Tuesday March 1, 2011

NWAO Spring Dinner Meeting: Registration is Open

Thursday, April 7, 2011
Seattle Tennis Club

Medical & Ethical Challenges when Resources are Scarce
Anna M. Pou, MD
Professor, Department of Otolaryngology
LSU Health Sciences Center, New Orleans

Click Here for the Registration Form

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Partial Supplemental Budget Keeps GAU, BHP and Interpreter Services Going

Last Friday the governor signed a supplemental budget package that partially patches the approximately half a billion dollar gap for the remainder of this biennium (through June 30). Negotiations took more than a month, which bodes ill for the legislature getting out of town by Easter. Now they must tackle the estimated $5 billion deficit in the 2011-13 budget for the next biennium starting on July 1.

The supplemental budget action still leaves the state some $226 million in the red over the next four months. Most legislators hope the March revenue forecast will provide some succor, and there remains the option of pushing some education expenses into July, thus loading up the next biennial budget with more expenses.

There is a bit of good news (or less bad news, if you will) for social services/health programs with the action taken last week:

• Payment for interpreter services will be retained through June 30 (it was to have been eliminated March 1).
• Eligibility for the BHP will be limited to those who qualify for Medicaid, effectively filtering out illegal immigrants who may be on the plan. Enrollment will drop;

  the program is spared, for the moment.

• Cash grants to the Disability Lifeline Program (formerly called GAU) are retained but reduced 50 percent (and are to be eliminated entirely in the next two-year budget). The program provides cash and medical care to unemployable disabled adults who aren't covered by federal Social Security benefits.
• Enrollment of children to the state's Children's Health Program will be limited to families at 200 percent of the federal poverty level.

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WSMA Joins the Governor’s Cost and Quality Effort

The WSMA has accepted an invitation from Governor Gregoire to participate in a state-wide effort – “Health Care Reform the Washington Way” – to reduce the overall rate of growth of health care spending to no more than four percent annually by 2014 while maintaining or improving patient health outcomes. The group will consist of purchasers, health plans, physicians, hospitals, and other organizations as well as consumers.

The thrust of the project is consonant with the WSMA’s strategic plan, and many elements are reflected in previously established positions. The work of the WSMA Foundation for Health Care Improvement also dovetails with the proposed project. Numerous issues to traverse will include, but are hardly limited to, macro-demographic shifts (e.g., an aging population), how to define and pay for quality, reform of the tort system to reduce pressures for defensive medicine, delivery system flexibility, and more.

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New Law Clarifies Who is Subject to the Red Flags Rule

Last month, the President signed into law the "Red Flag Program Clarification Act of 2010," which clarifies the type of "creditor" that must comply with the Red Flags Rule. This law states the Red Flags Rule should not be applied to physicians generally.

The new law indicates that creditors that fall under the Red Flags Rule are only those who regularly and in the ordinary course of business: (1) obtain or use consumer reports, directly or indirectly, in connection with a credit transaction; (2) furnish information to certain consumer reporting agencies in connection with a credit transaction; or (3) advance funds to or on behalf of a person, based on the person's obligation to repay the funds or on repayment from specific property pledged by them or on their behalf (this does not include creditors who advance funds on behalf of a person for expenses incidental to a service provided by the creditor to that person). Creditors that fall under one of the above-mentioned categories must comply with the Red Flags Rule by December 31, 2010. Creditors that do not fall under one of these categories are not subject to the Red Flags Rule.

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The 2011 Electronic Prescribing (eRx) Incentive Program with Penalty

CMS has been offering since 2009 an incentive for eligible professionals to implement and use electronic prescribing to improve the quality, efficiency and safety of health care delivered to beneficiaries. This initiative will continue in 2011, with successful e-prescribers earning a bonus of 1% of their total allowed charges for professional services covered by the Medicare Part B Physician Fee Schedule.

For the first time, a penalty has been introduced for 2011 that will affect Medicare payments in 2012 and 2013. Eligible professionals will be penalized if they do not report a minimum of 10 e-prescribing reporting events on a qualified system during the six-month period of Jan. 1 to June 30, 2011. A penalty of 1% will be assessed for all allowed charges for professional services covered by the Medicare Part B Physician Fee Schedule during 2012. The payment cut is estimated to be from $2,000 to $3,000 for the typical internal medicine physician. In addition, physicians that do not report a minimum of at least 25 e-prescribing reporting events between Jan. 1 and Dec. 31, 2011 will be assessed a 1.5% penalty for all Medicare allowed charges submitted in 2013.

Physicians participating in the Medicare EHR Meaningful Use incentive program will not be eligible for the e-prescribing bonus. But, they will still have to submit at least 10 e-prescribing events by June 30, 2011 to avoid the e-prescribing penalty for 2012.

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Truth-in-Advertising Legislation Introduced in U.S. House

A recent survey indicates that America's patients prefer a physician-led approach to healthcare and are often confused about the level of training and education of their healthcare providers. The survey results confirm the need for increased transparency and clarity in healthcare advertisements. To that end, on January 26, 2011, U.S. Reps. John Sullivan (R-OK) and David Scott (D-GA) introduced H.R. 451, the "Healthcare Truth and Transparency Act of 2011." This important legislation empowers patients by improving transparency in healthcare provider-related advertisements and marketing.

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Medicaid ProviderOne: WSMA Advocacy Continues

The WSMA continues its ongoing advocacy on behalf of member physicians and their practices in addressing concerns with Washington Medicaid’s ProviderOne claims system. Working closely with Medicaid leadership, WSMA offers these recommendations:

1. To better serve the practice community, Washington Medicaid is conducting “triage” of inquiries on claim related problems. Practices with a substantial volume of outstanding claims should make use of the Customer Service process, as Medicaid is using that mechanism to focus its efforts. Go to http://hrsa.dshs.wa.gov/contact/default.aspx. Note that the first option, WEBFORM, is a secure online communication, enabling practices to include protected health information when necessary. In the “Select Topic” menu, “Claim Denial” is the preferred choice if your claims have been rejected for reasons such as provider taxonomy. IMPORTANT: In the “Comments” section, if your practice is facing substantial amounts of outstanding or denied claims, with very high adverse impact on your practice, state that in your comments! Medicaid staff will assign a high “severity” rating to your inquiry.
2. If your claims have encountered problems with selecting the correct “Provider Taxonomy,” be sure to review the guidance available at http://www.dshs.wa.gov/provider/index.shtml. More specific detailed guidance on “Provider Taxonomy” is available in the ProviderOne Billing and Resource Guide at http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html. Go to Appendix L - Taxonomy and ProviderOne.
3. Avoid submitting paper claims if at all possible! Medicaid notes that paper claims take much longer to process, and typically are only successfully processed on initial submission about 10% of the time! Also, paper claims pull Medicaid staff away from resolving electronic claims, adding to the backlog.

Please keep the WSMA apprised of your claim problems! We will continue our advocacy on your behalf. Contact Bob Perna at rjp@wsma.org.

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Electronic Health Records and “Meaningful Use”

The third quarter 2010 issue of the WSMA Preceptor provided guidance on the “meaningful use” standards in the Final Rule issued by the Centers for Medicare and Medicaid Services (CMS). Practices without EHRs should watch for further developments on the temporary and final certification of EHRs as they select their own system. Practices with EHRs should ask their vendors how their systems will be brought into alignment with the new requirements and if the practice would incur additional costs as a result. If their current systems cannot be upgraded, practices may need to switch to different models. Useful resources include:

• CMS guidance on the Final Rule - www.cms.gov/EHRIncentivePrograms
• EHRs: standards and certification criteria - http://healthit.hhs.gov/standardsandcertification

Practices also should review the materials available from the Washington & Idaho Regional Extension Center (WIREC), offered through Qualis Health: www.wirecqh.org. See also the WSMA Practice Resource Center . For questions, contact Bob Perna at rjp@wsma.org.

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CMS launches physician compare website

CMS recently launched the first phase of a searchable online physician directory for Medicare patients called Physician Compare. The site currently includes information on contacts and addresses; gender, medical specialty, the professional' education, residency or other training; and languages the professional speaks besides English. Eventually, Physician Compare will show whether physician practices have submitted data to CMS on the Physician Quality Reporting System (PQRS).

Note that the majority of the information in the Physician Compare website comes from the Provider Enrollment, Chain, and Ownership System (PECOS) system. We anticipate that CMS will provide additional guidance on the appropriate process to update your information should you continue to find inaccuracies after the upcoming PECOS update.

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