The Medical Society of the County of Queens “Members Only” Helpful Information This Week… Table of Contents - “Tid-Bits”: Here is a brief summary of some important things that came across my desk this week and might be helpful to you… 1. Has the AMA heard the voice of the Physician? 2. The Centers for Medicare and Medicaid Services is convening a call for the physician community on September 14th to share information on H1N1. Questions may be submitted in advance via e-mail. Details of the call are below: 3. Medicare - Ask the Contractor Teleconference 4. Worker’s Comp Pilot Program – call for providers 5. Medicare - Dollars at Risk for Local Coverage Determination Computed Tomography Edit 6. Medicare - Dollars at Risk for Local Coverage Determination Lipid Profile/Cholesterol Testing Edit 7. Call for Speakers… “Events of Interest”... A. “Insurance Industry Updates for Physicians” Speaker: John Powell, Asst. Deputy Superintendent for Health New York State Insurance Department Date: Sept 15, 2009 Time: 6:30 PM Registration 7:15 Dinner Program Location: CitiBank Building 50 Floor th One Court Square Long Island City, NY 11120 REGISTRATION DEADLINE IS FRIDAY SEPT 11!!!! Pre-Registration Absolutely Required for Building Security Clearance (718) 268-7300 B. Join The Queens Medical Society and “ProSperus” for a two-hour seminar on September 16th covering: An explanation of the healthcare incentives in the stimulus program Tips on how to choose the right EMR for your practice Demonstrations of the best EMR systems A guide to getting started with e-prescribing A workshop on improving your billing and collections Choose one of the sessions on September 16th hosted by the Queens Medical Society in Forest Hills: Breakfast Session 7:00 a.m.—9:00 a.m. Cocktail Session 6:30 p.m.—8:30 p.m. Drop-in Consultation with Lunch Buffet 11:00 am.—2:00 p.m. Take advantage of free parking right beside the QCMS building at 112-25 Queens Blvd. If you are taking the subway, use the F train stop at 75th Ave. in Forest Hills. Call 718 268-7300 to Register “Tid-Bits”: 1. Has the AMA heard the voice of the Physician? Sept. 8, 2009 Congress and White House set "reset" button on health system reform As the U.S. House of Representatives and Senate reconvene today following their summer recess and President Obama prepares to speak before a joint session of Congress tomorrow evening, the stage is set for new and hopefully productive legislative discussions on health system reform. Over the next few weeks, leaders in the House will be crafting a bill for consideration on the floor following markups that were held in July by three different committees. The Senate Finance Committee is operating on a Sept. 15 deadline for reaching agreement on a health system reform plan that would subsequently merge with proposals crafted last June by the Senate Health, Education, Labor & Pensions Committee, so that a single bill can be considered on the Senate floor. A preliminary framework of a Senate Finance Committee proposal that was developed for discussion by committee members began circulating in Washington, D.C., this morning. Clearly, the situation is very fluid. During this critical time, the AMA is taking the opportunity to outline seven health system reform imperatives in its communications to Congress and the White House. These include: Providing universal coverage for all Americans. Repealing the Medicare physician payment formula that projects a 21 percent cut on Jan. 1, 2010, to preserve seniors' access to care. Enacting insurance market reforms that expand choice of affordable coverage and eliminate pre-existing conditions. Assuring that health care decisions are made by patients and their physicians, not insurance companies or government officials. Implementing medical liability reforms to reduce the cost of defensive medicine. Making investments and creating incentives for quality improvement, prevention and wellness initiatives, and work force development. Streamlining and standardizing insurance claims processing requirements to eliminate unnecessary costs and administrative burdens. In addition to advocating for addressing these issues in health system reform legislation, the AMA will continue to express opposition to provisions that would be harmful to patients and physicians such as a government plan linking physician payments to Medicare rates. The AMA will also continue to urge that Medicare invest additional funds in the primary care work force without imposing offsetting cuts in payments for specialty care. 2. The Centers for Medicare and Medicaid Services is convening a call for the physician community on September 14th to share information on H1N1. Questions may be submitted in advance via e-mail. Details of the call are as follows: Information Sharing from HHS on H1N1 Call: 1-800-837-1935; Conference ID: 2H1N1 Date: September 14, 2009 Time: 1:30 -3:00 pm, Eastern DS Time Opening Remarks --- Chair- Dr. Nicole Lurie, Assistant Secretary for Preparedness and Response Co-Chairs – CAPT Clare Helminiak, Dr. Sally Phillips, and RADM Ann Knebel Moderator – Susie Butler, CMS Office of External Affairs Agenda The purpose of this information session is to update and inform the provider community about issues around H1N1 preparedness and response, vaccine availability, infection control, and other questions that have come in. We will cover the following topic areas: 1. General Update 2. Vaccines and Antivirals 3. Special Populations 4. Healthcare System Surge Capacity 5. Infection Control and Personal Protective Equipment Submit questions in advance: We invite you to submit questions now at: H1N1.email@example.com Please note – we know that we cannot respond to each individual email question. Submitting questions prior to the call will allow us to address as many questions as possible. Helpful websites, should you have questions: www.flu.gov www.cdc.gov/H1N1flu http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm -- information on antivirals http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6539.pdf -- CMS billing information http://www.cms.hhs.gov/Emergency/Downloads/Medicare_FFS_Emergency_Qs_As_082609.pdf -- Information for Medicare Fee-for-Service Providers All callers, please dial: 1-800-837-1935 and use Conference ID 2H1N1. 3. Medicare - Ask the Contractor Teleconference Part B Jurisdiction 13 Ask the Contractor Teleconference National Government Services, Inc. hosts quarterly Medicare Part B Ask the Contractor Teleconference (ACT) calls. These teleconferences are similar to the Open Door Forums offered by the Centers for Medicare & Medicaid Services. They serve to respond to questions in a timely manner, provide methods of sharing information, and afford us the opportunity to listen to the concerns and feedback of our customers. This is your opportunity to speak directly to your Medicare Part B contractor on the topic of your choice. National Government Services will have staff available representing a wide variety of functions to answer your questions. The next Ask the Contractor Teleconference is scheduled for: Wednesday, September 23, 2009 1:00 – 2:00 p.m. Call: (888) 246-0290 and provide the following information to the conference operator: Conference ID – 29067529 Leader Name: James Bavoso Topic: Ask the Contractor Teleconference Date of Call: 09/23/2009 Time of Call: 1:00 p.m. Eastern Time Expected Duration: 60 minutes Please call in ten minutes prior to the start of the teleconference, as we will start promptly at 1:00 p.m. You will be asked to provide your name, phone number, the total number of attendees at your location, and the entity you are representing. 4. Worker’s Comp Pilot Program – call for providers As the interim Medical Director of the New York State Workers' Compensation Board (Board), I am pleased to announce a pilot program to test new procedures for the medical treatment guidelines (Guidelines). These procedures are designed to significantly reduce disputes over medical treatment and to expedite payment to providers. The Board is currently recruiting treating providers to participate in the pilot. Meetings are currently being scheduled with potential participants and the pilot is expected to begin in November 2009. Please notify your members about this opportunity to participate in the pilot and to help shape the implementation of the Guidelines. Providers who are interested in learning more should contact Elizabeth Miller at (518) 402-1576 or Joseph Salamone at (518) 474-2686. In addition, staff from the Board are available to speak about the pilot at medical association membership meetings. If you would like someone to address your association, please contact my assistant, Kim McCarroll, at (518) 402-1936. Very truly yours, Stephen Levin, M.D. 5. Medicare - Dollars at Risk for Local Coverage Determination Computed Tomography Edit As a Medicare contractor, National Government Services develops and implements Local Coverage Determinations (LCDs) for a variety of services billed to the Medicare Trust Fund. To help ensure that claims are paid based on the medical necessity parameters of the LCD, claims processing edits are created for the services addressed by the LCDs. New edits are in development for the above policy and will be implemented in the next 30 to 60 days. The LCD for Computed Tomography became effective on 12/1/07. Data analysis of the services addressed by this LCD, billed from October 1, 2008 thru January 31, 2009, indicate that if the edits had been in place during this timeframe, providers would have received denials for a percentage of these services. The graph below demonstrates the total services billed and the proportion of denials that would have occurred if an edit for these services was active. Providers are encouraged to review the current LCD for (Name of Service) to verify correct coding and coverage criteria for these services to avoid unnecessary denials. National Government Services LCDs are available on the Medicare Coverage Database at: http://www.cms.hhs.gov/mcd/search.asp Questions regarding this information may be directed to the Provider Outreach & Clinical Education Department at 1(800) 338-6101. 6. Medicare - Dollars at Risk for Local Coverage Determination Lipid Profile/Cholesterol Testing Edit As a Medicare contractor, National Government Services develops and implements Local Coverage Determinations (LCDs) for a variety of services billed to the Medicare Trust Fund. To help ensure that claims are paid based on Medicare regulations and statutes, edits are created based on the services addressed by the LCDs. New edits are in development for the above policy and will be implemented in the next 30 to 60 days. This Local Coverage Determination for Lipid Profile/Cholesterol Testing became effective on 11/15/08. Data analysis of services billed from January through June 2009 indicates that, if the edits had been in place for this timeframe; denials would have been received. This graph demonstrates the total services billed and the contrasting denials which would have occurred had an edit for these services been active. Providers are encouraged to review the current Local Coverage Determination for Lipid Profile/Cholesterol Testing to verify correct coding and coverage criteria are met and avoid unnecessary denials. The Local Coverage Determinations are available on the Medicare Coverage Database at: http://www.cms.hhs.gov/mcd/search.asp Questions regarding this information may be directed to the Provider Outreach & Clinical Education Department at 1(800) 338-6101. 7. Call for Speakers: The Academy of Medicine of Queens County is forming a ―CME Accredited‖ Speaker’s Bureau that will offer presentations in all specialties to hospitals, conferences, and medical groups. In addition, informational seminars will be offered to the public in the form of community education. Those members interested in being considered to make presentations should email either a detailed outline or power point of their presentation along with their CV or bio to jRegosin@QueensMD.org. The CME Committee will be reviewing submissions once monthly and candidates will be notified as soon as a decision is made. For questions or comments regarding the usefulness of these ―Tid-Bits‖: The Medical Society of the County of Queens 112-25 Queens Blvd. Fourth Floor Forest Hills, NY 11375 718 268-7300 info@QueensMD.org CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information or otherwise protected by law. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.