Winter 2005
_______________________________________________________________________
The Academy of Medicine
Cleveland/Northern Ohio Medical Association is again pleased to offer our
quarterly newsletter designed with you in mind—the practice manager,
administrator, associate staff, billers and coders—all key personnel in the
physician’s office. The AMC/NOMA
ardently supports your work and recognizes the importance of a shared knowledge
between our physician members and their staffs allowing for an expanded base of
input that helps us help you confront the rapid changes affecting the practice
of medicine and office management today.
The AMC/NOMA can provide you
information on topics from balance billing to managed care to terminating the
physician/patient relationship. Our
Practice Management Department catalogs newsletters, brochures and booklets we
make available to our physician members and their staffs covering topics from
Medicare reimbursements to effective tips for staffing the medical office. Whatever your question or concern, the
Practice Management Department is available to address or investigate any issue
left unresolved. We support our members
in being strong advocates for all patients and promoting the practice of the
highest quality of medicine.
If you have questions,
concerns or a specific issue you would like the AMC/NOMA Practice Management
Department to review, please contact Joanna Bonacci, Practice Mgmt.
Coordinator, at 216.520.1000 ext. 314 or email jbonacci@amcnoma.org
Regulatory Agenda Released
£ HHS
recently published its semiannual regulatory agenda, which lists upcoming
action on HIPAA and efforts to build a national health information
network. According to the agenda, the agency plans to take action on the
following items:
* Stark Amendment: A final rule is expected in March 2006 to give safe harbor
for some electronic prescribing initiatives under the federal anti-kickback
statute;
* Physician self-referral prohibition: A final rule is expected in 2008,
although federal officials recently said some rules to lift regulatory barriers
to e-prescribing will be delayed until certification programs are in place for
electronic health record components;
* Medicare Part D and Medicare Advantage: A final rule is expected in February
2008 to support e-prescribing and adopt initial related standards;
* HIPAA: A proposal is scheduled for June 2006 to establish a standard unique
national health plan identifier;
* National Plan and Provider Enumeration System: A notice describing available
data is scheduled for publication in February 2006;
* HIPAA: A final administrative enforcement rule is expected in February 2006;
* HIPAA: A proposal is expected in May 2006 to make annual modifications to the
standard electronic transactions and code sets. A proposed rule to call for
revisions to certain code sets is scheduled for September 2006;
* Claims attachments: A final rule to establish national electronic standards
for claims attachments is scheduled for September 2008;
* Medicare: A final rule is expected in December 2006 to employ requirements
for electronic submission of claims and conditions for granting a waiver; and
* Medicare: A proposal is scheduled for September 2006 to allow the release of
Medicare beneficiary-specific information - with patient consent - from quality
improvement organizations to clinicians who have a "treatment
relationship" with the beneficiary.
The complete agenda is available in the Oct. 31 issue of the Federal Register.
CMS CD Rom Changes
£ The
Centers for Medicare and Medicaid announced last month they have decided not to
place the 2006 fees on the CD-ROM this year in order to have greater
flexibility for making any last minute changes to the 2006 payment rates.
Placing the fees on the carrier Web site assures that providers will have the
most current and correct fees available. The 2006 information is now posted to
the www.PalmettoGBA.com Web site.
Palmetto GBA will send out an email notification, for those registered, letting
providers know when the fees will be available. The CD-ROM will still be packed
full of other information including items such as 2006 Medicare Participation
Enrollment, New Prescription Drug video and Provider Tool Kit, CMS 855
information and applications, claim submission information, and much more.
Transitioning to an NPI
£ Beginning earlier this year, providers have been able to submit an application to CMS to receive their own National Provider Identifier or NPI—the 10-digit ID number will eventually replace all other identifiers used in reimbursement and other transactions with private payers, clearinghouses and government programs, including the UPIN. This transition to NPIs will occur over the next two years. The NPI must be used by all HIPAA covered entities no later than May 2007. The process of switching will not be simple or cheap for health plans. Physicians can start using their NPI as soon as they receive it. However, they will likely need to use it in addition to whatever identifiers they are already using for each individual payer until 2007. Providers who do not have an NPI at the end of the two-year period could face delayed or rejected claims. The best way to apply is online through an easy Web-based application process at nppes.cms.hhs.gov, which takes approximately 20 minutes to complete. Frequently asked questions and other information about the NPI rollout are available at www.cms.hhs.gov/hipaa/hipaa2
Resources on
Prescription Benefit
£ The Medicare
Prescription Drug Plan Cost Estimator is available on the Web at www.medicare.gov. The tool will provide those considering prescription drug
coverage quick reference information.
By entering their monthly drug costs and the state they live in, users
will get an estimate of annual savings if they join a Medicare prescription
drug plan. The calculations are based
on the defined standard benefit and the lowest premium amount offered by a plan
for a particular region of the country.
Specifically for physician offices, the CMS Web site offers a host of
informative resources including the Physician Brochure that explains the
coverage for this audience, PSAs such as “What do you say when asked about new
Medicare Prescription Drug Coverage?” a toolkit for providers wanting to take a
more active role in educating patients as well as downloadable posters for the
physician office. All of this and more
is available at www.cms.hhs.gov/medlearn/drugcoverage.asp
Managed
Care Statewide Rollout
£ Mr.
Jeff Corzine from the Ohio Department of Job and Family Services met with the
AMC/NOMA board of directors in November to present information regarding the
statewide ODJFS roll out of Medicaid managed care. Mr. Corzine noted that more than 555,000 Ohio Medicaid consumers
are enrolled in one of seven MCPs, covering 17 Ohio counties. When it’s completed, the rollout scheduled
for the first quarter of 2006, an additional 170,000 will be enrolled in an
MCP, bringing total current state enrollment to more than 700,000. The AMC/NOMA board members were told that if
any physician in the Northeast Ohio region has an issue or problem with the
Medicaid managed care plan referable to payment timing, contracting, claims
review or other matters relative to the ODJFS Medicaid managed care plans that
they may contact him directly or work through the staff at the AMC/NOMA on
these issues. Mr. Corzine may be
reached at (614)-466-4693. Updated
expansion information is also available from the state office at www.jfs.ohio.gov/ohp/bmhc/statemhc.stm
Settlement Agreements
£ The Health
Net, Inc. and Prudential settlement agreements were approved in late September
2005. The Health net settlement
provides for greater transparency in Health net’s claims processing and payment
practices. Through this settlement, Health Net has committed to disclose
certain business practices, update and increase the efficiency of its
administrative and claims processing systems by improving the speed, accuracy
and efficiency of current information about eligibility of its Plan Members,
reducing the number of procedures requiring precertification by physicians,
reducing the number of services requiring submission of clinical information
for precertification and providing contracts to physicians in its provider
network that conform to the settlement.
Fairness Hearing
£ Physicians who filed by the November deadline to claim their share of the $135 million WellPoint/ Anthem settlement, must now set their calendars for the Settlement/Fairness Hearing scheduled for December 2, 2005. This hearing will determine if the WellPoint/Anthem settlement is approved and if the claim disbursements will be made. Many physicians may not realize that WellPoint, Inc. is the parent company to more than one hundred health plans and entities under different operating names. If a physician treated patients under any of WellPoint’s subsidiaries, they were eligible to file a claim. Such insurers involved in the multi-district litigation (MDL) settlement include: CIGNA Corp.; Aetna, Inc.; Coventry; Health Net; Humana, Inc.; Prudential and UnitedHealth Group. For a complete list of WellPoint subsidiaries and further settlement updates, visit http://www.ama-assn.org/ama/pub/category/15479.html
Changes to Physician Contracts
£ Between
Nov. 21 and Dec. 31, 2005 physicians across the country will receive an
“Addendum” to their current physician contracts with Aetna, Inc—the result of
an historic settlement agreement between the company and 30 medical
societies. Under its terms, Aetna
promised to make numerous changes to its business practices, many of which are
reflected in physician contract provisions.
Examples of provisions are:
definitions of “clean claim” and “medically necessary services,”
provisions covering gag clauses and all products clauses as well as a complete
list of Aetna obligations under the settlement with restatements of coding and
other payment provisions. Some key
highlights of the addendum include Aetna’s obligations to pay covered services,
plan or product participation, utilization management and payment rules and the
availability of external dispute resolution processes, independent from the
plan, with instructions and more detailed information at www.hmosettlements.com One may also submit specific questions via
email to AddendumInquiry@Aetna.com
Although
CMS announced earlier this year it was making available a version of the VISTA
electronic record used by the VA to physician practices on a trial basis, it
doesn’t help practices needing additional training to use the system. It also does not integrate well into the
practice billing software, with expectations that private companies will step in
and design lower cost products that successfully interact with VISTA, helping
practices function more effectively in the long-term. The following are four things your practice should do
BEFORE BUYING AN EMR SYSTEM:
1. Do site visits before purchase
and during installation—You should visit at least one practice using the EMR
system you are considering before you buy it.
But also visit others during installation to learn from their challenges
and mistakes.
2. Make sure you compare apples to
apples—Vendors will often alter your request for proposal to suit systems they
offer. Make sure you get each vendor to
answer your questions about the type of system you want, not the ones they
offer.
3. Use an IT consultant—Have an IT
consultant look over you existing data management infrastructure making sure
you have the capability to handle your new system.
4. Convert all physicians at one
time, with extensive training—During the implementation phase, offer as much
training as you can. But try to implement the new EMR with all practice doctors
at one time—which will prevent stragglers from delaying conversion and keeping
you on dual paper and electronic systems, more costly than a productivity
decline.
The
AMC/NOMA is proud to partner with Cuyahoga Community College in their practice
management seminar and class offerings, with significant discounts made
available to AMC/NOMA members and their staffs. Below is a class list for Winter/Spring 2006. Members and/or their staff will need an
exclusive AMC/NOMA course number to register and obtain the discount. For course numbers, call Linda Hale of
AMC/NOMA at 216-520-1000, ext. 309, or e-mail lhale@amcnoma.org. For course information visit www.advancecareer.info,
or contact Tri-C’s Center
for Health Industry Solutions at 216-987-3071.
CUYAHOGA COMMUNITY COLLEGE’S CENTER FOR HEALTH INDUSTRY SOLUTIONS
v
CPC CERTIFICATION EXAM REVIEW
for AAPC Exam
Jan. 28 9:00a-2:45p Corporate
College East Price $120.00
v
CPC-H CERTIFICATION EXAM REVIEW
for AAPC Exam
Feb. 4 9:00a-2:45p Corporate
College East Price $120.00
v ADVANCED CPT CODING CONCEPTS (4
CEU-AAPC, PMI)
Mar. 1 8:30a-1:00p Corporate
College East Price $120.00
v CCA CERTIFICATION CODING EXAM REVIEW
for AHIMA Exam
Mar.4 9:00a-2:45p Corporate College East Price
$135.00
v CCS CERTIFICATION EXAM REVIEW for AHIMA
Exam
Mar.
18 9:00a-2:45p Corporate College East Price
$135.00
v ADVANCED ICD-9-CM CODING CONCEPTS (4
CEU-AAPC, PMI)
Mar.
22 8:30a-1:00p Corporate College East Price
$120.00
v CPC
CERTIFICATION EXAM REVIEW for AAPC Exam
April 8 9:00a-2:45p Corporate
College East Price $120.00
v CCS-P CERTIFICATION EXAM REVIEW for
AHIMA Exam
April.
22 9:00a-2:45p Corporate College East Price
$135.00
v CPC-H CERTIFICATION EXAM REVIEW for
AAPC Exam
April
29 9:00a-2:45p Corporate College East Price $120.00
v RADIOLOGY: HIGH TECH/DEMAND CODING (3
CEU-AAPC, PMI)
April
26 8:30a-12:00p Corporate College East Price
$135.00
v MEDICAL TERMINOLOGY/ANATOMY &
PHYSIOLOGY (30 Hours) Price
$216.00
Corporate
College Westlake –Jan. 17-Feb. 23 (Tuesday & Thursday) 6:00-8:30
pm
Corporate
College East-Jan.
23-Mar. 1 (Monday & Wednesday) 6:00-8:30 pm
Corporate
College East-May
1-June 7 (Monday & Wednesday) 6:00-8:30 pm
v
MEDICAL
CODING FUNDAMENTALS (48 Hours) Price
$507.00
Corporate
College East – Jan. 17-Mar. 9 (Tuesday & Thursday) 6:00-9:00
pm
West-Mar.
6-April 26 (Monday & Wednesday) 6:00-9:00 pm
Corporate
College East – Mar.14-May. 4 (Tuesday & Thursday) 6:00-9:00
pm
v MEDICAL BILLING REIMBURSEMENT (24
Hours) Price
$282.00
Corporate College East –Jan.
11-Mar. 6 (Wednesday) 6:00-9:00
pm
Corporate College East -Mar.
8-April 26 (Wednesday) 6:00-9:00
pm
v CUSTOMER SERVICE WORKSHOP FOR HEALTH
CARE (3.5 Hours)Price $113.00
Corporate College East –April
27 (Thursday) 6:00-9:30 pm
