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Medigram - January 24, 2008


TOP STORY

IPFCF cash balance now over $40 million in the red

Because of the state’s raid on the Injured Patients and Families Compensation Fund in the 2007-2009 biennial budget, the Fund now has a negative cash balance and is being forced to pay interest to another state fund (or possibly multiple funds).

A front-page story in the January 18 Wisconsin State Journal highlights consequences the Society predicted: according to the state's Department of Administration, the Fund has a negative cash balance (not a negative asset balance) of $44.5 million as of November 20, 2007. This is due to the state taking $71.5 million on October 29, 2007—an amount the Fund did not have in cash on that date. The Fund was forced to borrow money from other state funds. The DOA memo to the legislature revealing this situation can be seen here.

The state will take another $127.5 million on July 1, 2008 to complete the $200 million raid. The Society issued this statewide press release to bring more public attention to the government-caused woes. The State Journal also published an editorial on Tuesday highlighting the raid as an example of poor fiscal policy, and called on state leaders to stop “plundering” funds like the IPFCF.

While a cash deficit does NOT mean there are no assets in the Fund for future claims, it does speak to the harm caused by the state taking money from the Fund in late October. The long-term effect of the raid, as projected by the Legislative Fiscal Bureau during the budget debate, is even more troubling.

The Society’s lawsuit against the state continues; both sides will meet in early February with the circuit court judge to set a potential trial date and litigation calendar.

For more information, e-mail Mark Grapentine.

NEWS BRIEFS

Medicare NPI requirement begins March 1, 2008; test claims now!

The March 1 deadline requiring physicians to use NPIs on all electronic claims submitted to Medicare is just around the corner, and the Centers for Medicare and Medicaid Services (CMS) is urging providers to test claims now to prevent future payment problems. While providers may continue to submit NPI/legacy pairs in the primary provider fields until May 23, claims containing only a legacy identifier in those fields not be accepted as of March 1. This deadline also applies to paper claims that are sent to clearinghouses that file electronically.

After submitting and receiving payment for claims containing both NPIs and legacy identifiers, Medicare suggests that providers test a small batch of claims with only the NPI in the primary provider fields. If the results are positive, begin increasing the number of claims in the batch.

(Reminder: For institutional claims, the primary provider fields are the Billing and Pay-to Provider fields. For professional claims, the primary provider fields are the Billing, Pay-to and Rendering Provider fields. If the Pay-to Provider is the same as the Billing Provider, the Pay-to Provider does not need to be identified.)

CMS will host a national NPI roundtable on Wednesday, February 6 from 1:30–3 p.m. The call will focus on the status of the Medicare implementation and will include a question and answer session. Click here for registration information. For more information about NPI, click here.


White Coat Wisdom celebrates Wisconsin physicians

Wisconsin doctors, including seven former Wisconsin Medical Society presidents, are featured in a new oral history book, released Monday. White Coat Wisdom was written by Steve Busalacchi who directed public relations at the Society for nine years before starting his own health communications firm a year ago.

“I’ve had the great privilege of getting to know so many talented and remarkable physicians throughout my career, I thought it high time the public had a chance to meet of a few of them, too,” said Busalacchi.

White Coat Wisdom highlights several dozen extraordinary physicians, delving into their upbringing and motivation for pursuing medicine. The topics discussed include end-of-life care with Kay Heggestad, MD, liver transplantation with Munci Kalayoglu, MD, and savant syndrome with Darold Treffert, MD.

The book is dedicated to the memory of Oshkosh neurologist Kenneth Viste, Jr. MD, a past president of the Society and Busalacchi’s longtime friend. A portion of the book’s proceeds will support the Wisconsin Medical Society Foundation’s Kenneth M. Viste, MD memorial fund.

Visit www.whitecoatwisdom.com for a complete chapter summary, audio from the interviews and excerpts.


Should your patient be driving?

The Wisconsin Department of Transportation has produced a brochure to help physicians determine if a patient is medically impaired to the point that he or she should not be driving. The brochure, titled “Be Safe, Not Sorry,” explains reasons for cancelling a driver’s license and the process of reporting patients who should not be driving. To request copies of the brochure, e-mail or call 608.266.2327. Click here for more information.

$1,000 essay contest seeks UW’s best rural health paper

Essays are now being accepted from UW students for a contest with a prize of $1,000. The contest does not have rigid requirements for length or format, but welcomes papers ranging from first-person essays to formal “journal-ready” articles.

The winning essay will be about rural health and will include some of these attributes:
  • relevant to rural communities
  • innovative
  • practical
  • multi-disciplinary
  • improves quality of care
  • team/relationship oriented
  • applicability to networking, cooperatives
Papers already written for a class or other purposes in the previous 12 months are eligible for this competition.

Established in 1993, this contest is open to anyone who has been a student at the University of Wisconsin within the preceding year (all campuses, programs, graduate, under graduate, part-time and non-degree included). The competition was established to honor the memory of Hermes Monato, Jr., a December 1990 graduate, as well as to highlight the importance of rural health.

All entries (no copies needed) must be submitted by April 15 c/o Monica Seiler, RWHC, PO Box 490, Sauk City, Wis 53583 with writer’s name, academic program and expected date of graduation. More information, including past winners, is available here.

YOUR PRACTICE. YOUR FUTURE.

Pharmacy consolidation to be implemented Feb. 1

Effective February 1, 2008, pharmacy services and some drug-related supplies will be reimbursed by fee-for service Medicaid for those enrolled in Wisconsin Medicaid managed care programs, including BadgerCare Plus HMOs, SSI HMOs and most special managed care programs. The following are exceptions to this change:
  • Prescription drugs and related services for members enrolled in the Program of All-Inclusive Care for the Elderly (PACE) and those enrolled in the Family Care Partnership
  • Physician-administered drugs
During the transition period from Feb. 1 to April 1, 2008, prior authorization (PA) and diagnosis restrictions will not apply to prescriptions for managed care members. Physicians are encouraged to work with their patients and pharmacy professionals during this transition period. Members will be required to receive their prescription drugs from a Wisconsin Medicaid certified pharmacy. Prescriptions currently filled by specialty or mail-order pharmacies may not continue after Feb. 1, and these prescriptions must be transferred.

This consolidation of pharmacy services will allow for one Preferred Drug List (PDL) for all Medicaid fee-for-service members. If a member is currently taking a non-preferred drug, the pharmacy professional should contact the prescriber to switch the prescription to a preferred drug. If it is medically necessary for a member to remain on a non-preferred drug, a PA request must be completed and signed. Prior authorization for non-preferred drugs will be required on and after April 2, 2008. Pharmacies can begin requesting PAs immediately. All PA requests should be submitted directly to the pharmacy where the prescription will be filled, not to Wisconsin Medicaid.

The following drug classes will be grandfathered and members currently taking non-preferred drugs in the PDL classes listed may remain on the drug indefinitely without a PA:
  • Alzheimer’s agents
  • Antidepressants, Other
  • Antidepressants, SSRI
  • Anti-Parkinson agents
  • Anticonvulsants
  • Atypical antipsychotics
  • Stimulants and related agent
Beginning February 1 most members in the BadgerCare Plus program will be required to pay a copayment for prescription and over the counter (OTC) drugs. The following copayments will apply to Wisconsin Medicaid and BadgerCare Plus Standard Plan members:
  • $3 brand name drug
  • $1 generic or compound drug
  • 50 cents for each OTC drug
The maximum per member, per month, per provider copayment is $12; there is no monthly maximum on the OTC drug copayment. See Chapter 49.45(18), Wis. Stats. for additional information regarding copayments.

The emergency medication dispensing policy allows pharmacy providers to dispense a 14-day supply of a drug in situations where it is medically necessary or an emergency.

For a detailed overview of the pharmacy consolidation project and to view the most current PDL, please see this BadgerCare Plus Update on the Wisconsin Medicaid Web site.

Physicians and pharmacy providers may e-mail additional questions.

EDUCATIONAL PROGRAMS

Call for speakers

The Wisconsin Medical Society’s Education department is seeking speakers for the 2008 Midwest Coding & Practice Management Symposium to be held September 21-23, at the Kalahari Resort in Wisconsin Dells. Physicians, coders, group managers and other health care professionals comfortable presenting to a large group are encouraged to participate. Topics this year will include E/M, cardiology, dermatology, compliance and more. If you are interested in sharing your specialized knowledge or there is a topic you would like to see added to the agenda please e-mail Penny Osmon.

FYI: FOR YOUR INSURANCE

Disability income insurance can help protect your livelihood

What if you couldn’t practice medicine? Through Principal Financial Group, Society members have an opportunity to help protect their livelihood—and receive discounts of up to 20 percent on high-quality individual disability income insurance. Please click here to read how individual disability insurance coverage can affect your life. Contact Wisconsin Medical Society Insurance & Financial Services, Inc. to learn more about the program by using our on-line contact form, e-mail us or call 866.442.3810.

FOUNDATION FOCUS

Think Spring! April 10, to be precise…

With the recent cold snap in Wisconsin, it helps to look toward Spring. And that is exactly what the Wisconsin Medical Society Foundation is encouraging members, county medical societies, clinics and hospitals to do—by marking April 10 on your calendars.

The Foundation will welcome Fran and Kim Peek as special guests for our annual fundraising dinner, silent auction and raffle at the Monona Terrace Convention Center on April 10, 2008 from 5:30-9 p.m.

Kim Peek was the inspiration for the movie Rain Man. With 98 percent recall on close to 8,000 books and other amazing talents, Kim is one of a handful of identified prodigious savants in the world. Kim and his father, Fran, have traveled and appeared on television throughout the world telling their unique story to audiences and inspiring everyone to look for the unique abilities in each of us.

With only one annual fundraising event, the Foundation counts on the success of this event to raise funds for current programs including scholarships, grants and fellowships. You can support the Foundation through this event in several ways:
  • Become a sponsor. Sponsors receive eight or more complimentary invitations to the event.
  • Encourage your county medical society to purchase a table for eight people.
  • Donate a silent auction item. While we welcome any donation, this year we hope to offer a variety of items for those of us who do not have Kim’s memory and instead need the assistance of technology with RAM—things like laptops, wireless handheld devices, smartphones, GPS, etc. If you have any connection to these types of items, please give us a call! Unique items of any kind are always appreciated.
  • Attend the event. Individual tickets available for $100.
For more information about these opportunities, e-mail Renee Reback or call 608.442.3720.

FAQ

Question:
When is it appropriate to report CPT 69210, removal of impacted cerumen (separate procedure), for one or both ears?

Answer:
CPT Guidelines state the reporting of 69210 involves direct visualization, in which the physician is removing impacted cerumen using suction, a cerumen spoon, or delicate forceps. If no infection is present, the ear canal may also be irrigated. If the use of an operating microscope is necessary you may also bill for the add-on code 69990, “Microsurgical techniques requiring use of an operating microscope.” Medicare will not pay additionally for the use of the operating microscope with code CPT 69210 per Claims Processing Manual 100-04, Chapter 12, Section 20.4.5.

Click here to read the answer in its entirety.

If you have questions about this or other coding matters, click here to review our FAQ archives, or e-mail efaq@wismed.org.

QUALITY CORNER

HRSA unveils free on-line health literacy training for health professionals

“Unified Health Communication 101: Addressing Health Literacy, Cultural Competency and Limited English Proficiency” is a free on-line learning experience designed to help health professionals improve their patient-communication skills, increase their awareness and knowledge of factors that affect their communication with patients and implement patient-centered communication practices. The course, developed by the Health Resources and Services Administration, comprises five modules and is estimated to take five hours to complete. The course may be completed at the user’s own pace and may be taken for credit (CEU/CE, CHES, CME and CNE) or not for credit. Click here for more information or registration instructions.