Volume 63 Issue 5 – February 3, 2012
	Featured Stories New Webpage Helps Physicians Navigate Changes in Workers’ Compensation To help physicians and their practices understand and adjust to these changes, the North Carolina Medical Society (NCMS) has created a new webpage, Workers’ Comp: Information for Physicians. Continue reading » What You Need to Know about Medical Audits The Physicians Advocacy Institute (PAI), in collaboration with NCMS and other state medical associations, has developed a new resource to help physicians avoid and respond to audits and financial reviews conducted by Medicare, Medicaid and private payers. Continue reading » CMS to Continue Current Policy Not to Extend EMTALA to Inpatients The Centers for Medicare and Medicaid Services (CMS) says it will continue its current policy that the Emergency Medical Treatment and Labor Act (EMTALA) does not extend to inpatients or to the transfer of inpatients to hospitals with specialized capabilities. Continue reading » In This Issue YouTube Videos Call for Permanent SGR Fix, Not More Patches What you Need to Know About the 2012 Medicare eRx Program NCMS Foundation to Hold Meaningful Use Webinar for Specialists NCMS Member Resource Center FAQ of the Week: Cash Clinics State Health Directors Honor NCHA President Physician Groups Push to Strengthen NC’s Indoor Tanning Law Keep Your Heart Healthy for American Heart Month DPH: Norovirus Infections Spreading Widely Across North Carolina In the News This Week… Learning Opportunities Center NCMS Due Deductibility Statement

	Meetings & Events 02/04/2012 NCSEPS 2012 CODEquest Coding College – REGISTRATION CLOSED! more info » 02/08/2012 Webinar: Blue Quality Physicians Program and Patient Centered Medical Home more info » 02/14/2012 Continuing Care of Congestive Heart Failure more info » Contact Info Address: PO Box 27167 Raleigh, NC 27611 Phone: 1.919.833.3836 1.800.722.1350 (NC only) Fax: 1.919.833.2023 FAX

© North Carolina Medical Society. All rights reserved.

Make the NCMS Workers’ Comp webpage your source for the latest news and resources as the NCMS Workers’ Compensation Task Force continues its long-standing mission to improve how doctors of all specialties treat injured workers and interact with the workers’ compensation system. NCMS Past President Richard Bruch, MD, chairs the Task Force, and Keith Kittelberger, MD, serves as Vice Chair.

The NCMS played a key role in the negotiations that led to the enactment of HB 709 – Protect and Put North Carolina Back to Work. This workers’ comp reform bill addressed many issues important to physicians, such as second opinions, independent medical exams, and access to medical information by employers. The law also directed the Industrial Commission to adopt rules that will require electronic billing and payment, standardize the medical documentation that accompanies claims to carriers, and require carriers to accept 5010 transactions and ICD-10 diagnosis codes.

NCMS members may contact the Member Resource Center with questions about workers’ compensation at kfreeman@ncmedsoc.org or by calling 800-722-1350.

See related Bulletin articles:

NC Industrial Commission Delivers on E-Billing and Electronic Payment in Workers Comp (6-17-11)

NCMS Efforts to Secure E-Billing Mandate in Workers’ Comp Gets National Attention (11-4-11)

“This is an important member benefit that will help physicians to prepare for the challenges they face from the business side of their practices,” NCMS EVP, CEO Robert W. Seligson said. “Understanding the types of audits and how to respond to them helps practices to better identify and correct errors in billing and coding, as well revealing when auditors might err in their findings.” Mr. Seligson serves as president of the PAI.

This white paper is available on the NCMS Fraud and Abuse webpage, where you will find other helpful resources covering Medicare and Medicaid audits. The principle author of the paper is Mr. Frank Cohen, a renowned expert in health care analytics and data mining, and a consultant to physicians and medical associations nationwide.

The NCMS is a signatory member of the PAI, which was formed in 2006 as a result of class action settlements with major national health insurers. Even though most of the settlement agreements have expired, the PAI continues to develop projects and tools that guarantee the viability of physician practices and the ability of physicians to deliver quality patient care. Read more about PAI at http://www.hmosettlements.com/.

When CMS published an Advanced Notice of Proposed Rulemaking on EMTALA [CMS-1350-ANPRM] on December 23, 2010, it indicated it was reconsidering the current policy which provides that:

1. a hospital’s EMTALA obligation ends upon the admission of a patient as an inpatient; and
2. EMTALA does not apply to the transfer of inpatient to a hospital with specialized capabilities.

The AMA submitted comments that strongly objected to the extension. The organization said that physicians are already bound by a host of legal and ethical obligations to provide necessary patient care, and take those obligations seriously. The AMA also asserted that EMTALA obligations often result in over-utilization of physician resources, uncompensated care, and administrative hurdles.

Physicians may submit comments electronically to http://www.regulations.gov/, or by regular mail to:

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS—1350—NC

P.O. Box 8013

Baltimore, MD 21244-8013

Comments must be received no later than 5:00 pm Eastern Time on April 2, 2012.

The videos—one geared toward Congress and the other toward seniors—warn that temporary patches to the SGR threaten access to care and choice of physician for seniors while increasing the taxpayer burden. The Congressional Budget Office has estimated that it will cost $298 billion to fix the SGR, with the cost continuing to rise as long as Congress continues to apply only temporary patches. The AMA projects that the cost will rise to $320 billion if Congress does not act in 2012.

As reported in the Bulletin last week, the NCMS has joined other physician organizations in calling on Congress to repeal the SGR by using excesses from Overseas Contingency Operations (no longer needed for wars in Iraq and Afghanistan). See Physician Organizations Propose Offset for Congress to Repeal SGR.

NCMS urges you to please take a moment to send an e-mail to your Senators and Congressman to let them know that it is time to fix the broken SGR. We need a permanent fix.

CapWiz call for action here. Contact your legislators today.

• Providers who plan to participate in the Medicare eRx program must report the G8553 code with any billing code on a minimum of 10 encounters, beginning from Saturday, January 1, 2012, through Saturday, June 30, 2012. This information can only be submitted via Medicare claims. The penalty for not participating in e-prescribing is a 1.5 percent payment adjustment.
  
• Providers who would like to receive the Medicare eRx incentive must submit a minimum of 25 encounters, beginning from Saturday, January 1, 2012, through Monday, December 31, 2012. This information should also be submitted via claims and using the G8553 code.  Participating in this incentive will exempt providers from any 2014 payment adjustments. The 2012 incentive payment will be 1 percent.
• If for some reason a provider is not going to participate in the Medicare eRx program, they have until Saturday, June 30, 2012, to submit a hardship exemption. There will be four hardship exemptions for 2012.

Medicare has been offering eRx incentives for a few years now. If you begin e-prescribing, instead of getting penalties you will receive rewards. Questions or concerns regarding the Medicare eRx Program can be directed to Terri Gonzalez (tgonzalez@ncmedsoc.org), NCMSF Practice Technical Assistance Coordinator, or Kristin Freeman (kfreeman@ncmedsoc.org), Member Resource Center Coordinator, at (919) 833-3836.

Please join the North Carolina Medical Society Foundation for a webinar on Wednesday, February 22, 2012, 12:00 – 1:00 pm, which will provide an overview of the Meaningful Use Requirements for Centers for Medicare and Medicaid Services (CMS) Electronic Health Records (EHR) incentive payments pertaining to Specialists. The webinar is free, but registration is required. The deadline to register is Monday, February 20, 2012.

The NCMS recommends that practices register for CMS’ Meaningful Use Incentives as well as North Carolina Medicaid incentives, if they have not done so already.

Click here to register for the webinar. Questions can be directed to Terri Gonzalez, NCMSF Practice Technical Assistance Coordinator, at (919) 865-5251 or tgonzalez@ncmedsoc.org.

Q: My practice is looking to open a cash clinic. Does the NCMS offer any resources to help with this process?

A: Yes, the North Carolina Medical Society offers resources to physicians who are looking to open a cash clinic. Franklin Walker, NCMS Foundation Director of Programs and Practice Management, can assist your practice with any practice management needs, including opening a cash clinic. For further assistance contact Franklin at (800) 722-1350 or fwalker@ncmedsoc.org.

You can also contact Physician Care Direct (PCD), a partner of the NCMS, who can help your practice transition to and provide cash-only services to your patients. For more information about the services offered by PCD, call (919) 729-5594.

You can also refer to the American Medical Association (AMA)’s “Cash practice alternative: Considerations for physicians,” for additional information.

Have a question? Contact the NCMS Member Resource Center at (919) 833-3836 or kfreeman@ncmedsoc.org.

William Pully

“Bill is well deserving of this prestigious recognition for his leadership in helping create a statewide disease event tracking system and the Public Health and Hospital Collaborative,” NCMS EVP, CEO Robert W. Seligson said. “These advancements contribute greatly to the quality of care given our citizens and to the public health of our great state.” 

The Collaborative is a public-private partnership between the Division of Public Health, NCHA, the NC Institute for Public Health and the NC Center for Health Quality that has developed standards for community health assessments as required for non-profit hospitals by the federal health care reform law and the Public Health Exchange.

Pully, a Rocky Mount native began his career with NCHA as director of government relations. He became president of the association in 1999.

Speaking for the NCDA were David Ollila, MD, Professor of Surgery at UNC-Chapel Hill and Co-Director of the UNC Melanoma Program; and Craig Burkhart, MD, Assistant Professor of Pediatric Dermatology at UNC-Chapel Hill. Also providing supporting statements were Amy Whited on behalf of the NC Medical Society and Christine Weason for the American Cancer Society.

Some of the key points in the NCDA’s testimony included:

• The science is clear: there are no health benefits from tanning beds that cannot be obtained more safely and without the risk of skin cancer.
• There are safe alternatives to tanning beds that many tanning bed operators are already offering.
• UV radiation in tanning booths can be up to 15 times greater than the sun.
• Every visit to a tanning bed increases the odds of developing melanoma.
• Melanoma incidence is rising at alarming rates.
• Melanoma ranks second among all cancers in years of productive life lost.
• Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for adolescents and young adults 15-29 years old.
• Melanoma is increasing faster in females 15-29 years old than males in the same age group.
• Even minimal exposure to UV radiation from tanning beds before the age of 35 can increase the risk of developing melanoma by 75 percent.
  [IARC. International Journal of Cancer: 2006 March 1;120:1116-1122.]
• A person who has used tanning devices for more than 50 hours, 100 sessions, or 10 or more years is 2.5 to 3 times more likely to develop melanoma than a person who has never tanned indoors.
  [Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM.  Indoor tanning and risk of melanoma: a case-control study in a highly exposed population. Cancer Epidemiol Prev 2010;19:1557-68.]
• North Carolina laws currently protect children’s health by restricting their access to: 
        -Tobacco         -Alcohol         -OTC medications
• The estimated total direct cost associated with the treatment of melanoma in 2010 was $2.36 billion
• Protecting children from tanning beds will save lives and millions of dollars in avoidable health care costs

The indoor tanning industry was represented by a paid consultant, Mr. Lee Feldman, who asserted that the research on indoor tanning was of poor quality and that the science is inconclusive. 

Following deliberation, the committee voted to send a recommendation to the full Child Fatality Task Force that it should support an increase on the age limit for indoor tanning from 14 to 18 years of age. The Task Force is scheduled to take up this issue at the April 16 meeting.

Questions about the indoor tanning issue may be directed to Alan Skipper, Director of Speciality Society and Meeting Services, at askipper@ncmedsoc.org.

On Wednesday, February 1, 2012, CBS News reported that a new congressional report accused tanning salons of lying to customers just to get their business. Click here to view Probe: Tanning Salons Lure Teens with Lies, by Correspondent Nancy Cordes.

Several ways to do this includes encouraging healthy eating, consistent exercising and to promote an overall healthy lifestyle. You can also participate in the Department of Health and Human Services’ (DHHS) Million Hearts™ campaign. This national initiative strives to prevent 1 million heart attacks and strokes in the United States over the next five years. For those who are interested in participating in the campaign, simply follow the link above, and find out what you need to do to become a partner. Partners of the campaign help spread awareness, make sure those with high cardiac risk are receiving appropriate treatment, promote healthy diet and physical activity, and support smoke-free environments to reduce current and future cardiac risk.

Please do your part and spread the word about this campaign. Together we can make North Carolina, and the rest of the United States, a healthier place to live. The Million Hearts™ campaign is co-led by Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC).

“The most important message we have right now is that people who are ill with vomiting or diarrhea should not work, go to school or attend daycare while they are having symptoms,” said State Epidemiologist Megan Davies, MD. “Everyone needs to wash their hands frequently and thoroughly with soap and water. This is the most effective way to protect yourself and others against norovirus since hand sanitizers alone are not as effective against this hardy virus.”

People with norovirus are contagious from the moment they begin feeling sick until at least three days after they recover. Dr. Davies says some people may be contagious for an even longer period. Dehydration can occur rapidly and may require medical treatment or hospitalization.

Noroviruses are easily transmitted by touching a contaminated surface as well as by direct contact or by eating food or drinking liquids that have been contaminated with the virus, according to a news release issued by the NC Department of Health and Human Services. Noroviruses are notoriously difficult to kill with normal cleaning and disinfecting procedures. Symptoms include nausea, vomiting, diarrhea and stomach cramping. Some people may have fever, chills, headache, muscle aches and a general sense of tiredness.

For more information on norovirus and precautions to minimize its spread, go to http://www.ncpublichealth.com/.

A doctor’s eye view of health care consolidation: Part 2, 1-30-12, Triangle Business Journal

Writer Jason deBruyn examines the recent trend of Triangle physician practices joining with larger networks in a 2-part article.

Unhealthy cuts in medical research, 1-31-12, The News and Observer

An op-ed by NCMS member Nancy C. Andrews, MD, Dean of the Duke University School of Medicine and Vice Chancellor for Academic Affairs, on the impact of mandatory budget cuts on medical research.

Health Costs, Regardless of Your Politics, 1-29-12, The New York Times

Five letters to the editor from physicians and other health care professionals responding to an op-ed by former White House advisor Ezekiel J. Emanuel, MD, What We Give Up for Health Care, 1-21-12, The New York Times.

Blues plans form subsidiary to handle expected boost in insurance claims, 1-26-12, American Medical News

Writer Emily Berry reports on Blue Cross and Blue Shield of North Carolina partnering with Blue Cross and Blue Shield of Kansas to create a new company to meet an expected increase in insured patients once health care reform is in place in 2014.

Health system weighs offers, 2-1-12, Smithfield Herald

Writer Colin Campbell reports that seven health-care companies are seeking to partner with Johnston County’s hospital system.

Talking about hospitals, 1-31-12, The News and Observer

An editorial about the ongoing debate over whether the state should sell Raleigh’s Rex Hospital to competitor WakeMed.

Medicare makes changes for 2012, 1-30-12, The News and Observer

A reprint of an article first published by the Burlington Times-News.

NC Neurological Society Annual Meeting, will be held on Friday, February 17, 2012 — Saturday, February 18, 2012, at the Grandover Resort and Conference Center, Greensboro. The meeting is designed for practicing neurologists and physician extenders in neurology practices. Attendees will be able to increase their knowledge and improve their diagnosis and treatment skills for illnesses such as headaches, movement disorders, stroke, Multiple Sclerosis (MS), and mitochondrial disorders. Medicare regulations that pertain to the practice of neurology will also be discussed. A maximum of 7.0 AMA PRA Category 1 Credits™ can be earned. Click here for more information and to register. Questions can be directed to Nancy Lowe, NCMS Associate Director Specialty Society and Meeting Services, at (919) 833-3836 or nlowe@ncmedsoc.org.

Quality Improvement 101 – A Toolbox for Improvement Wave 10, which addresses planning and implementing improvement, will be offered by Charlotte AHEC on Tuesday, February 21, and Wednesday, February 22, 2012 (Workshop 1). This professional development program includes four on-site workshops in February and June which allows participants to build skills and knowledge in quality improvement. By attending, participating hospital teams, clinical practices, AHEC regional offices, and other healthcare organizations can accelerate the application of quality improvement methods. The textbook “The Improvement Guide” by Gerald J. Langley et al., (2009), and both breakfast and lunch for each workshop is included in the registration fee. For more information contact Mary Webster at (704) 512-6545 or click here to register.

The American College of Physicians (ACP) North Carolina Chapter 2012 Scientific Session will be held Friday, February 24 – Saturday, February 25, 2012, at the Grandover Resort and Conference Center, Greensboro. The meeting will discuss updates in Infectious Diseases and Stroke Management, North Carolina Legislature, Advanced Directives, Management of Hepatitis C, Osteoporosis, and Patient-Centered Medical Home. Clinical skills sessions and special interest group lunch roundtables will also be available. Attendees can earn up to 10.5 AMA PRA Category 1 credits™. Click here to register. Click here for more information or contact Nancy Lowe, NCMS Associate Director Specialty Society and Meeting Services, at (919) 833-3836 or nlowe@ncmedsoc.org.

2012 NC OB/GYN Society Annual Meeting, which is sponsored by the American College of Obstetricians & Gynecologists, will be held Friday-Sunday, April 20-22, 2012, at the Embassy Suites Charlotte-Concord Golf Resort and Spa. The common conditions and concerns related to women’s health care will be addressed. Attendees can receive a maximum of 12 AMA PRA Category 1 Credits™. The registration deadline is Monday, March 19, 2012. For more information about the meeting, contact Nancy Lowe, NCMS Associate Director Specialty Society and Meeting Services, at (919) 833-3836 or nlowe@ncmedsoc.org. Click here to register.

Cracking the Codes: Coding and Billing for Influenza Virus Vaccines Across Multiple Sites, a webinar from October 2011 offered by Sanofi Pasteur, is now available for viewing at all times. The webinar features an expert-led review of coding and billing for influenza vaccination in various health care settings. Click here to view the webinar.