Administrative changes
Review the administrative changes.

Medicare pay cut coming; AMA urges you to act
A federal rule announced on Aug. 9 by the Centers for Medicare & Medicaid Services proposes a statutory formula requiring a minus 5.1 percent payment rate update for physician services in 2007.

The administration stated the rate cut is necessary because spending on physician and other Part B services has grown faster than target spending. Expenditures for physicians in 2005 were 10 percent higher than in 2004.

Even before this announcement, the AMA National House Call campaign was set to visit our state to demonstrate how the Medicare physician payment cuts would affect Indiana. AMA and ISMA leaders will meet with the media Aug. 23 and 24 in Indianapolis and South Bend.

Learn more about the proposed rate cut and access the Aug. 22 Federal Register; then go to 2006, August 22, Centers for Medicare & Medicaid Services.

Do your part
Act today! Contact Indiana’s Congressional delegation urging them to act before the October adjournment to stop the mandated cut and increase Medicare physician payments by 2.8 percent, as recommended by the Medicare Payment Advisory Commission.

Also, tell them to replace Medicare’s flawed payment formula with one that reflects physician costs.

Contact information, or call (800) 833-6354 to be connected with your members of Congress.

Mark your calendar for these important sessions:
Medicare and Coding Updates for 2007 — $99
Merrillville, Dec. 6
South Bend, Dec. 7
Fort Wayne, Dec. 8
Indianapolis, Dec. 13
Clarksville, Dec. 14
Evansville, Dec. 15

Restricted cards
Ann Randall, Restricted Card Program supervisor with HealthCare Excel (HCE), addressed the obstacles physicians experience being added to the restricted list, specifically for anesthesiologists, lab providers and radiologists who typically perform services prior to obtaining eligibility. More information>>

Care plan oversight
Daryl Davidson, field consultant for EDS, clarified uncertainty concerning whether physicians will be reimbursed for care plan oversight services if not employed or contracted hospice providers. Davidson confirmed that EDS will not reimburse non-hospice employed physicians for these services.

MCO credentialing
Because each MCO adheres to National Committee for Quality Assurance (NCQA) quality standards, a separate credentialing process is required for becoming a network physician. Further information>>

MCO filing limits
Although none of the MCOs follow Medicaid’s filing limit guidelines, each MCO publishes its own filing limit guidelines citing that documentation will be accepted for possible review. Find these on the ISMA Web site, on the OneSource Education tool.

MCO TPL claims
Some MCOs accept Medicaid’s 90-day rule. Please refer to Chapter 5 of the IHCP Provider Manual for details on sending a claim to the following MCOs using this rule. MCOs accepting the rule are:

• Molina
• CareSource
• Harmony

Currently, MDwise and MHS do not allow physicians to utilize the 90-day rule.