hospital Center - True Auditorium
110 Irving Street NW
Date: May 16 Time: 5:00pm - 7:00pm Presenters: Namirah Jamshed, MD; Tony Miles, JD
There is no cost to members. Refreshments will be provided at 5:00pm. Please arrive no later than 5:30pm for the CME program. |
| D.C. Doctors Say Insurance Company Requirements are Interfering with Ability to Treat Patients |
MSDC Survey Reveals Health Insurer Prior Authorization Protocols are a Burden on Medical Practices and Undermine Patient Care
MSDC released the results of a membership survey examining the impact of health insurance prior authorization protocols on patient care in Washington, D.C. The study reveals widespread concern among area physicians, with over 93% of respondents saying that insurance company requirements are having a negative impact on their ability to treat patients.
Prior authorization is an insurance company policy which requires doctors to go through an extra set of steps to obtain the health insurer's approval before they will agree to pay for a prescription medication, medical test, or procedure. While intended as a cost-control measure, the survey shows that prior authorization is currently an inefficient and confusing process that delays necessary treatments, drives up administrative costs, and limits what medications and medical procedures physicians are able to provide.
Specific findings of the MSDC survey include:
- 93.1% of D.C. physicians surveyed said that insurance company requirements such as prior authorization, pre-certification, therapeutic switching, and step therapy are having a negative impact on their ability to treat patients;
- Nearly 90%of those surveyed said that they have been forced to change the way they treated a patient, including changing prescription medications, due to restrictions imposed by an insurance company;
- Over 76%of physicians also reported that they have switched treatments in order to avoid dealing with prior authorization requirements;
- 94.8% of physicians surveyed said that insurance companies have delayed or denied treatments for their patients, such as prescription medications, diagnostic testing, or other services;
- 84.6% of physicians said that is it difficult to determine which prescription drugs or medical procedures require prior authorization;
- About half (47.2%) of MSDC members surveyed said that on average, prior authorization requests take several days or more to be resolved;
- 89.7% of respondents confirmed that completing and clarifying insurance requirements imposes "hidden" costs-such as extra staff time for the additional paperwork and phone calls-that have a negative impact on their medical practice.
Prior authorization is currently a cumbersome and convoluted process. It is not standardized, so each insurance carrier has its own set of requirements, which can vary further among that carrier's plans. To meet prior authorization requirements, physicians and their staff often have to complete a time-consuming series of faxes, phone calls, emails, and input of data into insurance carrier web sites. Worse, patients are often forced to wait days or weeks for insurers to approve treatments, or are simply denied prescriptions and procedures outright.
Implementing a standardized system across the District, with uniform requirements for filing and processing prior authorization requests, would expedite this onerous process and allow doctors to finally focus on what really matters-treating patients.
For a copy of the survey, please click here.
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| YMCA and MSDC Join Forces to Help Fight Rising Diabetes Rates in DC | |
To help fight the trend of rising rates of type 2 diabetes in the District of Columbia, the YMCA of Metropolitan Washington and the Medical Society of the District of Columbia are joining forces to empower physicians and other local healthcare professionals to spread awareness about the YMCA's Diabetes Prevention Program - an innovative behavior change program that can help people reduce their risk for the disease. This extraordinary collaboration, which launched on April 17, 2012, will help direct people at highest risk of developing type 2 diabetes into this life-changing program.
Medical costs and reduced productivity associated with diabetes cost the U.S. an estimated $218 billion in 2007. In addition, a staggering 79 million people (roughly 25% of the population) have prediabetes, a condition in which individuals have high blood glucose levels, but not yet at the level to be classified as diabetes. The progression from prediabetes to diabetes is said to take between 3-5 years if corrective action isn't taken.
People with prediabetes have a high risk of developing type 2 diabetes, heart disease and stroke. The YMCA's Diabetes Prevention Program is a group-based lifestyle change program designed for high-risk adults. The program provides a supportive environment where participants work together in a small group to learn about healthier eating, and increasing their physical activity in order to reduce their risk for developing diabetes. Individuals who participate in the program take part in 16 one-hour weekly classroom sessions with a trained Lifestyle Coach. Following these sessions, participants meet monthly for up to a year for added support in reaching their ultimate goals of reducing body weight by 7% and participating in 150 minutes of physical activity every week. Through lifestyle changes and modest weight reduction, the program has been shown to reduce risk of type 2 diabetes by 58%.
The YMCA's Diabetes Prevention Program is supported nationally by UnitedHealth Group and the Centers for Disease Control and Prevention and is available at 50 Ys in 26 states. The program is part of the CDC-led National Diabetes Prevention Program. To learn more about the YMCA's Diabetes Prevention Program or to find out if you qualify, please contact Irmina Ulysse at 202-862-3171, ext. 3171 or irmina.ulysse@ymcadc.org.
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Don't Just Talk About Leadership - LEAD!
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| On Medicare: Current Status of HIPAA V 5010; Medicare Shared Savings Program; Electronic Enrollment |
 National Provider Call: Current Status of Medicare FFS Implementation of HIPAA Version 5010 and D.0
Wednesday, May 16; 2-3:30pm ET
Please save the date for a National Provider Call on the Current Status of Medicare FFS Implementation of HIPAA Version 5010 and D.0 on May 16. The agenda and registration information will be provided soon on the CMS Upcoming National Provider Calls webpage. For more information on HIPAA 5010 and D.0 implementation, visit the Versions 5010 and D.0 website.
Medicare Shared Savings Program/ACO Call and Webinar The Philadelphia Regional Office of the Centers for Medicare & Medicaid Services will be hosting an Open Door Forum (ODF) call and webinar for Region III providers on Medicare Shared Savings Program (MSSP)/Accountable Care Organizations (ACOs) Featuring: Dr. Kenneth Goldblum, Chief Medical Officer, Renaissance Medical Management Company Date: May 8, 2012 Time: 9:00 A.M. - 10:30 A.M. Dr. Goldblum will highlight the lessons learned by Renaissance Medical Management Company, which was named a Pioneer Accountable Care Organization (ACO) serving Southeastern Pennsylvania. A question and answer period will follow. In addition, CMS will do an overview on the Medicare Shared Savings Program (MSSP)/Accountable Care Organizations (ACOs), application and the final rule. The presentation will conclude with helpful resources. Participants should register for this call by submitting their name, email address and organization to Thomas.robinson@cms.hhs.gov Webinar Link: https://webinar.cms.hhs.gov/regioniiimsspodf1/ Dial-in Number: 1-877-267-1577 Meeting ID 8411 You must dial into the webinar for the audio. Sign Your Medicare Enrollment Application Electronically Internet-based PECOS (Provider Enrollment, Chain, and Ownership System) now allows providers to sign Medicare enrollment applications electronically. https://www.novitas-solutions.com/bulletins/all/news-04262012-2.html |
| AMA Updates: Reforming Medicare; Practice Management Tips |
Take steps now to avoid the 2013 e-prescribing penalty
The Centers for Medicare and Medicaid Services (CMS) is urging physicians to report on at least 10 electronic scripts by June 30, 2012, to avoid the 2013 Medicare e-prescribing penalty that amounts to a 1.5 percent reduction in their 2013 Medicare Part B payments. Physicians can also file for a hardship exemption prior to June 30, 2012. The AMA has put together a tip sheet on the steps physicians can take to avoid the 2013 e-prescribing penalty. Visit the AMA website for more information about e-prescribing.
AMA Advocacy Improves Ordering & Referring Requirements
Since 2009, the AMA has strongly advocated to the Centers for Medicare and Medicaid Services (CMS) that its proposal to require ordering and referring physicians to enroll in Medicare via the Provider Enrollment, Chain, and Ownership System (PECOS), or experience rejection of such claims, would cause workflow problems for physicians.
In direct response to ongoing AMA advocacy and comments submitted by the AMA and 42 medical specialty societies, CMS has now published a final rule on these requirements that makes significant improvements to CMS' prior interim final rule and proposals on the subject, namely:
- Physicians who order or certify imaging or clinical laboratory services, DMEPOS, or home health services who are enrolled in PECOS or the legacy Medicare system will satisfy the enrollment requirement.
- Referrals to physician specialists have been excluded from the final rule.
What Physicians Need to Know
Physicians who order or certify imaging or clinical laboratory services, DMEPOS, or home health services for Medicare beneficiaries need to:
- Enroll or verify enrollment in Medicare now to avoid claim denials. While CMS will give 60 days advance notice to the physician community prior to turning on the edits that will deny a claim, it is the AMA's understanding that this date will be announced in the near future. Physicians who seek to enroll for ordering or certifying only may do so via PECOS or by submitting the CMS 855-0, a paper enrollment application. Note that this requirement does not extend to physicians who have validly opted-out of Medicare.
- Retain records related to orders or certifications for 7 years. There is no requirement regarding the manner of record retention (i.e. electronic or paper).
- Use their Type I individual NPI when certifying or ordering, even if they are being reimbursed under a Type II NPI. For example, if Dr. Smith orders home health services and uses his Type II NPI for John Smith, MD LLC instead of his personal, Type I NPI, the claim may be denied (even if Dr. Smith has reassigned Medicare reimbursement to John Smith, MD LLC).
See the AMA's Medicare enrollment website for more information.
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| Classified Ads |
Office Furniture for Sale
Retired Physician has office furnishings for sale. Beautiful executive desk and credenza. Reed chairs and small table. Numerous other items suitable for office or apartment. Offering reasonable price for complete lot but willing to negotiate separate items. To review, please call 301-656-6309 or 301-656-3977
Are you ready to get away from it all?
The Medical Society and Alliance Foundation (MSAF) owns a timeshare, available at The Historic Powhatan Resort, Williamsburg, VA. From April 22 to April 29, a three story townhouse with 3 bedrooms, 2 bathrooms is waiting for you, family and friends. Managed by Diamond Resorts International, on-site amenities include outdoor and heated indoor swimming pools, fitness center, cycling/bike rental, fishing, tennis, racquetball, putting green/mini golf, game room, playground, restaurants, and concierge services. Housekeeping services are available. Explore nearby attractions such as Historic Williamsburg, Jamestown, Busch Gardens, golf, spas, antique stores, and outlet shopping. This relaxing vacation can be yours for $1200, less than $200 per day! For more information, please contact Rose Smith at (202) 466-1800.
Dynamic, growing medical practice looking for medical staff. Positions to be filled include an Internist, a Physician's Assistant, and Nurse Practitioners. For more information, click here.
Two physicians are looking to sub-lease a fully-furnished, 5-exam room office with two conference rooms in downtown McLean, Va. The perfect location for a physician with an independent practice or a physician who needs additional space. The office is available Monday thru Friday, 8:30 a.m. to 5 p.m. All overhead including personnel, if needed, will be prorated based on office usage. Please email:mcleanobgyn@hotmail.com.
New Psychiatric Practice for Adults & Children
Conveniently located on the red line in Friendship Heights, the office of Enrico Suardi, MD is now open for psychiatric services. Dr. Suardi is board-certified and trained in adult, child & adolescent, and forensic psychiatry.
5028 Wisconsin Avenue NW Suite 400-15
(202) 615-9663
www.drsuardi.com
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