In This Issue:
- Featured Articles
- Committee Updates
MGMA’s Response to 2015 Medicare physician fee schedule
MGMA expressed a number of concerns to the Centers for Medicare & Medicaid Services(CMS) about the proposed 2015 Medicare physician fee schedule (PFS). This annual regulation sets the Medicare physician payment rates and makes changes to Medicare policies and programs. Please see MGMA’s full article
BC/BS Contract Language changes
The Payer Relations Committee has a meeting scheduled with BCBS leadership. If you are experiencing issues with BCBS Provider Service or have been adversely impacted by changes in BCBS contract language (passive amendments) during the contract year, please contact Melissa Larson, PRC Chairperson, at firstname.lastname@example.org.
Fair Contracting Legislation
Many providers are reporting an increase in recoupment of claims more than a year after payment. Per legislation passed in the 2009-2010 session, once a clean claim is paid, the payers have 12 months to recoup money and/or make adjustments. (With the exception of payments related to coordination of benefits, subrogation, retroactive terminations, and cases of fraud and abuse). We encourage MMGMA members to send the enclosed legislation to the payers when payers are recouping money past the legislated limits.
MN Health & Human Services Laboratory
MN DHS has changed their policy on billing for laboratory services. In the past, if the patient was on a Medical Assistance Managed Care plan, the providers were able to bill for the services even if lab was performed by a reference laboratory. As of January 1, 2015 the new policy states that the reference laboratory must perform the billing if they are providing the laboratory or pathology service.
Ebola Guidance for Ambulatory Clinics
The MMGMA Executive Committee met with the Minnesota Medical Association leadership on Thursday November 13, 2014. Topics discussed included Ebola outbreak preparation at the ambulatory clinic level. While there has been considerable attention given to hospitals and emergency care providers, there has been little guidance and protocol recommendation for ambulatory clinics. The MMA and AMA recommend using the Center for Disease Control's video
for their training.
Inhaler Website for Patients
Studies show that 50-75% of patients with inhalers use them incorrectly. A new website developed by a Fairview Physician Associates pharmacist, fpanetwork.org/inhaler can help educate patients about inhaler use during an office visit and can also help patients reduce exacerbations, experience better symptom relief and improve overall health. Patients can return later to the site as often as needed. For questions or input about the site, please contact FPA, 952-914-1800, email@example.com.
Patient and provider tools include:
- Pharmacist video demos of all inhalers available
- Searchable photos of inhaler currently available on the market
- Printable, patient-friendly information sheets
- Asthma and COPD education resources
Provider-specific tools include:
- At-a-glance inhaler summaries
- Prescribing information
- Black box warnings
Medica Health Plan & Children’s Hospital & Clinics Contract Update
In early November, Children’s Hospitals & Clinics and Medica announced that they had not come to an agreement for the 2015 contract. Patients going to Children’s Hospitals & Clinics would be out-of-network resulting in higher cost to the patients and their families. On Friday November 14th 2014, it was announced that they have resolved their contract dispute and Medica patients will have access to Children’s Hospitals and Clinics in 2015.
Three of our MMGMA members presented at the 2014 MGMA national conference in Las Vegas last month.
- Dave Silvernale, CPA participated in a specialty preconference that addressed current issues and trends in gastroenterology practice management.
- Dennis Wipperling, FACMPE and Troy Roovers, MHA MBA co-presented a session called “Integration, Merger, Sale or Dissolution? The Choice May Not Be Yours.”
MMGMA Committee Updates
Government Affairs Committee:
In November and December, the government affairs committee will be working on setting our legislative priorities for the legislative session that begins in January 2015. Input from all MMGMA members is welcome. You may contact any member of the Government affairs committee, or you may contact the committee chair, Mike Foley at firstname.lastname@example.org.
Payer Relations Committee:
Medical Assistance Fee Schedule
In prior years, due to budget cuts and shortfalls in funding, medical providers have seen stagnant or reduced reimbursement for their services. On October 1, 2015 providers will receive a 5% increase to the MN Medicaid fee schedule. We encourage providers to check their PMAP remittances for this increase.
America’s PPO Operational Fees Invoices
The Payer Relations Committee (PRC) recommends that clinic administrators reconcile their America’s PPO Operational Fees invoices. The following are common types of issues our members have experienced with America’s PPO invoicing (in error) of operational fees. The PRC committee suggests that that you contact America’s PPO if you are invoiced for any of scenarios below:
- Transaction invoiced before payment received.
- Transaction invoiced but America’s PPO provider discount is not taken. (e.g. Payer or aggregator pings America’s PPO network but does not use America’s PPO contractual discount.)
- Transaction invoiced but the discount applied is not America’s PPO discount, it is another contracted payer’s discount.
- Transaction invoiced but the payer is not contracted to access America’s PPO network. Not only should the fee not be assessed, the discount should not be taken.
- Transaction invoiced but the discount taken is related to a Federal or State fee statutory fee schedule – not America’s PPO’s contracted discount.
- Invoices are not consistently sent by America’s PPO to the providers on a monthly basis.
MN Department of Health & Electronic Exchange Standards
Minnesota Department of Health (MDH) announced proposed updates to Minnesota Uniform Companion Guide rules for the Payment/Advice (835) transactions and Eligibility Inquiry and Response (ASC X12 270-271). There is a 30-day public comment period from November 10, 2014 to December 10, 2014. For further information on the proposed revisions or to comment on them, please go to www.health.state.mn.us/asa/.
Exhibitor & Sponsorship Committee:
Sign up today to become an annual sponsor of MMGMA in 2015 and see your logo prominently displayed at three important events: Winter Conference, Day with the Payers and Summer Conference. Visit www.mmgma.org/sponsorship-opportunities to sign up online at one of the levels below:
- Platinum Sponsor - $6,000
- Gold Sponsor - $3,000
- Silver Sponsor - $1,500
- Bronze Sponsor - $750
Not quite ready for an annual sponsorship? We have other opportunities for you to support MMGMA while promoting your business. Tote bags. Food events. Parking passes. Golf, too. Call the MMGMA office at 651-999-5359 before December 1st to learn about sponsorship opportunities.
Our ACMPE Committee Chair, Bonnie Bina, MHHSA, FACMPE accepted her MGMA Fellowship honor this year at the MGMA conference. In addition, three Minnesota Fellowship were honored this year. They are David Berg, FACMPE; Aaron Keenan, FACMPE and Richard Prior, FACMPE.
- Manager, Hospitalist & Palliative Care Practice, posted 11/21/2014
- Financial Anly-Sr I, posted 11/14/2014
- Surgical Suites Nurse Manager, posted 10/31/2014
- Business Office Director, posted 10/24/2014
Visit our job board
to read more about these and other job postings.