verden group

The PCC Users' Conference is official for 2010.  Go ahead, sign up...I just really looked at the course schedule myself for the first time and it's amazing.  There will be some speakers from the AAP itself in addition to the typical cornucopia of amazing pediatric practice management knowledge. [I hope to announce a SOAPM-related surprise, as well.]

Ghana was...hard to describe.  Did I "enjoy" my trip?  Not really.  Did I have a "good time?"  That's not what I'd call it.  Would I do it again?  Definitely (with a caveat of needing family support).  It was an overwhelming, rewarding experience that I was priveleged to contribute to, in my meager way. 

I hope to have a photo-essay up soon, but here's an amazing result from the trip.

As I fall further behind with my blog postings, I must point to two recent additions to the on-line world (well, OK, three):

I was paging through my daily Verden Alerts and I noticed that Harvard Pilgrim had released a new set of payment policies regarding E&M codes.  In fact, you can read it here on their WWW site, Verden just makes this a lot easier.  I suspect that most of you are like me and wouldn't normally take more than a second or two to go th

Igor and I have been doing some behind-the-curtain work to examine the impact of the recession on our clients.  So far, the news is generally positive for PCC customers, but there are some signs on the horizon - or on the front page of your newspaper - that we need to keep an eye on.

Recently, Susanne Madden predicted that the payers were going to start making “administrative” changes in the face of the economic downturn.  Well, if these two examples from the last 24 hours are any indication, we’re in for a rough ride.

So, the furnace broke some time last night, just in time for our
first real snow.  As I waited at home for the repair guy to arrive (his
truck broke down on the way), I’ve had to be on the phone with my neck
scrunched for the last hour.  Which means no great updates to the blog
when I have some pretty awesome stuff to share.  So, I’ll just play catch up and then we’ll get back to RVUs for a bit, immunization purchasing organizations, etc.

Things I want to share with the world in the meantime:

While I work on some cool RVU research, enjoy this in-depth interview with Susanne Madden over on HISTalk. Note her specific comments about pediatricians!  It’s worth the 10 minutes, really.

It’s late on a Sunday night and my brain is fried from a bad combination of Drupal, planning for Bear Scouts, watching a messed up (but excellent) movie, working on our bathroom for the second year (almost done!), and wanting to blog about a really super-cool benchmark Igor and I have been working on, but I can’t handle the pressure.

Yes, I'm breaking my promise to post the appeal letter today. However, that's not the promise for which today's entry is titled. Something more important needs to be communicated.

I've written many times about Susanne Madden and her Verden Alerts. Why the world hasn't pounded down her door and signed up for her service is beyond me. Fortunately, in her own version of herd immunity, Susanne sometimes makes important information available to us all for free. Below, please find an update about some recent UHC payment/policy changes that will affect any pediatrician who participates with them.

Thank you, Susanne. The rest of you: start your engines. [Note that the Synagis change may even be retroactive.]

For those of you that are not Verden Alert subscribers, I wanted to make you aware of a couple of UHC policy changes that will affect Pediatrics:

Please note that 1. is titled After Hours and Weekend Care but only addresses services provided on an emergency basis . . .

1. After Hours and Weekend Care Policy

Under the current UnitedHealthcare policy for reimbursement of services provided in the office on an emergency basis, CPT code 99058 is reimbursed in certain places of service when reported with basic service codes. This CPT code has a status of 'B" (bundled into payment for other services not specified) on the National Physician Fee Schedule resulting in no additional CMS reimbursement. Effective in the fourth quarter of 2008, UnitedHealthcare will align reimbursement of this code with the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS). As a result, reimbursement for services provided on an emergency basis, CPT code 99058, will not be separately reimbursed.

Go to http://content.4at5.net/email_domains/unr/21553/hosted/reimburse_6.html

2. New Synagis Drug Procurement Protocol Effective July 1

A new protocol for the ordering, clinical coverage review and purchase of palivizumab (Synagis) takes effect July 1 for all participating physicians and health care providers. Beginning on that date, Synagis must be procured from our preferred specialty pharmacy provider, PharmaCare/CVS Caremark.

Palivizumab (Synagis) - Requirement to Use Participating Specialty Pharmacy to Obtain Synagis

UnitedHealthcare has selected PharmaCare/CVS Caremark, a national distributor of Synagis, as our preferred specialty pharmacy provider. PharmaCare/CVS Caremark's national network provides timely Synagis prescriptions and clinical services to meet the needs of participating physicians and our members. PharmaCare/CVS Caremark has been instructed to deliver Synagis consistent with UnitedHealthcare's Drug Policy for Synagis. PharmaCare/CVS Caremark works directly with our Clinical Coverage Review team in the Consumer Decision Support Advocacy unit to determine whether proposed Synagis use is consistent with the member's benefit plan.

Continued Use of a Non-Network Specialty Pharmacy for the Acquisition of Synagis Effective July 1, 2008, continued use of a non-specialty network pharmacy, wholesalers, or direct purchase from the manufacturer of Synagis, without prior approval from UnitedHealthcare may result in the physician or other health care professional not being reimbursed in whole or in part, as provided in the Participation Agreement. In addition, the physician or other health care professional must not bill our members for any amounts not paid due to non-compliance with the Synagis drug procurement policy.

Physicians who prescribed Synagis in 2007 will be sent a letter about the preferred specialty pharmacy providers to obtain Synagis and the drug policy for Synagis.

For more information, view the above protocol in the 2008 Physician Administration Guide and the drug policy at UnitedHealthcareOnline.com>Policies & Protocols> Medical Policies.