Another year is coming to a close and the 2010 ISMA dues bill may still be awaiting your attention. Perhaps you’re wondering what your state association has done for you lately.

ISMA Reports staff compiled the list of 2009 activities and accomplishments that appears below to provide a quick accounting of your dues dollars at work. But the experiences of individual practices may better demonstrate how to obtain maximum benefit from your ISMA membership.

Helping patients, recouping dollars…
The Coatesville family practice of Robert Heavin, M.D., began on May 18 to secure prior authorization for an MRI for a patient with a breast lump.

“I faxed information four different times to the insurance company, and they kept saying the information was not showing up in their system,” said staff member Laura Collier. “Then Dr. Heavin wrote a letter – and still nothing happened.”

Collier next contacted Gloria Kirkham, ISMA practice advisor, who called the insurer on behalf of the practice and talked to a nurse reviewer.

“Gloria got things worked out in one day. The patient was relieved and we were thankful,” said Collier. “I’ve only been working in this office for one year, but I know I’ll call the ISMA for help in the future.”

The Indiana Hemophilia and Thrombosis Center in Indianapolis, with five physicians who regularly see patients in the office setting, found help in several ways this year from the ISMA and Practice Advisor Jeri Biedenkopf, R.N.

Helen Taylor, M.B.S., the center’s clinical business director, attended the ISMA’s recurring session “Tools for Enhancing Patient Relations” and wanted others on staff to benefit from the education session, presented by Biedenkopf.

“We have four staff members at the front desk, and it’s difficult for them to get away,” said Taylor. So, Biedenkopf took the ISMA program to the practice. “It was so nice to have the ISMA set up here in the office and provide that service.”

Taylor said she also uses the ISMA’s Coding Hotline regularly to ensure proper coding on complex claims.

The office’s pharmacy billing director, Shaun Goodwin, had issues earlier this year with the processing of Medicare claims.

“Jeri (Biedenkopf) got me through to a contact person, someone I could speak to directly, in order to get detailed information on why our claims were being held up,” Goodwin explained. Biedenkopf assisted with 30 to 40 “large dollar” claim amounts.

“Jeri was able to review these claims with her Medicare contact person and determine that they were submitted correctly. Within a few weeks of Jeri’s assistance, Medicare released these claims from the ‘pending’ cycle and we received payment,” Goodwin explained. “These claims could have posed a tremendous financial burden to our center.”

Maximizing your membership
If you’re not regularly turning to the ISMA for claims and coding assistance, education for your staff, insurance and contract review services, you’re missing out.

You can easily recoup the dollars you spend on your dues with one call to the Coding Hotline or one contact to resolve a claim issue with an ISMA Medicare or Medicaid expert.

Make a resolution to review all your membership benefits on the ISMA Web site – and use them!

Here are some significant ways the ISMA worked for you in 2009

Collected examples of Anthem payment delays. Had two meetings with the insurer, another with the Indiana Department of Insurance to present examples. Filed a compliance dispute against Anthem in July; attended one mediation session and negotiations continue. Filed an amicus brief to help overcome a court challenge to the Patient’s Compensation Fund in Atterholt vs. Hebst. Donated $238,444 to the IU School of Medicine to help medical students with tuition. Alerted members to a Medicare scam in July, offering tips to help members avoid identity theft. Met with the new Office of Medicaid Policy and Planning leadership to share physicians’ concerns. During the 2009 General Assembly, the ISMA: – Kept the assignment of benefits issue alive, as it went to a summer study committee. – Passed a requirement to have insurers include a large print notice with out-of-network insurance checks, advising patients of their responsibility to pay health care providers. – Required insurers to cover certain services related to clinical trials under Medicaid, state’s employee health plan, HMOs and accident and sickness insurance. – Obtained a law instituting graduated licenses and other restrictions for teen drivers. – Secured a study committee for Medicaid MCOs aimed at reducing red tape, increasing reimbursement and limiting use of the emergency room. – Obtained an exemption from the state retention of medical records law in natural disasters. – Defeated a bill that would have forced Medicaid physicians to pay any alleged overpayment up front. Awarded the Medical Mission Scholarship (up to $3,000) in a random drawing to Indianapolis internist Elisabeth Kline, M.D., for her mission to Honduras. Provided educational sessions on Red Flags Rules, the future of medical practice, post-traumatic stress disorder, the HITECH Act, RAC audits, electronic medical records (EMR) and coding. Succeeded in securing the appointment of Stephen Tharp, M.D., ISMA past president, to the Medicaid Study Committee. Took ISMA House of Delegates issues, including concerns about health care reform, to the AMA House. Through partnership with athenahealth, guaranteed ISMA members a bonus payment for EMR adoption under the federal HITECH Act. Offered six opportunities for medical office staff to meet with Medicaid and Medicare representatives at coalition meetings. Conducted the annual Commercial Payer Forum to allow practice staff to hear directly from commercial insurers and discuss physician issues. Held two meetings with the presidents of specialty society state chapters to discuss concerns and unite for common goals. While not totally comprehensive, this listing offers a review of the ISMA’s key activities over the past 12 months. The ISMA is working for you – in every month!