NMMS Policy and Procedures for Protecting Patients from
Identity Theft
The Red Flag Identity Theft Laws may be put in place as of August 1, 2009. Right now, the AMA continues to battle on our behalf in order to have such red flag rules not apply to small group practices. However, we in New Mexico are concerned that the rules may in fact pass and apply to most of our practices. Therefore, we might suggest that you begin to look at the attached policies and procedures, have your staff review same, and determine whether they could apply to your own situation so that you will have something in place in order to meet the August 1, 2009 deadline if, indeed, we are unsuccessful in getting these rules to be inapplicable to medical practices.

AMA & Medicare's Sustainable Growth Rate
The AMA and 59 national medical organizations have endorsed a set of joint recommendations on eliminating Medicare's sustainable growth rate (SGR) formula and supporting efforts to promote health care quality and appropriateness. The recommendations underscore that the SGR should be repealed this year and replace with updates that reflect practice cost increases.

If Congress adopts a transitional approach to replacing the SGR, payment updates would be linked to the Medicare Economic Index for five years while innovative financing and delivery systems are further developed and tested. The recommendations oppose any mandatory physician participation in new models, support antitrust reforms to allow physicians to collaborate around health information technology and quality improvement initiatives, and call for testing programs that provide liability protection to physicians who participate in Medicare quality incentive programs. The joint recommendations are being shared with policymakers in Congress, the Obama administration, and the Medicare Payment Advisory Comission.

ICD-10-CM/PCS Conference Call Transcripts Available
The written and audio transcripts of the ICD-10-CM/PCS Implementation and General Equivalence Mappings (Crosswalks) National Provider Conference Call, conducted by CMS on May 19, 2009, are available in the "Downloads" section.

State Coverage Initiative (SCI) Listening Tour
The NM Human Services Department has scheduled meetings across the state - with the goal of learning how the SCI program can be improved to better serve the citizens of the state. Currently, the Medicaid Advisory Committee has a subcommittee working on possible changes to the health coverage program, which may occur due to changes at the federal level.  

Tour schedule:
June 25, 1:00 pm -3:00 pm, Roswell Chamber of Commerce
June 26, 10:00 am - 12:00 pm - Memorial Medical Center in Las Cruces
July 23, 10:00 am - 12:00 pm - CNM Workforce Training Center in Albuquerque (Native American Issues only)
July 23, 2:00 pm - 5:00 pm - CNM Workforce Training Center in Albuquerque
July 30, 2:00 pm - 4:00 pm - Taos Convention Center

The SCI is a public/private program for uninsured adults 19-64 years of age with incomes below 200% of the Federal Poverty Level. the employer pays a portion of the premium (typically $75 per employee per month), the employee pays a portion ($0 to $35 per month depending on income), and the state and federal governments pay the remainder. Currently the program serves more than 33,000 NM adults.  For more information, please contact the Insure New Mexico! Solutions Center at (888) 997-2583 or visit www.insurenewmexico.net.


Share Your NPI
Physicians must share their National Provider Identifier (NPI)...Once providers have received their NPIs, they should share it with other providers with whom they do business and with health plans that request it. As outlined in current regulation, all providers that are HIPAA covered providers, including Medicare providers, must share their NPI with other providers, health plans, clearinghouses, and any entity that may need that NPI for use in standard transactions, including the need to identify an ordering or a referring physician. Providers should also consider letting health plans, or institutions for whom they work, share their NPIs for them.  NPI Registry.

Silent PPOs
Many physicians do not realize how often their contractually-agreed, discounted rates are passed to other entities through the use of rental network PPOs, including both preferred and secondary provider networks. When the physician discount is shared without the physician's authorization, the arrangement if often referred to as a "silent PPO." Problems occur when the payer's relationship to the provider network is not clearly identified both prior to the time services are rendered and at the time payment is made.

AMA Resources on Silent PPOs:  

• Educational toolkit to help physicians get useful information up-front during contract negotiations with a provider network.
• Chart of existing state laws on rental networks (AMA members only).
• Interactive map on the AMA Practice Management Center site makes it easier to file a complaint with the proper state authorities.
• AMA's work on regulating the rental network industry (AMA members only).
  

AMA Resources - Medicare and Medicare Advantage
The AMA has created two new educational resources for current and potential Medicare Advantage benficiaries. AMA members can use these to help educate their patients and staff on the benefits and problems associated with participation in Medicare Advantage plans. "What you need to know about Medicare Advantage," provides basic information on the program, including what to expect in terms of benefits, enrollment and health insurer marketing of these plans. "Which plan is right for you," provides an overview of the different types of plans, including HMOs, PPOs, and private-fee-for-service plans. View these patient resources; AMA members may download them as a member benefit.

Presbyterian Suspends Prior Auth for Relenza and Tamiflu
All product lines of Presbyterian Health Plan - Commercial HMO, Senior Care, Salud!, PPO product lines - have removed all prior authorization requirements for Tamiflu and Relenza. Prescriptions written for all Presbyterian members will process at the pharmacy with a quantity of #10. If you have questions, please call Presbyterian Helpdesk at: 888-923-5757 (select option #3 for Pharmacy) or on-call clinical pharmacist at (505) 220-9063. 

Red Flags Rule Deadline Delayed to August 1st
The Federal Trade Commission (FTC) just voted to delay implementation of the Red Flags Rule until August 1, 2009. The AMA will utilize this time to convince the FTC and Congress that physicians who regularly bill their patients (including co-payments and coinsurance) are not creditors and therefore should not have to develop and implement written identity theft prevention and detection programs for their practices. In the meantime, guidance material is available from the AMA.

Health Access and Health Profession Supply Act of 2009
HAHPSA (S.790) was introduced by Senator Jeff Bingaman on April 2, 2009.

Health Reform Dialogue
This report identifies areas of common ground among health care providers, employers, consumers, insurers, public health professionals, and others on key issues that need to be addressed in the context of health system reform. The report, released March 27, 2009, represents the consensus reached by the group on steps that can be taken to reach the broad goals of increasing coverage and access, strengthening wellness and prevention, and ensuring quality and value.

ICD-10 and Electronic Transaction Standards Transition - Deadline Extension

On January 15, 2009, the U.S. Department of Health and Human Services released two final rules that will facilitate the ongoing transition to an electronic health care environment through adoption of an updated set of diagnosis and procedure codes and updated standards for electronic health care and pharmacy transactions. In accordance with the White House Chief of Staff’s memorandum of January 20, 2009, entitled “Regulatory Review,” a determination has been made that the effective date will not be extended and the comment period will not be reopened for either of these rules.
The first rule finalizes new code sets to be used for reporting diagnoses and procedures on health care transactions. This final rule replaces the ICD-9-CM code sets, developed nearly 30 years ago, with greatly expanded ICD-10 code sets. The second final rule adopts updated versions of the standards governing electronic transactions under the authority of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The updated versions replace the current standards and will promote greater use of electronic transactions. In response to public comments suggesting that more time would be needed for effective industry implementation, the final rules include later compliance dates of January 1, 2012, for the transaction standards and October 1, 2013, for the ICD-10 code.

Public Health Offices Go Electronic
NM Health Secretary Alfredo Vigil MD reports that the New Mexico Department of Health has electronic medical records systems in all of its 49 public health offices that provide clinical services across the state. The project for public health offices cost $1.3 million. The Department of Health received $750,000 in 2005 to implement electronic medical records in its public health offices. The Department has also received about $900,000 for a matching grant program to help private practices cover the costs of starting electronic medical records systems. (SEE NEXT STORY). According to a U.S. Health and Human Services Department national survey, among practices that used electronic medical records, 82 percent said they improve the quality of clinical decisions, 85 percent said they help improve the delivery of preventative care and 86 percent said they improve the delivery of preventive care.

EMR $$ Help
Medical providers from around the state can now get electronic medical records in their offices for an affordable price with help from the Department of Health (DOH) under the Strategic Health Partners Agreement. The agreement allows providers to pay the same discounted rate as DOH for an electronic medical record system. DOH will also provide consultation on implementation and train staff.  The cost associated with the system under the agreement will be $12,000 for physicians, $10,000 for other practitioners.  To take advantage of this program, practices must accept clients covered by either the Medicaid fee-for-service program or the Medicaid managed care program and participate in a local health information exchange or the New Mexico Health Information Collaborative. Providers will be expected to sign a HIPAA business associate agreement with DOH. DOH will require periodic reporting of the numbers of mammogram screenings conducted or ordered, pap tests, clients with asthma who have an asthma progress note completed at each visit, well-baby visits, EPSDT examinations, pre-diabetes patients, diabetes patients and colorectal cancer screenings conducted or ordered. For information, please contact Bob Mayer at the Department of Health, 505-827-0536 or robert.mayer@state.nm.us.

NM Medicaid News
COORDINATED LONG-TERM SERVICES (CLTS)....is a Medicaid managed care program that provides and coordinates services for specific Medicaid recipients. Information on the program.  

ELECTRONIC PRESCRIBING...Medicaid is pleased to announce the ability to respond to real-time eligibility, formulary and medication history inquiries for physicians participating in electronic prescribing. This data is available for the fee-for-service client population.  To receive the full benefit of your prescribing software, contact your software vendor to ensure that this information is being accessed.  If you have any questions, please contact Mark Zuliani, New Mexico Medicaid Transformation Grant Project Manager, at 505-827-3162.

TAMPER RESISTANT SCRIPTS...Remember, written prescriptions in the Medicaid program must have one feature to prevent unauthorized copying, another to prevent erasure or modification of information and a third to prevent counterfeiting. EXEMPT FROM THE LAW: prescriptions paid for by Medicaid managed care plans; nursing homes and other institutions; electronic, faxed or phoned prescriptions.  Prescriptions MUST contain your NPI. More.

NM Medical Board Waives Certain Licensure Fee
The New Mexico Medical Board (NMMB) is waiving the $400 licensure application fee for new applicants who choose New Mexico as their first state of licensure. In collaboration with Governor Richardson’s goal to attract more physicians to New Mexico, the NM Legislature, the NM Medical Society and the University of New Mexico Health Sciences Center, the NMMB voted to waive the application fee during in an effort to recruit and retain physicians in New Mexico. The Board will review the impact to the budget to determine the feasibility of this action annually and to use for future requests to the legislature. The licensure application is available on the Board’s web site:  www.nmmb.state.nm.us. You may also contact the NMMB for additional information at (505) 476-7220 or e-mail to nmbme@state.nm.us.

MORE FROM THE BOARD...Effective July 1, 2007, the New Mexico Medical Board requires all applicants for initial licensure and reinstatements to submit fingerprints for a state and national criminal background check. Health Services Corporation (HSC), a partner of NMMS in many projects, can do this for you at your office or theirs. Call 343-0070 or email: fingerprinting@nmhsc.com