SCMA Alert
July 28, 2006
Hold Aetna Accountable to Its Compliance Dispute Resolutions
For information
about
Aetna
’s compliance dispute resolutions, retroactive medical payment policy changes and
an updated list of compliance dispute officers, visit the AMA Private Sector Advocacy
(PSA) Web site
www.ama-assn.org/go/settlements.
Aetna
will reimburse
the following services that were not paid on claims retroactively to August 15, 2005.
-
CPT preventive medicine E/M service and a problem-focused E/M service appended with
CPT modifier 25.
-
CPT E/M service code appended with CPT modifier 57 when billed with a major procedure
(defined as one with a global period of 90 days or more).
Physicians can
resubmit these CPT modifier 25 and 57 claims
retroactive to August 15, 2005 for payment. Visit
www.ama-assn.org/go/settlements
for additional information.
WellPoint Inc.
(Anthem) Settlement Update
WellPoint Inc. payment distribution has been delayed due to appeals. However,
WellPoint, Inc. has agreed to honor its compliance dispute process. Please
forward any compliance disputes to the newly appointed compliance Dispute Facilitator,
Cam Staples. More information regarding the WellPoint, Inc. settlement can
be obtained at
www.ama-assn.org/go/settlements.
During its annual meeting last weekend, The South Carolina Chapter of the
American
Academy
of Pediatrics was presented the Best Medium
Size Chapter Award from the
American Academy
of Pediatrics. The chapter was recognized for their overall excellence in
programs that promote the health and welfare of children and advocacy for pediatricians
in
South Carolina
.
More than 1.5 million patients are estimated to be injured each year by medication
errors, a committee of the
Institute of Medicine
reported Thursday. The committee's report, "Preventing Medication Errors," was written
at the behest of the Centers for Medicare and Medicaid Services, which intended
to estimate the incidence of drug errors and identify the best preventive strategies
against them. Among the report's recommendations that directly affect physicians:
·
All
prescriptions should be written electronically by 2010.
·
Providers
should improve communication with patients about how to take drugs safely and about
potential risks.
·
All
medication mistakes should be disclosed to patients.
·
Doctors
should use electronic decision-support tools to write prescriptions.
·
Physicians
should regularly review all medications with patients and other providers involved
in a patient's care, particularly when a handoff occurs.
Read the full report at
www.nationalacademies.org/morenews/20060720.html.
On July 14, SCMA Past President John Evans, MD presented a dedicated copy of A
Brief History of the South Carolina Medical Association, 1948-2005 to the South
Carolina Historical Society in
Charleston
. The Society Librarian, Ms. Lisa Hayes accepted the book from Dr. Evans and the
SCMA. The MUSC and USC School of Medicine libraries have both received the SCMA
history book, as well as Furman
University Library.
The SCMA is encouraging its members, county and specialty medical societies to donate
copies of the book to their local hospitals, libraries, archives and historical
societies. Copies are available for $20.00 each (plus tax and shipping). For order
information, visit
www.scmanet.org/scma/History-book.aspx
or call the SCMA at (800) 327-1021, ext. 221.
United Healthcare’s (UHC) redesigned website will include pull-down menus for faster
access to features such as Patient Eligibility and Benefits, Claims Status, Claim
Submission and Claim Reconsideration/Claim Research Project, and Notifications.
UHC will introduce new features, including an enhancement to their claim submission
feature, Real-Time Adjudication, to allow physicians and health care professionals
to submit and process professional claims for patients quickly and receive an immediate
return of a fully adjudicated claim value and the patient's responsibility based
on contracted discounts and plan benefits. For more information, go to
UnitedHealthcareOnline-emailnews.com.
In February 2004,
Medicaid revised the twelve-office visit policy to allow the patient’s attending
physician to request additional visits from the Medicaid medical director. The request
must be received from the physician, in writing, on letterhead with an explanation
of the medical necessity for the additional visits. For a complete copy of this
policy, refer to the July 19, 2006 Medicaid
Bulletin or go to the Physician, Laboratories
and Other Medical Professionals Provider Manual at
www.scdhhs.gov.
The Medicare
Carrier Advisory Committee (CAC) will be reviewing a draft Medicare policy on Polysomnography
at their August 2 meeting in
Columbia
. To receive a faxed copy of the policy, e-mail Kelly Danias at
kelly@scmanet.org.
You have until September 22 to make comments on the draft.
CMA Launches Effort to Combat Fraud and
Abuse
The Centers for Medicare and Medicaid Services (CMS) has announced new efforts to
detect and prevent Medicaid fraud and abuse. The new Medicaid Integrity Program
(MIP) will use both full-time CMS staff and contractors to review the actions of
those seeking payment from Medicaid, conduct audits, identify overpayments, and
provide education on program integrity and quality of care. For more information,
visit
www.cms.hhs.gov/apps/media/press/release.asp?Counter=1900.
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.
SCMA's full service
travel website can take you further than you ever dreamed possible, while helping
to raise new funds for the SCMA. Just book your
personal and business travel through our website,
www.scmatravel.com. Not
only will you find the same airlines, hotels and rental cars, and the same low rates
offered by other websites, but our travel site can do so much more.
Every time you
book travel, a generous portion of the commissions you generate will be given directly
to the SCMA. This is a great way to help
the SCMA and take advantage of great deals on airfare, hotels, rental
cars, vacations, and other travel services at no additional cost to you. Book your
summer plans now!