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The scoop for ISMS practice management professionals

January 2019
In this Issue

  • February 13 Webinar: Medicare’s Quality Payment Program – Year Three
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    Medicare's Quality Payment Program is in its third year, and on its third set of rules and requirements since the program first launched. 

    Join ISMS' February 13 webinar, Medicare’s Quality Payment Program – Year Three, for a 30-minute overview of new quality payment program (QPP) participation and reporting requirements. 

    Highlights of the webinar will include: 

    • Who is eligible or required to participate in the Merit-Based Incentive Payment Program (MIPS) in 2019

    • How changes to required electronic health record use will promote interoperability

    • What’s ahead for Accountable Care Organizations (ACOs) under Medicare's Shared Savings Program

      This program is free for ISMS members and their staff. All others must pay $150. Register today! 

  • Effective Jan. 1, 2019: New Medicare Part D Opioid Management Policies
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    Be aware that your prescribers might see an uptick in prior authorization requirements

    As the nation’s opioid crisis continues, a new rule from the Centers for Medicare and Medicaid Services (CMS), which took effect January 1, seeks to reduce potential instances of opioid overutilization. 

    Here are the new pharmacy dispensing guidelines:

    • Pharmacies may not dispense more than a seven-day supply for an initial opioid prescription without an override or Medicare Part D plan authorization. If a patient needs more than a seven-day supply, a prescriber will need to contact the Medicare Part D plan and attest that the supply is medically necessary. Please note: Subsequent prescriptions aren’t subject to these limits. 

    • Pharmacies will be alerted when a patient’s cumulative dosage of morphine milligram equivalents (MME) across all prescriptions, prescribers and pharmacies exceeds 90 MME. The pharmacist will contact the prescriber whose prescription triggered the alert to review and approve the order. 

    • Pharmacies will be alerted when a patient has concurrent prescriptions for opioids and benzodiazepines. The pharmacist is expected to do additional safety reviews and may contact the prescriber(s) to determine the appropriateness of the concurrent medications.

    To learn more, check out CMS' Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019. Additional information about these and other Medicare Part D opioid management policies is available from CMS.

    Questions? Contact Corey McGee at 800-782-4767, ext. 6525 or by email.

  • It’s Back! Supplemental and Crossover Information Now Available When Conducting an NGSConnex Eligibility Search
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    National Government Services, Inc. (NGS) – your Medicare carrier for Illinois (Jurisdiction 6) – has announced that supplemental and crossover info is back! 

    Crossover data will be provided again for informational purposes on a preclaim basis when conducting eligibility searches in NGS' portal NGSConnex

    So now when you log on to NGSConnex and conduct an eligibility search, a new crossover panel will display directly below the Inpatient Services panel. If the beneficiary does not have any crossover information available, this panel will be blank. If relevant information is available, that data will display (click here to see what info will display; also learn why you may need to ask the patient directly if they have other supplemental coverage).

    Questions? As a practice management professional of an ISMS member, you may contact the ISMS advocacy team by calling 800-782-4767 ext. 1470, or by sending an email.

  • How’s it Going Out There in 'MBI Land'?
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    If your medical office sees Medicare patients, you have probably seen many of those new Medicare cards being pulled out of patients' wallets and presented to you. 

    CMS has finished mailing out the new Medicare cards to beneficiaries across all mailing waves. And, according to the Centers for Medicare and Medicaid Services (CMS), medical offices and other health care facilities are successfully submitting claims with the new Medicare Beneficiary Identifiers (MBIs)! 

    In a one-week snapshot ending Jan. 11, 2019, fee-for-service health care professionals submitted 58 percent of claims with the MBIs.

    While medical offices are still allowed to submit claims using the old Social Security Number-based Health Insurance Claim Numbers during the transition period (which ends Dec. 31, 2019), CMS encourages you to help protect your patients from possible identity theft by using the new MBIs for all Medicare transactions.  

    Fortunately, even if your patient is still using their old card, you can easily look up their new MBI number on the Medicare Administrative Contractor's secure provider portal.

    Questions? As a practice management professional of an ISMS member, you may contact the ISMS advocacy team by calling 800-782-4767 ext. 1470, or by sending an email

  • What Paperwork Should Be Collected When Hiring or Signing Collaborative Agreements with APRNs and PAs?

    Now that you have identified a new hire to fill that open position, it's time to collect some credentials. 

    If this candidate is an advanced practice registered nurse (APRN) or a physician assistant (PA), do you know what licenses, certifications or other paperwork you should obtain? 

    Access ISMS' handy APRN & PA Licensure Checklist,* showing at a glance what documents you should request copies of when hiring or signing a written collaborative agreement with these health care professionals.  

    Questions? Practice management professionals of ISMS members may contact ISMS' legal department at 800-782-4767 or by email.  

    This medical legal guideline is a member benefit and is password protected. If you wish to access this resource and need to request a username and password as a practice management professional of an ISMS member, please contact us.

    *This guideline is for educational purposes only.

  • Tackle That Nagging Issue! Ask Your Physician to Submit a Resolution to ISMS
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    As a practice management professional, you are on the front lines interacting with the public. You may also be dealing with various payers and state and federal regulations, not to mention encountering payment, billing, coding, compliance and reimbursement snafus. 

    How do you fix those problems that won’t seem to go away?

    You already know that you can call ISMS any time for help with day-to-day issues in your practice. But when the situation calls for a long-term solution, it’s important to know that any member physician can drive bigger changes in health care policy by submitting a resolution to ISMS.

    While only ISMS member physicians can submit resolutions, your perspective as a practice management professional is critical to improving health care in our state – so don’t hesitate to work with your physician to craft a proposal for ISMS action! Most likely, you are not the only one experiencing these problems in Illinois, and you’ll be helping to improve the medical landscape for others, as well.

    What is a resolution? 

    A resolution is simply a written proposal. It may suggest a change or addition to ISMS policies, or it may call for ISMS to take specific actions, such as supporting legislation or introducing a resolution to the AMA – or both. 

    Your physician can submit a resolution here

    If you or your physician haven’t been involved in this process before, don’t worry. Reach out and we’ll be happy to explain how to get started. Just send an email

    You can also access ISMS' Guide to Developing Resolutions.

    Please note: ISMS is now accepting resolutions on a rolling basis year-round. But in order for resolutions to be considered in time for the next Annual Meeting, being held April 5-7 in Peoria, they must be submitted by Feb. 15, 2019.

  • Do Patients Often Gripe About the High Cost of Medications?
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    In an alarming trend, many American adults are skipping their prescription medications when they don’t have the money to pay for them. Many patients have multiple health issues, which often means they need to take many prescriptions per day – sometimes up to 10 or more.

    ISMS offers a benefit partner that may help ease the high costs of medications. It’s called the Illinois Rx Card. Patients can save up to 75 percent on their prescription drugs with this FREE card!  

    The Illinois Rx Card is pre-activated and can be used immediately at more than 68,000 participating pharmacies nationwide, including Target, CVS, Walgreens, Walmart, Kroger, Kmart, SuperValu and many more.

    ALL Illinois residents are eligible to access this statewide prescription assistance program. 

    Get started today!   

    1. Create and print the discount prescription drug card coupon. You can also share this link on your practice web site, in emails and through social media.

    2. Staple the coupon card to new paper prescriptions to help patients save money.

    3. Printed cards and other materials can also be mailed to your patients at NO COST when they contact Illinois Rx Card Regional Manager Stacy Miller by phone at 888-615-1988 or by email to make the request. 

    All that’s left for the patient to do is simply present the coupon card to any participating pharmacy to receive the discount. Patients can create as many coupons as they wish and also send to friends and family members.

    All prescriptions processed through this program are confidential.

    Check out other ISMS Benefit Partners.

  • Time to Renew ISMS Membership for 2019! Don’t Lose Any Benefits!

    Physicians who have not renewed their ISMS membership for 2019 will have their benefits discontinued on Feb. 1, 2019

    Don't delay – make sure your doctor RENEWS TODAY!

    Renew online, or call the Division of Membership Services at 800-782-4767 ext. 1900.   

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