June 28, 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.


CMS Suspends Marketing for Private Fee-For-Service Plans
The Centers for Medicare and Medicaid Services (CMS) announced that in response to concerns about marketing practices, seven health care sponsors signed an agreement to voluntarily suspend the marketing of Private-Fee-For-Service (PFFS) plans. The signatories include: United Healthcare, Humana, Wellcare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross/Blue Shield of Tennessee.

Through a variety of methods, including their 'secret shopper' program that uses trained individuals to attend marketing events and report back on insurance agents' activities, and the eyes and ears of our thousands of partners throughout the nation, CMS states they are proactive in protecting beneficiaries from rogue agents. The agreement will apply to individual plans until they have demonstrated to CMS they have the systems and management controls in place to ensure they can meet all CMS requirements. Plans signing the agreement will be actively monitored to ensure they do not engage in marketing while the voluntary suspension is in place. Violations will be subject to a full range of available penalties, which can include suspension of enrollment, suspension of payment for new enrollees, civil-monetary penalties, and termination of the plan's involvement in the Medicare program. For more information click here.
Medicare Could Start Comparing Resource Use Among Doctors In 2008
In a recent report and testimony to Congress, the Government Accountability Office (GAO) said Medicare resource use comparison, also known as "physician profiling," could be ready to go live by the middle of 2008. By combing through Medicare claims and compiling utilization statistics for individual physicians and groups, the Centers for Medicare & Medicaid Services (CMS) could determine how doctors compare with each other when it comes to volume and intensity of services. CMS then could send doctors and physician groups reports that give them a sense of how much care they provide for particular patient conditions in relation to their colleagues. Federal officials hope that Medicare will save money in the long run by convincing doctors who bill for a relatively large volume of services to be more judicious in how much care they order. But CMS has not yet determined if or when it will implement such an initiative. For more information, click here.


PQRI Tool Kit
CMS has announced that the 2007 Physician Quality Reporting Initiative (PQRI) Measure Finder Tool (Version 1.0) is now available as part of the 2007 PQRI Tool Kit, Six Steps to Success. The Measure Finder Tool (Version 1.0) is designed to help eligible professionals and their coding/billing staff to quickly search for applicable measures and their detailed specifications. This tool will allow users to search for applicable measures based on a single code or a combination of codes. The addition of this new product expands the Tool Kit to six new and existing educational resources that will assist eligible professionals with successful reporting. To access the Tool Kit, visit, http://www.cms.hhs.gov/PQRI, on the CMS website in the PQRI Tool Kit section. Once on the PQRI Tool Kit page, scroll down to the "Downloads" section.


Florida Medicaid Sets Date for NPI Contingency Plan
CMS recently issued a contingency plan extending the deadline for full compliance with the National Provider Identifier (NPI) Rule to May 23, 2008. The NPI rule requires all covered entities to use the NPI for Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated transactions. The contingency does not delay the effective date of the NPI rule, but allows covered entities to avoid possible citations if they can show they are making due diligence to becoming compliant. CMS allows each payer to decide their own contingency deadline. Florida Medicaid is extending its contingency plan from July 1, 2007 to October 1, 2007. Providers will still be allowed to send in claims using the current Medicaid legacy numbers and claims will pay. However, we strongly urge providers to send in claims now with the NPI or NPI + taxonomy + zip they registered with Florida Medicaid. Testing now with the NPI solution will help ensure uninterrupted claims processing in October 2007. For more information, click here.


 Keeping Children Safe Act Signed Into Law
On June 12, 2007, Governor Crist signed the Keeping Children Safe Act into law effective July 1. The Act includes many new protections for children and also includes provisions for the development of new statewide standards for supervised visitation. This law might not have been passed without the persistent efforts and support of the Broward County Medical Association Alliance (BCMAA). The bill, initially introduced by Karen Oehme, Director of the Supervised Visitation Program at FSU, had been lying dormant on the floor of the legislature for four years. Thanks to Marietta Glazer, Immediate Past President of the BCMAA for taking the initiative to make it happen. Click here to view the bill's history.


 Member Spotlight
The FMA would like to take this opportunity to congratulate the following members for their outstanding achievements:

Phillip E. Andrews, M.D., FACS, (pictured left) an FMA member since 1973, was recently recognized for his dedication and service to the medical profession in the field of surgery. He was presented with the distinguished Raymond H. Alexander, M.D. Award at the 2007 Annual Meeting of the Florida Chapter American College of Surgeons held in Palm Beach, Florida. Dr. Andrews is in private practice in Otolaryngology Head and Neck Surgery in Fort Myers, Florida and is affiliated with Lee Memorial and Columbia Southwest Regional Medical Center.

Linda Susan Cox, M.D., an FMA member since 1994, has been awarded with the American College of Allergy, Asthma & Immunology (ACAAI) "Distinguished Service Award For 2007," in recognition of her tireless efforts on behalf of the ACAAI. Dr. Cox will be presented with the award at the ACAAI meeting in Dallas, Texas on November 10, 2007.

On Sunday, June 24, 2007, Dr. William Thompson, a partner at Tallahassee Orthopedic Clinic and primary physician for Florida State's basketball teams, completed the 2007 Ford Ironman Coeur D'Alene (Idaho) Triathlon in 12:30.44. It was Dr. Thompson's first full Ironman competition, and he finished 764 out of 2,085 who completed the event. There were 2,196 participants. He has been an FMA member since 1999. For more details, click here.


 Medicare 101 Seminars
The first in a series of free Medicare 101 seminars is scheduled for July 18 in Jacksonville, Florida. The seminars, presented by the Provider Outreach and Education Department of First Coast Service Options, Inc., (FCSO) are designed to educate new providers and their staff about the Fundamentals of the Medicare program. Each seminar will be broken out into Part A and Part B sessions, with topics ranging from Medicare as a secondary payer (MSP) and billing Medicare services, to the appeals process and where and how to get information.

To register for the Medicare 101 seminar, go to http://www.fcsomedicaretraining.com/. If you are already a registered user of FCSO's Learning Management System (LMS), simply log on, select the specific session you're interested in, and click the "Register" button. If you are a first-time user of the LMS, you will need to set up an account. To do so, follow these steps:
1. From the welcome page, click on the "I need to request an account" link just above the log on button.
2. Complete the "Request User Account" form. (Note: Providers who do not yet have an NPI # may use "9999.")
3. You will receive your log on information within 72 hours of requesting an account.
4. Once your registration is complete, log on and select "Course Catalog," then select "Catalog." Select the Specific session you're interested in, and then click the "Register" button.

 

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