Tuesday December 14, 2010

2011 Winter Conference

Register Now!

January 7-8, 2011
Bell Harbor International Conference Center

Featuring one and a half days of educational programming including:

• Category I CME Credits
• Timely Practice Management Updates:
  • Healthcare Reform
  • Regulatory/Compliance
  • Hospital Affiliation
  • Payer Contracting
• Effective Strategies and Scientific Updates:
  • Pediatrics
  • Facial Plastics
  • Allergy
  • Oncology
• Topic specific panel discussions with host of local and national experts
• Networking with your colleagues from around the Pacific Northwest

Meeting Information:
Register Online
Meeting Schedule

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Congress Halts Medicare Physician Payment Cut

Earlier today, Congress completed its work on H.R. 4994, the Medicare and Medicaid Extenders Act of 2010. H.R. 4994 halts, through 2011, the 25 percent cut in Medicare physician payments scheduled to take effect on January 1, 2011. The President is expected to sign the bill into law.

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Intelligence Report: Hospital Mergers & Acquisitions

Brand-new research shows that 64% of healthcare leaders expect an increase in M&A activity between acute care hospitals and both diagnostic imaging and ambulatory surgery centers. As the transaction tide continues to rise, the newest HealthLeaders Media Intelligence Report, Hospital Mergers & Acquisitions: Opportunities and Challenges, reveals key insights to help keep you afloat.

Read More...

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Bill Exempts Doctors from FTC's Red Flag Rule on ID Theft

The Senate and House have each passed a bill that changes the Red Flags Rule's definition of "creditor" and relieves doctors of complying with the Federal Trade Commission's identity theft prevention law.

Read More...

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Know Your Options Re: Medicare

From mid-November through December 31, physicians will have their annual opportunity to review and perhaps change their Medicare participation status. Given the severe Medicare payment disruptions and uncertainty going forward the WSMA encourages you to review your options carefully.

To help you choose the direction that is right for your practice, the AMA has developed the “Know your options: Medicare participation guide.” This kit contains a detailed explanation of the three available options:

1. participation (PAR),
2. non-participation (non-PAR), and
3. private contracting.

It also includes a helpful revenue calculator and various sample materials to help physicians share information with current, new, and prospective patients. The Medicare options kit is accessible at www.ama-assn.org/go/medicareoptions.

Also, please continue to urge your patients to get involved by directing them to our online petition www.wsma.org/melt-down.cfm.

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AAO-HNS Is Now Accepting Committee Applications

Get more involved with your Academy by applying to become a committee member! You can join an education committee to be involved in the Academy's education activities, a BOG committee to become more involved in the grassroots arm of the Academy, or one of our Academy or Foundation committees that fits your area of expertise. Apply now.

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Letter to CMS on the Medicare Program Integrity Proposed Rule

On November 16, 2010, the AAO was part of a coalition that sent a letter to Donald Berwick, MD, the administrator of the Centers for Medicare and Medicaid Services (CMS). In this letter, the AAO commented on the provisions of the proposed rule for the Medicare program integrity pertaining to fraud and abuse risk tiers, application fees, provider/supplier enrollment moratoria, and suspension of payments. View the letter.

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Interpreter Services Payment Cut Delayed

The Washington Medicaid program has delayed until March 1, 2011 its proposed elimination of coverage for interpreter services. As part of the state’s budget crisis, the cut was scheduled to take effect on January 1.

The WSMA, in cooperation with Physicians Insurance A Mutual Company, has prepared updated guidance on interpreters’ services, available on www.wsma.org (Practice Resource Center, Practice Management Operations).

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Washington State Budget: Waiting for the Other Shoe(s) to Drop

Saturday’s special legislative session went quickly and quietly as this latest round of budget cuts, necessary to get (most of the way) through the remainder of the fiscal year, were approved and sent to the governor. No one escaped some pain and the low pitched response to the cuts reflected the acceptance of shared pain – and the realization of more to come.

This week, the Governor is expected to roll out further changes to state agencies and her budget for the next biennium. We will get an analysis of the impact on health care programs to you as soon as possible.

RE: the special session, the cuts included $27.7 million to be gained by reducing enrollment in the Basic Health Plan; the state won't fill slots as they come open. We’ll get you numbers soon.

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WSMA Files Writ with Supreme Court Seeking Enforcement of State Law on Payment for Services

There has been considerable discussion – internally within the profession and with legislators and health plans – over the Insurance Commissioner’s non-enforcement of a 1997 state law on health insurer payment for emergency services, and legislative pressures to ban balance billing for some, or all, emergency services.

Last Thursday, in an effort to seek clarification and to set a “baseline” for the debate, the WSMA (with the participation of the state chapter of the American College of Emergency Physicians) filed a Writ of Mandamus with the State Supreme Court seeking to require Commissioner Mike Kreidler to enforce the statute (RCW 48.43.093) that requires health insurers pay for the emergency services of their policyholders, even when the physician providing those services is not contracted with the insurer. The law requires health insurers to pay the billed charges of nonparticipating providers for emergency services, less the specific cost-sharing arrangements permitted in the subscriber’s coverage with the insurer, and up to $50 additional. The law, passed in 1997, was enforced by Commissioner Kreidler’s predecessor, Deborah Senn.

The law was enacted to ensure that patients get the care they need in an emergency without delay or unnecessary expense. It was part of a larger health insurance reform bill, and established for the first time in state statute the coverage requirements and conditions for emergency services provided in a hospital emergency department. It requires health insurers to cover the cost of emergency services necessary to screen and stabilize the patient.

Points we’ve made in public discussion about this issue:

• This is about giving insurance company subscribers piece of mind that should they go to the hospital ED they will be treated and will not have unanticipated out of pocket expenses beyond what is defined in their coverage.
• Commissioner Kreidler’s interpretation of the 1997 law allows insurance companies to pay non-contracting physicians (those who haven’t signed a contract with the company) in the ED whatever they wish, sometimes at up to 50% discounts, forcing many physicians to balance bill the patient for the amount necessary to cover their expenses.
• Requiring the commissioner to enforce the 1997 law will mean insurance companies will have to cover their subscribers’ expenses when they go to the ED (to the limits of their policies) and patients don’t have to wonder who is, or is not, a contracting physician with their insurance company when they visit the ED.
• We don’t want to continue to have insurance companies transfer the risk they assume when premiums are paid to them to physicians who treat their subscribers in the ED.

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