Anti-Trust 101 for Physicians
The current anti-trust landscape is heavily weighted in favor of health insurers due to the severe limitations on joint physician activity. The American Medical Association (AMA) is working on behalf of physicians to fight for anti-trust reform. Physicians are urged to be cautious with business conduct and communications to assure they do not violate anti-trust laws. For information on recent actions taken against physicians for joint negotiations with health plans, visit www.ama-assn.org/ama/pub/category/9880.html.
Aetna Required to Pay for EKGs and E/M Codes
As part of the class action lawsuit settlement against Aetna, the insurer is required to pay for EKGs and Evaluation and Management (E/M) codes on the same day. Because Medicare and some private payors do not require physicians billing CPT Code 93010 with an E/M code to append a modifier in order to be paid, many physicians did not append a -25 modifier when submitting claims to Aetna. Therefore, this issue was addressed separately from the general modifier -25 dispute. Aetna has agreed to remove the edit in its entirety effective August 16, 2006 and to allow physicians to resubmit claims for six months prior to that date. This means that physicians will be paid for a 93010 billed with an E/M Code whether billed with or without a -25 modifier. This is above and beyond what Aetna was required to do under the MDL settlement. Additional information is available at www.hmosettlements.com.
Call for Artwork
The SCMA Foundation is accepting original artwork or photography from physicians and medical students to be considered for use as the 2006 Seasons Greetings cards. All mediums can be submitted. Please submit entries, preferably 8½ x 11” in size, to Melissa Hamby, South Carolina Foundation, P.O. Box 11188, Columbia, S.C. 29211. The deadline for submissions is September 22, 2006. For more information, contact Melissa at 800-327-1021, ext. 253.
National Provider Identifiers are Free
As the industry transitions to National Provider Identifier (NPI) compliance, remember there is no charge to get an NPI. Physicians can apply online for their NPI, free of charge, by visiting https://nppes.cms.hhs.gov or by calling 1-800-465-3203 to request a paper application. The CMS NPI page, located at www.cms.hhs.gov/NationalProvIdentStand/, is the only source for official CMS education and information on the NPI initiative; all products located on this site are free of charge. Once you receive your NPI, please forward it to the insurers, software vendors, and clearinghouses that you do business with.
NUCC Releases the Revised 1500 Health Insurance Claim Form
The National Uniform Claim Committee (NUCC) released the revised version of the 1500 Health Insurance Claim Form. The Office of Management and Budget (OMB) approved the 1500 Claim Form and the Centers for Medicare and Medicaid Services (CMS) will begin the renewal process for the form in January 2007. For more information on the 1500 Claim Form, please visit www.nucc.org.
SCMA HealthWatch – Understanding Obesity
The next issue of the SCMA's HealthWatch information sheets, “Understanding Obesity” is now available. This issue outlines why people gain weight and the dangers associated with obesity. The issue also describes the body mass index (BMI) and how to calculate your own BMI. Visit the SCMA website at www.scmanet.org/scma/healthwatch.aspx to download all issues of HealthWatch. SCMA members are encouraged to distribute this information to their patients. To subscribe, send an email to news@scmanet.org. Distribution options include e-mail, fax, and regular mail.
Make SCMA Financial Services Your Agent for the JUA
Ask yourself two questions. Do you have your current malpractice insurance through the Joint Underwriting Association? Do you want to put your money back to work for YOU?
If your current agent is not SCMA Financial Services, Inc.....then what are you waiting for? A portion of the commissions for all policies sold through SCMA Financial Services, Inc. accrues back to your association to help fight for the needs of SC physicians. Help support your association by letting SCMA Financial Services, Inc. represent you for your malpractice insurance needs. What do you have to lose? Let us start working for you today! Download the form at www.scmanet.org/FS/FS-aor.aspx and fax it to 803-750-1115.
SCMA Alliance in the News
The SCMA Alliance (SCMAA) was recently featured in PawPrints, the national newsletter of the Internet Keep Safe Coalition. The coalition’s mascot, Faux Paw, traveled to Columbia with President Marsali Hancock for the launch of the state’s Internet safety campaign on May 22. SC First Lady Jenny Sanford, Attorney General Henry McMaster, the South Carolina Medical Association Alliance, EdVenture Children’s Museum, and iKeepsafe sponsored the event that highlighted problems with technology faced by parents today.
“The Internet brings the world to our doorstep—the whole world, both good and bad; and the iKeepSafe solution to the bad: training parents to protect their children,” Marsali Hancock explained. SCMAA Immediate Past President Lauren Sutton discussed how the Faux Paw program is being implemented at the state level. The event received major media coverage by ABC television and two radio stations.
Coalition Works to Help Smooth Part D Hassles
A working group formed by the AMA has partnered with CMS officials to resolve some of the most serious implementation problems encountered with Medicare's prescription drug benefit, particularly those associated with plan denials and prior authorization requirements.
At least one national insurance plan will no longer require prior authorization for some Medicare Part D beneficiaries to obtain their Alzheimer’s drugs. In a June 16 letter to the Centers for Medicare and Medicaid Services (CMS), the Alzheimer’s Association, a partner in the working group, pointed out that three major plans, Medco, RxAmerica and Silverscript (Caremark), required prior authorization for four drugs used to treat the disease. The letter disputed the criteria used to determine prior authorization such as patients’ scores on the Mini-Mental Score Examination and FDA labeling, and said it is up to the prescribing physician to decide on appropriate medications. The letter achieved results in less than a month.
The working group has also worked with health plans to develop a standard one-page form for prior authorizations and exceptions that Medicare now requires all Part D plans to accept. Visit http://enews.ama-assn.org/UM/T.asp?A40.442.3539.31.182179 to view that and other resources related to Medicare Part D.