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Monthly Report-September 2010
You are cordially invited to attend the
Fourth ANNUAL MEMBERSHIP & GENERAL BUSINESS MEETING
MSEPS MEMBERS-ONLY DINNER MEETING
Tuesday November 2, 2010
6:30 - 9:30pm
THE CENTER CLUB
100 Light Street, Baltimore, MD
Free to all MSEPS Members!
Keynote Address
"Premium IOL Technology forthe Modern Day Cataract Surgery"
Sanjay D. Goel, MD
LasikPlus - Baltimore, MD
Please click here for the RSVP form
From your President Michael X. Repka, MD
Hurricane Earl passed us by last week leaving us with little impact compared with the predictions in the media. We were fortunate to enjoy a terrific Labor Day weekend. With the return of a more predictable work schedule the board of MSEPS and I would appreciate your assistance. We have added several benefits to membership including on-call third party billing assistance from Jim McNally described elsewhere in this newsletter. This will cover Highmark but also other payers in our region. My thanks to Mr. Richard Thomas, Administrator at the Wilmer Institute, for helping the eye society and its members participate in this program. Please use it and let us know if it is valuable or not. If it is valuable to your or your billing staff, let your colleagues know about it. If they are members ask them to try it and let us know. If they are not members encourage them to consider joining. Because we have added this benefit plus the membership dinner in November the board authorized a reduced-fee end of year membership for this year only. Please ask your colleagues who are not members and work in Maryland to strongly consider joining MSEPS. While we do not wish to ignore advocacy, networking and practice management are areas in which we would like the society to grow.
It appears with summer gone and the mid term elections are just two months away vision professionals are seeking work in DC. A number of ophthalmologists are running for Congress this year, two with strong chances of success: Rand Paul, MD for the Senate in Kentucky and Nan Sutter Hayworth, MD for the House in the New York 19th Congressional District. An optometrist, Representative John Boozman (R-AR-3) is running well against incumbent Senator Blanche Lincoln in Arkansas to move to the Senate. The next Congress will have a lot to do with tinkering with Health Care Reform and these results will matter.
Despite these intriguing races physicians will once again be left to worry about the SGR. A negative 21% impact on Part B physician fees in scheduled for December, with an additional -2% in January 2011. There is no doubt our federal legislators thoroughly understand this and the potential damage to beneficiary access in Maryland if this reduction were to take place. However, there would seem to be no way to address this issue before the election. The lame duck Congress will have the option to act (or not). Most pundits see a short term fix passing both houses, thereby pushing the problem to the next Congress early in 2011, while the cost of a fix grows toward $300 billion and becomes increasingly unlikely. There seems to be increasing physician fatigue with this problem, assuming that it will get fixed. One of these times it likely will not and a negative update may happen. The Academy has a record of supporting rebasing and then instituting two spending targets for procedures and E/M services as a way to move forward. This is not a solution that has found universal support in medicine or in Washington.
Some have wondered about the future of balance billing in Medicare. A bill was introduced by Tom Price (R-GA-6) during the current Congress (HR 1384). As in years past this bill will not get acted upon. There is simply too much public pressure against raising the out-of-pocket payments for program beneficiaries.
New Member Benefit!
New!! Third Party Payer Assistance
MSEPS is pleased to offer its members unlimited, free consulting assistance for problems or questions they encounter relating to third party payer matters. Assistance is not limited to Medicare issues, but includes all insurers, public and private.
The Third Party Insurance Help Program is a popular member benefit in other states and has helped hundreds of ophthalmologists and their staff to become more efficient and effective in their billing practices. Now you can access it too!
Advice and assistance can be provided to you via e-mail, a fax-back service or by telephone for questions you may have on proper CPT, ICD, and HCPCS coding and reimbursement issues with an applicable policy research function if needed.
James A. McNally, CPC - Health Care Consultant Services is on retainer to provide this important benefit to MSEPS members.
Only MSEPS members in good standing are eligible to take advantage of this service, and membership status will be verified for all inquiries.
Use the attached form to start sending questions!
New!! Lower your Credit Card Costs!
Global Payments is a leading, full service provider of authorization, processing, settlement, and funding on all card types and technologies including the newest, Web-based services.
Global offers payment products specifically developed for business applications, investing millions of dollars in R&D to ensure smooth interface with your systems.
Some highlights of the program include: Reduced processing and equipment rates for our members, support for all payment methods and card types: American Express, Discover, Diners Club, MasterCard, Visa, Debit, EBT and Checks, 7 day/24 hour Help Desk, no need to change bank accounts, Automated Fraud Control and Chargeback Systems
Get started today by calling Sheri Milutin at (410) 742-8159.
Tell your non-member friends - Discount on Second Half 2010 Dues!
MSEPS is now offering a discounted rate of $295.00 (down from $650)!
MedChi UpdateGene Ransom, III, Esq.
MedChi Special Survey on Medicaid Cuts
Maryland physicians were dismayed last week to receive notice from the Maryland Department of Health and Mental Hygiene that a new policy was being implemented, decreeing that the Medicaid Program will no longer pay Part B Medicare coinsurance or copayments for dates of service beginning August 1, 2010, on claims where the Medicare payment exceeds the Medicaid fee schedule. Therefore, if Medicare pays the claim at an amount equal to or greater than the Medicaid fee schedule, Medicaid will make no additional payment. If Medicare pays the claim at an amount less than the Medicaid fee schedule, Medicaid will pay all or part of the coinsurance to bring the total payment to the provider equal to the Medicaid fee schedule. MedChi has contacted the Department of Health and Mental Hygiene (DHMH) with our concerns and has received the following explanation.
According to DHMH, the federal government authorized states to make this change several years ago. DHMH had made a similar change for nursing homes 4 or 5 years ago but had not applied this cut to physicians. DHMH states that Maryland is one of the last states in the country to implement this policy in large part because DHMH understands the fragile nature of our Medicaid provider network and has tried hard to avoid any cuts that would adversely affect that network. Approval for this change occurred last fall when the Board of Public Works approved mid-year budget cuts; however, DHMH did not implement the policy immediately because a necessary reprogramming of their computer system was not completed until early July. The change will not affect all physicians. It does not affect the MCOs. It only applies to patients who are "dually eligible" and whether it affects physicians depends on what codes they bill. Specialty services where Medicare and Medicaid pay the same will not be affected. Anesthesia will also not be affected because of the payment methodology used for those services. Further, as listed in the bulletin, there are a number of services and billing codes to which the policy will not apply.
DHMH has been responding to all physicians who have questions and asks that physicians with questions e-mail them to . DHMH states that they hope to rescind this policy when the fiscal situation improves.
Although MedChi appreciates the attempt by DHMH to clarify the situation and understands the fiscal crisis that the state is in, we believe it is important for policymakers to understand the full impact of this change.
Fromthe MSEPS Third Party Insurance ConsultantJames McNally, CPC
Changes Coming for Medicare in 2011
In response to physicians' frustration with narrowly missing the Physician Quality Reporting Initiative (PQRI) bonus, CMS lowered the claims-based reporting requirements for 2011 to 50 percent (from 80 percent) of eligible patients. In addition, incentives continue for physicians who successfully participate in the 2011 PQRI, with a 1.0 percent bonus on all Medicare allowable charges. In order to qualify, a physician must report on three or more measures (or less than three if fewer apply) at least 50 percent of the time.
More information on this will be provided at a later date.
In addition, and as reported previously, there was no appeal right afforded to physicians who wanted to challenge the CMS determination that they did not qualify for an incentive payment in previous years.
However, CMS is now required to set-up an informal appeals process by January 1, 2011 for physicians who seek to review a determination that the physician did not satisfactorily report in PQRI.
CMS proposes that a physician request for an informal review be made within 90 days of release of the physician's feedback report. CMS will respond with a written report within 60 days of receiving the original request.
More information on this will be provided at a later date.
Finally, and beginning January 1, 2011, Medicare beneficiaries will be covered for a new annual wellness visit or physical with no out-of-pocket costs. Created under the new health reform law, physicians and patients will have an opportunity to develop a comprehensive plan to improve the patient's health and reduce risks of chronic disease.
As per the AAO, for ophthalmologists, referrals could increase from primary care reviewing the patient's functional ability and level of safety, including the ability to successfully perform activities of daily living, on the first visit. A requirement to establish an appropriate screening schedule for the next five to 10 years will encourage beneficiaries to obtain the preventative services already covered by Medicare. For ophthalmology patients, this includes a glaucoma check for those at high risk and complete eye exams for people with diabetes.
For guidance on this issue, contact us through the Third Party Insurance Help Program.
Roth IRA Conversion Opportunity
You may be aware of the opportunity (as of 1/1/2010) for taxpayers with an adjusted gross income above $100,000 to convert their traditional IRA to a Roth IRA. There are many potential reasons to consider the conversion.
Glass Jacobson advises you to consider all the factors and circumstances- each taxpayer is unique. It is difficult to develop general rules that can substitute for an individual analysis. However, situations we have seen where it generally (but not always) makes sense to convert to a Roth IRA are:
- Taxpayers that do not need the income from the IRA in retirement and want to provide an inheritance for their children or grandchildren. This is because there are no minimum distributions from Roth IRAs starting at age 70 1/2 and all distributions are tax-free.
- Taxpayers that can pay the income taxes from sources other than the IRA and have a number of years to recover the income taxes paid.
Contact Gary Anderson, JD, CPA with questions at .