April 26, 2006

Montana ASCs Challenged

ASIPP recently learned that two Montana ambulatory surgery centers (ASC) have been challenged for performing interventional pain procedures. One of the surgery centers, Yellowstone Surgery Center LLC, was reportedly told by DPHHS Medicare and Medicaid surveyors that the facility could be closed for performing pain procedures, pain control procedures, and/or pain management. In addition, the centers were also advised that extended stay for non-medicare and non-medicaid patients up to 23 hours can not be done in an ASC.

Upon learning of this situation ASIPP quickly began investigating. Based on CMS-Baltimore sources, it appears that this issue is tied to a misinformed surveyor and regional office and not a new CMS directive. ASIPP has been informed there has been NO change in CMS’s policy regarding interventional pain procedures performed in an ASC. CMS will pay for interventional pain procedures that are listed as ASC procedures.

ASIPP will continue to follow-up on this critical situation.

Treatment for Abuse of Prescription Drugs and Meth on Rise

The Substance Abuse and Mental Health Services Administration (SAMHSA) released new data on Monday that indicate a rise in admissions to substance abuse treatment of methamphetamine and opiate pain medications. According to the press release, methamphetamine admissions to treatment programs rose 11% between 2003 and 2004 while admissions for opiate treatment increased by 21%.

SAMHSA Administrator Charles Curie said, “Because there are many pathways to recovery, we continue to work with the states to provide flexible funding sources to meet emerging trends in treatment need. In addition to the $1.8 million block grant to states for substance abuse treatment and prevention, the President has proposed almost $100 million in FY 2007 for new ACESS to Recovery grants to states.”

The full Treatment Episode Data Set (TEDS) report will be available later this summer.

See the SAMHSA news release and the USA Today article on the release.

Physician Voluntary Reporting Program (PVRP).

As part of its overall quality improvement efforts, the Centers for Medicare & Medicaid Services (CMS) launched the Physician Voluntary Reporting Program (PVRP) on January 1, 2006. The new program builds on Medicare’s comprehensive efforts to substantially improve the health and function of beneficiaries by preventing chronic disease complications, avoiding preventable hospitalizations, and improving the quality of care delivered. Under the voluntary reporting program, physicians who choose to participate will help capture data about the quality of care provided to Medicare beneficiaries.

To help CMS gauge the number of physicians who intend to participate in the PVRP, the Regional CMS Office staff needs to identify physicians who want to start reporting now in the Physician Voluntary Reporting Program (PVRP). Physicians can report on the PVRP measures regardless of whether or not they register their intent to participate, however, CMS is STRONGLY encouraging physicians to register their intent to participate through the secured link: http://www.qualitynet.org/dcs/ContentServer?pagename=QnetPublic/Page/QnetHomepage

Ms. Dolores Perteet, Doctor Susan Nedza, and others from CMS are eager to answer any questions and help you get involved. Ms. Perteet's e-mail is Dolores.Perteet@cms.hhs.gov; her telephone number is (312) 353-9864. Doctor Nedza's email is Susan.Nedza@cms.hhs.gov.

Read the Department of Health & Human Services (HHS) letter to physicians explaining PVRP: http://www.cms.hhs.gov/PVRP/Downloads/PVRPDearDoctorLetter.pdf

Read the CMS Medical Learning Network (MLN) Matters news release: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5036.pdf

Information about the PVRP can also be found on the AdminaStar Web site: http://www.adminastar.com/Providers/Carrier/PVRP/PVRP.htm

Answers to Issues On Pump Refill Code: Supplies Added to CPT Code 95991

Led by President David Kloth, ASIPP recently formed an alliance with the American Academy of Pain Medicine (AAPM) the American Society of Anesthesiologists (ASA), International Spine Intervention Society (ISIS), and North American Neuromodulation Society (NANS) for the purpose of working with CMS to develop appropriate reimbursements for pump refills across the country. The coalition presented several issues surrounding pump refill reimbursements which, in our collective view, needed to be addressed.  CMS indicated some of these areas would be considered, but others would not. As we obtain definite response(s) from CMS, we will keep you informed.  One of the primary areas of our efforts relates to the wide discrepancy, state by state, in reimbursements for the refill medications. In some states, the reimbursement by Medicare for the medications is below cost due to the lack of coverage/reimbursement for shipping fees and/or compounding costs incurred.  As a result, the reimbursement for the entire refill procedure may barely cover the actual costs involved. 

In addition to looking into the pump refill medication reimbursement, the coalition also petitioned CMS to recalculate the RVU’s for 95991 to include the cost of the refill kit (which costs $28).  CMS has recognized that the reason this cost was not included in the RVU calculation for 95991 was due to an administrative error (it was included in the RVU calculation for 95990).  CMS is considering options to make the determination retroactive to the first of the year but has NOT made a ruling on this yet. Retroactivity is not likely to be considered for any time period beyond this year.

Prior ASIPP News articles may have given the impression that CMS had now sanctioned the billing of both SA076 (the refill kit) and 95991.  This is incorrect – these codes are inclusive and cannot be billed together.  If CMS makes the changes they are now considering, they will remain inclusive, but the reimbursement for 95991 may be increased to reflect the cost of the refill kit.

ASIPP apologizes for the misunderstanding.

Update on Correct Coding Initiative

CMS has released an update on the Correct Coding Initiative (CCI) in Interventional Pain Management effective April. 1, 2006 to June, 2006. There are no changes from January 2006 updates.

Click here for April, 2006 CCU updates.

Pain Physician Journal

Pain Physician, April 2006 is now available online at www.painphysicianjournal.com

Pain Physician Journal Now Accepting Article Submissions

The Pain Physician Journal, recently included and indexed on MEDLINE, is accepting manuscript submittals for publication consideration. Pain Physician is a peer-reviewed, multi-disciplinary journal written by and directed to an audience of interventional pain physicians, clinicians and basic scientists with an interest in interventional pain management and pain medicine.

Pain Physician is the official publication of the American Society of Interventional Pain Physicians (ASIPP). Pain Physician requires that all manuscripts be prepared in accordance with the uniform requirements for manuscripts submitted to biomedical journals, with the exception of reference citations and format. For information on manuscript submittals go to http://www.painphysicianjournal.com/infoforauth1.php Submit articles to: editor@painphysicianjournal.com

AIS Government News

A final rule published in the April 21 Federal Register, requires that providers and suppliers periodically update and certify the accuracy of their Medicare enrollment information to receive billing privileges. It also implements provisions to ensure that Medicare providers and suppliers are qualified to provide the appropriate health care services. "These statutory provisions include requirements meant to protect beneficiaries and the Medicare Trust Funds by preventing unqualified, fraudulent, or excluded providers and suppliers from providing items or services to Medicare beneficiaries or billing the Medicare program or its beneficiaries," CMS says. The rule will take effect on June 20, 2006.

See the rule at:

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/06-3722.pdf

New Form Cuts Part D Headaches

The AMA, in collaboration with Medicare drug plans and several physician and patient advocacy groups, has created a form that doctors can use to request coverage exceptions on behalf of their patients. This new master form is a one-page document that “standardizes and streamlines” the information doctors must provide before they can go outside the plan’s drug formulary or obtain prior authorization for a nonpreferred drug.

The form is being touted as a “major time-saver” for physicians who previously had to fill out multiple, lengthy request forms that differed from plan to plan.

Medicare Part D coverage determination request form (pdf): http://www.cms.hhs.gov/mlnproducts/downloads/form_exceptions_final.pdf

Check out more Medicare Part D resources from the Kaiser Family Foundation.

Registration Still Open for May 4-8 Review Courses & Exams

It is not too late to register for the Controlled Substance Management and Coding Compliance and Practice Management review courses and competency exams – a few spots are still available!

The review courses in and the certification exams in Controlled Substance Management and Coding Compliance and Practice Management will be held in beautiful downtown Chicago on May 4-9.  The four-day intensive review course (May 4-7) is planned as a CME activity to prepare physicians seeking competency certification and to provide Interventional Pain Management Specialists and other healthcare providers an in-depth review of multiple areas of interventional pain managements. The Competency Certification Exams will be held on May 8.

To view the May brochure or register online, click here…http://www.asipp.org/meetings.htm.  Register today for the review courses and exams and come to the “Windy City” in May! Register today!

Registrants can now access review material for the courses on our Web site at: www.asipp.org

Medicare Learning Network Announces New Provider Education Products

The Medicare Learning Network recently announced the availability of new provider education products. The electronic version of the Evaluation & Management Services Guide, which provides evaluation and management services information regarding medical record documentation; International Classification of Diseases, 9th Revision, Clinical Modification and American Medical Association Current Procedural Terminology Codes; and key elements of service is now available from the Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/eval_mgmt_serv_guide.pdf

Liability Insurance Rates Hold Steady

Good news for physicians! After many spikes in medical liability premiums in the past five years, some insurers in states with recent tort reforms are reporting no increases in premiums, and others are reporting actual reductions for physicians in 2006.

Medical malpractice insurance covers doctors and other professionals in the medical field for liability claims arising from their treatment of patients. The cost of medical malpractice insurance began to rise at the beginning of this decade, after a period of essentially flat prices. Rate increases were precipitated in part by the growing size of claims, particularly in urban areas. Among the other factors driving up prices was a reduced supply of available coverage as several major insurers exited the medical malpractice business because of the difficulty of making a profit.

New research suggests that premium increases may be moderating but for any turnaround to take root significant reforms in the delivery of medical care and in the liability system need to occur, industry observers say. Overall, insurers say the stabilization is due to the continued decline in the number of medical liability lawsuits filed. Also, after years of raising rates to keep up with massive claims, they have now adjusted premiums to an adequate level to manage litigation costs and jury awards. In addition, insurers partially credit tort reforms for the moderation, but say it is too early to tell whether the efforts have taken root.

While the rate trend is leveling off, physician’s premiums are still extremely high and high jury awards continue to plague the legal system. Many believe that more reforms are still needed and crucial to continue the trend of premium reductions.

Sources: AMA News and Insurance Information Institute

Oregon Wrongful Death Liability Cap Upheld: Could Still Be in Danger

Last month the Court of Appeals for the State of Oregon upheld the $500,000 award limit in wrongful death claims. But the AMA News reported judges made note that the limit could be a contradiction of a 1999 high court ruling that wiped out caps on pain and suffering damages in personal injury cases. The issue in question is whether wrongful death lawsuits should be lumped in with personal injury cases, which would cost these cases their award ceiling.

The Oregon Appeals Court “conundrum” over the Supreme Court precedent is tied to a technicality in Oregon law which did not recognize wrongful death actions at the time the state constitution was formed in 1857. To date, no deadline for the high court to decide the case has been set.

Or subscribers can read about the mandate at AMA News

State Society News

Louisiana Society

The Louisiana Society of Interventional Pain Physicians will hold its meeting on Thursday, April 27, 2006, at 6:30 pm, at Fleming’s Steakhouse in Baton Rouge. Laura Stuart with Pfizer will host our meeting. Noor Gajraj, MD, an anesthesiologist and pain management doctor from Baylor University will be the guest speaker.

California Society

California Society of Interventional Pain Physicians (CSIPP) will hold its Annual Meeting and board elections on Tuesday, May 16, 2006 at 6:30 p.m. at:

Morton's Steakhouse

South Coast Plaza Village

1641 W. Sunflower Ave.

Santa Ana, CA  92704

Guest speaker will be Carl Brakensiek, MBA, JD, Executive VP of the California Society of Industrial Medicine and Surgery. Brakensiek’s topic will be "Upcoming Changes in Workers' Compensation in California.” Workers’ Compensation continues to be volatile, with further legislative changes inevitable and pending. Mr. Brakensiek's expertise in this area is unequaled in the state and should prove to be enlightening

Please RSVP and send nominations to sheri@pcpmc.com

All CSIPP board positions are open.

If your state society has any news you would like to share, please e-mail your news items to mmartin@asipp.org