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May 3, 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.
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Florida RAC Begins To Look
At E&M Codes |
Health Data Insights, Inc. (HDI), the Florida RAC, has
identified a number of Florida physicians who are charging
inappropriate "new visits" for patients. Medicare rules state
that if a physician has not seen a patient in three or more
years, he/she can file the claim as a new patient. If it has
been less then three years, the physician must charge for an
established patient. Several physicians have been charging for
new patient services prior to the three-year time frame. CMS
states that the dollar amounts are quite low, but because the
claims were paid inappropriately, the physicians should return
the money. The RAC statement of work does not allow them to look
at E&M levels of service, but it does allow them to look and E&M
codes used in the global period, duplicate E&M codes, and new
versus established E&M codes. HDI is working with CMS to set up
the guidelines for requesting refunds from physicians. The FMA
staff will keep you posted as issues develop. |
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Florida Medicaid NPI
Implementation |
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The Health Insurance Portability and Accountability Act (HIPAA)
of 1996 required the adoption and use of the National
Provider Identifier (NPI) for all health care providers.
The NPI replaces all identifiers (provider numbers)
currently in use, including Medicaid provider numbers. May
23, 2007 is the date mandated for the use of NPI on all
HIPAA transactions. However, the Centers for Medicare and
Medicaid Services (CMS) is allowing a 12-month period for
covered entities to have a contingency plan to ensure the
smooth flow of payments. Florida Medicaid will implement
NPI with a contingency plan and will mandate the use of NPI
beginning July 1, 2007. We will keep you informed of any
possible changes to this date. Currently, 65% of providers
required to have a NPI have registered their number with the
agency. When registering the NPI with us they are providing
the NPI or combination of NPI, taxonomy and zip code that
is cross-referenced to their Medicaid provider number. The
agency will implement the NPI contingency plan in three
phases.
Click here for more details.
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Special Update From The
PSA |
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The AMA Private Sector Advocacy unit has received numerous
complaints from state medical associations about
solicitations from Three Rivers Provider Network to
physicians. These solicitations appear to be a routine
request for a W-9, but in fact, if signed, result in the
physician practice agreeing to be "in network" with Three
Rivers and agreeing to accept 25% discounts off their fees.
The AMA sent a letter to Three Rivers CEO Todd Breeden
outlining its concerns about this solicitation and urging
Three Rivers to make its contracting practices
transparent. To view this letter,
click here.
We encourage you to be on the lookout for these
solicitations and to sign the document only if they wish to
be in the Three Rivers network. We will keep you informed
as more information is obtained.
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The FMA would like to congratulate Dr. E. Coy Irvin
Jr., AMA Delegate, for being named
Life Care Centers of America's company-wide Medical Director
of the Year for 2006. Dr. Irvin is a medical director at
Life Care Center of Pensacola.
The FMA would also like to congratulate Dr. Kamel
Elzawahry, an FMA member for 26
years, for being chosen by the American Academy of Neurology
to be the first recipient of the Kenneth M. Viste, Jr., M.D.
"Patient Advocate of the Year" award. Dr. Kamel Elzawahry
will be receiving this award in early May 2007 at the annual
meeting of the American Academy of Neurology in Boston,
Massachusetts.
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