Welcome to 2012, what an exciting time to be in the healthcare business. There is no doubt we are at a turning point as we all weigh in on our nations quest to improve healthcare. The presidential and other elections will give us all the opportunity to voice our opinion on how we feel both personally and professionally on how our leaders are doing to improve healthcare. We are waiting and watching to see how the Supreme court will rule on the healthcare law that took effect. No matter which side of the fence you are on, 2012 is a critical year for healthcare providers and our patients
As we face 2012 I would like to share with you what MASA accomplished in 2011 and is doing in 2012 to help you remain informed. Some of our highlights for 2011 included changing up the seating to improve networking, three general membership meetings with defined and posted topics for all the breakout sessions, fly in to Washington by our members to discuss our concerns and garner support for the ASC industry, our annual education day with the addition of an extra day for materials managers. Consequently this was our largest attended educational day. Continued work on the our Workers Compensation issues and improved reimbursement for spine cases (Thank You Julie Green), we attended well coordinated meetings in Lansing with Bill Kandler to further discuss our concerns and we had many of you step up to host a senator or congressman at your facility, further strengthening our ties to those who decide our fate. The board worked hard to develop a three year strategic plan that will help MASA in the next few years meet the needs or our members and vendor members.
What's in store for 2012? We have already scheduled three general membership meetings at the Kellogg Center for March 15th, June 7th and December 13th. The board will continue their quarterly meetings to make sure we are meeting the needs of the organization. Our committees all have chairs but are always looking for volunteers, it is a great way to get involved. In order to help maintain our fiscal responsibilities we have signed contracts for our Educational day for 2012 and 2013. To keep it fresh our 2012 program will be at the Soaring Eagle in Mt Pleasant on October 24-26 and 2013 will be in Traverse City in October. When investigating the best venue we found Grand Rapids to be the most expensive with no ability to negotiate costs. We also investigated Frankenmuth but they did not have enough space to accommodate us. We plan on again offering a two day program. Day one will be for clinical and materials management and day two will be our usual format. The group working on developing a purchasing alliance has been busy meeting and details will be forthcoming on our website. We will again solicit feedback from our vendor members on how to enhance their vendor experience within MASA. As you know we could not exist without the unwavering support of our vendor members. Thank you vendor members!
This is just a quick snapshot of what we have planned for 2012. I encourage all of you to become active in MASA in some way. We would love to tap into all the talent we know we have out there. Finally, as debates rage in Washington about healthcare reforms and where we are going in 2012, our ASC's are already exceeding the bar on so many quality levels. We already know what is important--our Patients-- and we all work hard everyday to ensure each patient who visits us receives high quality personalized care. We know this is not a new trend but rather commonsense; patients are the highest priority for all who provide healthcare in 2012. As ASC's we do a great job and with an organization like MASA we can only get better.
Anne Hargrave-Thomas
President, MASA
MASA Calendar of Events
General Membership Meetings
March 15, 2012 -11:00 am General Membership Meeting Kellogg Center, East Lansing, MI
June 7, 2012 -11:00 am General Membership Meeting Kellogg Center, East Lansing, MI
December 13, 2012 - 11:00 am General Membership Meeting Kellogg Center, East Lansing, MI
2012 Education Day
October 25th & 26th, 2012 Soaring Eagle Hotel, Mt. Pleasant, MI
2012 MASA Officers & Board
President
Anne Hargrave-Thomas, CEO
OakLeaf Surgical Hospital, LLC.
3430 Oakwood Mall Dr., Suite 400
Eau Claire, WI 54701
Phone: 715-831-8130
Fax: 715-831-7894
athomas@nshinc.com
1st Vice President
Rick Brochu, CEO
The Surgery Center of Genesee County
5202 Miller Road
Flint, MI 48507
Phone: 810-732-7700
Fax: 810-733-5840
richardb@surgerycenter-flint.com
2nd Vice President
Steve Corl, Administrator
Mackinaw Surgery Center
5400 Mackinaw Road, Suite 11
Saginaw, MI 48604
Phone: 989-583-5205
Fax: 989-583-5215
scorl@nueterra.org
Treasurer
Kimberly C. Andry R.T., CASC
Administrator
Great Lakes Surgical Center
26051 Lahser
Southfield, MI 48034
Phone: 248-223-9954
Fax: 248-223-9957
kandry@greatlakesasc.com
Secretary
Kris Kilgore, RN, BSN
Surgical Care Center of Michigan
750 E. Beltline, NE
Grand Rapids, MI 49525
Phone: 616-949-2600 ext. 1205
Fax: 616-954-0213
kkilgore@seeitclear.com
Immediate Past President
Jim Stilley, CEO
North West Michigan Surgery Center
4100 Park Forest Drive
Traverse City, MI 49684
Phone: (231) 392-8950
jstilley@northwestmichigansurgerycenter.com
Executive Director
Marcy Lay
CKR, Inc.
124 W. Allegan, Suite 1700
Lansing, MI 48933
Phone: 517-485-4044
Fax: 517-485-4045
laym@ckronline.com
Legislative Update
The legislature has returned from the holiday break. By Constitution, the legislature must convene at noon on the second Wednesday in January every year. Because the legislature is convened for two year periods known as "legislatures" (we are currently beginning the second year of the 96th legislature), all bills introduced last year carry over into this year. At the end of this year (an election year for the House of Representatives) all bills that have not been enacted will "die" and must be reintroduced in the 97th legislature if they are to be considered.
This being an election year for the House (the Senate and the Governor run every four years) it is likely that the legislature will recess for the campaign season early in the summer. The main responsibility that the legislature will have to address prior to departing is the enactment of a state budget for the 2013 fiscal year that begins October 1, 2012. Other issues may be considered, such as education reform and the Governor's pet project, a new international bridge over the Detroit River. However, once the several appropriation bills that constitute the state's budget are enacted, it is very likely that legislators will want to get out of Lansing in order to campaign back home.
One issue that should be of interest to MASA members will be the tax credit that the administration has proposed to fund legislation to mandate coverage for certain autism treatment. The Snyder administration has proposed offering a tax credit to health insurers to compensate for the cost of legislation the administration is pushing that would require insurers to provide payment for certain autism treatment. The proposal as it now stands would require that coverage up to $50,000 per year. Not surprisingly, insurance companies have balked at the cost. In response, the administration has proposed offering a credit to insurers against the recently enacted health insurance claims tax. This is a 1% tax assessed on all health insurance claims paid.
Why is this of interest to MASA members? Many of you will recall the several year battle to force Medicaid to pay facilities for procedures performed at ASC's. Even though we were ultimately successful, most facilities are not thrilled with the rate at which ASC's are paid for Medicaid procedures. There are never enough Medicaid dollars to go around. The State has argued that it cannot pay more. The claims tax that the legislature enacted last year was to provide badly needed dollars to match for federal Medicaid funds. Now the Snyder Administration is proposing to take some of those dollars out of the Medicaid funding stream and use them as a tax credit to fund the autism mandate.
Recall that Michigan is currently receiving approximately $2.00 in federal match for every state dollar it puts up. In order to meet Michigan's projected case load every year, the state has to scramble to come up with sufficient dollars for the match. That is the reason the health insurance claims tax was implemented. The odd thing about using the claims tax revenue for a tax credit is that for every dollar of credit granted to health insurers, Medicaid will lose $3.00. That should be of concern to all health care providers.
We will all want to keep our eye on this one.
Bill Kandler
Cusmano, Kandler & Reed
MASA Feature Article
A Strategy for Refinancing Your Debt
We recently completed the refinancing of our debt (building) in the past couple of days. What a cumbersome, time consuming, and gratifying experience. If you need to refinance in the near future, here a few bits of advice that resulted in an incredible mortgage that has our surgeon owners smiling from ear to ear.
1. Start early - we began the process to refinance our loans six months prior to our closing date. Each bankengaged in discussions, advised us that this is the number one mistake of most mortgagors. Not enough time. Start early it gives you time to negotiate and execute a great deal.
2. Engage multiple banks - we started out the bid process with six banks. All came highly recommended by our physician owners, and each was anxious to do business with us. Let the banks know who they are competing with. Competition leads to great deals. Bankers hate to lose to the branch down the street.
3. Communicate your debt-reduction strategy - make sure you are clearly communicating your strategy to the banks. They are more receptive to working with you and structuring a deal, if they are confident that you have a plan. In our case, we were very clear that we wanted this to be our last refinance. We advised them of what we could afford in terms of a monthly payment, and the time horizon. If you are clear what your goals are, they will work hard for your business. Loaning money to you is a risk for them, so give them confidence you know your stuff.
4. Schedule a final bid proposal - we narrowed our original six banks down to three for final bid proposals. We gave each of them a format to follow, which would give us the information we needed to make a decision. We only allowed them 20 minutes to present, which also included Q & A. Although they like more time, this puts you in control. The three banks came prepared and gave precise details of the proposed refinance package. We had our accountant and three board members present. The final result was a package, we could not have imagined, just two months earlier.
If you are in the process of refinancing your debt, your timing couldn't be better. These are historic times in the lending business. The interest rate and terms we agreed to this week were incredible, and as I mentioned our surgeon owners are ecstatic. In fact, many of them are now using our refinance template for their own practice.
Rick Brochu
CEO
The Surgery Center of Genesee County
Committee Updates
MEMBERSHIP
Margaret Acker- Chair
Harry Petaway- Member
Cindy Collison-Mis- Member
Ken Hammer- Member
Rick Brochu- Member/Board Liaison
Marcy Lay- Board Liaison
In early 2011, the Membership Committee began the task of marketing and recruiting members for MASA. Initially, we called each and every non-member ASC (or alleged ASC) in the state, and followed up with a letter and an invitation to join us for a Member's meeting.
Early on, we realized there were some obstacles for vendor members. The Board of Directors developed and approved a four-tier level of membership for vendors, effective in 2012. These associate memberships allow all facilities to partner with vendors who support MASA.
Our membership has increased significantly! We are very much interested in continued growth. Please help us market MASA to your vendors or ASC peers. The Committee will be delighted to follow up on all Member recommendations. Please e-mail Margaret atackermg@trinity-health.org.
EDUCATION
Educational Days will be held at the Soaring Eagle this year.
We are currently looking for speakers for topics on Administration, Clinical, Materials Management, Coding/Billing and Business Office Management.
If you have a great topic or suggestion please contact Marcy Lay atlaym@ckronline.com.
PAYER UPDATES
Business Office Managers News Brief
Preparing for the ICD-10 Transition
In weathering the electronic changeover to version 5010 for electronic claims, know that 5010 is the first step toward implementing the long-anticipated and somewhat dreaded ICD-10 codes. Ready or not, CMS is staying firm with the ICD-10 compliance date of October 1, 2013.With adequate preparations, we can all be prepared once ICD-10 is here.
To that end MASA has formed a workgroup to assist members in their ICD-10 transition, which should include assessmentsand possible modification in several areas, such as:
IT - Billing/practice management software, clearinghouses.
Clinical-Educating physiciansso that documentation supports the increased level of code specificity. Case in point, ICD-10 diagnosis codes call for greater detail. There is even the belief that "education and physician adoption components will overshadow the IT challenges in complexity." [From http://fortherecordmag.com/archives/011612p8.shtml]
Operational - Coder training; this should include education focusing on anatomy and physiology, in order to accommodate the increased specificity of ICD-10
Financial- Budget for implementation costs, much of which is training and support-related, but this could also be time to consider the investment in an encoder or computer-assisted coding software, as coder productivity will decrease. It has also been recommended to plan for an interruption in accounts receivables, as there may be payer, software or clearinghouse caveats that cannot be foreseen.
Thankfully, CMS hasFREEtools available to us. ICD-10 Implementation Handbooks areavailable on the CMS ICD-10 website:https://www.cms.gov/ICD10/02b_Latest_News.asp. Most useful for many ASCs may be the step-by-step plans for Large Provider Practices.
CMS' "FAQs: ICD-10 Transition Basics" states:
Providers can begin to prepare by taking the following steps:
Talk with your billing service, clearinghouse, or practice management software vendor NOW
Identify ICD-9 (and presumably ICD-10) touch points in your systems and business processes
Identify needs and resources, such as training, printing, etc.
An ICD-10 transition plan should take into account specific practice or organization needs, vendor readiness, and staff knowledge and training.
Providers should check with their billing service, clearinghouse, or practice management software vendor about their readiness plans.
The MASA ICD-10 workgroup plans to progressively offer useful ICD-10 transition tools to our members. Please don't hesitate to share your needs or suggestions with:
By now, most ASCs are well aware of the Quality Reporting requirements from CMS that are on the horizon. Here is a brief overview (for more information go to ascassociation.org/ascquality reporting).
The Centers for Medicare and Medicaid have established measures that ASCs will be required to report on or face a reduction in Medicare payments. Beginning on October 1, 2012, the five required measures for reporting are:
Additionally, in 2013 ASC's will also report on the use of a Safe Surgery Checklist in 2012, and volume of certain procedures.
To avoid financial reductions, ASC's will need to report that they have had a safe surgery checklist in place as of January 1, 2012.
For reporting on items 1 - 5 above, if a facility does not submit the required reporting data beginning on 10/01/12, they will face a 2% reduction in the 2014 ASC conversion factor. This poses a challenge for ASCs everywhere. Coordination between clinical, administration and business office staff will be critical. MASA would like to support our members in meeting the requirements and welcome any suggestions or feedback that you may have. Please let us know how we can work together to develop a shared knowledge base that can benefit every facility.
Upcoming membership meeting's will take place March 15th and June 7th at the Kellogg Center in East Lansing. See you there!
Tina Piotrowski
Clinical Manager
Northwest Michigan Surgery Center
Materials Management News Brief
How much do you spend every month?
If one of your physician-owners asked you how much your ASC spends on a monthly basis on a specific specialty, would you be able to answer?
Supply costs are second only to staffing in total spend at most ASC's - which is why materials managers need to make it a point to collect and sort data if they aren't already doing so. The ability to track and trend where a facility's money is spent is an important step in identifying areas for focused cost containment. Additionally, if one specific specialty, vendor or resource group is increasing or decreasing at a dramatic rate, it might be time to re-negotiate contracts or work with physicians on shifting product use to a more cost-efficient item.In many cases, supply spend data can help shape physician expectations on which types of cases are appropriate for the ASC setting, which could have a significant impact on the bottom line.
Above and beyond the trending data for internal costing, the historical spend on a certain specialty (or CPT code, if possible) helps administrators effectively negotiate contracts with payers on the revenue side - the more data that materials managers can help present, the more likely a payer will appropriately reimburse. For 2012, make it a goal to drill down on cost for at least one of your major specialties. Work with your administrator to identify high priority areas and the next time negotiations are taking place, your ASC will be well prepared to benefit from higher reimbursements or lower supply costs.
Brett McGreaham Supply Chain Manager Northwest Michigan Surgery Center
Purchasing Alliance Group News Brief
Steps have been made to establish a MASA Purchase Alliance Group. First, volunteers formed a committee to help identify specific goals and requirements necessary to get an alliance started. Next, the committee sent out requests for proposals from several GPO's including Med Assets, Premier, and Amerinet. The committee's next steps will be to meet with each organization and learn what the structure of an alliance may look like to all members of MASA. The committee's next meeting will occur during the March MASA meeting, so stay tuned for more updates.
Jennifer Butterfield
Administrator
Lakes Surgery Center
COMMUNICATION
The communications committee is working to create an environment with "near" constant contact capabilities. The goal is to let you, the members, decide which communication porthole (web, email, telcon, etc.) you wish to access to get updates on MASA issues.
MASA members are working on so many varied projects and committees that effective communication of what we are doing and where to find information is becoming tougher and tougher to accomplish.
A goal of the commutations committee is to create a structure/platform that allows members to post and share information in a secure membership environment that fosters sharing and openness that members will find useful. In order for this to occur we desperately need your feedback, ideas and insight into the information you are interested in asking and receiving from your peers.
This newsletter is an example of a "connected" era in MASA's development and growth as a relevant organization in your center's daily life.
Jim Stilley
CEO
Northwest Michigan Surgery Center
New Compliance Videos
MASA Members:
Wow - the OIG is getting innovative! In January, 2012, the OIG released 11 video and audio educational pieces for provider use. This is part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative. They even put the education on youtube!
To access the information you can use the following URL (note: there is an underscore between heat and modules)
or you can go to youtube and search for OIG Training Videos
The videos are on:
Tips for Implementing an Effective Compliance Plan
Compliance Program Basics
Physician Self-Referral Law
False Claims Act
Federal Anti-Kickback Guidance
OIG Guidance
Exclusion Authorities and Effects of Exclusion
Your Board is ultimately responsible for the compliance within the surgery center. These videos would be excellent to show to your staff, physicians, and your Board for routine compliance education. It is nice to see the government put out something that is both useful and could save us money on education. If using these videos for compliance education, I recommend putting together a short quiz that could be given to staff while watching the video. This is the documentation that education has taken place.
Thank You,
Julie Greene
Don't see something you'd like to read about, or have a great story/column idea? We want to know! Please send us an email with your suggestions by clickinghere.
MASA members Northwest Michigan Surgical Hospital, Lakes Surgery Center, The Eye Center of Michigan and UnaSource Surgery Center have been honored with Becker's 100 Best Places to Work in Healthcare! Go to the article!
Dear MASA Members,
I wanted to take a moment to thank the outgoing MASA board for their dedication and hard work on behalf of all the Michigan ASC's. Their time and effort on behalf of MASA is greatly appreciated. Thank you.
It has been a busy time for the incoming MASA board members. As you are aware many of us are new to the board but not new to ASC's and the issues we face as an industry. As a healthcare provider we continue to tackle the daily problems of declining reimbursement, increased expenses and poor image just to name a few. Your board is working hard to help give us all a voice on these and many other issues facing ASC's. I wanted to share with you some of what has been going on behind the scenes since January.
The board has met several times and committees have been formed. We currently have a membership, legislative, communication and education committee. The bylaws are under review so appropriate updates can be done. Once the review is completed and changes made they will go out to the membership for a vote. We held our first general meeting in East Lansing on March 10th. The meeting was well attended and the survey responses were very informative and positive. Those results will be shared at the next general membership meeting. The board is currently working on a three year strategic plan for MASA to help ensure our continued growth and success. The ASC battle for improved workers compensation reimbursement continues. Julie Greene and Bill Kandler have championed this cause on behalf of MASA. Bill will discuss our legislative initiatives later in the newsletter. Medicare at this point in time will not be decreased, however with Washington waging their own battle this may change we will keep you updated as information becomes available. Our communications committee has been busy working on new ways to keep our membership informed and as always the billers/coders have been working to keep everyone up to date with any changes. The membership committee has done a great job of increasing our MASA membership; we currently have 53 members plus 17 vendor members.
Finally, I am asking all of you, as MASA members, to get involved. This is your organization and we need your help in order to succeed. Your skills and input are critical to our survival in this changing and challenging healthcare market. As an organization we can never have enough volunteers and help.
Please consider taking an active part in MASA we really need you. If you have an interest please contact me or another MASA board member. I look forward to an exciting 2011 for MASA and the ASC industry.
Anne Hargrave-Thomas
President, MASA
MASA Calendar of Events
Member Meetings
Thursday June 16, 2011 - Kellogg Center, E. Lansing -
11am - 3pm
Thursday December 15, 2011 - Kellogg Center, E. Lansing - 11am - 3pm
2011 Education Day
November 10 & 11 - Grand Traverse Resort, Traverse City
2011 MASA Officers & Board
President
Anne Hargrave-Thomas, Administrator
Lakes Surgery Center
2300 Haggerty, Suite 1000
West Bloomfield, MI 48323
Phone: 248-896-6300
Fax: 248-896-6303
athomas@nshinc.com
1st Vice President
Rick Brochu, CEO
The Surgery Center of Genesee County
5202 Miller Road
Flint, MI 48507
Phone: 810-732-7700
Fax: 810-733-5840
richardb@surgerycenter-flint.com
2nd Vice President
Steve Corl, Administrator
Mackinaw Surgery Center
5400 Mackinaw Road, Suite 11
Saginaw, MI 48604
Phone: 989-583-5205
Fax: 989-583-5215
scorl@nueterra.org
Treasurer
Kimberly C. Andry R.T., CASC
Administrator
Great Lakes Surgical Center
26051 Lahser
Southfield, MI 48034
Phone: 248-223-9954
Fax: 248-223-9957
kandry@greatlakesasc.com
Secretary
Kris Kilgore, RN, BSN
Surgical Care Center of Michigan
750 E. Beltline, NE
Grand Rapids, MI 49525
Phone: 616-949-2600 ext. 1205
Fax: 616-954-0213
kkilgore@seeitclear.com
Immediate Past President
Jim Stilley, CEO
North West Michigan Surgery Center
4100 Park Forest Drive
Traverse City, MI 49684
Phone: (231) 392-8950
jstilley@northwestmichigansurgerycenter.com
Executive Director
Marcy Lay
CKR, Inc.
124 W. Allegan, Suite 1700
Lansing, MI 48933
Phone: 517-485-4044
Fax: 517-485-4045
laym@ckronline.com
Legislative Update
William Kandler, MASA Lobbyist
Cusmano, Kandler & Reed
The first four months of this year in Lansing have been pretty fascinating. We have seen the seating of a new legislature that is dominated by Republicans. There are 63 Republican members of the House out of a total membership of 110 and 26 Republican Senators out of 38. Republican Governor, Rick Snyder, has replaced Democrat Governor, Jennifer Granholm.
As you have no doubt read, Governor Snyder has proposed many initiatives that would drastically change the budget and tax structure in Michigan. He has submitted a budget that would result in significant cuts to Michigan's institutions of higher education and to K-12 school districts. These initiatives have generated howls of protest from some corners and praise from others. But the most striking aspect of his program is the tax policy reform initiative.
Where one stands on the governor's approach would depend on "where you sit". Looking at it from the perspective of a business, it would look pretty good. The Governor has called for the repeal of the Michigan Business Tax and wishes to replace it with a 6% corporate income tax. This change should be very good for Ambulatory Surgery Centers. Gone will be the gross receipts aspect of the tax. Overall, this change will reduce taxes paid by business by 82%. That is a reduction of $1.7 billion. In order to offset that rather large loss of revenue, the governor has proposed numerous taxes to the personal income tax act that would result in an increase of $1.5 billion paid by individuals. So, as I stated above, whether or not you like the pending new tax regime, depends on from what perspective you review it.
One very encouraging aspect of the Governor's proposed budget for fiscal year 2012 is Medicaid reimbursement rates. In spite of the cuts elsewhere, his budget keeps Medicaid payments at the current year level. While these rates are not great, the status quo is better than a cut. Even more encouraging are the Governor's remarks that one of his top priorities for future years is to increase Medicaid payments.
On behalf of MASA, your leadership and CKR have continued to pursue a more equitable fee schedule for Workers' Compensation cases. As you may recall, the Workers Compensation Agency promulgated a new fee schedule late last year that provides for payment at 130% of Medicare with no reimbursement for implants. MASA members have complained that such a payment scheme comes nowhere near covering the cost of many procedures.
In a turn of good fortune, there is a new director at the Workers' Compensation Agency. The new Director, Kevin Elsenheimer, appears to be interested in reviewing the recently implemented fee schedule. He is willing to listen to our arguments and, unlike his predecessor, is willing to consider the data we submit in support of our arguments. We have no guarantee of success but for the first time in over three years of working on this issue, we believe that data and logic will be the determining factor.
While budget and tax policy negotiations are dominating the legislative process now and into the early summer, other issues will surface soon. I will keep you posted on issues of concern to MASA.
MASA Feature Article
Amy K. Fehn
Wachler & Associates, P.C.
Waiving Patient Co-payments under the Michigan False Claims Act.
The relevant law in Michigan that creates risk for providers with regard to waiver of out of network copayments/sanctions is the Michigan False Claims Act. Some insurance companies have taken the position that a waiver of the patient's responsibility can result in a "false statement" to the insurance company because the discount is not reflected on the bill presented to the insurer. For example, some third party payors could take the position that if the actual charge of the service is reported as $100 and the co-payment is $20, and then waiving the co-payment will result in an actual charge of only $80.
The Michigan False Claims Act provides as follows:
§ 752.1003. False claims, statements, or representations; violation as separate offense; liability of health facility or agency; concealing or failing to disclose certain events; violation of section as felony; penalty; section inapplicable to application for coverage.
Sec. 3:
(1) A person shall not make or present or cause to be made or presented to a health care corporation or health care insurer a claim for payment of health care benefits knowing the claim to be false.
(2) A person shall not make or present or cause to be made or presented to a health care corporation or health care insurer a claim for payment of health care benefits which he or she knows falsely represents that the goods or services were medically necessary in accordance with professionally accepted standards. Each claim which violates this subsection shall constitute a separate offense. A health facility or agency shall not be liable under this subsection unless the health facility or agency, pursuant to a conspiracy, combination, or collusion with a physician or other provider, falsely represents the medical necessity of the particular goods or services for which the claim was made.
(3) A person shall not knowingly make or cause to be made a false statement or false representation of a material fact to a health care corporation or health care insurer for use in determining rights to health care benefits. Each claim which violates this subsection shall constitute a separate violation.
(4) A person who, having knowledge of the occurrence of an event affecting his or her initial or continued right to receive a health care benefit, or the continued right of any other person on whose behalf he or she has applied for or is receiving a health care benefit, shall not conceal or fail to disclose that event with intent to obtain a health care benefit to which the person or any other person is not entitled, or to obtain a health care benefit in an amount greater than that to which the person or any other person is entitled.
(5) A person who violates this section is guilty of a felony punishable by imprisonment for not more than 4 years, or by a fine of not more than $50,000.00, or both.
(6) This section does not apply to statements made on an application for coverage under a certificate or policy of insurance issued by a health care insurer or coverage under a certificate issued by a health care corporation. One way to minimize the ability of a payor to take the position that a waiver of out of network copayment or sanction is a "false claim" is to indicate on the face of the claim that the copayment/sanction will not be collected. In this manner, the provider has made full disclosure of its policy regarding waivers of out of network copayments/sanctions.
Providers should also be aware that there may be additional considerations where Medicare Part C claims are at issue.
Committee Updates
Membership
The MASA Membership Committee (MMC) as is off to a fast and productive start for 2011. The MMC is comprised of a combination of facility and vendor members which include:
· Margaret Acker- Chair
· Harry Petaway- Member
· Cindy Collison-Mis- Member
· Ken Hammer- Member
· Rick Brochu- Member/Board Liaison
· Marcy Lay- Board Liaison
The Membership Committee serves to represent and monitor the needs of the membership and ensure a vital membership organization. Working closely with the Executive Director the committee works to develop strategies to enhance the membership for both the general and vendor memberships. Additionally, the committee will develop and implement strategies to retain and recruit facility and
vendor members.
The MMC kicked off the year authoring a letter to 53 non-members. This initial contact focused on the networking and peer to peer breakout sessions that have become the showcase of our general sessions. Shortly following; Chair Margaret Acker of Southwest Surgery Center and vendor member Harry Petaway from AmkaiSolutions presented "Building Professional Relationships". The content was
well received and was a refreshing reminder of the critical role communication plays in a productive work environment
The MMC has been initiating phone calls and updating contact information for non-member facilities and vendors.
Preliminary discussions have begun in an effort to establish tiered vendor membership levels providing more value to vendors that support MASA.
The MMC is also asking for your help to strengthen our facility membership. Please contact us if you know of a non-member center or vendor that would like to attend the June meeting as our invited guest. A personal invitation will be sent. We hope that this personal approach will help provide an
opportunity to showcase all the benefits we have to offer.
Education
Billing/Coding Committee News Brief
June 16 Breakout Educational Session for Billers and Coders Transitioning to ICD-10-CM
Regina Glenn, PhD, RHIA, CCS, HIM Program Director, Davenport College - Lettinga and Holland Campus, will join the Biller and Coder breakout session to present an Introduction to ICD-10 during at the June 16 General MASA meeting. Ms. Glenn's presentation will be geared toward both coding and billing staff. This educational opportunity will be provided at no additional cost to meeting attendees. An abbreviated open forum session will follow the presentation.
Note that ICD-10-CM will be replacing ICD-9-CM as the diagnostic coding system used for health care claims effective October 1, 2013. This will be a significant change for the health
care industry. Has your organization begun to prepare for this transition? A very crucial step is adequate training of coding and billing staff. Ensure your organization is prepared
for ICD-10. Inform your coding and billing staff of this opportunity and encourage them to attend.
PAYER UPDATES
BCBSM Implementing Medical Necessity for "Cosmetic" Procedures
Effective August 1, 2011, BCBSM will implement medical policy changes, which will standardize medical necessity criteria for procedures that could possibly be considered cosmetic. This will pertain to most contract groups, with the exception of UAW Retiree FEP groups. Some procedures included in this policy are blepharoplasty and repair of brow ptosis; rhinoplasty; otoplasty; and breast procedures, such as augmentation, removal and insertion of breast implants. For complete information, refer to May 2011 The Record article "Medical Policy Changes for Some Procedure codes Viewed as Cosmetic."
HAP Plans APC Methodology Transition in 2012
MASA has been informed that Health Alliance Plan will make the transition from the 2007 Medicare Groups to Medicare APC Methodology in 2012. The anticipated implementation date for ASC claims is January 1, 2012. Expect provider contract amendments as part of this transition.
Updated BCN Fee Schedule Effective January 1, 2011
Are your Blue Care Network claims being paid correctly? With some exceptions, claims should generally be paid at 90.01% of BCBSM rates. Contact your Provider Representative to obtain a current copy of the commercial fee schedule.
Business Office Managers News Brief
The Business Office Manager breakout is a success! Our first meeting was little over a year ago and since then, attendance and interest has increased. The BOM breakout gives everyone the opportunity to present areas of interest, share in open discussion, problem solve and learn from others experience.
We are in the process of scheduling speakers for our MASA Education Day, November 10 & 11, 2011. Please share issues/topics that would be of interest to you for these breakout sessions. You may email them tomherweyer@northwestmichigansurgerycenter.comor bring them to our June 16th meeting in Lansing.
Clinical Committee News Brief
At the March 10, 2011 meeting, John May from Medline presented the Medline Hand Hygiene Program for Surgery Centers. The clinical education committee members are: Kris Kilgore, Grand Rapids Ophthalmology Surgical Care Center and Tina Piotrowski, Northwest Michigan Surgery Center. In order to serve you better, we welcome and encourage input on what topics you would like to have presented at the MASA breakout sessions and the Fall Education Day. A member survey was sent out in February and your feedback is much appreciated. If you have not completed a survey, please contact Marcy Lay.
As Chair of the Clinical Education Committee: our mission is to evaluate the needs of the MASA membership and develop an educational strategy (CME/non CME activities) designed to promote ongoing learning and the development of best practices in the ambulatory health care environment in Michigan.
We look forward to a great year of networking, education and growth. Thank you for your continued support of MASA!
Materials Manager News Brief
At the MASA June16th meeting, the Materials Managers will have Jeff Wagner speaking on behalf of MAHRMM (Michigan Association for Healthcare Resources & Materials Management). Jeff can explain and share information about the CMRP (Certified Materials and Resource Professionals) testing, membership dues and many other questions you may have.
Communications
The Communications Committee was formed by the MASA Board in late 2010 in an effort to develop a group that would oversee the enhancement of both the MASA brand and the level of communications that our membership receives. The committee began meeting in early 1Q 2011 and quickly identified three key objectives for the year to fulfill the board's directive. By the end of 2011, the communications committee is dedicated to delivering the following:
· A new MASA brand and brand guidelines
· A new MASA website based on best practice examples from the ASC industry
· Regular and more accessible communications through a managed member email database
This newsletter, in its new format is an example of how we are striving to improve the communications from MASA in order to provide you, our member, with relevant information that builds value for your membership.
In the coming months, you will begin to see the results of the Communications Committee's work. We are excited to be part of this improvement to MASA's offerings and always welcome your feedback. The 2011 Communications Committee members are:
· Jim Stilley; CEO - Northwest Michigan Surgery Center
· Andrew Jacobs; A/R, A/P & Marketing - Lakes Surgery Center
· Kim Andry; Great Lakes Surgery Center
· Drew Dungan; Director of Sales & Marketing - SurgiScreen
Memorial Day Breakfast
MASA Members:
As many of you are aware Senator Pappageorge has been a staunch advocate for ASC's in our battle with Workers Compensation reimbursement. MASA membership has been asked by Senator Pappageorge to help fund a breakfast for participants (soldiers and families of fallen soldiers) in the Senate's Memorial Day Service. This is a tradition that has been carried out for the past 17 years.
The total amount requested is $250.00 toward the breakfast. I am asking each of our centers to consider a
donation toward the requested $250.00. This is not a political contribution so it can be made from corporate
funds. We will need to receive all donations by May 20th.
I can think of no better way to honor our servicemen and women on Memorial Day and acknowledge the help
we have all received from Senator Pappageorge's efforts on our behalf.
Please consider a donation to this worthwhile event.
Please make checks payable to: COB Fund - send any donations to Marcy Lay at 124 W. Allegan, Suite
1700, Lansing, MI 48933. I have attached a W-9 for your assistance from COB.
Thank you, Anne Hargrave-Thomas MASA President
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