Jan 5, 2007

The FMA E-News is emailed to all members of the Florida Medical Association semimonthly. The FMA, located in Tallahassee, Fla., serves as an advocate for physicians and their patients to promote the public health, to ensure high standards in medical education and ethics, and to enhance the quality and availability of health care.

TIME IS RUNNING OUT - HAVE YOU RENEWED YOUR LICENSE?
Approximately half of Florida MDs are set to have their licenses to practice medicine expire on January 31, 2007. However, the Florida Department of Health reports that only 50 percent have renewed. If you have not received your licensure renewal information and are unsure if it is your year to renew, go to www.flhealthsource.com to view your profile, which has your license expiration date at the top. You cannot practice if your license expires. Renewing after the deadline is costly and time consuming, and third party payors can refuse to reimburse you for services rendered under an inactive license so renewing early is important. The Board of Medicine has made this easy by putting the renewal process online. To renew online, go to www.doh-mqaservices.com and click on "Licensees" and then "Renew License." You will need an account/user ID number and password, which was included in your license renewal notice sent in October. If you do not have your notice, you may email licensure_services@doh.state.fl.us or call 850.488.0595, and press menu option 3. If you are an FMA member, you can contact the FMA for more information at .
 
 ACT TODAY TO RESUBMIT AETNA CLAIMS
In the wake of Aetna's settlement of its Multi-District Litigation lawsuit, physicians and their practice staff are encouraged to scrutinize claim payments to make sure Aetna adheres to the terms of its settlement agreements. In many cases, it will be up to physicians to hold Aetna accountable.  For example, Aetna has reached an agreement with state medical societies to pay resubmitted claims for Evaluation and Management visits billed with a Modifier-57-(indicating that the decision for surgery was made during the visit-when billed with major global 90-day procedures. After seeking input from medical societies and the independent Physician Advisory Board, Aetna changed its policy effective February 12, 2006, and began paying these claims that it had previously denied.  To be properly compensated, physicians must take action early in the new year.  For 120 days starting January 1, 2007, physicians can resubmit previously denied claims for service that took place between January 1, 2005, and February 11, 2006. Visit http://www.ama-assn.org/ama/pub/category/12754.html to learn more.

 
PHYSICIAN CELEBRATES 50 YEARS OF PRACTICE
Arnold "Bud" Tanis, M.D., of Hollywood, FL will celebrate his 50th year caring for South Florida's infants, children and adolescents on January 16, 2007, making him the longest practicing pediatrician in the area. Congratulation to Dr. Tanis.

 
CMS 270/271 (ELIGIBILITY) EXTRANET TRANSACTIONS
In June of 2005, CMS created the necessary database and infrastructure to provide a centralized HIPAA compliant 270/271 health care eligibility inquiry and response transaction in real-time. Currently approximately 2.5 million provider eligibility transactions are processed this way weekly.

Access to this eligibility transaction is through direct contact with the CMS Medicare Eligibility Integration Contractor.  The 270/271 eligibility Extranet transaction is being conducted by CMS over a private network and not the Internet.  For more information about the Extranet and obtaining access go to http://cms.hhs.gov/HETShelp, or to the Florida Medicare website at www.floridamedicare.com.

 
2007 MEDICARE FEE SCHEDULE
This article is based on Change Request (CR) 5448. The Tax Relief and Health Care Act of 2006 changes the update to the 2007 conversion factor for services paid under the MPFS, and this change is effective for services provided on or after January 1, 2007.  The Tax Relief and Health Care Act of 2006 set the 2007 conversion factor for physician payment at the same level as in 2006 ($37.8975), reversing the statutorily mandated 5.0 percent negative update. However, it does not maintain 2007 physician payments at 2006 levels. There are a number of other factors that affect payment rates for 2007. Other changes adopted in the physician fee schedule final rule that affect 2007 payment rates include changes in the practice expense RVU-setting methodology, refinements to the practice expense RVUs, re-weighting of geographic adjustment factors, limits on payments for imaging services required by the Deficit Reduction Act, and other annual refinements including coding changes. Both the Centers for Medicare & Medicaid Services (CMS) and your local Medicare contractor will display the resulting new fees on its Web site no later than December 31, 2006. The effective date for any participation change is January 1, 2007.   For more information, go to the Florida Medicare website at www.floridamedicare.com.

 
ONLY FIVE MONTHS REMAIN UNTIL THE NPI COMPLIANCE DATE
Are you ready to use your NPI?  A recent survey of the health care industry, conducted by the Workgroup for Electronic Data Interchange (WEDI), indicates that providers should be moving from the enumeration stage into the implementation stage to ensure NPI readiness by the compliance date.  Remember, it is estimated that it may take up to 120 days to complete the work needed in order to implement the NPI into your current business practices.  The following steps will assist you in your preparation:

Enumerate:  Have you applied for your NPI(s)?  Not only should individual providers (Type 1) have enumerated, but organizations and subparts (Type 2) should have enumerated also.

Update:  Have you received your software application updates, upgrades and/or changes relevant to NPI?  Be sure that the updates not only address the HIPAA Transactions, but includes the CMS1500, UB04 and/or Dental claim form changes.

Communicate:  Have you communicated your NPI(s) to your health plans and other organizations you work with?  Keep in mind, as outlined in current regulation, all covered providers must share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes -- including designation of ordering or referring physician.

Collaborate:  Do you know the readiness of your trading partners (such as health plans, TPAs, clearinghouses, etc...)?  It's important to work with your trading partners to know their readiness with NPI and how it impacts you.

Test:  Have you started testing the NPI, both internally and externally? 
Not only do you need to test the HIPAA Transactions such as 837 Claims, but if you process 835 Remittance Advice, be sure to test that your system can process the NPI appropriately.  Also, if you submit paper claims, be sure that you've tested the data being printed in the correct fields.

Educate:  Have you educated your staff on what the NPI is and the use of it?
It's important that staff who may be using the NPI in day-to-day work, such as verification of eligibility, or other tasks that may need the NPI, be aware of the NPI and the provider identifiers that it replaces.  The staff may have to change policies and procedures.

Implement:  Have you implemented the NPI into your business practices?
Once testing is complete, changes will go into production.  Prior to doing this, you'll need to make sure your trading partners are ready to process with the NPI only.

 

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