June 2012

President's Letter

by Brett Vandenberg, CMPE

Hi Everyone,

Change must be in the air.  As I begin my Presidency amidst all of the changes in healthcare (BTW I am honored to begin serving as your President!),  I must also announce that we must fill the big shoes of Jan Larsen, our Executive Director, who after 14+ years with our organization has decided to ride off into the sunset (aka retirement). We cannot thank Jan enough for all the work she has done over the years! 

The Board was made aware of this in early April and established a task force to do due diligence in reviewing the candidates with resumes, references, and interviews. The task force members were Tom Hutchinson, Willa Nizolek, Kris Linden, Cyndy Jackson and myself.  I am pleased to announce that the task force completed its work and we selected Kyle Vixie to continue Jan’s work as our Executive Director.  Kyle was unanimously chosen by the task force for his professionalism, strong work-ethic, and sponsorship understanding among other things.  A little more about Kyle, he attended the University of Washington for his Bachelor’s Degree and has a Master’s Degree in Public Administration from Seattle University.  Prior to being hired by us he had done some consulting and was formerly with the Downtown Seattle Association where he helped build sponsorships for numerous neighborhood events among his many other tasks.  Kyle started with us on May 14th working closely with Jan to begin the process of transition and change. 

I would personally like to thank in no particular order Tom, Willa, Kris, and Cyndy for their participation in the process and being willing to take the extra time to interview the candidates and provide their feedback. 

In addition to Kyle beginning in May, we also held our Joint Annual Conference with Oregon in Portland.  It was very well attended by our membership and included 120 exhibitors plus our nationally recognized general session speakers Keith Ferrazzi, Lee Woodruff, Dr. Bill Crounse, and Jaime Orlikoff.  On top of these wonderful speakers we also were blessed to have Lee Ann Webster, Frank Cohen, and many other tremendous breakout session and preconference speakers to further our knowledge.  A special thanks to our Platinum Sponsors of the event Greenway Medical Technologies, Physicians Insurance, Legacy Health, and Sterling Bank.  I hope that everyone who attended enjoyed their time in Portland and I encourage all of you to try to attend our Joint Conference next April in Tacoma.  I am sure we will continue the success of this conference!

Again we welcome Kyle and thank you to everyone for their support of our association in the ever changing healthcare environment!

Yours in Health,

Brett Vandenberg, CMPE

New to Tips, Tricks and Tools

Locums Agreement
NP or PA-C Employment Agreement
Obtaining, uploading and utilizing your contracted fee schedule
Employee Handbook (template)
Work Behavior Standards Policy (Code of Conduct)
Work Behavior Standards Acknowledgement Form

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Welcome New Members

Michael S. Reyes, Clinic Manager – Cascade Orthopaedics, Auburn
Angela Joy Lohman, Clinic Manager - Tri State Memorial Hospital, Clarkston
Dawn Hillis, Administrator - Puget Sound Ear Nose & Throat/Proliance Surgeons, Inc., Edmonds
Karly Port, Office Manager - Palouse Pediatrics, Pullman
Lori Michelle Gutierrez, Support Staff Supervisor - Physician’s Immediate Care & Medical Center, Richland
Tammy De Jong, MS, PHR, Human Resources Manager – Allergy, Asthma & Dermatology Associates, Vancouver
Tim Franks, Clinic Manager – Yakima Heart Center

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New WSMGMA Directors and Officers for 2012-2013

Please welcome our 2012-2013 slate of officers and trustees, as elected at the WSMGMA Annual Business Meeting on May 31.

Brett Vandenberg CMPE, of Pediatric Associates in Bellevue takes over as President. Our President Elect is Willa Nizolek BSN MBA FACMPE, The Polyclinic, Seattle and Vice President is Lisa Barry, (transitional member) of Bellevue.  Rounding out the officer slate are: Secretary Thomas Hutchinson Jr. MSPH, FACMPE, (Transitional) of Longview, Treasurer Kris Linden, OB/GYN Associates of Spokane, and Past President Tricia West MBA CMPE, Washington Urology of Bellevue. 

Newly elected trustees-at-large are:  James D. Hudson MPH MHA FACMPE, Women’s & Family Health Specialists, Renton – elected to a 3 year term,  and Siska Treacy CMPE, The Everett Clinic – elected to a two year term to fill the vacancy left by Tom Hutchinson who moved into the secretary seat.

Continuing to serve terms as trustees-at-large are Pete Lolos FACMPE, Wenatchee Valley Medical Center, Sarah Doxey CMPE, Spokane Eye Clinic, Timothy Lewis MHSA, Physicians Immediate Care & Medical Centers, Richland, and Glenda Smith, Evergreen Orthopedic Center, Kirkland.

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Proposed Dues Structure Change for IDS Groups

In our effort to address the growing number of members and their practices shifting to integrated delivery systems (IDS), a marketing plan was drafted by our IDS committee, which included a proposed 10% discount to all practices with more than 20 providers and at least 2 or more WSMGMA members.

The 10% discount to our over 20 + provider groups was not approved at our annual business meeting in Portland.  The WSMGMA board will continue to evaluate the best value for our membership as we continue with our IDS marketing plan.

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New Seattle Sick Leave Ordinance Begins September 1

by Sheryl Willert, Williams Kastner, (206) 628-2480 swillert@williamskastner.com

On September 1, 2012, Seattle will join the ranks of the three other cities in the country that require employers with five or more employees to provide paid sick and safe leave to their employees. 

Which Employers Will be Impacted by this Ordinance?  This ordinance will not only impact employers whose primary place of business is in the City of Seattle, it will also impact employers who have employees who work at least 240 hours within the city of Seattle.  Work will be defined as performing any function other than simply passing through the city.  The definition of workplace is equally broad and may include telecommuting.  However, the ordinance will not apply to employees who are on work study.

To reduce the burden on employers, the ordinance establishes different tiers of benefit accrual.  Tier 1 employers have between  5 and 49 employees, Tier 2 employers have between 50 and 249 employees and  Tier 3 employers have at least 250 employees.  A determination of the tier in which an employer falls will be based upon the average number of full-time equivalent employees paid per calendar week during the preceding calendar year.  In order to arrive at this number, an employer must consider all  compensated hours of all employees (including  full time, part time and hours worked for the employer by temporary workers regardless of the source of those temporary employees).  In arriving at their tier, employers must consider hours regardless of whether the hours were worked inside or outside Seattle.  Once an employer has determined the tier in which it falls, the employer will know how many hours of paid leave it must provide.

Special Considerations Regarding Employers:  New employers are provided a grace period under the ordinance and are not required to comply with the provisions of the law until 24 months after they hire their first employee. 

The definition of an employer may also be more expansive than one might think.  An employer could include more than one business entity and may be treated differently depending on whether the entity is considered an integrated enterprise.  If multiple businesses are considered an integrated enterprise, they would be treated as a single employer.  However, if they are not an integrated enterprise, each business will be required to provide benefits under the ordinance.

How Much Leave Will Employees be Entitled to Under this Ordinance?  The amount of sick and safe time leave will depend upon the tier in which the employer falls.  Tier 1 and Tier 2 employers must provide at least one hour of leave for every 40 hours worked.  However, the cap on the accrual is different for the two tiers: Tier 1 maxes out at 40 hours of accrual while Tier 2 maxes out at 56 hours.   Accrual for Tier 3 employers is different in that Tier 3 employers provide 1 hour of leave for every 30 hours worked with a maximum accrual of 72 hours.  If employees do not use the accrued time, the ordinance requires that an employee be permitted to carry the time over into the next year at the rate of maximum accrual for each tier. Employers are not, however, required to pay for accrued hours if an employee leaves. However, if the employee leaves and is reinstated within seven (7) months, the employee’s unused leave must be reinstated.

For What Types of Things can this Leave be Used? 

Sick Time:  Employees may use the leave for their own medical issues or to facilitate preventive care or to care for a family member with a mental or physical injury who needs diagnosis, care or treatment.  In order to secure this leave, an employee need only request the leave in a manner that is consistent with the employer’s usual and customary procedures relating to sick leave.  If an employee is absent for any portion of  three (3) or more consecutive days, an employer may require signed  medical certification from a health care provider that the leave is necessary. An employer may not require that the health care provider explain the nature of the medical condition.  If an employer does not provide health care insurance for their employees but wishes to require a medical certification for absences of 3 or more days, the employer must pay half (1/2) of any out of pocket expenses incurred by the employee in obtaining the medical certification.

Safe Time:  Employees may also use the leave to attend to issues related to sexual assault, domestic violence and stalking, including time to receive treatment, time to avail themselves of other necessary services and time to participate in legal proceedings related to these things.  The purpose of permitting leave for these activities is to enable the employee to maintain financial independence, achieve safety and minimize both physical and emotional injuries arising out of the domestic violence, sexual assault or stalking.

Employees may also use safe time leave to assist immediate family members, domestic partners, individuals with whom the employee has a child in common, individuals with whom the employee has either a biological or legal parent child relationship and/or individuals to whom the employee is or has been married or, if the employee is over the age of 16, someone with whom the employee has had a romantic relationship as defined by Washington law.

Safe time leave is also available to employees in the event of a public official determining  that either his/her place of business and/or their child’s school should close to limit exposure to infectious agents, hazardous materials or biological toxins.

Impact of Ordinance on Universal Leave Programs:  If an employer has a combined sick and vacation leave policy, the policy must permit use for those things which are covered in the ordinance.  Additionally, some larger employers who have integrated leave programs (combined vacation and sick leave –PTO) will be required to increase the amount of sick leave and vacation if the base amount of leave is inadequate to accommodate the maximum hours of leave required by the law. Specifically, employers with combined leave programs will be required to provide at least 108 hours of leave and permit up to 108 hours to be carried over.  Therefore, this ordinance may require the amendment of policies which are currently use it or lose policies.  If the employer permits the employee to use vacation time to cover leave permitted under the ordinance, then they will not be deemed to have a universal or combined plan. 

Employers who are deemed to have a combined policy may not require employees to disclose whether they are using PTO for purposes permitted under the ordinance.  However, if the permitted universal leave is adequate to cover that required by the law,  and an employee exhausts his/her PTO, then the  employer will not be required to provide additional leave.

How Will Pay be Calculated?  Compensation for non-exempt employees will depend upon when the leave is taken.  If the leave is taken when the employee is  scheduled to work straight time hours, then the straight time rate will apply.  If leave is taken during a time when the employee is entitled to overtime and/or a premium rate, then the overtime or premium rate will apply.  Employees are not entitled to lost tips or commissions during use of paid sick/safe leave.

Pay for exempt employees will be determined by dividing the employee’s annual salary by 52 weeks to arrive at a weekly salary.  Once the weekly salary is determined, then the weekly salary is divided by the actual hours regularly worked in a week not to exceed 40 hours.  What Happens if an Employer Suspects Abuse?  Although the ordinance clearly prohibits any form of retaliation for use of leave pursuant to the ordinance, abuse is not sanctioned by the ordinance.  Consequently, the regulations permit a requirement for documentation, and presumably discipline for failure to adequately respond, if there is a pattern or clear evidence of abuse.  The regulations define abuse as repeated absences, repeated instances of absences which precede or follow regular days off or some other pattern which might be indicia of abuse.

Conclusion: Though complicated, careful review and planning can help every impacted employer navigate the new leave grid without too much difficulty.

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Negotiating Your Lease to Lower Operating Expenses

By Brian Dougherty and Richard Muhlebach, Commercial Brokers and WSMGMA Partners

In this era of increased bottom-line pressure, every effort should be made to address the various components to profitability, especially significant individual expense line items. This would certainly include rent and other occupancy expenses.  Typically, the only opportunity a medical practice has to lower its rent and other lease/occupancy charges is when renewing its lease, leasing new space or renegotiating existing lease terms.  This article provides eight insider tips on how to negotiate the best “deal” and lease terms. 

1. There is no standard lease form.  Many lease provisions are negotiable.  Do not hesitate to negotiate to modify, eliminate or add lease provisions which are important to the practice.

2. To negotiate the best rental/occupancy terms, you must know specific market conditions, i.e. vacancies and market dynamics and nuances. These conditions will influence rental rates, tenant improvement allowances and free rent.  Currently, many markets are considered ‘tenant’s markets’, and landlords may be more willing to accept overall lower compensation than in previous years

3. Rents are negotiable.  There are sources to find competitive rental rates in the market. You can ask other medical group managers their rental charges or ask a commercial broker who specializes in leasing medical office buildings or represents medical practices.

4.  You may attempt to negotiate a cap, usually five percent, on annual CPI (consumer price index) rental adjustments. Also, attempt to negotiate the CPI adjustments every three years. This provision is especially beneficial in an environment of higher inflation.

5. Always ask for a concession of free rent, i.e., one to six months depending on the lease terms being discussed.

6. The Common Area Maintenance (CAM) or building operating charges can represent a significant portion of your total rental/occupancy charge. These charges are often at least 30% of your total rental payment. Carefully check the lease language to know what the landlord is including for operating charges as well as capital improvements to the building. Some landlords are very aggressive in interpreting industry standards as to what operating expenses are charged to tenants. Be sure there are provisions in the lease to allow for an audit of the annual charges and a method to resolve rental charge disputes.

7.  When negotiating your lease, be sure to address three critical option provisions.
     a. Option to renew upon lease expiration.  Most landlords are willing to provide an extension option
         equal to the length of the initial lease term .   
     b. Right to expand. Ask for a First Right of Refusal for upcoming available space in the building,
         particularly adjacent space.
     c. Purchase the building, if the landlord offers the building for sale.
Options do not need to be exercised, but certainly provide you valuable, future rights.

8.  In today’s uncertain health care market, there are additional lease provisions that are advisable to negotiate.  These include a right to cancel the lease, exclusive right to offer a service, assignment and subletting rights as well as a non-disturbance provision which provides protection if the building is foreclosed.

When considering a lease situation, if you do not negotiate for concessions or changes which will be critical to maximum flexibility of the practice during the lease term, you very well may not get them. This could be detrimental to the future ability to maximize options and the direction of the practice.

You can attempt to negotiate your lease yourself, which should, of course, involve an attorney reviewing any final documents. Another option is to hire an attorney to handle the entire process. And yet another option would be to use the services of a commercial real estate broker who specializes in
representing medical practices in the leasing process and, if needed, to develop a strategy for your long term real estate/space needs. 

How your lease is negotiated will impact a practice’s rental charges and its bottom line for several years until the lease expires.

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6 Ways to Improve Your Practice’s Operations

MGMA Blog: Written by Madeline Hyden, MGMA-ACMPE web content writer/editor

When managing patient flow, dealing with staff issues and figuring out how to get paid, every minute counts. By making a few small changes in your day-to-day operations, you can free up provider time, streamline your front office processes and create an opportunity to chip away at your own to-do list.

Know your cancellation rate
Do you have more cancellations on Fridays or more no-shows around lunch time? If you can determine when cancellations, no-shows or last-minute rescheduling happens most frequently during the week, you can double book or overlap appointments, eliminating open space in the schedule.

Consider daily huddles
Before patients arrive, gather your administrative and clinical staffs together to review the day’s schedule. This is an opportunity for staff to give share details about patients that may affect other staff members’ time. For example, if a patient mentions on the phone that she's bringing a list of questions, the front office staff employee who took the call will be able to communicate that to the clinical staff in the morning huddle so that they can manage their time appropriately.

Rethink your open-door policy
As an administrator, you wear many hats. This also means your staff comes to you for help and answers on just about anything. Unless it’s an emergency, encourage them to save questions and discussions for daily huddles or weekly meetings. A quick question can turn into an hour-long discussion, which, over the course of a week, can take up a lot of your work day.

Learn providers’ scheduling preferences
Some providers may prefer a heavy schedule at the beginning of the day, while others may want a steady stream of back-to-back patients all day. Train your front office staff to schedule accordingly so providers don’t get over or underwhelmed by a schedule that doesn’t fit their needs.

Substitute nonphysician providers (NPPs) if appropriate
Train front office staff to get as many details as possible from patients' about why they're booking an appointment. When appropriate, NPPs may be able to handle appointments and free up physicians to treat more time-consuming, complicated patient cases, potentially generating more revenue for the practice.

Establish clear expectations for staff
Clear expectations reduce duplications and confusion and ultimately save time. This is true whether you're dealing with expectations in employee performance plans or the expectations of day-to-day tasks.

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New Physicians in Your Practice? Encourage Them to Join the WSMA

If new physicians have come on board at your practice in recent months, please urge them to join the WSMA. As a practice manager, you know the pressures medicine is facing.  Medical practice involvement at the state level – with direct input from physicians and practice managers -- is essential to influencing medical issues that affect our businesses, profession, patients and communities. The WSMA fights the battles that will impact the practice of medicine. With close to 10,000 physicians and physician assistant members, the WSMA remains the largest physician organization in our state – one that policy makers and representatives have listened to for more than 130 years.

Membership makes this work possible.  Please share this link with the physicians in your practice today.  http://www.wsma.org/about_wsma/whatwedo. They can also join by calling our Seattle office at 1.800.552.0612 (206.441.9762).

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Payment for Quality Moves Ahead

Contributed by the WSMA

Last week, Premera Blue Cross announced expansion of its Global Outcomes Contracting model, another incremental move away from classic fee for service reimbursement. The health plan announced it is working with 12 major physician groups and an independent practice association on the project. About 100,000 Premera members are treated by the participants. The groups are being rewarded annually based on a combination of the cost savings they demonstrate and the quality of care they provide to their patients.

Two medical groups that have been in this sort of arrangement with the Plan preceding the announcement last week – The Everett Clinic and The Polyclinic – have produced total health care cost trends last year for Premera patients at the clinics about 3-5 percent below the average of other Premera patients in the same region who have a regular physician, after accounting for differences in health status.

Many traditional models for changing the inefficient fee-for-service system focus only on specific cost measures. Premera’s new payment model takes it a step further by examining the total cost of the patient and also incorporating an important quality component. This ensures that costs are contained without a reduction in the quality of care for patients. In addition, the physician groups participating in this initiative are implementing new strategies to improve quality and control healthcare costs.

One of the problems we have seen with reengineering care delivery is lack of financial wherewithal to help practices make the investments to fund necessary changes. This arrangement could help bridge that gap.

Additional groups participating in Premera’s new payment model include The Polyclinic, The Everett Clinic, Family Care Network (Bellingham), Franciscan Medical Group, Northwest Physicians Network (south Sound), Pacific Medical Center, Pediatric Associates (east of Lake Washington), Puget Sound Family Physicians (south Snohomish County), Rockwood Clinic (Spokane) and the Wenatchee Valley Medical Center.

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15-Working Days Left – E-Prescribing Penalty

by Tricia West,  MBA, CMPE, CCP-P; WSMGMA Past President

The penalty for NOT participating in the Medicare e-prescribing program or NOT applying for an exemption on time is a 1.5% reduction in payment for all Medicare claims based on the 2013 fee schedule amounts during the year. 

If you are a physician (MD,DO), a podiatrist, or an eligible professional (nurse practitioner, physician assistant), and you have already taking one the actions below, the 2013 e-prescribing penalty will NOT apply:

• You e-prescribed using a qualifying e-prescribing system or certified electronic health record (EHR) and submitted 10 or more e-prescribing codes (G8553) on your Medicare Part B claim forms from January 1, 2012 to June 30, 2012, and the claims were received and processed by CMS by no later than July 31, 2012.

• You do not have prescribing privileges and you reported the G-code, G8644, at least one time on a Medicare Part B claim prior to June 30, 2012.

NOTE:  For those of us who reported e-prescribing through meaningful use for 2011, and were forced to apply for an exemption by November 8, 2011 in order to avoid 2012 penalties, I do not see or read anything above which allows the exemption from last year to carry forward to this year – only if you reported claims based even if redundantly with meaningful use reporting.  Also, I do not see – at least as of yet, any exemptions for reporting through meaningful use in 2012, to avoid the 2013 penalty.  Therefore, my practice is and will continue to make sure each eligible provider (EP) has 10 e-prescribes for Medicare patients before June 30th, 2012.  Also notable is that the reporting different between last year and this year, is, this year you do NOT have to tie the electronic prescription to a qualifying visit or services.  As long as you e-prescribed for a Medicare patient you treated, you can report the G8553 code on the Medicare Part B claim on any Medicare service or visit you rendered for your patient.

The 2013 e-prescribing penalty does not apply to you if:

• You are not an MD, DO, Podiatrist, Nurse Practitioner, or Physician Assistant as of June 30, 2012.
• Office visits and other qualifying services represent less than 10 percent of your allowed Medicare Part B charges in the first 6-months of 2012 – January 1, 2012 through June 30, 2012.
• Less than 100 of your claims for Medicare Part B services that fall within the e-prescribing measure specifications for dates of service between 1/1/2012 and 6/30/2012.

Hardship Exemptions to avoid 2013 penalty:

• Your practice is located in a rural area without high speed internet access.
• Your practice is located in an area without sufficient available pharmacies for e-prescribing.
• You are unable to electronically prescribe due to local, State of Federal law or regulations.
• You prescribe fewer than 100 prescriptions between 1/1/2012 and 6/30/2012.

To file for an exemption, click here.

Also an important note:  There is NO appeals process for exemptions, therefore, make sure you include your TIN, the EP’s NPI (not the groups), mailing address, and email for each affected EP, choose the correct category, and take your time with the explanation. 

In summary,  if – in 2011, you did not successfully report 10 each for the EP’s in your practice, and were subject to the 2012 penalties, or you did not report 10 each for the EP’s in your practice - claims based, but received an exemption for meaningful use, and you do not qualify for an exemption listed above – I would highly recommend you get 10 Medicare claims based e-prescribing encounters submitted before June 30th, 2012, to avoid a 1.5% reduction in 2013.  An exemption for meaningful use MAY come later – but, you can’t go back if it doesn’t.

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CMS to End Enforcement Delay June 30. Are Your Claims 5010 Ready?

The Centers for Medicare & Medicaid Services (CMS) HIPAA 5010 discretionary enforcement delay is scheduled to end June 30, 2012. After that date, Medicare and other health plans will begin rejecting non-compliant claims. Members are urged to take the following steps:

• Reach out to your clearinghouse and health plans to determine if you are submitting fully compliant claims using the new 5010 format;
• If not, assess what changes to the data content of your claims needs to occur and include those changes into your organization’s workflow; and
• If you have concerns that claims may be rejected after June 30, protect your practice by establishing a line of credit with your local financial institution, setting aside cash reserves and/or postponing major capital expenditures until your cash flow issues are resolved.

The national MGMA remains concerned with clearinghouses, health plans, and practice management system software vendors readiness as the end of the enforcement delay approaches.

To help MGMA understand the current environment please complete a very short questionnaire. We also urge those practices that are not currently experiencing any 5010-related issues to complete the study. Manager participation is critical as MGMA will use these research results to provide feedback to policymakers on the need to extend the enforcement delay beyond June 30, 2012.

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Version 5010 CMS Webinar

Join the Centers for Medicare & Medicaid Services (CMS) Regional Offices for an informative webinar on Version 5010 for health care providers, clearinghouses, vendors and others, on June 20.

Version 5010 refers to the standards that HIPAA-covered entities must use when electronically conducting certain health care administrative transactions, such as claims, remittance, eligibility, and claims status requests and responses.

Health care organizations that submit transactions electronically are required to upgrade from Version 4010/4010A to Version 5010 transaction standards.

To be compliant, organizations must use Version 5010 to send and receive claims and all other HIPAA-adopted electronic transactions starting January 1, 2012; however, CMS has implemented an enforcement discretionary period, which is in effect through June 30, 2012. 

WHAT: CMS Webinar
DATE: June 20, 2012
TIME: 1:00 pm – 2:00 pm PST

This event will allow you to learn more about:

• Current Conversion Statistics
• Final Preparations for 5010/D.0 Cutover
• Operational Concerns
• Future of EDI Communications
• Resources and Contact Information

To register go to: http://registration.intercall.com/go/cms2

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CMS Releasing Comparative Billing Reports To Providers

The Centers for Medicare and Medicaid Services (CMS) has announced three new reports comparing select providers with their peers.  On June 4, CMS released 5,000 Comparative Billing Reports (CBR) for primary care providers who bill certain evaluation and management CPT codes.

A sample report is available at Safeguard Services’ website, the contractor responsible for producing the CBRs. A similar report for Family Practice and Internal Medicine physicians performing certain cardiology services was released on May 21. A report on home oxygen services is scheduled for a June 26 release, though no sample is yet available.

CBRs contain actual data-driven tables and graphs with an explanation of findings that compare a provider’s billing and payment patterns to those of their peers located in their state and across the nation. According to Safeguard Services, the CBR is not intended to be punitive or sent as an indication of fraud. Rather, it is intended to help providers identify potential errors in their billing practices.

For more information and to review FAQs, please visit the CBR Services website or call the SafeGuard Services’ Provider Help Desk, CBR Support Team at 530-896-7080.

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Final Rule Reducing Regulatory Burdens Includes Enrollment and ASC Changes

The Centers for Medicare & Medicaid Services (CMS) released a final rule aimed at reducing Medicare and Medicaid regulatory burdens on healthcare providers and beneficiaries. The rule focuses on regulations the agency identified as unnecessary, obsolete and burdensome and is part of a series of similar rules.

The agency finalized its proposal to no longer apply a one to three-year Medicare re-enrollment ban in instances where a physician’s billing privileges were revoked as a result of failing to respond to a Medicare revalidation request within a timely manner. CMS will continue deactivating Medicare billing privileges for physicians who do not submit a Medicare claim for 12 consecutive months.

CMS also finalized a proposal to remove a government-mandated list of emergency equipment that Ambulatory Surgical Centers (ASCs) must have. The list of equipment had not been updated since 1982, resulting in outdated equipment requirements. ASCs will have to develop policies and procedures specifying emergency equipment appropriate for their facility.

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Local Health Care Providers Earn Overall Good Marks for Communicating

Primary care providers around the Puget Sound in general get good marks for communicating with patients. But when it comes to questions of timely care and staff courtesy? Consumers are less likely to have a positive experience. Even where consumers feel their providers do a good job, there’s still room for improvement.

These are key findings of a survey that measures patients’ experiences with local primary care providers. The survey results were released by the Puget Sound Health Alliance (the Alliance). The initiative — called Your Voice Matters — marks the first time any organization in Washington state has systematically asked patients about their primary care experience and made comparable results publicly available.

The survey was completed by about 32,000 patients. The results cover 40 medical groups with 156 locations in King, Kitsap, Pierce, Snohomish and Thurston counties. Research shows that patient experience is linked to quality, including improved clinical outcomes, better independent decision-making and self-care, and reduced medical errors.

The survey results are summarized in four categories: Getting Timely Appointments, Care and Information; How Well Providers Communicate with Patients; Helpful, Courteous and Respectful Office Staff; and the Patient’s Overall Rating of the Provider. The performance results reflect the “top box” score, the percentage of patients whose responses indicate high performance for a given measure. Results are available on the Alliance’s Community Checkup website: www.wacommunitycheckup.org.

Among the survey’s highlights:
• Patients report the best performance overall in the category of how well providers communicate with them, with a regional average of 81 percent;
• Seventy two percent of patients on the survey report that their medical group’s office staff was always helpful in meeting their needs; and
• Only 56 percent of patients report that they always get timely appointments, care and information, the area where there is the most room for improvement.

In addition to reporting the results, the Alliance is also launching a consumer awareness campaign to help consumers understand what they should expect from visits with their health care provider and to provide consumer tips and resources to take more control over their health care.

Patient experience refers to what happens to people when they are interacting with the health care system and seeking to have their needs met. While many medical groups conduct their own patient satisfaction surveys, the patient experience survey differs in several important ways. Patient experience surveys ask patients whether or not or how often certain events happened and not simply the patients’ expectations and feelings, which can be highly subjective.

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Physicians Can Now Submit Medicare Enrollment Applications 60 Days Before the Effective Date

The Centers for Medicare & Medicaid Services (CMS) is now allowing more flexibility for physicians when submitting their Medicare enrollment applications. Physicians may now submit CMS-855 enrollment applications and Internet-based PECOS applications up to 60 days prior to their effective date.

Previously, providers could only submit applications up to 30 days before the effective date, which created a very tight timeframe requiring practices to carefully coordinate the effective date and the application submission. The effective date is the later of the date of filing the enrollment application or the date a physician first begins furnishing services at a new practice location.

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CMS Delays “Sunshine” Data Collection

The Centers for Medicare & Medicaid Services (CMS) announced that it will not meet its previously set timeline to begin collecting information on drug and device manufacturers’ payments to physicians and teaching hospitals. The collection, required by the Affordable Care Act and referred to as the “sunshine” rule, also covers physician ownership in manufacturers or group purchasing organizations (GPOs). 

CMS has a statutory deadline to collect information on 2012 data by March 31, 2013. The agency released a proposed rule in Dec. 2011 and had planned to finalize that proposal in time for manufacturers and GPOs to collect a partial year’s data for the latter part of 2012. Given that the reporting process is based on a calendar year, it is anticipated that CMS will require manufacturers and GPOs to report 2013 data by March 2014. The statute requires data to be made public by June 30 of each year.

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Obtaining, Uploading And Utilizing Your Contracted Fee Schedules

The AMA has created a new educational resource “Obtaining, uploading and utilizing your contracted fee schedule” to help physicians understand the importance of utilizing their contracted fee schedules. This resource provides step-by-step instructions on how to upload your contracted fee schedule into your practice management system, as well as guidance on reports or spreadsheets that can help you ensure that payments you receive align with what you agreed to in your contract.

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Calendar of Events

CMS Webinar on Version 5010
June 20, 2012
1:00 pm – 2:00 pm PST
This event will allow you to learn more about:
• Current Conversion Statistics
• Final Preparations for 5010/D.0 Cutover
• Operational Concerns
• Future of EDI Communications
• Resources and Contact Information
To register go to: http://registration.intercall.com/go/cms2

2013 OR/WA MGMA Annual Meeting
April 14-17, 2013
Tacoma, WA

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Welcome New WSMGMA Partners

Kinetic Datacom
Consulting, Information Systems & Software, Medical Records
With Kinetic Datacom you can make smarter decisions about how to deliver and maximize clinical operations through technology. Our comprehensive solutions are created to give you integrated options for EMR/EHR, PACS archiving, mobile clinical computing, network design, hardware solutions, and more from a company you can trust.
Contact:  Morris Pettit
Address:  107 N Tower Ave Ste 7, Centralia, WA 98531-4253
Phone:  (360) 807-9006
Email:  mpettit@kineticdatacom.com
Web site:  kineticdatacom.com

Vivid Learning Systems
Legal, Human Resources, Medical Supplies
Vivid Learning Systems is a leading national provider of online training, delivering best-in-class off-the-shelf compliance training and custom training solutions designed to meet compliance requirements, optimize employee potential, and elevate business performance. We partner with healthcare organizations both large and small to deliver solutions that mitigate risks, and improve our partners’ bottom-line.
Contact:  Annie Bixler: Marketing Specialist
Address:  5728 Bedford St, Pasco, WA 99301-8214
Phone:  (509) 545-2566
Fax:  (509) 542-8869
Email:  abixler@learnatvivid.com
Alternate Phone:  (509) 545-1800

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Thank You To The Following Partners For Their Continued Support

Audit & Adjustment Company
Financial Services, Collections
Audit & Adjustment Company provides a full range of HIPAA- compliant debt collection products to healthcare providers throughout the Pacific Northwest- including physician groups, clinics and hospitals. We deliver cost-effective recovery solutions that emphasize respectful and professional communication with patients.
Contact:  Jennifer McNatt
Address:  20700 44th Ave W Ste 100, Lynnwood, WA 98036-7752
Phone:  (425) 776-9797 x227
Fax:  (425) 776-5454
Email:  jenniferm@audit-adjustment.com
Alternate Contact:  Larry Denenholz
Alternate Phone:  (425) 776-9797 x214
Alternate Email:  larry@audit-adjustment.com
Web site:  www.audit-adjustment.com

Healthwind Horizon Practice Management System
Information Systems & Software
Healthwind Horizon, one of the Northwest's most trusted health information system vendors, specializes in practice management software for clinic and clinic groups for whom boosting revenue is a primary goal. Healthwind Insight, our flagship Windows-based product, allows you to assess, plan, and improve practice performance. Complete EMR integration available.
Contact:  Joanie P. Eaton
Address:  8640 154th Ave NE, Redmond, WA 98052-3556
Phone:  (425) 883-6588
Fax:  (888) 794-7507
Email:  jeaton@healthwind.com
Alternate Phone:  (800) 269-1171
Web site:  www.healthwind.com

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Job Postings

Healthcare Manager/ARNP Pullman 06/12/12
Marketing/Sales Representative  Pacific Northwest  06/05/12
Practice Manager  Stanwood and Camano Island  06/01/12
Clinic Administrator Position  Ellensburg  05/23/12
Operations Manager  Bellevue  05/15/12

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Job Posting Information

To have your job posting included in the e-Update, submit your copy to kyle@wsma.org

Please include a mailing address for billing purposes when submitting your advertisement. Your ad will appear in one issue of our electronically distributed e-Update. Ads for job postings will also be placed in the Job Posting section of the WSMGMA website for one month.

Advertising Rates:
WSMGMA Member or Partner $75
Non-member or Non-Partner $200

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E-Update Contributions and Suggestions

The WSMGMA e-Update is your newsletter! All member contributions are welcome! We encourage you to submit articles, letters, practices tips to share in the newsletter, or send us a question you would like answered or your ideas for future articles. Email your contribution and suggestions to Kyle Vixie at kyle@wsma.org

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Contact the WSMGMA

WSMGMA
2033 6th Ave Ste 1100
Seattle, WA 98121
Phone: (800) 552-0612 Ext. 3026
Kyle Vixie, Executive Director
Email: kyle@wsma.org
www.wsmgma.org
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