During the last 9 days of the Federal fiscal year (September 22 through 30), the Centers for Medicare and Medicaid Services (CMS) will place a hold on payment of all Medicare claims. For this you can thank Congress which approved the hold as part of the Deficit Reduction Act of 2005. In announcing the hold, CMS also announced that no interest will be accrued and no late penalties will be paid to an entity or individual as a result of this one-time hold on payments. All claims held during this time will be paid on or soon after October 2, 2006. This policy applies only to claims subject to payment. It does not apply to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments, and cost report settlements. Please note that payments will not be staggered and no advance payments will be allowed during this 9-day hold. For more information, please view the MLN Matters article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047.pdf.
Vincent Gray, the DOCPAC-endorsed candidate for DC Council chair, emerged victorious in the September 12 Democratic Primary. He drew about 57 percent of the vote over opponent Kathy Patterson who received 31 percent. Although technically Gray must win the November 7 general election, his victory is all but assured as overwhelmingly Democratic District voters are expected to choose him over any write-in candidates from the Republican or Statehood/Green parties.
DOCPAC Chair John H. Niles, Jr., MD, said, "Although not all DOCPAC-supported candidates won, our fundraising activities for candidates was unprecedented thanks to DOCPAC members who hosted fundraisers and contributed to candidates either directly or through membership in DOCPAC. My sincere thanks to all of them. We will build on this momentum in the coming months to get even more physicians involved with District politics. Who knows? Now that there will be special elections to fill the Ward 4 and Ward 7 Council seats, maybe a physician will choose to run!"
Medical Society of DC leaders will be meeting with representatives of UnitedHealthcare in the Mid-Atlantic region on Monday, September 18. On the agenda are
• New referral policies for MD IPA and Optimum Choice;
• MD IPA and Optimum Choice products administered with UnitedHealthcare technology;
• New initiatives including Premium Designation and direct deposit; and
• MSDC members' concerns and comments about UnitedHealthcare policies and practices
That last agenda item is particularly important to MSDC leaders. So, please contact Dianne Bricker (bricker@msdc.org or 202-466-1800, ext. 105) regarding your thoughts and recent experiences with UnitedHealthcare. If you've had problems let us know about any efforts to resolve them. If you're pleased with any changes in the business practices of the health plan, let us hear about those too. And while the meeting is being held in mid September, call the Medical Society at any time for assistance in dealing with health plans in this region.
Employment Law specialist Michelle Bodley Radcliffe, Esq., will discuss employment law at the next meeting of the Greater Metropolitan DC Medical Group Management Association on Thursday, September 21 at the Medical Society of DC, 23175 K Street, NW, from 7:45 to 9:30 a.m. Ms. Radcliffe is with the law firm of Isler, Dare, Ray and Radcliffe which advises employers about counseling and disciplining employees. The firm also represents employers in discrimination and harassment claims before the EEOC and in federal or state court. In addition, the firm provides guidance on wage-hour issues and litigates issues relating to non-compete agreements. Practice administrators and other practice staff are invited to attend this free breakfast seminar. No RSVP is required.
After a brief hiatus, the Medical Society of DC's popular CPR classes for physicians and other providers of health care will resume on Tuesday, October 10 at 4 p.m. at the Medical Society's headquarters, 2175 K Street, NW, Suite 200, Washington, DC. The cost is $50 for MSDC members and staff of MSDC members; $75 for non-members and the staff of non-members.
The course is the American Heart Association's Healthcare Provider CPR course, a nationally-recognized course that includes techniques for rescue breathing, CPR and relief of obstructed airways for both conscious and unconscious adult, child and infant victims. In addition, two-rescuer CPR, use of the plastic face mask (mouth-to-barrier device), the modified jaw thrust for trauma victims and use of an Automated External Defibrillation (AED) will be covered. Immediately upon successful completion of this training, the participants receive an American Heart Association course completion card with a suggested retraining date of two yeas.
To register for the course, contact Rose Smith at 202-466-1800, extension 115 or smith@msdc.org.
The Medical Society of DC joined with the Legal Aid Society of DC and others in a successful effort to get the City to take steps to mitigate the effects of federal law which requires that persons applying for or renewing Medicaid coverage must present proof of US citizenship. In addition a lawsuit aimed at blocking implementation of the new rule in DC was voluntarily dismissed after the plaintiffs were satisfied that health and nursing home coverage was no longer at risk.
The rule, which took effect July 1, requires that in order to receive Medicaid benefits, persons would have to document their citizenship. Critics warned that many persons, including millions who were born in the US, would be unable to supply the documentation and would therefore be denied coverage.
More than 142,000 people in the District receive Medicaid benefits. The recent federal rule affected about 34,000 of them.
District officials decided that individuals who can show that they are making a "good-faith effort" to produce passports, birth certificates or other paperwork will continue to have Medicaid coverage. MSDC was a signatory to a letter recommending 6 ways the District could mitigate the effects of the federal mandate.
CareFirst BlueCross BlueShield invites physicians and practice staff to attend its eServices Open House to learn about available electronic solutions and ways to eliminate paper claims. The event will be held Wednesday, October 4, 2006 beginning at 7:30 a.m. and running until 2:30 p.m. at the Hilton Columbia, 5485 Twin Knolls Road, Columbia, Maryland 21045.
CareFirst noted that the 2006 event will build on the success of the 2005 OpenHouse. "We will still focus on electronic claims solutions and e-vendors will be in attendance to show their products. This year, we will also present information about our new CareFirst eLearning capabilities, including CareFirst Direct, EDI Helpful Hints and more. Presentations will occur throughout the day, so attendees should feel free to join us at any time. Snacks will be provided and participants will receive a thank you gift just for attending."
Showcasing their products and answering your questions will be representatives from Emdeon, Gateway EDI, MedAvant, Payerpath, ProtoMed and RealMed. In addition, CareFirst representatives will be available to discuss and demonstrate:
To register, call 877-269-2219.
The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that physicians and other health care providers obtain a National Provider Identifier - NPI - by May 23, 2007. This one number will replace all the assorted numbers assigned to you by Medicare, Medicaid and private health plans. The number will also not change but will remain with you regardless of job or location changes.
You can apply for an NPI either online or by completing and mailing in a printed application.
There is no charge for an NPI.
Are you required to get an NPI? Even if you are not a "covered entity" under HIPAA, you might be required to get an NPI because some private health plans will require it. Check with the health plans to which you submit claims to determine their policy on the NPI. Also, even physicians who do not bill electronically for services may need to disclose their NPIs to those providers who do (e.g. physicians who order lab tests or refer patients for diagnostic tests must be identified on the lab's or testing facility's claims). Also, Medicare will require the NPI on its paper claim forms.
The Centers for Medicare and Medicaid Services (CMS) is sponsoring an NPI Roundtable conference call. During the call, CMS representatives will address common questions about the NPI as it relates to Medicare. It is a free call, open to all healthcare professionals, and will be held Tuesday, September 26 from 2:00 to 3:30 p.m. To participate, call 1-877-203-0044. The pass code is 4795739. To read frequently asked questions about the NPI, visit http://questions.cms.hhs.gov and do a search for "NPI."
MSDC Annual Meeting, afternoon and evening of Wednesday, November 1, 2006. The Ritz-Carlton, Washington. Plan to attend!
Thanks to significant input from the Medical Society of DC and area hospitals and health plans, the DC Department of Insurance, Securities and Banking (DISB), recently finalized a uniform credentialing/re-credentialing application that will all but eliminate one of practice administrators' biggest headaches - the onerous task of completing a different credentialing application for each hospital medical staff and health plan network a physician wishes to join.
Hospitals and health plans in the District of Columbia are now required to use the amended application which was published in final form in the August 11 DC Register.
The application is available at www.credentialingapplicationdc.org.
In developing the application for use in the District, stakeholders began with the application shared by all health plans affiliated with CAQH's Universal Credentialing DataSource. Locally, these plans include CareFirst BlueCross BlueShield, UnitedHealthcare, Aetna, CIGNA, and others.
The officers and staff of Medical Society of DC extend their condolences to Director of Member Services Barbara Allen, whose father passed away on September 6, 2006.
Congratulations to District of Columbia pediatrician Renee R. Jenkins, MD, who will take office as president-elect of the American Academy of Pediatrics at AAP's October meeting in Atlanta.
The DEA recently unveiled a proposed rule that will allow physicians to prescribe up to a 90-day supply of Schedule II controlled substances during a single office visit, where medically appropriate. In conjunction with this, the DEA updated its Practitioner's Manual and issued a new policy statement, "Dispensing Controlled Substances for the Treatment of Pain."
In announcing the proposed rule, a DEA press release stated, "The overwhelming majority of medical professionals who provided written input expressed concern about the statutory provision that restricts doctors from refilling Schedule II prescriptions. . . . The proposed rule is intended to make sure patients get the pain relief they need, and that doctors have the latitude to prescribe in a manner consistent with their sound medical judgment, while enabling DEA to fulfill its legal obligation to prevent drug abuse and diversion." Under the proposed rule, physicians, as they have always done, must determine whether a patient has a legitimate medical need for the prescribed substance, and the physician must be acting in the usual course of professional practice. DEA's proposed regulation would then permit the physician to issue multiple Schedule II prescriptions, during a single office visit, allowing patients to receive a total of up to a 90-day supply of controlled substances according to the fill date that the doctor gives the pharmacist.
The policy statement accompanying the proposed rule outlines the longstanding legal requirements on dispensing controlled substances for the treatment of pain. It addresses the requirement that controlled substances be prescribed only for a legitimate medical purpose, examines the issues surrounding the treatment of pain and elaborates on DEA's policy for taking appropriate legal action against those very few physicians who illegally prescribe controlled substances.
The proposed rule can be found at http://www.deadiversion.usdoj.gov/fed_regs/rules/2006/fr0906.htm
The policy statement can be found at http://www.deadiversion.usdoj.gov/fed_regs/notices/2006/fr09062.htm
The Updated Practitioner's Manual can be found at http://www.deadiversion.usdoj.gov/pubs/manuals/pract/index.html
From Delmarva Foundation
Paper. Doctors love paper. We grew up with it. We wrote long histories and physicals on it. We leafed through pages of paper in search of the expert wisdom of our teachers and our consultants. We held it in our hands. It was real. So anyone who wants to take my paper away is going to have a fight on their hands. “I’ll give up my paper chart when you pry it from my cold dead fingers!”
If you’re not a doctor of a certain age, you may be rolling your eyes right about now. A word to the wise, however—you ignore a doctor’s love affair with paper at your peril if your goal is to replace it with an electronic medical record (EMR). As you contemplate the transition from paper record-keeping to the new world of electronic clinical information, here are three lessons to consider:
Lesson 1. Before you think about scanning the first document or discarding the first lab slip, you must have “The Conversation” with the physicians in your practice. They should have already been part of the decision-making process that launched the conversion. They need to know what is about to happen and what their options are. For instance, if the goal is to become completely paperless, that should be stated up front. A phased implementation toward that goal may be feasible and most practical in your setting, but there should be no “opt out” path for your staff. Everyone must understand that there will be a single solution to information management; one of the worst mistakes is to end up with parallel systems—one electronic and one paper—in the same practice. It is only fair for people to learn this up front so they can choose to stay or to seek other opportunities. Once everyone is on board with the goal, there may be good reasons to proceed at a measured, incremental pace, especially if your providers need training and gentle handling. The ultimate goal, however, should never be in doubt.
Lesson 2. “OK, I’m ready to move forward, so let’s scan every piece of paper in the office.” Do not even think about scanning everything in the chart. Consider for a minute—how many patient encounters entail looking at every page of a chart? (The correct answer is zero.) This strategy is used by physicians who have submitted begrudgingly to Lesson 1, but still want to hang on to the comfortable world of a familiar chart. There are two major reasons for avoiding the total scan. First, it’s an enormous waste of resources in the form of storage space on your server, as well as the manpower involved to physically scan all those pages. Second, and more important, this mega-scanning will only result in an electric filing cabinet, and not an EMR. Other than looking at these records on a computer screen, there is no advantage of this approach over a traditional paper chart. None of this patient information will be “computable,” which means that nearly all of the power and functionality of your EMR is being wasted. Certain documents must be retained and scanned into the patient’s record, of course, but going forward a physician needs to capture discreet data elements (e.g., age, gender, HgbA1C level, blood pressure) in order to measure, understand, improve, and deliver the best care.
Scanning documents is an essential way to get information into your EMR, but it is not the only way. Certain clinical data should probably be entered into the EMR manually (in a process called “backloading”) before a patient encounter even occurs. This process will produce discrete data elements (e.g., allergies, medications, diagnoses) that can be organized, searched, displayed, and reported. In most cases, information that is scanned can only be looked at—not searched or organized. The process of backloading is time intensive, but the payoff is significant, and it only needs to be done once per patient. In many cases, backloading can also serve as a learning experience for staff members who are developing new computer skills.
Lesson 3. You must have a plan. It may seem like the best idea would be to start pulling charts from left to right and proceed with your scanning and backloading. However, your time will be better spent if you go about this more thoughtfully. Here are some questions to ask yourself as you create your plan:
• What information do you want to backload? Examples include allergy lists, medication lists, pertinent lab values and immunizations. Which charts should be processed first? Which patients have upcoming appointments?
• Should charts be entered into the EHR for patients that haven’t been seen in 4 to 5 years?
• What is the volume of information that we need to scan? What kind of scanner is needed?
• Who will do this? When?
You get the idea. MassPRO, the Massachusetts Quality Improvement Organization, has created a great resource that may be very helpful in your planning. A Systems Approach to Organizational Redesign is available online at http://www.masspro.org/HIT/DOQ/docs/literature/DOQITOrganizationalRedesign workbook.pdf. The document management section begins on page 63 of the workbook.
Finally, what to do with all the paper you no longer use? It is crucial to be aware of your responsibility to retain patient information. For instance, DC regulations require that physicians keep medical records for a minimum of 3 years after last seeing the patient or three years after a minor patient reaches 18 years of age. [ Editor's note: The Medical Society of DC recommends that physicians also consult their medical liability insurance carriers when making decisions about the retention of medical records.] Maryland law requires that physicians retain records for 5 years from the last date of service. For minors under the age of 18, records must be retained until the individual reaches 21 years of age or 5 years from the last date of service, whichever comes later. You must ascertain the requirements that will affect your practice’s location.
The transition from paper to electronic clinical information can seem daunting. The best way to get the most from your new EMR, and avoid the discouragement of a difficult implementation, is to plan ahead. Your motivation and enthusiasm will be fueled by the vision of taking your capacity to practice medicine to a new level.
Questions about HIT? Email them to doqitdelmarva@dfmc.org.
The Center for Medicare and Medicaid Services' Medicare Learning Network (MLN) website contains dozens of valuable tools for physicians, practice staff, and patients. These include brochures, fact sheets, quick reference sheets, posters, etc. Most documents are available in hard copy, CD Rom or can be downloaded from your computer. To access this valuable information, visit www.cms.hhs.gov/mlnproducts.
A sampling of the documents:
The DC Department of Health reminds you that if you haven't reserved flu vaccine through a manufacturer or distributor for the upcoming season, you can and should do it now. Place your order (or get on a waiting list) by contacting one or more of the entities listed below. All vaccines must be ordered through distributors at this point except for FluMist, which can be ordered directly through Medimmune. As in previous years, providers are encouraged to vaccinate their high-risk patients first due to the uncertainty of flu vaccine production.
Vaccine Manufacturers
Sanofi-Pasteur (Aventis) (Fluzone)
1-800-822-2463
www.vaccineshoppe.com
Chiron (Fluvirin)
1-800-244-7668
www.chiron.com
MedImmune (FluMist™)
1-877-358-6478
www.medimmune.com
GSK (Fluarix)
1-866-475-8222
www.gsk.com
Primary Vaccine Distributors (receive vaccine directly from manufacturer)
ASD
1-866-281-4358
www.asdhealthcare.com
Henry Schein
1-800-772-4346
www.henryschein.com
Henry Schein / GIV
1-800-521-7468
www.giv.com
Henry Schein / Caligor
1-888-225-4467
www.caligor.com
FFF Enterprises
1-800-843-7477
www.fluvaccine.net
McKesson
1-800-999-2923
www.mckesson.com
CuraScript
1-877-599-7748
www.priorityhealthcare.com
PSS Worldwide Medical
1-800-344-0019
www.pssd.com
Seacoast Medical
1-800-732-2115
www.seacoastmedical.com
Secondary Vaccine Distributors (receive vaccine from the primary distributors above)
ANDA
1-800-621-7143 x4640
www.andameds.com
Besse Medical
1-800-543-2111
www.besse.com
Dubin Medical
1-800-929-4364 x238
www.dubinmedical.com
Expert-Med, Inc.
1-800-447-5050 x140
www.expert-med.com
Moore Medical
1-800-234-1464 x5735
www.mooremedical.com
Rally, Inc
1-800-337-2559
www.rallyinc.com
Stat Pharmaceuticals
1-800-748-5665
www.fluvaccine.com
For additional information, contact Stephanie Richard of the Department of Health's Immunization Program, 202-576-9338 or Stephanie.Richard@dc.gov
For sale. Titan Ultrasound system with stand. Just over a year old. UP895 MD, BMW Printer RM91. Remote Commander. Call William Kurstin, MD, at 202-966-1313.
Office for Sublet. Available Tuesday and Friday. In beautiful medical building with excellent view. If interested, call Wendy at 202-463-4925.
Sublease Available. Foxhall Square/American University area. Gynecologist office available to sublet with 832 square feet and full days and Saturdays. Lcoat6ion is convenient to Georgetown and Sibley Memorial hospitals. Call 202-363-4828.
If You're Looking for Part Time Downtown Space, call 202-628-5982. Available four days a week.
Sublease Available Downtown. 2311 M Street, NW. Solo internal medicine practice. Elegant, ultra-modern facility. 4,000 square feet. Includes: (7) exam rooms, (5) private offices, infusion room, full lab, variety of medical equipment, kitchen, (2) bathrooms, large business area, ample storage space and parking. Convenient to Red and Blue line Metro. Opportunity to share staff, computer, billing services, etc. Contact Dr. Moody Mustafa, 202-331-3338.
Medical Office Sublet. Medical Office sublet at 2440 M Street, NW. 916 square feet. Large reception area, 2 exam room s, 5th floor, large windows and lots of light. Metro accessible. Available one or two days a week. Call 202-833-0048.
Looking for a Better Lease for Your Practice? Want to Renegotiate Your Current Lease? With over 20 years of experience in medical and dental office leasing, we at Gittleson Zuppas Commercial Realty specialize in your practice's special needs. Give us a call today and we can audit your lease at no charge and help you make the best decision for your practice. Greater Washington's Medical Office Leasing Experts! Gittleson Zuppas, Commercial Realty Inc., Medical Real Estate Specialists. Contact David Gittleson or Nick Zuppas at 301-961-1941.
Greenway Medical. What Is Your Experience? (R) The Integrated Physicians Infrastructure. PRIMEResearch (TM) PRIMESuite® PRIMEExchange®, PRIMEPatient™. A fully integrated Electronic Health Record (EHR) Suite featuring Electronic Health Record, Integrated Practice Management, Interoperability. For more information, please contact Rick Greenberg, Regional Sales Manager, rickgreenberg@greenwaymedical.com, 703-357-3766 office phone; 703-997-2167 fax.
Buy a Practice. Visit: buyapractice.com. Or, call 301-934-3666. A complete selling and buying of medical practices.
Medical Collections. Attorney Sherry Berson, Agent of Equifax Credit Reporting Bureau ~ Credit Listing ~ Address Tracing ~ Insurance Appeals ~ Billing Disputes ~ Contingency Fee. Email Bersonaty@aol.com; 6012 Massachusetts Avenue, Bethesda, MD 20816. Phone 301-229-6012
If you wish to run an ad in Marketplace, please contact Dianne Bricker at 202-466-1800, ext 105 or bricker@msdc.org. As a benefit of membership, Medical Society of DC members may run ads free of charge.
e-Newsline is published monthly by the Medical Society of the District of Columbia, 2175 K Street, NW, Suite 200, Washington, DC 20037. Phone: 202-466-1800 ~ Fax 202-452-1542 ~ www.msdc.org ~ Editor/Director of Health Policy and Advocacy: Dianne Bricker.