APMA News - June 2011 - (Page 48)

Reimbursement Health Policy Committee Issues—Part I The following is the first in a two-part series outlining current health-policy issues for podiatrists. QUESTION: What is the Health Policy Committee (HPC) doing to address the numerous issues affecting podiatrists as a result of health-care reform and other Medicare changes? ANSWER: This year is pivotal for the HPC, dealing with Accountable Care Organizations (ACOs), diabetic therapeutic shoe documentation requirements and audits, supplier screening requirements, Medicare guidelines regarding wound debridement codes, and Tricare, to name a few top issues. APMA’s ACO Task Force is developing a means for communicating the details and effects of CMS’ proposed rule on ACOs to members. The APMA House of Delegates created the task force to provide guidance and communication related to ACO strategies. ACOs were established by the 2010 Patient Protection and Affordable Care Act (ACA), or Health Reform Act, to create better coordination of care among doctors, hospitals, and other health-care providers for Medicare beneficiaries. The following are some preliminary points related to the ACO proposed rule: Although not included under the definition of ACO professionals, DPMs are eligible to participate in ACOs and in the shared savings; Regardless of the model (two tracks indicated by CMS), there will be some element of risk for participating physicians; Current relationships with key hospitals, health systems, and IPA groups are likely to be crucial for physicians in establishing future ACO participation; ACOs have been designed such that primary care physicians (PCPs) will wield the majority of the power in determining who participates and how savings will be shared— specialists in general medicine (including DPMs) will be subject to PCP decision-making; DPMs in small single-specialty group practices not part of a local health system infrastructure or those who practice in rural settings may be overlooked for ACO participation; and Due to incremental infrastructure costs and antitrust paperwork, ACOs may be wary of adding groups they perceive to be non-crucial or less likely to create savings (all specialists may face this issue). and simplify documentation requirements. At press time, the issues were not yet resolved. Documentation associated with the diabetic therapeutic shoe program became an issue when National Government Services, the Region B DMAC, and CIGNA (Southeast) began conducting random prepayment audits of supplier therapeutic shoe claims. APMA member survey results indicated that DPM physician–suppliers were cited for failure to maintain and provide sufficient proof of medical necessity from the physician supervising the patient’s diabetes care. Thus far, APMA’s conversations with various CMDs, while useful, failed to achieve the desired acknowledgement that, in serving as both the prescribing and supplying doctors under the program, podiatrists maintained records that contain detailed examination findings of any lower extremity conditions. Documentation requirement talks are ongoing. HPC is working with its health policy consultant, Health Policy Alternatives (HPA), to prepare a plan for addressing CMS. APMA is considering several approaches, including partnering with other organizations or continuing to work with DMAC CMDs to develop a documentation package acceptable to CMDs and APMA. CMS issued a Supplier Screening Requirement Final Rule effective March 25, 2011. The HPC and APMA reviewed a requirement summary provided by HPA. According to HPA, APMA’s issues relate mainly to the treatment of physicians who are DMEPOS suppliers (requiring an application fee, fingerprinting, etc.), and the potential implications for newly practicing physicians in the event of a moratorium on enrollment of new DMEPOS suppliers. APMA is exploring a concerted effort with other stakeholders and considering conferring with congressional staff about the application fee issue (Congress exempted physicians and other health professionals, but CMS requires a fee from physicians applying to be DMEPOS suppliers). APMA members have experienced numerous issues regarding use of CPT codes 97597 and 97598 when selective debridements (which are designated “therapies,” not surgical procedures) are performed on skilled nursing facility (SNF) residing patients. These codes, as therapies, are included in SNF consolidated billing rules and are not payable under Medicare Part B. APMA wrote to CMS on June 1, 2010, expressing its concerns. APMA asked for CMS’ understanding and assistance in resolving these issues, which were established before the surgical CPT codes, 11040 and 11041, were deleted with instructions for doctors to use CPT codes 97597 and 97598. HPC is working with a coalition of general surgeons and other specialists to resolve this issue with CMS; deletion of the surgical debridement codes with directions to use the therapeutic selective debridement codes has been confusing to members and payers. The HPC will continue to prioritize these and arising issues, and it will dedicate resources to try to obtain favorable resolution for members. Look for an update in your July/ August issue, and visit www.apma.org/Members/Reimburse mentIssues.aspx for more information. n • • • • • • For more information on podiatric medicine’s issues with ACOs and other health-care reform developments and their impact on podiatric medicine, visit APMA’s new Web page at http://members.apma.org/Members/Advocacy/Health-CareReform.aspx. The HPC and APMA have communicated on numerous occasions with regional DME Medicare Administrative Contractors’ (DMACs) carrier medical directors (CMDs) to clarify 48 APMA News June 2011 http://www.apma.org/WorkingForYou/content.cfm?ItemNumber=2395 http://www.apma.org/WorkingForYou/content.cfm?ItemNumber=2395 http://www.apma.org/yourpractice/content.cfm?ItemNumber=1367&navItemNumber=594 http://www.apma.org/yourpractice/content.cfm?ItemNumber=1367&navItemNumber=594

Table of Contents for the Digital Edition of APMA News - June 2011

APMA News - June 2011
President’s Message
Contents
Stepping Up to Prevent Falls
State Advocacy Forum Focuses on Relationships
Patrick DeHeer, DPM: On a Mission
Affordable Care Act, One Year Later: Part Two
Updated List of Seal Holders
Annual Scientific Meeting Preliminary Program
Annual Scientific Meeting Registration Form
Annual Scientific Meeting Sponsors
Reimbursement
Members Who Know Media
Technofile
Young Voices
Small Business 101
CPME Update
New and Deceased Members
Worthy of Note
Affiliates Corner
Insurance Advisor
APMAPAC Update
Development Update
Classified Advertising
Dates to Remember
Advertising Index

APMA News - June 2011