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Archive for July, 2010
|OxyContin (Oxycodone) prescription usage in Nassau County
Thursday, July 29th, 2010
I’m writing to inform you and your membership of the increasingly alarming statistics concerning OxyContin (Oxycodone) prescription usage in Nassau County over the past 24 months.
While we have seen a 21% increase in Nassau County Medicaid enrollment for the years 2008-2010, during that time we have also seen a corresponding 580% increase in OxyContin Prescriptions filled during the same period of time, and an 800% increase specifically for 80 mg OxyContin tablets.
Nassau County Medicaid expenditures for OxyContin has doubled each year since 2007, with $1.4 million to date and projected expenditures of over $2 million in 2010.
Nassau County Department of Social Services has initiated a number of efforts to stem the tide of this rising prescription drug usage. Our Medicaid Investigative Unit’s collaborative efforts with the NYS Office of the Medicaid Inspector General (OMIG) and the Nassau County District Attorney’s office have resulted in multiple consumer and provider arrests over the last 3 years for forging or selling OxyContin and other Medicaid narcotics drugs.
We have initiated a Prescription Drug Fraud Outreach to every pharmacy in Nassau County including establishment of a tip hotline (516-227-7813) for suspicious prescriptions.
We also recommend certain recipients to the OMIG’s “Restricted Recipient Program” which limits a recipient to one doctor, one pharmacist and one hospital, so that their prescription drug usage can be more closely monitored. The OMIG receives and approves the recommendations and then sends them back to the county to implement the restrictions. Each recipient is typically restricted for 24 month periods and will result in $150k in cost avoidance for Nassau County.
Consumer and medical education are also vital in stemming the tide of prescription drug misuse, especially OxyContin. The Nassau County Department of Mental Health, Chemical Dependency and Developmental Disability Services does provide speakers for public education forums, as does the Long Island Council on Alcoholism and Drug Dependency (LICADD).
We appreciate that your membership will continue to support our efforts to closely monitor the inappropriate usage of prescription drugs.
If there is any further information we may provide, please feel free to contact me at 516 227 7403, ext. 5
Sincerely,
John E. Imhof, PhD
Commissioner
Posted in HEALTH DEPARTMENT UPDATES | No Comments »
Helpful Tips for Expediting Part B Enrollment Computer-Based Training
Wednesday, July 28th, 2010
National Government Services has recently posted the CBT, “Helpful Tips for Expediting a Part B Enrollment PECOS Web and Paper Applications” to our Web site, www.NGSMedicare.com. After you log on, select Enrollment > Information & Tools.
Although not a step-by-step guide, it does provide information on the following:
§ Helpful tips to avoid the most common application errors
§ Separate sections for both PECOS and paper submission of applications
§ Valuable contact information
§ Information regarding timeliness / turnaround time for processing applications
§ Information on where to mail the application
§ A reminder of what documents may need to be included
§ Answers to the most frequent asked questions
This CBT takes approximately 15 minutes to complete and while not answering every question, it covers a large percentage of the most common errors we see with submitted applications.
Thank you!
Posted in MEDICARE UPDATES | No Comments »
Contact Gov. to Assure Coverage for Treatment to Intoxicated Drivers
Monday, July 26th, 2010
Physicians are urged to contact the Governor in support of a measure (S.7845, Breslin/A.11116, Dinowitz) passed by the Legislature to require No-Fault carriers to cover the costs of providing emergency care to intoxicated drivers. MSSNY strongly supports this legislation. The bill would at last rectify an anomaly in the law whereby under federal law physicians and hospitals are required to provide emergency care to all patients, but a separate state law permits insurers to deny coverage for care provided to intoxicated drivers. As a result, many physicians have experienced the situation where they are not paid for providing this often-life saving treatment. Perhaps most importantly this bill would eliminate the current disincentives to testing patients for alcohol and better assure that patients can obtain the counseling they need. Please indicate your support for this legislation by asking the Governor to sign this measure into law.
The bill was delivered to the Governor for his consideration this past Monday, so by law he must take action by the end of next week. Physicians can send a letter to Governor Paterson by clicking here.
Posted in NEWS FROM THE NYS LEGISLATURE | No Comments »
GOVERNOR PATERSON ANNOUNCES “EXTRAORDINARY” SESSION ON WEDNESDAY 7/28
Monday, July 26th, 2010
Governor Paterson has just announced that he will be calling the legislature into “extraordinary session” on Wednesday to “consider legislation to complete the state budget.” He stated: “The State budget is 15 weeks late, we have yet to close our $9.2 billion current year deficit or reduce our out year gaps, and have no plan to address an additional billion dollar problem that may arise if the Federal government does not provide FMAP contingency funds. New Yorkers cannot afford to wait any longer for a final State budget.” Governor Paterson will call the Legislature into extraordinary session on Wednesday, July 28, at 6 p.m., to consider legislation required to complete the State budget, as well as other critical policy issues that were not addressed in the regular session of the State Legislature.
Posted in NEWS FROM THE NYS LEGISLATURE | No Comments »
NYS Medicaid Preferred Drug List effective 7.28.10
Friday, July 23rd, 2010
Attached is the most recent updated Preferred Drug List. Please feel free to share this with your members or post a link to your website. If your organization would like to schedule a presentation or if you have any questions or concerns regarding this program, please contact 518-951-2051 .
Please be aware of changes to the preferred and non-preferred status of some drugs on the preferred drug list, effective July 28, 2010.
Please visit: https://newyork.fhsc.com/
The preferred drug list can be found at:
https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDL.pdf
A ‘quicklist’ of preferred drugs only can be found at:
https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDLquicklist.pdf
All changes to the NYS Medicaid Preferred Drug List will be communicated to providers via the monthly Medicaid Update publications. Notifications will no longer be mailed to providers.
We appreciate your support of the New York State Medicaid Program.
Posted in MEDICAID UPDATES | No Comments »
CDC HEALTH ADVISORY – Dengue Infection Risks
Friday, July 23rd, 2010
Distributed via Health Alert Network
July 22, 2010, 18:35 EST (6:35 PM EST)
CDCHAN-000315-2010-07-22-ADV-N
Increased Potential for Dengue Infection in Travelers Returning from International and Selected Domestic Areas
Summary: Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics. Travelers to these areas are at risk of acquiring dengue virus and developing dengue fever (DF) or the severe form of the disease, dengue hemorrhagic fever (DHF). The Centers for Disease Control and Prevention (CDC) strongly advises that health care providers in the United States should: 1) consider DF and DHF when evaluating patients returning from dengue-affected areas–both domestic and abroad–who present with an acute febrile illness within two weeks of their return, 2) submit serum specimens for appropriate laboratory testing, and 3) report all presumptive and confirmed cases of DF and DHF to their local or state health department.
Background
Dengue transmission has been increasing to epidemic levels in many parts of the tropics and subtropics where it had previously been absent or mild. Dengue-affected areas are widely distributed throughout Africa, Asia, Pacific, the Americas and the Caribbean. This calendar year, more than 50 countries have reported evidence of dengue transmission; including 17 countries in Asia, 17 in the Americas, 10 in Africa, seven in the Caribbean, and one in the Pacific. With an extensive dengue outbreak occurring in Puerto Rico and evidence of continued transmission in Key West, Florida, travel to certain domestic locations may also pose a risk for the traveler. The mosquitoes known to transmit dengue virus, Aedes aegypti and Aedes albopictus, are present throughout much of the southeastern United States and infected returning travelers may pose a risk for initiating local transmission.
Symptoms
Dengue virus infections can manifest as a subclinical infection or DF, and may develop into potentially fatal DHF. DF is a self-limited febrile illness that is characterized by high fever plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., bleeding of nose or gums, petechiae, or easy bruising), and leukopenia. Because the incubation period for dengue infection ranges from 3 to 14 days, the patient may not present with illness until after returning from travel. Clinical management of DF consists of symptomatic treatment (avoid aspirin, NSAIDS and corticosteroids, as they can promote hemorrhage) and monitoring for the development of severe disease at or around the time of defervescence. A small proportion of patients develop DHF, which is characterized by presence of resolving fever or a recent history of fever, lasting 2–7 days, any hemorrhagic manifestation, thrombocytopenia (platelet count ≤100,000/mm3), and increased vascular permeability, evidenced by hemoconcentration, hypoalbuminemia or hypoproteinemia, ascites, or pleural effusion. DHF can result in circulatory instability or shock. Adequate management requires timely recognition and hospitalization, close monitoring of hemodynamic status, and judicious administration of intravascular fluids. There is no antiviral drug or vaccine against the dengue virus. Updated guidelines for the management of dengue can be found at http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf
Recommendations
· Health care providers seeing patients with dengue-like illness who have recently traveled to Puerto Rico, Key West, Florida or international dengue-affected areas (See world distribution of dengue maps at http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx) should report cases to the local or state health department and send specimens for laboratory testing. DF and DHF are now nationally notifiable conditions in the United States. Please remember that apart from individuals traveling for tourism, individuals responding to international disasters (e.g., Haiti earthquake), participating in medical or religious missionary work, and visiting friends and relatives are often returning from dengue-affected areas and should be evaluated for dengue infection if they present with dengue-like illness during or after their travel.
· Reporting to local public health officials and consideration of hospitalization to initiate supportive care should not be delayed pending test results. Reporting suspected dengue cases will trigger a public health investigation and the implementation of prevention measures.
· Specimens from patients with acute febrile illness, who returned from dengue-affected areas within the past 14 days, should be submitted to their local or state health department, if the health department laboratory offers dengue testing. State health departments with the capacity to test for dengue include: AZ, CA, CT, FL, NY, PR, and TX.
· If the local or state health department does not perform dengue testing, submit specimens directly to CDC laboratories in San Juan, Puerto Rico (address below). CDC offers free diagnostic testing for health care providers and confirmatory dengue testing for health department and private laboratories. A completed CDC Dengue Case Investigation Form (http://www.cdc.gov/Dengue/resources/DCIF_English_ColorSept1508_FINAL_.pdf) must accompany the specimens for the appropriate testing to be performed.
Whenever possible, submit paired acute and convalescent specimens (2 ml of centrifuged serum.) Accuracy is increased when both acute and convalescent specimens are available for testing. But providers should not wait and should submit acute specimens as soon as available; a convalescent specimen can be submitted when available.
Type of specimen Interval since onset of symptoms Type of Analysis
Acute until day 5 RT-PCR for dengue virus
Convalescent 6 to 30 days ELISA for dengue IgM
Centers for Disease Control & Prevention
Dengue Branch
1324 Cañada Street
San Juan, Puerto Rico 00920
Tel: (787) 706-2399; Fax (787) 706-2496
For More Information
· Instructions for the preparing and delivering specimens for dengue testing to the CDC Dengue Branch is available at: www.cdc.gov/Dengue/resources/TestpolEng_2.pdf.
· Additional information about dengue is available at: www.cdc.gov/dengue
· Call CDC’s toll-free information line, 800-CDC-INFO (800-232-4636 ) TTY: (888) 232-6348, which is available 24 hours a day, every day.
Posted in HEALTH DEPARTMENT UPDATES | No Comments »
The Transition to ICD-10 is Coming October 1, 2013
Tuesday, July 13th, 2010
Remember: – On October 1, 2013, medical coding in U.S. health care settings will change from ICD-9-CM to ICD-10. The transition will require business and systems changes throughout the health care industry. Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition, not just those who submit Medicare or Medicaid claims. The compliance dates are firm and not subject to change. If you are not ready, your claims will not be paid. Preparing now can help you avoid potential reimbursement issues. Ask your clearinghouse, billing service or software vendor what you need to do to be ready for ICD-10. For more information about ICD-10 Implementation, please read MLN Matters® Special Edition article SE1019 located at http://www.cms.gov/MLNMattersArticles/downloads/SE1019.pdf on the CMS website.
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
CMS Will Not Automatically Deny PECOS Claims for Missing Deadline
Monday, July 12th, 2010
This week, CMS announced that it will not automatically deny Medicare claims filed by providers who do not meet the July 6 deadline for enrolling in the Provider Enrollment, Chain and Ownership System, CQ HealthBeat reports. PECOS is designed to ensure that only eligible providers bill Medicare for services, CQ HealthBeat reports. In May, CMS changed the deadline for PECOS enrollment for providers from Jan. 3, 2011, to July 6, 2010. However, the National Association of Chain Drug Stores said that the July deadline would effectively deny access to products, such as diabetes testing strips and monitoring devices, covered under Medicare Part B. Part B covers certain types of care outside hospitals.
CMS denied NACDS’ request to reinstate the Jan. 3 deadline. However, the agency said that it will “for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers” whose application have not been approved by July 6.
About 800,000 providers successfully have enrolled through PECOS, but “some providers have encountered problems,” CMS said, adding that it will continue to remind providers to enroll and help them with the procedure, as well as “process all applications expeditiously.”
Posted in MEDICARE UPDATES, NATIONAL HEALTHCARE NEWS | No Comments »
CMS TO REVIEW PECOS ENROLLMENT PROCESS
Tuesday, July 6th, 2010
Medicare Working with Ordering and Referring Providers and Suppliers to Streamline Enrollment Process
The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need. PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.
As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010. While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems. CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days.
CMS issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) , and certain items and services under Medicare Part B. The new law applies to orders, referrals and certifications made on or after July 1. The comment period for the regulation closes on July 6, after which the comments will be reviewed and considered before a final regulation is issued.
The Affordable Care Act provisions and the regulation were designed as steps to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.
Many physicians and other providers and suppliers have continued to make good faith efforts to comply with the requirements of the law and regulation. These efforts will be a significant factor in determining the procedures and processes that will be incorporated in the final rule.
While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.
Additionally, though CMS is taking a more deliberative approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the ACA requirement that written orders and certifications are only issued by eligible professionals effective July 1.
CMS will continue to send informational notices to providers reminding them of the need to submit or update their enrollment and will work with the provider community to provide guidance on enrollment and will process all applications expeditiously.
Posted in MEDICARE UPDATES | No Comments »
Medicare Part B Providers and Trading Partners in Connecticut and New York (Jurisdiction 13) Experiencing System and Payment Issues
Tuesday, July 6th, 2010
Medicare Part B Providers and Trading Partners in Connecticut and New York (Jurisdiction 13) Experiencing System and Payment Issues
Due to system issues, Part B providers and trading partners in Connecticut and New York are currently unable to access the MCS system.
Both electronic and paper remittance advice and Claims Status Response 277 files from the Wednesday, June 30 cycle will be delayed until late tonight, Thursday, July 1 or very early tomorrow, Friday, July 2.
Additionally, a Part B cycle will not run on Thursday, July, 1, 2010. Claims for July 1 will be processed on July 2, along with the claims for July 2. Payments will be subject to all CMS payment floor and claim timeliness guidelines. We expect remittances and 277 Claim Status Inquiry Response transactions to be available on Tuesday, July 6.
Thank you for your patience as we work to resolve these issues.
Posted in MEDICARE UPDATES | No Comments »
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