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January 30, 2012

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Trailblazer Part A/B Cross Claim Reviews

 

TOA President Omer A. Ilahi, MDBy Omer A. Ilahi, MD
President, Texas Orthopaedic Association

The TOA Executive Office has received questions from some of our members regarding Trailblazer Part A/B Cross Claim Reviews.  More specifically, Trailblazer is reviewing claims billed with MS-DRG 470 (major joint replacement or reattachment of lower extremity without major complication or comorbidities).  Our members are reporting the common denial reasons for these claims as missing documentation in admission orders - to needing more documentation from the physicians, or the clinical end.  TOA leadership is working with the Texas Medical Association and the American Association of Hip and Knee Surgeons to address this reimbursement issue.  Please let us know if you are experiencing MS-DRG 470 denials.

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Thank You To Our Sponsor: Acumed

 

EMR Implementation and Meaningful Use Luncheon Feb. 28, 2012
 

TOA logoFree Educational Seminar and Lunch (Earn CME)!

EMR Implementation and Meaningful Use

Penny Crow, RHIA, CEO of Operational Strategies

Tuesday, February  28, 11:30-1:00 p.m.
at Maggiano's in The Domain
10901 Domain Drive #100
Austin, TX 78758

You are cordially invited to join us for a FREE and FABULOUS lunch at Maggiano's Little Italy in The Domain.  Penny Crow, RHIA, was a speaker at the T-Bones (Texas Orthopedic Administrators Society) 2011 Annual Meeting and will give an informative presentation on dealing with the critical issues of EMR Implementation and Meaningful Use.

NOTE: Seating is limited so please register as soon as you can!
(Registration deadline is Tuesday, February 21).

Invitees: TOA Orthopedic Surgeons and Orthopedic Practice Administrators
When: Tuesday, February 28, 11:30 a.m. to 1:00 p.m.
(lunch with presentation)
Where: Maggiano's in The Domain, 10910 Domain Drive #100, Austin, TX 78758
RSVP: By Tuesday, February 21. 
Email: masa@toa.org or call 512-370-1505.

 

Many thanks to our premier sponsors:

ARA logo gloStream logo Greenway Medical logo
CRI CPA logo   Phoenix Ortho logo
simplifyMD logo Methodist Health System

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Thank You To Our Sponsor: Desert Radiology Solutions

 

Desert Radiology Solutions
Click on graphic or here to visit their website!

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EHR Incentive Payments Doubled in Last Three Months of 2011

 

TOA logoTotal payments to hospitals through the Medicare and Medicaid electronic health-record system incentive programs more than doubled from October through December to more than $1.9 billion, according to the CMS' latest monthly report on payment and registration support.

Combined payments to physicians and other so-called eligible professionals jumped 99% over the same period to nearly $570.4 million.

There were 176,049 active registrants in the programs by the end of December, up 27% since October, according to the CMS' data. Among them, 98% were eligible professionals; 2% were hospitals. About 75% of eligible professionals receiving payments—10,530 of them—are physicians, with nurse practitioners, dentists, certified nurse midwives and physician assistants accounting for the rest, according to the CMS.

To put those numbers in context, there are 565,024 office-based physicians in the U.S., according to the American Medical Association, and 5,754 hospitals, according to the American Hospital Association.

Final participation numbers for the two federal information technology incentive programs for their first year of operation won't be available until later this year, Dr. Farzad Mostashari, head of the Office of the National Coordinator for Health IT, said last week. Although the initial qualification period for hospitals ended with the federal fiscal year on Sept. 1, 2011, the qualification period for eligible professionals didn't end until Dec. 31, and they have 60 days beyond that to compile their data and submit applications for payment.

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Thank You To Our Sponsor: Greenway Medical

 

Greenway Medical Logo
Click on graphic or here to visit their website!
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eRX Penalty Revealed in Fine Print of Medicare Remittances
 

TOA logoPhysicians who wonder whether they received a hardship exemption from Medicare's 1% penalty in 2012 for failing to e-prescribe in 2011 will have to find out by reading the fine print on their payment remittance statements.

The Centers for Medicare and Medicaid Services (CMS) had intended to inform physicians and other prescribers whether they would be subject to the penalty through a feedback report that they could access online. However, on December 29, the agency announced that "due to the high volume of significant hardship exemption requests, it is no longer technically feasible for CMS to provide a...feedback report."

Instead, CMS encouraged prescribers to check their remittance statements for claims submitted for services rendered since January 1, 2012. If they were hit with the 1% penalty (a "payment adjustment" in CMS parlance), they would see the letters "LE" on the statement and 2 different codes. The first is Claim Adjustment Reason Code (CARC[I1]) 237, indicating a "legislated/regulatory penalty." The second is Remittance Advice Remark Code (RARC) N545, which explains that the provider was an "unsuccessful e-prescriber" in 2010 as defined by Medicare's e-prescribing incentive program.

If CMS penalizes a prescriber in error, it will reprocess the claims in question and return the 1% that was originally subtracted. One example of such an error that the agency cited is a penalized prescriber who requested a hardship exemption that is "ultimately approved." That statement suggests that as of December 29, CMS might not have ruled on all the exemption requests submitted before the deadline of November 1, 2011. As of press time, Medscape Medical News had not received an answer from CMS as to how many exemption requests it has received and when it expects to finish processing them.

First Carrots, Then Sticks

The 1% penalty is part of a carrot-and-stick approach taken by the government to persuade physicians to electronically transmit scripts from their computer to a pharmacy's computer. A 2008 law called the Medicare Improvements for Patients and Providers Act (MIPPA) authorized bonus payments for physicians who use approved e-prescribing software in the course of treating Medicare patients. The bonus in 2012 is 1% of fee-for-service (FFS) charges. It decreases to 0.5% in 2013 and vanishes in 2014.

MIPPA penalties for paper-bound prescribers, meanwhile, debuted in 2012 at 1% of FFS charges. The penalty increases to 1.5% in 2013 and 2% in 2014.

Physicians are automatically spared the penalty in 2012 - and the need for a hardship exemption - if they:

  • Reported at least 10 e-prescriptions via claims in the first half of 2011;

  • Reported that they lacked prescribing privileges on at least 1 eligible Medicare claim before June 30, 2011;

  • Were not a licensed physician, nurse practitioner, or physician assistant as of June 30, 2011;

  • Did not have at least 100 claims for patient visits involving 1 of the 56 required billing codes for the first 6 months of 2011; or

  • Did not generate at least 10% of their total allowed Medicare charges in the first half of 2011 through services associated with the 56 billing codes.

All other physicians had until November 1, 2011, to apply for 1 of 6 hardship exemptions, which included practicing in a rural area that lacks high-speed Internet access and having registered to participate in the government's program to reward "meaningful use" of electronic health records.

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Thank You To Our Sponsor: Methodist Bone and Joint Center

 

Methodist Bone & Joint
Click on graphic or here to visit their website!
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25 Sports Medicine Physicians Honoured in 2011

 

TOA logoJames Andrews, MD, founder of Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Fla., was named the 2010-2011 Southeastern Conference Team Physician of the Year by the Southern Orthopaedic Association SEC Program. He served as the medical director for intercollegiate sports at Auburn University.

American Orthopaedic Society for Sports Medicine honored John Bergfeld, MD, senior orthopedic surgeon and director of operating rooms at Cleveland Clinic, with the Thomas A. Brady Community Service Award.

Baylor Regional Medical Center in Plano, Texas, named Robert Berry, DO, medical director of sports medicine.

Charles Bush-Joseph, MD
, sports medicine physician at Midwest Orthopaedics at Rush in Chicago and team physician for the Chicago White Sox, was elected 2012 president of the Major League Baseball Team Physician Association.

Cleveland Clinic named A.J. Cianflocco, MD, director of primary care sports medicine at the Cleveland Clinic Center for Sports Health. He is currently the director of the Primary Care Sports Medicine Fellowship Program and team physician for the Cleveland Cavaliers.

Texas Tech Athletics recently named Kevin Crawford, MD, as medical director and orthopedic physician. He previously served as team physician for the U.S. Ski and Snowboard team.

Mercy Foundation North named Riico Dotson, MD, a general orthopedic surgeon and director of sports medicine at St. Elizabeth Hospital in Red Bluff, Calif., to its board of trustees.

John C. Elfar, MD, an orthopedic surgeon at the University of Rochester (N.Y.) Medical Center, was awarded the North American Traveling Fellowship by the American Orthopaedic Association.

Chairman of the orthopedic surgery department at the University of Pittsburgh Medical Center School and UPMC Freddie Fu, MD, was given the Sports Leadership Award at the 76th Dapper Dan Dinner & Sports Auction.

In 2011, Dr. Fu also hosted the first Buffalo Bills Sports Medicine Symposium Series, where he discussed advancements in ACL reconstruction in a lecture for orthopedists and medical professionals.

Charles Gatt, MD
, was appointed program director of the Rutgers-Cleveland Clinic Consortium of the Armed Forces Institute of Regenerative Medicine. He and co-investigator Michael Dunn, MD, pioneered the creation of a weight bearing scaffold that facilitates the body's repair of meniscus tears.

Peter Indelicato, MD
, an orthopedic surgeon with NeuroSpine Institute in Orlando, Fla., was named the 40th president of the American Orthopaedic Society for Sports Medicine during the organization's annual meeting earlier this year.

The U.S. Olympic Committee selected Hamish Kerr, MD, a sports medicine specialist at Albany (N.Y.) Medical Center, to serve as a team physician for the U.S. Rugby team at the 2011 Pan American Games in Guadalajara, Mexico.

Richard Lehman, MD, who was team physician for the St. Louis Blues and Tampa Bay Lightening during his career, was inducted into the Missouri Sports Hall of Fame.

T. Scott Maughon, MD
, an orthopedic surgeon with Sports Medicine and Orthopaedic Institute of Gwinnett in Duluth, Ga., was selected as the healthcare provider for the Atlanta Professional Golf Association 2011 tournament.

Green Bay Packers team physician Patrick McKenzie, MD, received the Jerry "Hawk" Rhea Award for NFL physician for the year from the Professional Football Athletic Trainers Society.

Director of sports medicine at Children's Hospital Boston Lyle J. Micheli, MD, received the 2011 Robert E. Leach Mr. Sports Medicine award during the American Orthopaedic Society for Sports Medicine annual meeting earlier this year.

The American Shoulder and Elbow Surgeons named Peter Millett, MD, a sports medicine physician at The Steadman Clinic in Vail, Colo., as chair for the American Shoulder and Elbow Surgeons Open Program for their 2013 meeting.

The Greater Regional Medical Center in Creston, Iowa, named sports medicine physician Damian Mizera, MD, as the leader of its orthopedics practice, which is scheduled to open this spring.

Marc Philippon, MD
, a hip surgeon and sports medicine specialist at The Steadman Clinic in Vail, Colo., was named among the most influential Canadians in baseball by the Toronto Sun.

U.S. Ski and Snowboard Team Foundation also named Dr. Philippon to its board of trustees in 2011.

The University of Alabama College of Community Health Sciences appointed James Robinson, MD, as the first endowed chair of sports medicine for family physicians.

Cleveland Clinic named head team physician for the Cleveland Indians and Cleveland Browns Mark Schickendantz, MD, director of the Center for Sports Health.

David Schmidt, MD, team physician for the San Antonio Spurs and president of Sports Medicine Associates of San Antonio, was selected as chairman of the 2011 Valero Alamo Bowl after serving on its board of directors since 1993.


Clarence L. Shields, MD
, a clinical associate professor at the University of Southern California, was inducted into the American Orthopaedic Society for Sports Medicine Hall of Fame at the organization's annual meeting earlier this year. He is a past president and previously earned the Mr. Sports Medicine award.

The Orthopaedic Foundation for Active Lifestyles awarded Russell Warren, MD, an orthopedic surgeon and former surgeon-in-chief at Hospital for Special Surgery, with the Excellence in Sports Medicine award. He served as team physician for the New York Giants for 20 years.

Resurgens Orthopaedics co-president Steven B. Wertheim, MD, who previously served as team physician for the Philadelphia Flyers and Olympic Games, was named an Atlanta Healthcare Leader for 2011 by Business Leader magazine.

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