May 7, 2007  

New members

Alexander W. Ramsay, MD First District

March E. Seabrook, MD, Second District

Sunil V. L alla, MD, Fifth District

Richard Charles Osman, MD, Sixth District

Chris Robert McWhorter, MD, Ninth District

Todd Eric Schlesinger, MD, YPS

Steven E.Burdine MD, Resident and Fellow Section

Erin Mary Burns, Medical Student Section and Clerk

 
Look out for Friday's SCMA Alert which will list the many award winners and AMA Delegates representing the SCMA.

This Week at the Statehouse

Ann S. Perdue Heart Patient Safety Act Amended, Surprisingly Passed to Full 3M Committee

H. 3626, requiring a hospital that performs therapeutic heart catheterizations to have a cardiologist on site twenty-four hours a day, seven days a week and to only utilize full-time and part-time nursing personnel who are directly employed by the facility to provide nursing services to cardiac patients, was amended in a House 3M subcommittee and passed to full Committee.  

The subcommittee amended the bill to direct a hospital that performs diagnostic heart catheterizations that does not consistently have a cardiologist on site full time or on stand by, shall inform its cardiac patients at the time of admission, verbally and in writing, that the hospital does not have such a physician on site in the event of an emergency. The subcommittee further amended the bill to direct that such hospitals may only utilize nursing personnel in the care of cardiac patients if the nurse has documented experienced and training in cardiac care; contract nurses or those new to the cardiac unit shall receive unit orientation and training provided by the hospital and shall sign documentation to that effect. According to the amendment, these provisions may be phased in over a six month period.

The proposed amendments additionally require that a heart catheterization hospital develop policies and procedures for early recognition of a patients’ potential deterioration and/or crisis and shall establish a team of clinicians for rapid response to such patient, and further provide the patient or family of the patient direct access to this team via written and verbal information upon hospital admission.

SCMA opposes this legislation as written and is working this week to ensure this legislation does not make it out of full 3M committee this year.

Podiatry Bill Stopped in House Subcommittee

A House 3M subcommittee voted to adjourn debate last week on H. 3741 (Mahaffey, et al), a bill expanding the scope of practice of podiatrists. After testimony from both sides of the issue, the subcommittee agreed the bill should not progress to full committee.

A big thank you to Dr. Thomas Joseph and Dr. Robert Santrock for testifying on behalf of SCMA and SCOA in opposition to this legislation.

Shaken Baby Bill Headed to Conference Committee

Upon the Senate’s non-concurrence with amendments made to S. 518 in the House, the bill will soon head to conference committee in order to reach a compromise between the two versions. S. 518, requiring mothers and/or fathers and caretakers of newborns to be offered upon hospital discharge an opportunity to view a video on the dangers of shaken baby syndrome, was amended in a House subcommittee to include a provision that infant CPR information must also be provided as well as the addition of protection language for health care facilities and providers as it pertains to civil and criminal liability.

The bill’s conference committee appointments are Senators Ryberg, Hutto, and Cleary and Representatives Hayes, Bowen and Hart.

Doctor of the Day

Thanks to Dr. Dana King (Mt. Pleasant ), Dr. Ben Nicholson (Edgefield) and Dr. Coleman Floyd (Florence) for their service at the Statehouse this week!

Medicaid and Medicare Matters

Medicare Fee-For-Service National Provider Identifier (NPI) Contingency Plan National Provider Roundtable with Q&A Session

The Centers for Medicare & Medicaid Services (CMS) will host a National Roundtable on the recently released Medicare Fee-For-Service (FFS) NPI Contingency Plan. This toll-free call will take place from 2:00 p.m. – 3:30 p.m. on Thursday, May 10, 2007.

The call will open with a presentation on the Medicare FFS Contingency Plan announced on April 20^th. Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.  The Medicare FFS Contingency Plan does not change the requirement for Medicare FFS health care providers to acquire an NPI. Getting an NPI is easy and free. Go to www.cms.hhs.gov/NationalProvIdentStand for more information. 

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. If you cannot attend the call, replay information is available below.

Registration will close at 2:00 p.m. EST on May 9, 2007, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

To register for the call participants need to go to http://www2.eventsvc.com/palmettogba/051007. Fill in all required data. Click "Register". You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter. (Note: If you do not receive the confirmation email, please check your spam/junk mail filter as they may have gotten caught in that.)

For those of you who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 05/10/2007 until 05/17/2007, 11:59 p.m.  EST. The call in data for the replay is (800) 642-1687 and the passcode is 7087149. For technical difficulties registering, call 1-877-812-4520 and reference call #7087149.

SC Medicaid Announces National Provider Identifier Contingency

On April 2, 2007, the Centers for Medicare & Medicaid Services (CMS) announced it is implementing a contingency plan for covered entities who will not meet the May 23, 2007, deadline for compliance with the National Provider Identifier (NPI) regulations under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The CMS contingency plan allows covered entities that have been making a good faith effort to comply with the NPI provisions to implement contingency plans for a period up to twelve (12) months after the compliance date. Contingency plans can include accepting legacy provider numbers on HIPAA transactions.

In response to this announcement, the South Carolina Department of Health and Human Services (SCDHHS), will implement the following contingency plan effective May 23, 2007, through May 23, 2008. Effective May 23, 2007, providers may use any of the following to identify themselves

on standard transactions and hard copy claims:

• Six-Character Legacy Medicaid Number Only (Only Medicaid legacy numbers are used on the claim.
• Six-Character Legacy Medicaid Number and NPI: Both the Medicaid legacy number and the NPI are used for each billing/pay to and rendering provider on the claim. For example, do not enter the Medicaid legacy number only for one provider on the claim and the NPI only for another provider on the claim.
• NPI Only: Only NPI numbers are used on the claim. The provider must ensure that NPIs used on the claim are registered with SCDHHS prior to using NPI only.

For additional NPI information, refer to the South Carolina Medicaid bulletins available online at www.scdhhs.gov (publication dates 10/19/05, 04/24/06, 09/11/06, 09/26/06, 10/12/06, 01/18/07, 02/09/07 and 4/9/07).

Empower Your Practice--The Value of The MDL Settlements Explained
Do you have questions about the multi-district litigation (MDL) settlements and their value to the physician practice? Are you up to date on unfair reimbursement practices or uncertain if your practice is being paid appropriately under a given health plan payer's terms? Read our recent letter to medical group administrators (PDF, 69KB) to learn more about the protections and actions the MDL settlements may provide your practice.

Have you experienced any of the following reimbursement issues with your health plan payers: bundling, downcoding, refusal to recognize modifiers, delays in payment, retrospective refund requests, failure to pay in accordance with your contract with a health plan payer? If so, you will be interested to learn that the protections provided in the multi-district litigation (MDL) settlements can help. The American Medical Association (AMA), the American Medical Group Association (AMGA) and the Medical Group Management Association (MGMA) want you to know that Aetna Inc., CIGNA Corp., Health Net Inc., Humana Inc., and WellPoint Inc. (Anthem) MDL lawsuit settlements are all effective. As a result of these settlements, the unfair practices mentioned above are prohibited.

The true value of these settlements is found in such protections going forward and can be achieved through the compliance dispute process, which allows physicians to have a neutral mediator resolve disputes with the settling health plans. You are encouraged to stay vigilant in reviewing, auditing and tracking claim payments from the settling health plans to make sure each health plan processes and pays your claims according to its settlement agreements. If you are not being paid appropriately under the health plan payer’s settlement terms, you are encouraged to file a compliance dispute. A compliance dispute that was recently filed by physicians resulted in more than $12.5 million dollars being refunded to physicians. Did you submit your eligible claims by the deadline to receive your refund? Visit www.ama-assn.org/go/settlements for more information regarding the compliance dispute process. The AMA and SCMA are working with the MDL compliance dispute facilitators who can assist you in filing compliance disputes free of charge. If you have questions regarding the settlement terms for specific insurers, contact Kelly Danias at the SCMA via email at kelly@scmanet.org.

The AMA has created informational fliers to assist you in understanding the MDL settlement and the key provisions of each individual settlement. To learn what protections these settlements provide your practice, visit www.ama-assn.org/go/settlements or www.hmosettlements.com to download these complimentary fliers.

What You Need to Know: Medicare Private Fee-for-Service Plans

Private Fee-For-Service (PFFS) plans are Medicare Advantage (MA) health plans offered by a state licensed risk bearing entity which have a yearly contract with CMS to provide beneficiaries with all their Medicare benefits plus any additional benefits the company decides to provide. One major difference between a PFFS Medicare Advantage Organization (MAO) and other MAOs is that, in most cases, people who join a PFFS MAO are not required to use a network of providers, nor do they require a referring physician for most services. Beneficiaries can see any provider who is eligible to receive payment from Medicare and agrees to accept payment from the PFFS MAO.

The PFFS plans address the needs of the population that want to reduce their cost sharing in Original Medicare while having greater flexibility in choosing doctors. Many of the companies offering PFFS products have begun using third party verification to ensure that prospective members fully understand the features of the PFFS plan.

As a reminder, the following defines what it means be a deemed provider with a PFFS plan:

• A provider is a deemed provider and must follow a PFFS plan’s terms and conditions of participation if the following conditions are met: a) In advance of furnishing services the provider knows that a patient is enrolled in a PFFS plan, and b) the provider either possesses or has access to the plan’s terms and conditions of participation.
• It is important to note that a provider is not required to furnish health care services to enrollees of a PFFS plan. However, when a provider chooses to furnish services to a PFFS enrollee and the deeming conditions have been met the provider is automatically a deemed provider (for that enrollee) and must follow the PFFS plan’s terms and conditions of participation.  

What this means to you: If you know a patient is covered under a Medicare Advantage plan and you still treat the patient, you must abide by all of the Medicare Advantage plans rules and regulations. Additional information for providers on the PFFS plans is available in the Provider Q&A’s link found at www.cms.gov.

First Annual Equipment Road Show
The South Carolina Medical Association is pleased to promote the First Annual Equipment Road Show by its business partners, Schein Management team and Schein Capital Equipment Team. The “mobile showrooms,” will house revenue-generating medical equipment represented by various manufacturers such as Welch Allyn, Hitachi, and MedCorp. There will be on-site special pricing, financing and leasing options available. Please join us at a location near you on Tuesday, May 8 in Florence; Wednesday, May 9 in Columbia, and Thursday, May 10 in Greenville. The Road Show “showrooms” will be open for our customers from 8:00 a.m. – 6:00 p.m. each day, but if you come during lunch, there will be hot dogs, hamburgers, chips, and drinks available.

For more information please click here. Please make plans to see your South Carolina Medical Association representative at the Road Show!