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February 18, 2008 |
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IN THIS ISSUE
WCMSSM Mourns Sophie Womack, MD, Leader, Pioneer
'To
whom much is given, much is required'
'A Loss For All
Of Us'
Editor's Column: We Have
Met The Enemy...And He Isn't Us
NPI Update: Can Your Practice Survive Without Payments?
African-American Health Issues Discussion, Feb.
23 |
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WCMSSM Mourns Sophie Womack, MD, Leader, Pioneer
It is with the
greatest regret and deepest sadness that I must advise you of the
death Feb. 17 of our beloved President, Sophie Womack. We have lost
a tremendous leader who had much more to give to her community, the
city and the medical society here in SE Michigan as well as at the
state level. Just nine months ago we celebrated her inauguration as
our President. Later this week, we will remember her all too brief
life; but yet one filled with enormous accomplishments and, yes, one
that had yet so much promise. Our condolences to her family; our
thoughts will be with them.
WCMSSM offices
will be closed Friday, Feb. 22, the day of Dr. Womack’s funeral, in
consideration of her family, friends and colleagues.
Funeral
arrangements are as follows: 2-9 p.m. Wednesday at Swanson's Funeral
Home, 14751 McNichols, Detroit; 12-8 p.m. Thursday at Plymouth
United Church of Christ, 600 E. Warren, Detroit and 10 a.m. family
hour with funeral at 11 a.m. Friday at Plymouth United Church of
Christ.
In lieu of
flowers, the family suggests contributions be made to The Coalition
Incorporated, 2310 W. McNichols, Detroit 48221.
Below are links to memorials
celebrating Dr. Womack's life, career and service to the community
printed in the Detroit Free Press and Detroit News this morning.
-Adam Jablonowski
WCMSSM Executive Director
http://www.freep.com/apps/pbcs.dll/article?AID=/20080217/NEWS08/80217037
http://www.detnews.com/apps/pbcs.dll/article?AID=/20080218/OBITUARIES/802180371
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'To whom much is given, much is
required'
The following is a statement from Dr. Jimmy Womack.
I am, of course, grieved at the sudden loss of my wife Dr. Sophie
Womack. However, as we come to grips with this sudden tragedy, my
family and I are grateful for the outpouring of support of the
community.
Sophie and I were partners in every sense of the word. As a
husband, I was blessed for 25 years to have a helpmate that shared
identical value and visions for family, church and community. As a
woman of God, Sophie embodied the biblical adage of: To whom much is
given, much is required. (Luke 12:18)
Sophie was a special person who always extended herself not only
to our daughters, Brandi and Ashley, and me but also to her family,
profession and the community that she loved. Her legacy is one that
any person could revere and emulate.
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'A Loss For All Of Us'
It is with deep regret and sadness that I inform you about the
passing of our colleague, fellow MSMS Board member, and WCMS
president Sophie J. Womack, MD. She died early Sunday morning while
recovering from surgery on Friday.
Doctor Womack was a exceptional leader for her profession, her
community, her patients, her family and friends. Doctor Womack's
experience and knowledge were invaluable to our organization at both
the state and county levels. We will miss her wisdom, her straight
talk, and her smile.
She is survived by her husband, James (Jimmy) Womack, MD, and
daughters Brandi and Ashley. Our thoughts and prayers go out to the
family.
Cards may be sent to the family at 2310 W. McNichols, Detroit,
MI, 48221.
-Gregory Forzley, MD
Chair, MSMS Board of Directors
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Editor's Column: We Have Met The Enemy...And He
Isn't Us
By JOSEPH
WEISS, MD
The enemy: the health insurance companies and their subordinates,
the pharmacy benefits managers. Their crime: prior authorization. No
medicine appears exempt. In my field of rheumatology, their demands
for prior authorization run from Enbrel to Salsalate.
The prior
authorization assault is twofold: (1) the uncompensated time that we
and our office staffs spend responding to the demands prior
authorization brings. That time includes phone time with the
benefits representatives and the time spent responding to the
distress of a patient denied therapy. (2) The theft of our rights
and responsibilities by the pharmacy benefit managers. Today, we can
only recommend treatment, they determine therapy.
Prior
authorization is increasing, applying to more medications and now
asserting itself for renewals. Worse, at least in my field, the
medications that benefit managers mandate I use are outmoded and
inappropriate. No one today would treat a patient diagnosed as
psoriatic with methotrexate. The anti-TNF drugs are the drugs of
choice. But according to the benefits manager, I must no only give a
trial of methotrexate, but must try Azulifidine, Plaquenil and Arava
before even thinking of requesting Embrel, Remicade or Humira. Some
benefit! Some manager!
The Wall Street
Journal reports that for 2007, Caremark will report revenue of $76
billion, Medco $44 billion and Express Scripts will come in with
nearly $19 billion. Despite this revenue, they operate shorthanded:
letting us wait half an hour on the phone and up to 45 days by
e-mail. The employee cost becomes ours, not theirs.
However, we may
not be crushed under the burden of prior authorization. Help is
coming from an unlikely place: Wal-Mart. Already, thanks to
Wal-Mart, a patient of mine who had my prescription for Salsalate
rejected outright by pharmacy benefits, can purchase Salsalate for
$4/month at Wal-Mart. I suspect the small profit margin weighs
heavily in the benefits manager’s decision to wave off even
considering the drug.
The word in
business circles is that Wal-Mart plans to expand its $4/month
generics. We should watch what Wal-Mart does and support its
efforts. We can make resolutions, call on the AMA, and ask Congress
to intervene. But nothing will move big business to change its ways
like an even bigger business challenging its turf.
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NPI Update: Can Your Practice Survive Without
Payments?
It is crunch
time for obtaining, reporting and testing your National Provider
Identifier (NPI)! Several payers have recently expressed their
concerns about physicians and other health care providers not
reporting NPIs to them. Statistics show that most physicians have
obtained an NPI, but have not reported that number to the payers.
Getting an NPI isn't good enough – it must be reported to payers,
clearinghouses, vendors, pharmacies, hospitals, nursing facilities,
physicians you refer patients to, labs, diagnostic centers, etc.
Whether or not
physicians can meet the deadlines below, action must be taken now to
ensure that any possible disruption in health plan payments is kept
to a minimum.
Critical Dates
Blue Cross
Blue Shield of Michigan (BCBSM):
BCBSM set a
Feb. 15, 2008, deadline for professional and facility providers to
register their NPI with the Blues.
Professional
providers will need to register their NPIs with Provider Enrollment
and Data Management. Facility Providers must register their NPIs
with Provider Contracting. Electronic claim submitters must also
register their NPIs with the Electronic Data Interchange department
(EDI).
Failure to
have reported your NPIs to BCBSM by Feb. 15, 2008, will affect
BCBSM's ability to process your claims after May 23, 2008.
Also effective
Feb. 15, 2008, all providers must submit electronic and paper claims
with both their NPIs and BCBSM provider IDs (PINs).
This applies
to all BCBSM claims, except Medicare Advantage, for the rest of the
contingency period, until BCBSM informs you that they are ready to
accept claims with only the NPI before the contingency period ends.
Medicare:
As of March 1,
2008, claims with both an NPI and Medicare legacy number will
continue to be rejected if the pair is not found on the Medicare NPI
Crosswalk. Claims without an NPI in the primary provider field will
be rejected. Claims with only a Medicare legacy number in the
primary provider field will be rejected.
This means
that you will not be able to get paid for any Medicare services you
provide until you begin using your NPI. Also, if needed, you must
correct any data that may be preventing an NPI/legacy match on the
NPI crosswalk. The correction might require that you file a CMS-855
Medicare Provider Enrollment form with your Medicare carrier, A/B
MAC, or DME MAC – a process that can take a number of months to
accomplish.
Test NPI-only
NOW! If you have been submitting claims with both an NPI and a
Medicare legacy number and those claims have been paid, you need to
test your ability to get paid using only your NPI by submitting one
or two claims today with just the NPI. If the Medicare NPI Crosswalk
cannot match your NPI to you Medicare legacy number, the claim with
an NPI-only will reject. You can and should do this test now! If
the claim is processed and you are paid, continue to increase the
volume of claims sent with only your NPI. If the claims reject, call
your Medicare carrier or A/B MAC enrollment staff for advice right
away. The enrollment number is likely to be quite busy after the
March 1, 2008, deadline, so don't wait.
In keeping
with the contingency guidance issued on April 2, 2007, CMS will lift
its NPI contingency plan, effective May 23, 2008, meaning that only
the NPI will be accepted and sent on all HIPAA electronic
transactions, paper claims and SPR remittance advice.
Did you
know...
-
Retired
physicians may need an NPI?
-
If a
retired physician is still referring, ordering or prescribing,
he/she must obtain an NPI
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Clearinghouses you transmit through need your NPI?
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It is not
just the payers who need your NPI. Be aware of other business
associates
-
Your NPI
needs to be tested to be sure it has an appropriate crosswalk?
There is no
intelligence built into the NPI. Payers create a crosswalk to your
legacy number, which holds all the intelligence they need in order
to direct payment appropriately
If you are not
sure what an NPI is and how you can get it, share it and use it, you
can find information and education on the NPI through the CMS NPI
page at
www.cms.hhs.gov/NationalProvIdentStand
(http://www.cms.hhs.gov/NationalProvIdentStand)
on the CMS website.
Providers can
apply for an NPI online at
https://nppes.cms.hhs.gov
(https://nppes.cms.hhs.gov)
or by calling the NPI enumerator to request a paper application at
1-800-465-3203.
For more
information about reimbursement issues, contact Stacie Saylor, CPC,
at MSMS at 517-336-5722 or ssaylor@msms.org. Get additional news
and information from MSMS publications, such as Medigram, Michigan
Medicine and the Monthly Top 10, online at
www.msms.org
(http://www.msms.org)
.
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African-American Health Issues Discussion, Feb. 23
Congressional
action is needed to preserve seniors’ access to physicians. Current
Medicare physician payment rates are scheduled to be cut 10.6
percent on July 1, 2008, and an additional 5 percent on Jan. 1,
2009. Legislation must be passed to replace the cuts with payment
updates that cover practice cost increases.
Senior
citizens and people with disabilities who rely on the Medicare
program for their health care needs are counting on Congress to act
in time to prevent a crisis:
§
In an AMA survey of almost 9,000 physicians, more than half said
they could not meet their current payroll with a 10 percent Medicare
pay cut and would be forced to reduce their staff.
§
Even more – 60 percent – said they would have to limit the number of
new Medicare patients they treat if the pay cuts are not stopped.
§
The Medicare Payment Advisory Commission reports that 30 percent of
Medicare patients looking for a new primary care physician already
have trouble finding one.
Two-thirds of physicians say the steep cuts will also prevent them
from investing in health information technology that can be used to
improve the quality of care.
Today’s
Medicare physician payment rates (before the July 2008 cut)
are on average the same as in 2001, while practice costs have risen
20 percent since then. The widening gap between payment rates and
the cost of care will make it extremely difficult for physicians to
stay involved with the Medicare program … just as millions of baby
boomers are about to become eligible for Medicare.
Congress has
promised America’s current and future seniors health care benefits
through Medicare. Lawmakers must keep their promises by acting soon
to enact legislation that will:
-
stop the
pay cuts for 18 months;
-
extend the
positive 2008 update through the rest of the year;
-
provide a
positive 2009 update that covers the increase in the cost of
care, and;
-
begin to
pave the way for permanent replacement of the physician update
formula.
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