STAT

April 1, 2009 - Volume 39, No. 4

Physician’s Workforce Survey Mailed – Surveys can also be Completed Online

  • Legislative Session Update: Senate Committee Open to OMA’s Proposals
  • Recovery Audit Contractors Program Protest Resolved – Oregon set to be Reviewed in August
  • Information Available from CMS on Anti-Markup Pricing Limitation
  • Medicare Carrier Transition Update – No Announcement of New Carrier to Date
  • One Month Remains Until Red Flag Rules May 1 Compliance Deadline
  • Centers for Medicare & Medicaid Services Announces New Web Page on the Electronic Prescribing Incentive Program
  • New Web Site Provides Up-to-Date Resources on Treating Resistant Infections
  • OMA Remembers National Doctor’s Day
  • 135th House of Delegates this Month
  • Practice Managers Convene in Portland for Must-Attend Conference – May 17-20
  • It’s Not Too Late! Order Coding Books Today!
  • Upcoming OMA Educational Programs
  • OMA Involved in National Effort to Promote Surgical Safety
  • 2009 Northwest Patient Safety Conference – Register by April 3 and receive a $50 Discount!
  • You’re Invited to Breakfast Event with Senator Wyden Hosted by Housecall Providers
  • Rx Security to Offer Free Shipping for Tamper-Proof Prescription Pads Starting April 1
  • Member Deaths
  • April Classified Ads – link to classifieds
  • Inserts– link to Spring Coding Workshop (OMA Headquarters) brochure

Physician’s Workforce Survey Mailed – Surveys can also be Completed Online

The Physician's Workforce Survey hit mailboxes the week of March 9. You can help ensure we have an accurate picture of state of the physician workforce in Oregon by returning your survey by May 1. You also have the option of completing the survey online by visiting and clicking on 2009 Physician Workforce Survey link.

If you will be completing the survey online, you will need the Survey ID number found on the cover page of the survey you received in the mail. If you do not have a hard copy of the survey, you will be directed online to enter your name and zip code, which can then be matched to a mailing list.

The survey is a joint effort of the Oregon Medical Association, the Office of Oregon Health Policy Research and the Division of Medical Assistance Programs. For further questions or concerns contact Charles Gallia, Ph.D. at DMAP at (503) 945-6929.

Legislative Session Update: Senate Committee Open to OMA’s Proposals

The OMA has introduced four of its own bills this session that will benefit physicians and their patients:

Senate Bill 506 improves physicians’ ability to determine patients’ insurance eligibility and coverage for medical treatment and prohibits health plans from denying payment once coverage is determined and authorization is granted.

Senate Bill 507 implements a reasonable timeframe on the health plan credentialing process to ensure that physicians who are qualified, ready and able to provide health care services are allowed to do so and are reimbursed for their work.

Senate Bill 508 ensures that physicians and health plans are held to the same standards in matters of billing and payment to prevent physicians and patients from bearing the cost of health plans’ payment errors.

Senate Bill 509 improves transparency and fairness in contracts between physicians and health plans.

Public hearings were held at the end of February, and the bills were well received by the Senate Health Care Committee. Committee Chair, Senator Laurie Monnes Anderson (D-Gresham), requested a work group be formed around SB 506, 507 and 508. The first work group meeting was held on March 13. We will keep you informed as we continue to work with the committee to improve the business of health care in Oregon. For more information on the OMA’s legislative proposals, see .

Recovery Audit Contractors Program Protest Resolved – Oregon set to be Reviewed in August

Late last year, the Centers for Medicare & Medicaid Services delayed implementation of the Recovery Audit Contractors program due to protests that were filed. On Feb. 4, the protests were settled and CMS will now continue RAC program implementation. The new RAC for Region D, which includes Oregon, is HealthDataInsights, Inc. of Las Vegas, Nevada. The program is scheduled to come to Oregon in August of this year.

As reported in past issues of STAT, the goal of this RAC program is to review physician and other health care provider claims to identify underpayments and overpayments and to recoup overpayments for the Medicare Fee-For-Service Program. The RACs will be paid on a contingency fee basis on both the overpayments and underpayments they find.

CMS suggests that physicians prepare for the start of the program by conducting an internal assessment to ensure that submitted claims meet the Medicare rules. Other steps to consider include:

  • Identifying where improper payments have been persistent by reviewing the RAC website and identifying any patterns of denied claims within their own practice or facility.
  • Implementing procedures to promptly respond to RAC requests for medical records.
  • If the physician or health care provider disagrees with the RAC determination, filing an appeal before the 120-day deadline.
  • Keeping track of denied claims and correcting these previous errors.
  • Determining what corrective actions need to be taken to ensure compliance with Medicare’s requirements and to avoid submitting incorrect claims in the future.

The OMA will work closely with the AMA and CMS to identify how to best prepare physicians and their staff for this process. The OMA, along with other medical associations, also sent a letter to CMS stating their concerns regarding the RAC program. To read the full RAC program update, visit the CMS website at .

Information Available from CMS on Anti-Markup Pricing Limitation

Section 1842(n) (1) of the Social Security Act requires CMS to impose a payment limitation on certain diagnostic tests where the physician performing or supervising the test does not share a practice with the billing physician or other supplier. Such a test was formerly referred to as a “purchased diagnostic test”. In the 2009 Medicare Physician Fee Schedule final rule, CMS finalized changes to include alternative methods to determine when not to apply anti-markup rules. The payment limitation in the rule went into effect on Jan. 1.

CMS has released a Medicare Learning Network article on this topic, which provides further information on this limitation as well as instructions for physicians and their staff for determining when the anti-markup payment limitation applies and when it does not apply. To view this article, visit .

Medicare Carrier Transition Update – No Announcement of New Carrier to Date

Early last year, CMS announced that National Heritage Insurance Corporation had been awarded the contract for the combined administration of Medicare Part A and Part B fee-for-service claims for the states of Alaska, Idaho, Oregon and Washington.

Noridian Administrative Services, the current Medicare carrier, submitted a formal protest to the US Government Accountability Office in May regarding the new contract with NHIC. This protest set back the original Dec. 31 transition date, and NAS continued as the Medicare carrier through the beginning of 2009.

Although, the new MAC has not been announced, CMS has created a resource to help physicians and their staff prepare in the event that a new MAC is awarded the contract. This Medicare Learning Network article is titled, “Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor” and is available at .

Physicians and their staff should continue to conduct business with NAS as usual until further information is provided. The OMA continues to meet with CMS and Noridian and will keep members informed of any developments in this regard.
One Month Remains Until Red Flag Rules May 1 Compliance Deadline

OMA offers numerous resources to help physicians and their staff prepare.

Effective May 1, 2009, the Federal Trade Commission will be enforcing the Red Flag Rules, which require financial institutions and creditors (includes physicians and physician offices) to establish an identity theft protection program.

On Feb. 23, the OMA signed on to a letter from the AMA to the FTC’s Chairman that objects to the FTC’s interpretation that physician’s are “creditors” and therefore subject to the Red Flag Rule. The letter also noted the AMA’s belief that the FTC failed to comply with the Administrative Procedure Act, which requires the FTC to explain its regulatory proposals and provide the public with notice and opportunity to comment.

In addition to working with the AMA and other state medical associations regarding the application of the Red Flag Rule to physicians, the OMA is offering several resources that will help physicians be in compliance by the deadline, which include:

  • Red Flag Rules Overview: Provides an overview of the requirement, which includes an explanation of the inclusion of health care entities as “creditors;” the criteria used to determine if a creditor must comply with the “red flag” Rules; and the “red flag” categories of an identity theft protection program, which can successfully indicate an identify theft event or potential event. This document is available at .
  • Red Flag Rules Audio Conference Recording: The OMA recently hosted an audio conference that reviewed these rules and assisted physicians and physician practices to implement an identity theft program. If you missed this audio conference, you can still order a recording. Please visit for a description of the audio conference and ordering information, or contact Jenn Webster at or (503) 619-8000.
  • HIPAA How To’s Workshop Includes Red Flag Rules Component: The Red Flag Rules will also be addressed at the upcoming HIPAA How To’s workshop. For more information or to register for this workshop, visit or contact Jenn Webster at or (503) 619-8000.

The OMA is also in the process of developing Red Flag Rules policy templates and additional resources that will be available in late April. We will update members as soon as those resources are ready. For additional information on the Red Flag Rules requirement, contact Reina O’Beck at or (503) 619-8000.

Centers for Medicare & Medicaid Services Announces New Web Page on the Electronic Prescribing Incentive Program

The Centers for Medicare & Medicaid Services announced the new Electronic Prescribing Incentive Program web page on the CMS website at . All information about the E-Prescribing Incentive Program has been moved from the CMS PQRI web page at to . This new web page provides information about the new E-Prescribing incentive program that was authorized by the Medicare Improvements for Patients and Providers Act of 2008.

Please note that many new resources have also been added to the E-Prescribing Incentive web page as part of the migration to the new URL. Included on this page in the Downloads section is:

  • A 2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple Fact Sheet;
  • A Spanish version of the Introduction to E-Prescribing Incentive Fact Sheet;
  • A Sample Electronic Prescribing Claim; and
  • Information on how to access the audiotapes and slides from the National E-Prescribing Conference that was held in October 2008 for continuing education credit.

New and updated information will continually be added, so please visit the Electronic Incentive Program web page on the CMS website at on a frequent basis.
New Web Site Provides Up-to-Date Resources on Treating Resistant Infections

Infectious disease experts at The JohnsHopkinsUniversitySchool of Medicine launched a website to help clinicians treating patients with pathogens associated with multidrug-resistant organisms. This website, , will serve as an easily accessible resource and will specifically address the increasing prevalence and incidence of MDROs in hospitals and community practice settings.

Using the new Web site, physicians can:

  • Recognize the prevalence and incidence of the epidemic of community-acquired and healthcare-associated MDROs.
  • Differentiate the clinical presentation and sensitivity patterns of community-acquired versus healthcare-associated resistant infections.
  • Compare and contrast infection control practices used to reduce the incidence of MDROs by healthcare providers in both the community and hospital settings.
  • Develop detailed diagnosis and treatment plans for patients undergoing guidance for MDROs.

This website is particularly timely because health care settings are facing new scrutiny and regulatory hurdles by both government and public agencies. For example, The Centers for Medicare & Medicaid Services has recently implemented a policy to ensure optimal patient outcomes to hospitals for certain conditions such as healthcare-associated MRSA, given the rationale that these “never events” should not happen if appropriate identification and treatment takes place. Confronted with these challenges, providers require new knowledge and instruction on the application of guidelines to improve the quality of care specific to MDROs.

135th House of Delegates this Month

The annual meeting of the OMA’s House of Delegates will take place at the EugeneConvention Center April 24-25. At press time, no resolutions had been submitted. For more information or to register, visit: or call (503) 619-8000.
Practice Managers Convene in Portland for Must-Attend Conference – May 17-20

The Oregon Medical Group Management Association is the state affiliate of the national MGMA, which provides benchmarking, best practices, and management certification for the Medical Management profession. OMGMA partners with Washington State Medical Group Management Association for its Annual Meeting. This year 400 practice managers from Oregon and Washington are expected to convene at the Portland Convention Center for this conference featuring seven nationally renowned speakers and several regional expert presenters.

To request a brochure, contact Jan Larsen at 206-956-3643, or send an email to . A meeting brochure and online registration can also be found at .

It’s Not Too Late! Order Coding Books Today!

Coding books and all other publications offered by the AMA are available to OMA members at discounted prices. For an order form and more information, visit or contact Christi Donaugh at (503) 619-8000 or .
Upcoming OMA Educational Programs

Did You Miss the HIPAA Audio Conference Series? Recordings are Now Available for these Popular Courses!

You may have missed the HIPAA Audio Conference series that was held several weeks ago. The series was full of timely topics to help physician offices prepare for and comply with upcoming governmental regulations. These courses included information on the clinical and business impacts of updated electronic transaction standards and the transition from ICD-9 to ICD-10; Red Flag Rules regulation from the FTC; electronic claims attachment tool; and impending CMS HIPAA audits and how physicians can prepare.

If you missed these great courses, you can still order a recording. For audio conference descriptions and ordering information, visit or contact Jenn Webster at or (503) 619-8000.

HIPAA How-To’s: Practical Tools to Improve Privacy & Security Programs and Comply with HIPAA:

This workshop series will cover some of the common areas where physician organizations are having difficulty or are not fully compliant with the HIPAA Privacy and Security Rules. After attending this workshop, you will walk away with workable solutions if your office is targeted for a HIPAA Security Rule audit by CMS.

April 8, 1:00 pm-5:00 pm (OMA Headquarters)

April 17, 8:00 am-12:00 pm (Bend)

April 23, 8:00 am-12:00 pm (Medford)

April 24, 8:00 am-12:00 pm (Eugene)

May 5, 8:00 am-12:00 pm (OMA Headquarters)

Practice Management Series - (Bend)

  • Preventing Money Leaks in Medical Practices: April 15, 9:00 am -12:00 pm

Learn how to establish financial controls and reporting systems in your practice that are easy to monitor and practical to implement. Topics include billing and collection controls, accounts payable and payroll safeguards, and some simple, but effective audit techniques for physicians. Attendance by non-physicians will be limited to participants accompanying physicians or with express written authorization of a supervisor.

  • Treating Patients Right: Tact, Courtesy and Etiquette in the Medical Office: April 15, 1:00 -4:00 pm

Learn the essentials of etiquette and customer service for the medical office. Group exercises, role playing, and case studies will be used to make learning fun and memorable.

  • Human Resources Basic Training: April 16, 9:00 - 4:00 pm

Learn the best way to approach both routine and sensitive personnel matters to maintain staff morale, productivity and to protect against regulatory and civil risks.

Practice Management Webinar Series

Register now for these upcoming Webinars – presented by the Practice Performance Group – that will offer vital information on recession-era planning for practices.

  • Controlling OverheadSM: Recession-era budgeting

April 21, 1:30-3:00 pm or April 30, 10:00-11:30 am

This Webinar is designed to help prepare clear reports to assist the “non-accountant” in understanding practice overhead, and to explore the most productive areas to save money. We’ll focus on cutting waste and simplifying processes – cutting fat, not muscle.

  • Appealing Unfair PaymentsSM: Recession-era claims follow-up tactics

May 7, 10:00-11:30 am or May 27, 1:30-3:00 pm

Based on our most popular half-day course, this Webinar is designed to cement the message: “You don’t just have to settle for what Medicare and other carriers decide to pay anymore.” We supply practical and proven techniques to “go back to the well” when managed care organizations and insurance carriers’ payments are disappointing.

Spring Medical Coding – OMA Headquarters

These programs have prior approval of the AmericanAcademy of Professional Coders for 6.0 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content or the program sponsor.

  • Basic ICD-9-CM Coding: April 28, 9:00 am – 4:00 pm
  • Basic CPT Coding: April 29, 9:00 am – 4:00 pm

Spring Medical Collections: Slow Pay? No Pay? Keeping Up When the Economy Is Down