Insurance Alert!!
April 9, 2009
The Medicare Carrier Advisory Committee (CAC) meeting was April 8th, and I thought there was some useful information that came out of the meeting. As you probably are aware, we typically talk about local coverage decisions and not many of these decisions have involved dermatology for the past 2-3 years; however, changes are on the horizon, not in terms of the local coverage decision but a change of Medicare carrier, region change, etc. Links to attachments are below.
1) Palmetto GBA will no longer be our Medicare Carrier with the transition to take place in the next 6-12 months. Highmark has been awarded the contract. Highmark has been the carrier in Pennsylvania and dermatologists there give this company a high rating in terms of communication, reasonableness, etc. CIGNA has filed a protest to the Highmark contract so the potential is for CIGNA to be the Medicare carrier but I would be surprised if their protest was accepted.
2) Because either Highmark or CIGNA will be the new contractors, it will be necessary for dermatologists who submit electronic claims to complete a new EDI (electronic data interchange) application to Highmark or potentially, CIGNA.
3) No one knows whether Highmark or CIGNA will continue CAC meetings but the drift was they will and the new carrier will cover not only Ohio but also Kentucky. Look for CAC meetings to perhaps occur in Cincinnati.
4) Expect audits from CMS utilizing the Recovery Audit Contractor (RAC) system or the Zone Program Integrity Contractor (ZPIC). RAC works on a contingency basis and will be expanded nationwide January 1, 2010. Their role is to collect overpaid medical dollars and audits may start out as rather simplified, for example, looking for units billed in excess of 1 such as more than one blood transfusion, appendectomy, etc., but I see this coming to include more common issues in our day in and day out practice. Another group, the Program Safeguard Contractor (PSC) is specifically a fraud and abuse group so the bottom line is your medical record needs to be really focused upon to avoid any unpleasant circumstances. If there is anxiety about RAC and more details needed, the AdvanceMed group (contractors for CMS that are doing the RAC) have a special “open door forum” which will be conducted at 2pm EST on Tuesday, April 14. The call in phone number is 800-837-1935 with a password of 92489480.
5) Effective April 6, 2009, if your practice needs to speak to a representative from CMS they will require you to provide three data elements for authentication: National Provider Identifier (NPI), Provider Transaction Access Number (PTAN), and a new requirement - the last five digits of your tax ID number.
6) The final item is a note from Inga Ellzey that, starting April 20, 2009, CIGNA will implement ClaimCheck 8.5 such that CIGNA will start requesting office notes for claims that have the 25 modifier accompanying an EM visit or a 59 modifier attached to a procedure. It would appear that this is another tactic to delay and/or reject a claim but obviously it will be up to the individual physician as to whether the process is too onerous and whether one wants to continue to provide medical services for CIGNA.
Perhaps by anticipating/preparing or whatever, the obstacles can be minimized.
RAC-Olsen.pdf
Medicare Education-Olsen.pdf
Hot Topics-Olsen.pdf
Tom Olsen
Chair, ODA Insurance Committee
CAC Representative
Co-Pay Resolution
Recently the American Academy of Dermtology and the Ohio State Medical Association passed the following resolution introduced by the ODA: Equal Co-pay for Any Patient to See Any Physician in the Same Health Plan. This will now be sent to the AMA.
ODA Resolution - Equal Co-Pay - AAD - 2009
Co-Pay Statistics
SAVE MEDICARE ACT OF 2008
The "Save Medicare Act of 2008" (S.2785) is being considered by our senators in Washington,D.C. We need to write letters to our two Ohio Senators at the following addresses: for both Senators...Washington address: Senate Office Building, Washington, D.C. 20510; for Senator Sherrod Brown: 600 East Superior Avenue, Room 2450, Cleveland, OH 44114; for Senator George Voinovich: 37 West Broad Street, Room 310, Columbus, OH 43215.
Attached is a sample letter Senator Voinovich Letter-Senator-Save Medicare. You can also contact your senators by email. Email your senators and ask them to support nothing less than 18 months of payment relief for physicians by co-sponsoring S. 2785. You can contact your senators via email through the AADA's advocacy website. Simply go to www.aad.org/dan and click on "Take Action" where a model letter for you to personalize has been provided for your convenience. You will be able to send the email to your senators directly from the website.