Archive for February, 2010

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LEGISLATION WOULD REQUIRE GREATER EXPERTISE FOR HEALTH PLAN DENIALS

Tuesday, February 9th, 2010

Legislation (A.723, Gottfried) passed the Assembly this week that would require a coverage denial decision made by a health plan to be made by a physician board-certified in the same or similar specialty as the physician who typically provides the recommended treatment. MSSNY strongly supports this legislation. Under current law, the only qualification required for a person who, on behalf of a health plan, may contradict the treatment recommendation of the patient’s treating physician is that such reviewer be a licensed physician. Therefore, the person reviewing the treatment request may not have the sufficient training or experience necessary to decide whether the treatment that has been requested is appropriate. As a result, care that may be needed for the patient may be unnecessarily delayed or denied while the patient has to resort to taking an External Appeal to attempt to receive the care that has been recommended.

Similar legislation (S.3450, Oppenheimer) is before the Senate Health Committee. Please call your Senator 518-455-2800 to express your support for this legislation.

Posted in NEWS FROM THE NYS LEGISLATURE | No Comments »

Medicare Physician Fee Schedule Fact Sheet – Feb.2010

Friday, February 5th, 2010

The Medicare Physician Fee Schedule Fact Sheet (February 2010) has been revised to include information about the two month zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) effective only for dates of service January 1, 2010 through February 28, 2010. This fact sheet, which also provides information about MPFS payment rates and the MPFS payment rates formula, is available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf .

Special Open Door Forum: Medicare Provider & Supplier Enrollment

Centers for Medicare & Medicaid Services

Special Open Door Forum:

Medicare Provider & Supplier Enrollment

February 17, 2010

2:00 PM – 3:30 PM ET

Conference Call Only

The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum (ODF) to discuss Medicare provider enrollment issues. During this call, CMS staff will discuss:

• Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for physicians, non-physician practitioners and provider and supplier organizations

• Provider and supplier reporting responsibilities

• Medicare ordering and referring Issues

• Revalidation efforts

Afterwards, there will be an opportunity for the public to ask questions.

We look forward to your participation.

Open Door Forum Instructions:

**Capacity is limited so dial in early. You may begin dialing into this forum as early as 1:45 PM ET.**

Dial: 1-800-837-1935

Reference Conference ID 52537484

Posted in MEDICARE UPDATES | No Comments »

CDC HEALTH UPDATE: (H1N1) Influenza Vaccine in Pre-Filled Syringes — Shortened Shelf Life

Wednesday, February 3rd, 2010

This is an official
CDC HEALTH UPDATE

Distributed via Health Alert Network
Tuesday, February 2, 2010, 18:45 ET (6:45 PM EST)
CDCHAN-0309-2010-02-02-UPD-N

Sanofi Pasteur Monovalent 2009 (H1N1) Influenza Vaccine in Pre-Filled Syringes — Shortened Shelf Life of Certain Lots

Summary

Sanofi Pasteur has notified CDC and FDA that some lots of monovalent 2009 (H1N1) influenza vaccine in prefilled syringes will have a shorter expiration period than indicated on the label. The lots of Sanofi Pasteur monovalent 2009 H1N1 influenza vaccine in prefilled syringes should be used by February 15, 2010, as indicated in the table below regardless of the expiration imprinted on the package.  This is to ensure that the vaccine is used while it remains within its potency specification.  There are no safety concerns with these lots of 2009 H1N1 vaccine. People who received vaccine from the lots listed below with shortened shelf life do not need to take any action.

Background

As part of its quality assurance program, Sanofi Pasteur performs routine, ongoing stability testing of the vaccine after it has been shipped to providers. Stability testing means measuring the strength of a vaccine over time.

The 50 lots subject to this change in expiration date include approximately 12 million doses.  These lots were shipped to providers between November 2009 and January 2010. Although these lots remain potent, they are losing their potency more rapidly than expected, and therefore the shelf life is being shortened.  While most of the doses from these lots are believed to have already been administered, there are almost certainly some doses that have not yet been used.

The change in expiration date described here is specific to the 50 lots of Sanofi Pasteur 2009 H1N1 influenza vaccine in pre-filled syringes listed below.  However, a related recall (See http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00306) was conducted recently, which involved lots from Sanofi Pasteur’s 2009 H1N1 vaccine in 0.25 mL and 0.5 mL pre-filled syringes. These actions do not affect Sanofi Pasteur’s 2009 H1N1 vaccine in multi-dose vials.

Sanofi Pasteur will send a notification to providers who received doses from any of the 50 lots of vaccine described below.

Lot Information

These lots should be used by February 15, 2010, as indicated in the table below regardless of the expiration date imprinted on the package.

All pre-filled syringes that have not been used by February 15, 2010 should be discarded in an appropriate manner, or you may return the product for destruction to Sanofi Pasteur Inc., c/o Capital Returns at 6101 N. 64th Street, Milwaukee, WI 53218

Influenza A (H1N1) 2009 Monovalent Vaccine in Pre-Filled Syringes

Expiration Date Change

Product Code (NDC)

Description

Lot Number

Labeled Expiration Date

Re-Assigned  Expiration Date

49281-650-25

0.25mL

UT014AA

March 4, 2011

February 15, 2010

syringes in

UT014BA

March 4, 2011

February 15, 2010

10-packs

UT014CA

March 4, 2011

February 15, 2010

UT014DA

March 4, 2011

February 15, 2010

UT014FA

March 27, 2011

February 15, 2010

UT014EA

March 25, 2011

February 15, 2010

UT029DA

April 7, 2011

February 15, 2010

UT029BA

April 6, 2011

February 15, 2010

UT029CA

April 6, 2011

February 15, 2010

UT029EA

April 8, 2011

February 15, 2010

UT030EA

April 10, 2011

February 15, 2010

UT030FA

April 11, 2011

February 15, 2010

UT033CA

April 12, 2011

February 15, 2010

UT033DA

April 12, 2011

February 15, 2010

Product Code (NDC)

Description

Lot Number

Labeled Expiration Date

Re-Assigned  Expiration Date

49281-650-50

0.5mL

UP033CA

April 16, 2011

February 15, 2010

syringes in

UP036CA

April 19, 2011

February 15, 2010

10-packs

UP034BB

April 22, 2011

February 15, 2010

UP036EA

May 3, 2011

February 15, 2010

UP037CA

April 30, 2011

February 15, 2010

UP037DA

May 2, 2011

February 15, 2010

UP048CA

May 6, 2011

February 15, 2010

UP040CA

May 4, 2011

February 15, 2010

UP048DA

May 9, 2011

February 15, 2010

UP049FA

May 16, 2011

February 15, 2010

UP049CA

May 11, 2011

February 15, 2010

UP049DA

May 13, 2011

February 15, 2010

UP035BA

April 15, 2011

February 15, 2010

UP059DA

May 16, 2011

February 15, 2010

UP060CA

May 17, 2011

February 15, 2010

UP060DA

May 19, 2011

February 15, 2010

UT047BA

May 11, 2011

February 15, 2010

UP033AB

April 9, 2011

February 15, 2010

UP041BA

April 30, 2011

February 15, 2010

UT041AA

April 29, 2011

February 15, 2010

UT034AA

April 19, 2011

February 15, 2010

UT045BA

May 5, 2011

February 15, 2010

UP061DA

May 21, 2011

February 15, 2010

UP061FA

May 23, 2011

February 15, 2010

UP035AA

April 12, 2011

February 15, 2010

UT048BA

May 12, 2011

February 15, 2010

UT058BA

May 16, 2011

February 15, 2010

UT059AA

May 18, 2011

February 15, 2010

UT058AA

May 14, 2011

February 15, 2010

UT061GA

May 24, 2011

February 15, 2010

UP045EA

June 9, 2011

February 15, 2010

49281-650-90

0.5mL

UT036DA

April 26, 2011

February 15, 2010

syringes in

UT040BA

April 28, 2011

February 15, 2010

25-packs

UT047AA

May 9, 2011

February 15, 2010

UT046BA

May 9, 2011

February 15, 2010

UT046AA

May 4, 2011

February 15, 2010

For More Information:

  • CDC’s toll-free information line, 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, is available 24 hours a day, every day.
  • For other inquiries, please contact Sanofi Pasteur Customer Services: 1-800-VACCINE (1-800-822-2463) or visit www.vaccineshoppe.com

Posted in FLU/IMMUNIZATION UPDATES | No Comments »

WC BOARD SUSPENDS USE OF CONTROVERSIAL MEDICAL REPORT FORM

Monday, February 1st, 2010

In response to a growing health care access problem for injured workers in the greater Rochester area, New York State Workers’ Compensation Board (WCB) Chair Robert Beloten this week suspended the requirement that the use of any of the C-4 series of forms, whether those mandated in 2009 or previous versions, be utilized in the six-county region surrounding Rochester. According to the WCB release, “authorized physicians, podiatrists, chiropractors and psychologists in the Provider Shortage Area may submit a CMS-1500 with a detailed narrative report or office notes in lieu of one of the prescribed C-4 forms.”

Since other medical providers across other counties in New York State have continued to express concerns regarding the implementation of these forms into their practices, WCB Chair Beloten has also rescinded statewide the requirement that physicians treating injured workers use the newly expanded (2009) family of C-4 forms, and instead may use the previous version of the C-4 form, which is far simpler, but still requires that some version of the C-4 form be used. According the WCB release, “In all areas of the State, the Board will enforce payment in accordance with the Workers’ Compensation Law and regulation regardless of the version of the C-4 form used to report examinations, services and/or treatments rendered by providers.”
MSSNY member Dr. Jeffrey Kahn, a Syracuse physiatrist who chairs the MSSNY Committee on Workers’ Compensation and No Fault Insurance, has led an effort since 2007 when the WCB first disclosed its intent to implement these new C-4 forms, to convince the WCB to significantly alter its proposed plans regarding the use of any new C-4 forms. Dr. Kahn and other physician leaders informed the WCB that the use of these new forms would impose significant new administrative burdens on physicians across New York State, and potentially cause some physicians to leave the Workers’ Compensation program altogether. We are pleased that some of the MSSNY recommended changes were incorporated, as well as the WCB’s integration of Dr. Kahn’s recommendations to offer both paper and electronic versions of the C-4 forms with a centralized fax submission system. Nevertheless, both MSSNY and the New York State Society of Orthopedic Surgeons (NYSSOS) have continued to object to the usage of these forms, even after their implementation, due to the hardship to many medical practices regarding both the time and costs forced upon medical providers who have attempted to remain in compliance.
A related concern is the fact that physician reimbursement for treating injured workers has not been increased since 1994. In several recent meetings between the WCB with Dr. Kahn and MSSNY, the WCB has acknowledged the need for an increase in these fees to bring them to a level consistent with the type of care provided as well as the financial burdens placed upon physician practices due to the new C-4 forms. The Board and MSSNY are working with the Governor’s office to achieve such an increase. The New York State AFL-CIO has also advocated for such an increase. MSSNY will continue to advocate to assure that a fair and reasonable fee schedule increase for treating injured workers is implemented as soon as possible.
To read the full Board release, click here.

Posted in WORKERS' COMPENSATION UPDATES | No Comments »

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