FOS

House Democrats unveil first draft of healthcare reform plan.

Politico reports that Democratic leaders in the U.S. House of Representatives have released their draft of healthcare reform legislation. The bill creates a public insurance option, expands Medicaid, and requires employers to provide coverage or pay a tax. It also carries an individual mandate, with exception for cases of hardship. Those who are not covered by health insurance would pay a penalty based on 2 percent of their income above a certain level. The draft does not contain details on how to pay for the plan. Additionally, Rep. Henry Waxman (D-Calif.), head of the House Energy and Commerce Committee, stated that the House wants to find a permanent fix for the Medicare Sustainable Growth Rate reimbursement formula.

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Obama tells AMA: Liability is an issue but caps aren't the answer; reaffirms need for government plan.

Speaking June 15 at the annual meeting of the American Medical Association (AMA), President Obama said that he is willing to "explore a range of ideas" about ways to reduce the risk of medical liability lawsuits, but won’t support capping damage awards. He reaffirmed his stance on the need for a government plan option for the uninsured, and said that most of the cost of revamping the U.S. healthcare system can be recouped through more efficient medical record-keeping, paying physicians for results rather than procedures, and cutting back on reimbursements to hospitals for emergency room visits as more people are insured.

Read the complete transcript...

An editorial published online in the New England Journal of Medicine examines the role of medical liability reform in reforming the U.S. healthcare system.
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New online tool helps medical practices meet FTC identity theft prevention program requirements.

The U.S. Federal Trade Commission (FTC) has designed an online program to help medical practices and other businesses comply with its Red Flags Rule. The "Do-It-Yourself Program for Businesses at Low Risk for Identity Theft" contains two parts: Part A consists of a series of questions to help you determine if your practice is at low risk for identity theft, and Part B guides you through the four steps required to comply with the requirement of a written identity theft prevention program. FTC has delayed the enforcement date of the Red Flags Rule to Aug. 1, 2009.
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Division of Workers Compensation Releases Report on Reimbursement Disputes and Overutilization

The Division of Workers' Compensation has submitted to the Three-Member Panel its Annual Report on Reimbursement Disputes and Overutilization. This notice is to advise all registered users of the DWC e-Alert system that the report is now available for public viewing on the DWC website: http://www.myfloridacfo.com/WC

According to the provisions of section 440.13(12)(e)4., Florida Statutes, "The Department shall provide the panel with an annual report regarding the resolution of medical reimbursement disputes and any actions pursuant to s. 440.13(8).:  This year's report provides a detailed accounting of the Petitions for Resolution of Reimbursement Dispute received and adjudicated as well as activity generated by Carrier Reports of Over-Utilization for Fiscal Year 2007-2008.

Drugstore clinics look to expand scope of practice.

According to the Chicago Tribune, several large pharmacy companies plan to increase the range of specialized services found in their outpatient clinics to include care for "sprains and strains" and injections for chronic conditions such as osteoporosis. The retail clinic model has been supported by health insurers, employers, and consumer groups as one way to address rising numbers of the uninsured. However, some critics argue that patients with certain conditions would be better served by physicians—especially if the physician has a history with the patient. Retail clinics must operate under physician supervision but are often staffed by nurse practitioners.
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Uncompensated care cost each insured family $1,017 last year.

A report released by not-for-profit advocacy group Families USA states that subsidizing uncompensated health care for the uninsured cost insured American families an average of $1,017 each during 2008. According to the report, which was based on data from the Medical Expenditures Panel Survey and other federal and private sources, 37 percent of care is paid for out-of-pocket by the uninsured, with third-party sources such as government programs and charities, paying for another 26 percent of care for the uninsured. The remaining costs were considered uncompensated and totaled $42.7 billion across the United States in 2008.

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Read the complete report (PDF)... 

Action Alert: Please Send Letter to Governor Crist Asking for Support of SB 1122

Dear Florida Orthopaedic Society Members,
 
SB 1122, which would require managed care companies to honor an insured’s assignment of benefits, has passed the legislature and now awaits action by the Governor. The Florida Medical Association (FMA) and Florida Orthopaedic Society (FOS) were able to pass this legislation with the help of your society’s leadership, lobbyists and members. It took a tremendous effort with all of organized medicine pulling together to pass this bill. The opposition from big insurance, including Blue Cross Blue Shield of Florida and United was ferocious, and unfortunately this opposition continues.
 
We have discussed this bill with the Governor’s staff, who have indicated that they have serious concerns. The managed care companies have been attempting to persuade the Governor to veto this bill, and will stop at nothing to achieve their goal. As demonstrated by their argument, during the last few days of session, that mandatory assignment would put Blue Cross out of business, their goal is to cause as much confusion and fear of this bill as possible.
 
To convince the Governor to sign this bill, it is imperative that all of organized medicine forcefully transmits the message of how important this bill is, both to physicians and patients.

The legislation requires insurance companies to recognize a valid Assignment of Benefits for non-contracted physicians.  This would require insurance carriers to send reimbursement to the non-contracted physician rendering the services rather than the patient, if requested by the patient.  This will address the routine practice of Blue Cross Blue Shield & United who send the reimbursement to the patient for out-of-network care.  Often times the patient does not forward the reimbursement to the physician and the physician is unable to collect reimbursement from the patient for services rendered. 

We are requesting your help in sending individual letters to Governor Charlie Crist.  I have attached a sample letter to this email and copied it below.  Please feel free to copy and paste into an email to the Governor.  Better yet, you may consider dropping the letter onto your letterhead and faxing it in and mailing a hard copy.  Please consider adding your own personal touch to the letters as well so they are not all identical.

Thank you very much for your assistance.  Please confirm with me if you are able to generate any letters.  It is critical that we compete with the significant volume of letters that the insurance industry is generating against this legislation.  Please ask all of your physicians and your staff to send in letters at this time.

 Contact information for the Governor:

Email address:   Charlie.Crist@myflorida.com

Fax: (850) 487-0801

Office of Governor Charlie Crist
State of Florida
The Capitol
400 S. Monroe St.
Tallahassee, FL 32399-0001

Thanks very much for your assistance on this important issue.

Sincerely,
Fraser Cobbe
Executive Director
Florida Orthopaedic Society

Download Sample Support Letter for SB 1122

 

HEAT initiative created to chill purveyors of Medicare fraud.

The U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) have announced the creation of a joint task force to combat Medicare fraud. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) will include senior officials from DOJ and HHS who will strengthen existing programs to combat fraud and invest in new resources and technology designed to prevent future fraud, waste, and abuse.
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Dear BSOF Members,

The Board of Directors for the Bones Society of Florida is extremely pleased to unveil the preliminary program for the 2009 BSOF Annual Meeting.  The meeting is taking place September 25-27 at the Marriott Harbor Beach Resort & Spa in Fort Lauderdale. 

We are busy creating a fancy brochure to distribute to everyone but did not want to waste any time in sharing what we have planned.  I have attached the agenda as well as the housing instructions and a registration form.  We are ready for you to make plans, secure your hotel rooms, and return your registration forms. 

We are looking forward to continuing to build upon our reputation of offering stimulating educational content and unmatched networking opportunities with colleagues around the state.  We anticipate this year’s meeting will be our largest yet and encourage you to make plans to participate. 

You will note on the program that we still have to finalize some of the content specifically relating to Ancillary Services.  We want your help in crafting your content.  Please look for a survey in the coming days asking for your input as we incorporate the topics you want to hear into the program. 

We also have a series of panel discussions and breakout sessions planned for which we will be seeking volunteers.  If you would like to volunteer to facilitate a breakout session or serve on a panel discussion, please feel free to submit your name to us. 

Thank you very much for your participation.  We look forward to seeing you in Fort Lauderdale.

Sincerely,
Fraser Cobbe

Download 2009 BSOF Annual Meeting Preliminary Program

Download 2009_BSOF_Housing_Instructions

Download 2009_MTG_Member_Registration_Application

Majority of Physicians Now Compensated for ER Call

Modern Physician reported on April 1st that according to a report released by the Medical Group Management Association that almost two-thirds (62%) of healthcare providers receive some form of additional compensation for on-call coverage.  The report notes that compensation agreements are in the form of a daily stipend or hourly rate with variations for specialty, group size and region.

See the full story, Most providers receive compensation for on-call duty, MGMA survey finds or go to www.modernphysician.com.

New AMA resource a one-stop shop for ePrescribing information

An online learning center launched this week by the AMA can help physicians and practice managers make informed decisions about electronic prescribing, also known as ePrescribing. With vast educational content and interactive tools, this convenient resource allows users to assess ePrescribing technology at their own pace in an impartial environment.

Aspects of the learning center include complete and unbiased coverage of ePrescribing system vendor pricing and features, calculators to estimate potential time savings and determine Medicare ePrescribing incentive payments, the latest information on federal and state programs offering ePrescribing incentives, and readiness and planning tools to help physicians map out an implementation plan.

“The AMA’s new ePrescribing learning center takes the guesswork out of the decision-making process by giving physicians all the tools they need to decide what system is best for their practice,” AMA Board Chair Joseph M. Heyman, MD, said.

Visit www.ama-assn.org/go/eprescribing to access the learning center.

Practice Management Center

American Medical Association
www.ama-assn.org/go/pmc

OrthoSupersite Reports End of Orthopedic Device Company Deferred Prosecution Agreement

According to the OrthoSupersite News Wire several leading orthopedic device manufacturing companies announced the Deferred Prosecution and Non-Prosecution agreements entered into with the United States Attorney’s Office for the District of New Jersey in September 2007 have expired. ( March 2009) Read More

New Jersey Law Protects Physician ASC Referrals

According to an article from Modern Physicians, legislation that protects the ability of physicians in New Jersey to refer patients to ambulatory surgery centers in which they have ownership was recently signed by Governor Jon Corzine.  The bill will be applied retroactively.

See the full story (registration required) or go to modernphysician.com

Aetna Agrees to Settle with Florida Physicians on Non-Contracted ER Care

Who is Eligible for this Settlement:
Any and All physicians, physician groups , or physician organizations who provided emergency services and care in Florida to any HMO plan members and who were paid by Aetna for those services outside of any contract or agreement during the class period.   (June 3, 2003-December 15, 2008)

What is this settlement about:
The Class alleged that Aetna violated Sections 641.513 Florida Statutes, a statue governing “usual and customary” payments by Florida HMOs to physicians who rendered Emergency Services and Care to HMO plan members.   For each claim you properly re-submit through the settlement process, you should receive the difference between 125% of Medicare Rates (Aetna’s historical allowance) and 238% of Medicare Rates (the agreed upon settlement amount)

How do you file:
You can choose to file on your own, or you may decide to enlist the assistance of an experienced third party to file on your behalf.  The FOS has lined up a firm, Managed Care Advisory Group (MCAG), that is willing to assist our members in filing if necessary.   To file on your own, you must submit a claim form to the settlement administrator by May 4, 2009.  At this point, Aetna will use its “Best effort” to determine how much they underpaid your practice for the time frame of June 2, 2007 through December 15, 2008, and send you payment.  If you choose to use MCAG (or another third party) to assist you in filing, you must complete the attached contract and submit it to MCAG no later than April 27, 2009.  At this point, a MCAG representative will contact you to gather the information necessary to file a claim.  MCAG will use the billing information (Provided by you, or your billing company) to audit Aetna’s “Best Effort” calculation, and perform the necessary appeals to ensure that you receive what is rightfully yours.  MCAG will also use the billing data to determine if you are eligible to submit claims that were underpaid before June 2, 2007.  To do so, the settlement requires the class member to submit supporting documentation, which MCAG will recreate from the billing data when possible, and work with your practice to retrieve other documents if necessary.
Click below to view the settlement agreement.  The agreement will give you more details and information on how to file on your own.

Assistance with filing?
If you decide you would like assistance to ensure you receive the appropriate compensation from the settlement, the FOS is teaming up with Managed Care Advisory Group (MCAG) to assist physicians in filing. 
Who is Managed Care Advisory Group:
Managed Care Advisory Group (MCAG) is a company that has been very successful working with AMA and many other State, Local and Specialty Medical Societies to help physicians collect the maximum amount they were due under the MDL HMO Class action Settlements.  MCAG was able to help over 90,000 physicians across the country collect more than $150 million under these class action settlements. 

If you have any questions, please contact MCAG at (800) 355-0466.   

Download Aetna Settlement Agreement Clean Copy 

Download Aetna Settlement Proof of Claim Form  

Stimulus packages targets $19 billion for EHRs.

Although the federal government plans to use $19 billion of the economic stimulus package to facilitate increased adoption of electronic health records (EHRs), some obstacles remain. The Los Angeles Times reports one 10-physician practice that adopted EHRs 3½ years ago has been able to eliminate tens of thousands of manila files and reduce its record-keeping staff from seven to three. The office also eliminated 2½ positions in its billing department because clerks no longer have to review handwritten notes. However, the upfront costs of implementing EHRs can be high—as much as $30,000 per physician, and interoperability across competing records systems remains low. The U.S. Department of Health and Human Services has been tasked with developing a set of standards for EHRs by the end of 2009. Watch for an in-depth article on EHRs in the April issue of AAOS Now.

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