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New Address Effective November 1, 2010 Orleans Parish
Medical Society office will move. Orleans Parish Medical Society Post Office Box 26683 New Orleans, La. 70186-6683 Phone 504-241-8081 Fax-504-241-8082 Please send all future invoices and correspondence to
this address. President Patrick C. Breaux, MD
LSMS to File Suit
On Wednesday, October 6, the LSMS
Executive Committee decided to file a lawsuit against the Louisiana Department
of Health and Hospitals (DHH) challenging the validity of the recoupment
process and the Medicaid cuts. The LSMS believes that this lawsuit must be
filed to protect the rights of Medicaid patients to have access to quality
medical care and to preserve the financial viability of the physicians who care
for them. Due to the drastic cuts to the Medicaid Program in the last two
years, it now costs most physicians more to treat a Medicaid patient than they
are being paid. LSMS members are devoted to their patients, but at these
reimbursement levels many will be forced to stop seeing Medicaid patients and
some will close their practices.
As we prepare to file our lawsuit,
we need the help of our membership. We are looking for physicians and patients
to serve as plaintiffs in this suit along with the LSMS. If you are interested
in serving in this important role please contact
Recoupment Process Errors
May Affect Providers
The Department of Health &
Hospitals notified the LSMS earlier this week that Medicaid providers may be
affected by an error in the RA Payment/Recoupment Process. Providers with
payment plans established as a result of the claims adjustments on the RA of
9/22/10, may see an error on their 10/5/10 RA that caused the amount the
provider was set to be paid this week to be recovered in-full. The error is being corrected, and the payments
that were incorrectly recovered from providers over-and-above the weekly
payment plan established will be re-paid by DHH. The Department is working
diligently to get these repayments to affected providers as quickly as
possible. Upon resolution, the correct negative balance will be re-established
to allow correct deductions to be made on future RAs. Providers that did
not have negative balances established due to budget adjustments and providers
that requested that their negative balances be recouped in full are not
affected by this error. Providers should continue to monitor future RAs
and www.lamedicaid.com for updates on these
issues. Contact Molina Provider Relations at (800) 473-2783 or (225)
924-5040 with questions.
Louisiana Medicaid Coordinated Care Networks (CCN) Following the
recent release of CCN Program Announcements by the Louisiana Department of
Health and Hospitals (DHH) concerning the status of establishing program
networks, the LSMS has received calls from members concerning contacts they
have received from insurance plans that have filed letters of intent to enroll
as providers in the CCN Program. It is the opinion of the LSMS that members
should not assume that any of the entities who have applied to DHH will be
officially approved as a plan provider (network). Discussions with these
entities with the objective of becoming more familiar with their plan
provisions and physician participation requirements would be appropriate if you
have an interest in joining a CCN network in Phase 1, 2 or 3 of the
implementation of the program. However, it would be premature to enter into a
contract until all financial provisions are made known and DHH has completed
its negotiations with potential network plans. There are critical details
remaining to be developed regarding crucial program functions within the
regions, important service and delivery obligations as well as program
reporting and data requirements for participating medical providers. Read more… http://www.lsms.org/cms/component/content/article/625
Please stay tuned to www.LSMS.org for the latest information on
the Medicaid cuts recoupment process, CCNs and the progress of the legal
challenge by the LSMS.
New Leadership at LSMS
The LSMS is under the leadership –
“For the past five years,
Williams has more than 12 years of
professional experience in financial and strategic planning, accounting,
project management and general management. Prior to joining LSMS, he led
multiple engagements for two national accounting firms conducting operational,
compliance and financial reviews of business processes for Fortune 500 clients.
Additionally, he has experience with the Louisiana Legislature reviewing and
drafting fiscal notes for proposed legislation. He now serves as a member of
the Louisiana Health Data Panel, the Louisiana Health Information Exchange
(LaHIE), and the Louisiana Health Information Technology (LaHIT). Learn more
about Jeff in the November 2010 issue of Capsules. http://www.lsms.org/cms/images/stories/Wiiliams%20New%20LSMS%20EVP.pdf
Take the 2010 Member
Satisfaction Survey: http://survey2.9gs.org/survey.php?code=1u517kq
If you have already completed our
member survey request from last week – Thank You! We understand you probably
get a lot of requests to take surveys. That being said we made this one
short and to the point. It shouldn’t take more than a few minutes to provide
the valuable feedback we need to improve. This survey is completely anonymous
so please don’t hold back. We want to know how you are feeling. In
December, results will be compiled with other medical societies across the
nation to give us a view of how we compare on a national scale, as well as
presented during the LSMS Strategic Planning Session on December 11, 2010. Your
input will make a difference and will be used to guide discussion during the
session.
Nearly Two Years of Medicaid Cuts to Be Implemented This Fall
Facing a difficult economy and dwindling state and federal funding, the Department of Health and Hospitals (DHH) has been tasked with identifying and implementing cuts to its 2010-11 budget while trying to protect access to medical care, specifically the Louisiana Medicaid program. In addition, cuts to the 2009-10 Medicaid program budget have been identified and announced but not actually implemented. This means that DHH must now go back and collect those rate reductions from the August 2009 and January 2010 cuts. Each claim will be adjusted to reflect the amount the provider must pay back to the Medicaid program as a result of those delayed cuts.
DHH is unable to delay implementation of the rate reductions any longer, since budget savings associated with all of the reductions must be realized before June 30, 2011. All participating Medicaid physicians will be mailed a letter from DHH with the following details regarding the plan for implementation:
§ Each provider will see their total adjustment amount on only one of the midweek RAs, either on September 22, 2010, or October 6, 2010.
§ The adjustment balance will not be deducted from either of the midweek RAs. Instead, the balance will be divided and applied in equal amounts to the normal weekly RAs immediately following the midweek adjustment RA & continue through June 7, 2011. Any remaining balance after the June 7, 2011 RA must be paid in full by June 30, 2011.
§ Please note that the adjustment balance will equal the total adjustment amount less any adjustments for claims that encounter edits due to system changes since the claim initially paid. It is anticipated that there will be a minimal number of such claims so these will be resolved in each providers’ future normal weekly RAs.
Providers may contact Bureau of Health Services Financing to inquire about an alternative payment plan, request an estimated total dollar amount of the adjustment balance, or submit any questions. These inquiries may be submitted via e-mail to
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or written correspondence to:
Bureau of Health Services Financing
Professional Services Program
More information is available, including the Rate Reduction Summary and the Claims Adjustment Memorandum, on LA Medicaid’s Website:
http://www.lamedicaid.com/provweb1/Recent_Policy/Claim_Memo_RR.htm
Read the DHH Emergency Rules: http://www.doa.louisiana.gov/osr/emr/emr.htm
Medicaid Cuts – LSMS Physician’s Share Their Perspective
Earlier this summer, the LSMS requested that you share your experience by taking the 2010 Medicare & Medicaid Participation Survey. As of August 6, 386 physicians had answered the call. The results are telling:
§ More than half of respondents (56.6%) indicated that they have either stopped or will stop accepting new Medicaid patients; another 24.8% are considering this as an option.
§ A majority (69.0%) of respondents indicated that they have either limited or will limit the number of new Medicaid patients accepted by their practice; another 16.0% are considering this option.
§ 40.3% of respondents indicated that they no longer see or will no longer see any Medicaid patients; another 31.4% are considering this as an option.
§ When asked to indicate their experience in referring Medicaid patients for specialty care, respondents who chose “difficult to make referrals” and “almost impossible to make referrals”, the percentages are substantial: 94.9% in 2010 compared to 86.7% in 2009.
How Can You Make Your Voice Heard?
The LSMS wants to know… how will your practice be affected by the cuts? What actions will you take or have you taken to ensure the viability of your practice? In an effort to demonstrate how these cuts will further exacerbate access to quality medical care for all patients, especially those who rely on the Medicaid program, we ask that you share your experience with us by:
§ Calling 800.375.9508 or emailing the Department of Public Affairs at
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and we will connect you with a reporter in your area.
§ Taking the survey: http://www.surveymonkey.com/s/NN8JQ8Y OPMS Members:
The Louisiana State Medical Society is requesting Nominations
2010 LSMS Nominations for Hall of Fame
The Hall of Fame honors a member, either living or deceased, who has shown long term meritorious service to the Louisiana State Medical Society.
2010 Nominations for LSMS Community Service Award
The candidates for the Community Service Award shall be living members of the Society licensed to practice medicine in
You are invited to submit recommendations for consideration. These recommendations should be accompanied by current curriculum vitae of the member or members recommended.
Please forward all nominations and supporting materials to Toni Johnston,
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no later than Friday, November 19, 2010.
Presentation
The award shall be presented to the honoree(s) at the Annual Meeting of the House of Delegates.
Electronic Health Record (EHR) Incentive Programs Informational Teleconference
September 9, 2010 – 9:00 a.m. to 10:30 a.m.
The Centers for Medicare & Medicaid Services (CMS) Dallas Regional Office invites all interested healthcare professionals to participate in a toll-free teleconference about the EHR Incentive Programs. This call is for the benefit of Eligible Professionals interested in learning the specifics of the Medicare and Medicaid EHR incentive programs.
Date: Thursday, September 9, 2010
Time: 9:00 to 10:30 AM Central Daylight Time
Toll Free #: (800) 603 - 1774
Conference ID: 96020172
NOTE: In order to join this conference call, all speakers and participants will be required to provide the Conference ID listed above. Please call in 10 minutes prior to the call’s start time. Pre-Registration for this call is not required.
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________________________________________________________ MEDICARE MELTDOWN Congress Approves Yet Another Plan to Delay Cut
On June 24, 2010, the U.S. House of Representatives approved a six-month plan to prevent a 21 percent cut in doctors’ fees paid by Medicare. The House approved Senate-passed legislation that raises payments by 2.2 percent through Nov. 30. President Obama signed the bill on June 25. The increase will be applied retroactively for claims for services on or after June 1. The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on June 25, 2010, that would update payment policies and Medicare payment rates for services furnished by physicians and nonphysician practitioners that are paid under the Medicare Physician Fee Schedule. Comments on the proposed rule are due by August 24, 2010, with the final rule to be issued by November 1, 2010. The program faces an even steeper cut later this year when this latest temporary fix ends. Let your Representatives and Senators know that enough is enough. Patients and physicians deserve a long-term solution to the SGR formula, and a more stable Medicare physician payment system that provides security for patients and the physicians who care for them.
§ Sign the Petition, joining with other physicians from medical societies across the nation. Or download the print petition, sign and fax to the LSMS.
§ Contact your US Senators and Representatives and tell them to find a permanent replacement for the Medicare payment formula.
§ Post this informational flyer in your office, on your website, etc. Distribute the flyer to your patients, fellow physicians, family and friends.
§ Write a letter to the editor of your local paper, or call your local radio and TV station. Click here and enter your zip code to find your local media outlets.
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Medicaid Providers Required to Identify Oil-Spill Related Illnesses/Injuries for Medicaid Recipients
The Department of Health and Hospitals is implementing claims billing indicators to be used to identify services provided to Louisiana Medicaid recipients when treated for an oil spill-related illness or injury. This information is necessary to track and evaluate health outcomes and costs related to the BP Oil Spill. Providers should begin immediately using these indicators on claims submitted for Medicaid payment. Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 with any related questions. Effective immediately, providers are asked to use the following indicators on applicable claims submitted to LA Medicaid for processing and payment:
▪ EDI 837P Transaction for Professional Services - Enter modifier U9 (Disaster Related Service or Illness) with all appropriate procedure codes. This modifier should follow any other modifiers currently required for claims payment.
▪ CMS-1500 Claim Form - Enter modifier U9 (Disaster Related Service or Illness) with all appropriate procedure codes. This modifier should follow any other modifiers currently required for claims payment.
▪ EDI 837I Transaction for Institutional Services – Enter the Condition Code DR (Disaster Related Service or Illness) as the first Condition Code with all appropriate services.
▪ UB-04 Claim Form – Enter the Condition Code DR (Disaster Related Service or Illness) as the first Condition Code with all appropriate services.
▪ Pharmacy POS Transactions – Enter the NCPDP Field Reason for Service Code (Data Element 439-E4) valid value “RE” (Suspected Environmental Risk) with all appropriate services. ________________________________________________
Emma Borders Installed as President-Elect of AMA
The LSMS Alliance now has national representation. Emma Borders, long-time LSMS Alliance member and former officer, was installed as president-elect at the AMA Alliance Annual Meeting, June 12-15, 2010. Attending as
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2010 Member Satisfaction Survey
Let us know how we are doing as a society! The LSMS urges members to take five minutes to complete a member satisfaction survey. In December 2010, results will be compiled with other medical societies across the nation to give us a view of how we compare on a national scale. Access the survey online at http://survey2.9gs.org/survey.php?code=1u517kq. Thank you in advance for your time and input.
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Join LSMS on Facebook
Calling all Facebook friends… Become a fan of our site and get involved with the Society online: www.fbook.me/LSMS. Having trouble? Contact the LSMS Dept of Public Affairs at 800.375.9508 or 225.763.8500; or by email at
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.
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Capital Area Medical Society Hosts Disney Institute in
Every hospital, clinic, group medical practice, dental practice, or freestanding medical care provider has the opportunity to distinguish themselves through the delivery of quality services. A one-day local workshop, Disney’s Approach to Quality Service for Healthcare Professionals program will show you the importance of attention to detail in everything Disney does -- from training its Cast Members (employees) to treating every Guest (patient) as a VIP. You will hear the stories and see how Disney best practices can be easily adapted to your healthcare delivery organization.
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