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Medicaid spending to "substantially" outgrow U.S. economy.

According to a report released by the U.S. Centers for Medicare & Medicaid Services (CMS), spending on Medicaid is expected to substantially outpace the rate of growth in the U.S. economy over the next decade. According to projections, Medicaid benefits spending will increase 7.3 percent from 2007 to 2008, reaching $339 billion, and will grow at an annual average rate of 7.9 percent over the next 10 years, reaching $674 billion by 2017. The growth rate of the general economy is projected to be 4.8 percent over the same period. The report also finds that Medicaid enrollment is projected to increase at an average annual rate of 1.2 percent over the next 10 years, reaching 55.1 million by 2017.
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Read the complete report...

Hawaii.

According to the Associated Press, the state of Hawaii is dropping its universal child health care initiative 7 months after the program was launched. The governor cited budget shortfalls and other available healthcare options as reasons for the cut, and one state official said that some families were dropping private coverage to make their children eligible for the subsidized plan.

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ICD-10 implementation costs higher than CMS estimates.

AAOS and 11 other healthcare organzations have released a study conducted by Nachimson Advisors, LLC, which suggests that the U.S. Centers for Medicare and Medicaid Services (CMS) has underestimated the cost of implementing the International Classification of Disesases (ICD)-10 code set. According to the study results, the implementation cost for a three-physician practice could be as much as $83,290, while a 100-physician practice might pay more than $2.7 million. CMS has proposed implementing the codes by October 2011.

The AAOS has been monitoring the proposed transition to ICD-10, and is actively engaged to ensure that the transition places as little administrative and cost burden on physician practices as possible.
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Read the complete study(PDF)...

California.

The Los Angeles Daily Journal reports that several physician organizations, including the California Medical Association, have filed suit to contest new state regulations barring balance billing. Some experts have argued that outlawing balance billing, in which healthcare providers bill patients an additional amount to make up for low insurance reimbursement, can reduce the availability of specialists for emergency calls.
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Reminder: MOC deadlines approaching.

Dec. 15, 2008 is the deadline to satisfy key MOC requirements for diplomates who plan on taking the American Board of Orthopaedic Surgery (ABOS) Maintenance of Certification™ (MOC) exam in 2010. Documentation of 120 AMA PRA Category 1 Continuing Medical Education (CME) Credits™ (including 20 credits from one or two scored and recorded self-assessment examinations) must be submitted to the ABOS by the Dec. 15 deadline. If you choose the written examination pathway, you must submit a 3-month surgical case list, or a maximum of 75 consecutive cases, by Dec. 15, 2008. (Note that if you choose the oral examination pathway, you have until Dec. 15, 2009 to submit a 6-month list of surgical cases you performed during 6 consecutive months in 2008 – 2009.)

If your board certification expires in 2009 and you missed the May 1, 2008, application deadline for the recertification exam, you must meet the reporting deadline of Dec. 15, 2008, to enroll in MOC. The exam application is due May 1, 2009. You will not be allowed to complete an application if you do not meet the Dec. 15, 2008, deadline for reporting CME, self-assessment, and case list.

If you are short of the required 120-credits or the 20 credits in scored and recorded self-assessment examinations, the Academy offers a wide range of resources that can help you obtain credits.
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For information about the MOC deadlines you must follow and to learn about each MOC component, visit the ABOS online and click on the "Diplomates" tab; then, select the year your certificate will expire from a drop-down menu. You may also call the ABOS at (919) 929-7103.
http://www.abos.org

Medical practices need to develop an Identity Theft Prevention Program by November 1, 2008.

Last month, many in the healthcare industry learned that a 2007 amendment to the Fair and Accurate Credit Transactions Act of 2003 (FACTA) will affect them. Originally, FACTA applied primarily to businesses operating in the financial industries; however, the Federal Trade Commission (FTC) determined that the new 2007 Identity Theft Red Flag Regulations and Guidelines do extend to the healthcare industry. 'Red Flag" applies to any business or organization that does not receive full payment at the time of service or product purchase, and where there may exist an ongoing relationship with the purchaser. This means that orthopaedic practices and other healthcare entities must make a good faith effort to develop and implement a written Identity Theft Prevention Program by November 1, 2008. The elements and scope of an Identity Theft Prevention Program are identified in the article, "Identity Theft Red Flag Regulations and Guidelines: What the new regulations mean for medical practices," found on the AAOS Practice Management Center in the compliance section.
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CMS announces program to fight Medicare fraud and abuse.

As part of enhanced efforts to find and prevent waste, fraud, and abuse in Medicare, the U.S. Centers for Medicare and Medicaid Services (CMS) plans to begin consolidating its fraud detection efforts, work more closely with healthcare providers, strengthen its oversight of medical equipment suppliers, and launch a national recovery audit contractor program. Additionally, the agency will, among other things, conduct unannounced site visits and implement extensive review of claims to fight fraud and abuse among equipment suppliers in Florida, California, Texas, Illinois, Michigan, North Carolina, and New York.
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MedPAC considers proposals regarding physician disclosure.

On October 2, the U.S. Medicare Payment Advisory Commission (MedPAC) met in Washington, D.C., and the Commission's staff made a one-hour presentation on public reporting of physicians' financial relationships. Recommendations from the Commission may be forthcoming at a later date.
Review a copy of the meeting brief (PDF)...

Review the MedPac staff presentation (PDF)...

Major funding for orthopaedic trauma research comes through Department of Defense.

On September 30, 2008 President Bush signed the "Consolidated Security, Disaster Assistance, and Continuing Appropriations Act" (H.R. 2638). The measure includes the FY 2009 appropriations bills for Defense, Homeland Security, and Military Construction-Veterans' Administration and funds most of the remaining federal programs at FY 2008 levels through March 6, 2009. The bill includes $66 million for peer reviewed orthopaedic trauma research. The funding is a major success for orthopaedic trauma research and a direct result of the AAOS vision and lobbying efforts, according to Andrew Pollak, MD, chair of the extremity war injuries and disaster preparedness project team. During the past 2 years, $101 million in additional funding has been earmarked for orthopaedic trauma research. "Over the next few months we will continue to work with the Army to make sure these funds are used to stimulate the best possible research and to foster an environment that both improves clinical care for our injured warriors while supporting and stimulating the careers of orthopaedic clinician-scientists," said Dr. Pollak. "Our next steps will be to grow this program further to match levels of funding in the Department of Defense currently enjoyed by breast and prostate cancer research and to ensure that these programs are funded at appropriate levels in perpetuity."
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SCOA & SCAOE Power Coding Seminar

October 23, 2008 ~ 8 am to 2:30 pm
Moore Orthopaedic Clinic Conference Room
104 Saluda Point Drive
Lexington, SC  29072

This programs is sponsored by:
SRS Soft

What You Will Learn…

Designed for the experienced physician, surgical scheduling and coding staff, billing and account follow up staff with a strong working knowledge of orthopaedic coding—this course will take you to the ultimate level.  It’s a hands-on course filled with interesting cases. 

Objectives:
1. To apply basic modifier and coding knowledge to surgical case combinations
2.  To understand coding and reimbursement rules as they related to accurate 
      coding and bundling of surgical case combinations.

Please bring your CPT book to this course.  ICD-9 coding tools are not necessary.

Topics to be addressed include:  2008 Updates:  Rules to Support Reporting Services and the Appeal Process; Global Service Data Guide/Code-X 2008; Key Components of an Operative Note; Surgery Code Modifiers Revisited; Fracture Care; and Specific Case Presentation and Discussion   
 
$150 per person

Registration Deadline is October 16th

Classes fill fast.  Early registration guarantees a seat.

For further information, please contact:
South Carolina Orthopaedic Association
17503 Mallard Court, Lutz, FL 33559 ~ Phone: (813) 949-3121; Fax: (813) 949-8994
Email: scoa@cobbemanagaement.com

Please make checks payable to:  South Carolina Orthopaedic Association

Please see attached registration form

Download 2008_coding_seminar_columbia_october_23.pdf