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National group targets Kansas physicians

The 2014 Legislative session is just two months away and already legislators are being courted for support on a variety of issues. It has recently come to our attention that the state chapter of Americans for Prosperity (AFP)–a conservative national advocacy group focused on economic policy – has decided to support the advanced practice nurses in their bid for independent practice authority.

Members may recall the APRNs introducing a bill last year (HB 2251) which would dissolve the collaborative practice agreement between a physician and an APRN. The bill did not advance and we have been waiting for communication from the APRNs regarding their intentions for 2014.

In recent weeks, AFP has been meeting with legislators expressing their support for the APRN proposal. It is their belief that the current collaborative arrangement between physicians and APRNs represents unnecessary regulation and limits "economic freedom." On that basis alone, AFP is suggesting that Kansas eliminate any and all distinction between the practice of medicine and the practice of nursing.

To protect patient safety, every state in the nation has a law or regulation distinguishing the roles of health care providers; Kansas is–and should be–no different. Our current law reflects that there are differences between medical education and nursing education. At a minimum, physicians complete 12,000 hours of training; APRNs complete a maximum of 720 hours. The collaborative practice arrangement ensures access to health care and balances that with the need for quality care.

AFP's reason for involvement is not clear to us. However, their engagement in the issue is causing a change in the discussion's dynamics. Many newly-elected legislators were supported by AFP in the 2012 election cycle and there has been suggestion that votes on the APRN issue will be considered as part of AFP's legislative scorecard for the coming session.

Please help us by contacting the legislator in your area and express your support for laws and regulations protecting patient safety. You may find your legislators here.

For more information on legislative issues, please contact Rachelle Colombo, KMS Director of Government Affairs. Rachelle can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. or 800.332.0156.

Future Directions Task Force continues work

The KMS Future Directions Task Force has convened for the last phase of its two-year evaluation of the organization; the task force is engaged in a comprehensive effort to ensure KMS is well-positioned to remain a strong, relevant advocate for physicians well into the future. During the coming months, the task force will review a number of important issues including the future of the House of Delegates/Annual Meeting, KMS' relationship to county medical societies, the structure of KMS membership and the cost of KMS membership. The task force's final report will be considered at the 2014 Annual Meeting in Kansas City. If you have questions about the task force's work, please contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Communications & Membership. She can be reached by phone at 800.332.0156.

KMS expresses concern over SGR fix

The committees in Congress that are responsible for the Medicare program have released a draft blueprint for repealing the flawed SGR formula, which has been one of organized medicine's highest priorities for several years. Though SGR is long overdue for repeal, the draft blueprint for reforming physician payment under Medicare is very complex and presents some cause for concern. In brief, the proposal would:

  • freeze physician payment levels for 10 years
  • replace fee for service with "alternative payment models" that involve bundling payments
  • combine existing quality and resource-use incentive payment programs in a new Value-Based Performance Program (VBP)
  • require public posting of quality and resource use data on physicians

KMS has contacted the Kansas congressional delegation to express strong concerns over parts of the draft proposal, particularly the ten-year freeze on physician fees. KMS believes that freezing Medicare payments for the coming decade will have very serious consequences for the viability of many physician practices in Kansas, particularly in rural areas. KMS also expressed concern that the fee for service model needed to remain a viable option, as alternative payment models may not be feasible in all areas or workable for all specialties (Complete statement available here). A sample of KMS' letter to the Congressional delegation can be found here.

KaMMCO sponsors statewide essay contest

kammco logoKaMMCO has partnered with the Sunflower State Games in 2013 through the sponsorship of a statewide essay contest aimed at spotlighting healthy behaviors.

"A common goal exists amongst health care professionals of Kansas and the Sunflower State Games – to inspire Kansans to lead a healthy and active lifestyle," said Doug Iliff, MD, of Topeka. "The Your Health Matters essay contest sponsored by KaMMCO is a fun and unique way for health care providers, citizens of Kansas, and Sunflower State Games to make strides towards a healthier state."

The essay contest is open to all Kansans. Cash prizes along with medals from Sunflower State Games will be awarded.

Contest guidelines and flyers are available at www.KaMMCO.com for you to post in your office/facility to encourage patient participation.

For questions, please contact Lisa Ignoto at KaMMCO at 1.800.232.2259.

Kansas HEN mid-course meeting: April 18

KHC Logo_Final_Pantone_294408The Kansas Hospital Engagement Network (HEN) is approaching the mid-way mark of the highly-focused and accelerated patient safety initiative to reduce preventable hospital acquired conditions by 40 percent and reduce hospital readmissions by 20 percent by December 2013. Kansas has 92 hospitals participating in the HEN.

To mark the occasion, the Kansas Healthcare Collaborative will host an all-day mid-course meeting at the KMS/KaMMCO Conference Center on Thursday, April 18. In addition to highlighting progress to date, the agenda is designed to energize and empower participants to achieve the HEN goals.

Dr. Steve Tremain, HRET improvement advisor from Cynosure Health, will deliver the morning keynote focused on the principles of patient safety culture. His presentation will set the stage for an interactive workshop using real scenarios so attendees can practice applying the principles. In addition the event will feature hospital-sharing panels, project updates, roundtable discussions with Kansas improvement leaders, poster presentations and much more.

Attendees will have an opportunity to review progress to date, share what they have learned along the way, and discuss the strategies and resources that have been utilized.

Hospitals are encouraged to share their progress by bringing a poster for display. During the afternoon break, Dr. Tremain will facilitate a poster review session.

This seminar is approved for a total of 6.0 contact hours applicable for RN and LPN relicensure. The complete agenda is on line and registration is open.

Medicaid PCP rate increase: deadline to attest

KDHE has set a deadline of March 31 for physicians to attest for the Medicaid PCP rate increase. As previously reported, the Affordable Care Act provided federal funding to increase Medicaid physician reimbursement for primary care services in 2013 and 2014 for certain E/M services and vaccine administration codes. Advanced practice nurses under the personal supervision of an eligible physician may also be eligible and reimbursed at 75 percent of the increased rate. Increased payments do not apply to Rural Health Clinics and Federally Qualified Health Center services.

To qualify, eligible providers must self attest to a covered specialty or subspecialty designation. As part of that attestation, they must specify that they are either board certified in an eligible specialty or subspecialty, or that 60 percent of their Medicaid claims for the prior year were for E/M and vaccine administration codes. The attestation form can be found here, and should be sent or faxed to the address in Section 1 of the form. The completed form must be returned by March 31, 2013. For attestations received after this time, the effective date of the rate increase will be the date of the application for attestation.

Additional information about this program can be found here or contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance.

Learn more about Medicare RAC appeals

The Kansas Medical Society, in collaboration with the Missouri State Medical Association, will host a conference call with HealthData Insights and WPS Medicare at noon on March 28 to assist you in understanding the Recovery Audit Contractors and the appeals process. Questions may be submitted in advance to This email address is being protected from spambots. You need JavaScript enabled to view it..

The conference call phone number is: 888.330.9939; and the PIN: 767288#. Handouts for the call will be available a week in advance.

Sequestration to reduce Medicare fees

CMS has released information regarding the two percent Medicare fee reduction scheduled for April 1, 2013. Medicare fee-for-service claims with dates-of-service or dates-of-discharge on or after April 1, 2013 will incur a two percent reduction in Medicare payment. Claims for durable medical equipment, orthotics and supplies, will be reduced by two percent based upon whether the date-of-service or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.

The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments. Beneficiary payments for deductibles and coinsurance are not subject to the two percent payment reduction. Medicare's payment to beneficiaries for unassigned claims is subject to the two percent reduction. Questions remain as to the effect, if any, this will have on rural health clinics, and how this reduction will be communicated on the remittance advice. We will keep you informed as additional information becomes available.

TriCare transitions to UnitedHealthCare

On April 1, 2013, the managed care support contract for the TRICARE West Region will transition to UnitedHealthcare Military & Veterans (UHC). TriWest Healthcare Alliance (TriWest) will remain the TRICARE West Region managed care support contractor through March 31, 2013, and will continue to provide service to all customers throughout the transition.

To help you understand the timing and key information about the TRICARE transition, TriWest created the Provider Transition Update Center for specific information on important deadlines, online submission, status of referrals/authorization and claims issues resolution.

UHC has a Tricare Provider Handbook available online, and will host national webinars every Tuesday, Wednesday, and Thursday through the end of April. Registration is required. There will also be local town hall events at the following locations. Registration for these events will be available in the near future-we'll keep you posted as information becomes available.

April 8; 2-4pm

Newman University (3100 W McCormick St; Wichita)

April 9; 2-4pm

North Kansas City Hospital (2800 Clay Edwards Dr; Kansas City, MO)

April 16; 2-4pm

Doubletree of Overland Park (10100 College Blvd; Overland Park)

April 24; 2-4pm

Kansas Medical Society (623 SW 10th Ave., Topeka)

March Madness hits the Statehouse

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March Madness has hit the statehouse with committees working to kick out priority bills before the deadline next week. By next Friday, "non-exempt" committees will no longer have the opportunity to meet and all issues will have to have previously passed out of committee or be amended into a related bill.

Senate Public Health and Welfare passed HB 2066, the PT direct access bill. The bill went to the floor of the Senate unchanged and passed on a final action vote of 39-1. The bill allows patients to self-refer to a physical therapist and receive ten treatments over the course of fifteen business days or less before a physician referral is required if the patient is not improving. Per HB 2066, the physical therapist must disclose that a PT diagnosis is not a medical diagnosis. The bill also allows medical care facilities to continue to require a referral from the attending physician prior to PT treatment. The bill does not expand the scope of practice for physical therapists, but does allow them limited direct access to patients.

The House considered HB 2199, the Second Amendment Protection Act, in conjunction with several other bills focused on gun owners' rights. Though the Federal and State Affairs committee spent a considerable amount of time focusing on physician inquiry regarding firearm possession as it relates to patient safety, language prohibiting such inquiry was stricken at KMS' request, and was not offered as an amendment when the bill was debated by the full House. Some second amendment enthusiasts still feel that physician inquiry needs to be addressed to address their privacy concerns. KMS continues to cite the privacy protections provided under HIPAA as well as the importance of protecting the first amendment free speech rights of patients and providers. The measure now moves to the Senate. KMS testimony on HB 2199 can be found here.

The Senate Health Committee also heard SB 210, which contains several amendments to the Health Information Technology Act. The principal focus of the legislation is to transfer regulatory and administrative oversight for health information exchange to the Kansas Department of Health and Environment. Joe Davison, MD, of Wichita, who serves as Chair of the statewide board that has overseen the development of HIE in Kansas, testified in support of the bill. KMS also supported the bill.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

Physician Leadership symposium: one more opening

The HRET Hospital Engagement Network announced that it will underwrite the attendance of two physicians from each state to attend HRET's Inaugural Physician Leadership meeting in Miami, Florida on February 25-26, 2013. Kansas has one more slot available.

HRET recognizes that physician engagement is vital to reaching the Partnership for Patients (PfP) 40/20 goals by 2013. The two-day conference will offer physician leaders training on how to accelerate progress towards these goals, and an opportunity to network and learn from their peers. An ideal candidate would be someone who is involved with the Kansas HEN, supports clinical quality improvement at your facility, and would like to learn more about the national project and the Science of Improvement. View the flyer for more information.

The Kansas Healthcare Collaborative (KHC) is the organization implementing the Kansas Hospital Engagement Network. If you or another member of your physician team would be interested in attending the leadership meeting, please let KHC know as soon as possible by sending an email to Kendra Tinsley, KHC Executive Director, at This email address is being protected from spambots. You need JavaScript enabled to view it..

Medicaid PCP rate increase update

The Affordable Care Act provided federal funding to increase Medicaid physician reimbursement for primary care services in 2013 and 2014. Medicaid fees billed with E/M codes 99201-99499 and some vaccine administration codes will be increased to Medicare payment levels for the following specialties; family medicine, pediatrics and general internal medicine. The amount of the payment increase is based on Medicare rates for 2013 or 2014, or if greater, the Medicare rate using the 2009 conversion factor. In response to the CMS final rule, the state has issued a Bulletin regarding Medicaid Payment for Primary Care Services.

The state must first submit a State Plan Amendment (SPA) and have it approved by CMS before implementing the program. The SPA, by rule, could not be submitted prior to January 1, 2013. This means eligible providers likely won't see a payment until the first quarter of 2013. The payments will be retroactive back to January 1. Until the SPA is approved by CMS, we won't know for sure how payments will be made.

To qualify, physicians must self attest to a covered specialty or subspecialty designation. As part of that attestation, they must specify that they are either board-certified in an eligible specialty or subspecialty or that 60 percent of their Medicaid claims for the prior year were for E/M and vaccine administration codes. The attestation form can be found here, and should be sent to the address in Section 1 on the form. We recommend submitting your attestation by Feb 15, 2013.

The increased payment levels will apply to the Medicaid program and CHIP which is a change from previous reports. They do not apply to services provided in Rural Health Clinics and Federally Qualified Health Centers.

The state Bulletin indicates that effective with dates of service on and after January 1, 2013, the Kansas regional Vaccine for Children (VFC) ceiling will be increased to $20.26. This increase will be reflected in the reimbursement for procedure code 90460. Procedure code 90461 will no longer be covered per federal regulation. The reason, VFC statutory requirements only allow for one payment per vaccine administered regardless of the number of antigens in the vaccine."

KMS will continue to monitor this issue and will provide updates in future publications. Additional information about this program can be found at the CMS informational bulletin and a questions and answers document or by contacting This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance.

2013 medical record copying costs

State law [K.S.A. 65-4971(b)] which required the Secretary of Labor to annually adjust the maximum fees that may be charged for non-workers compensation medical records copying, was repealed by the 2011 Kansas Legislature. Without any state guidelines, federal law governs the establishment of copying charges.

Under HIPAA, a covered entity may impose "reasonable", cost-based fees for copy of medical records. The fee may include only the cost of copying (including supplies and labor) and postage, if the patient requests that the copy be mailed. If the patient has agreed to receive a summary or explanation of his or her protected health information, the covered entity may also charge a fee for preparation of the summary or explanation. The fee may not include cost associated with searching for and retrieving the requested information. See 45 CFR 164.524(c). Of course now the question is, how is "reasonable" defined?

Since there has been no additional guidance on this issue some practices have decided to simply stick with the 2012 fees, those previously provided by the Department of Labor, and/or adding an adjustment to keep with the rate of inflation.

The worker's compensation copying fees will remain the same for 2013 and can be found here.

KanCare goes live

KanCare-LogoThe state's new Medicaid program, KanCare, launched January 1, 2013, and as expected with a transition of this size, there have been some bumps. Below are some of the issues reported by members and the status.

There's been a disconnect between the Continuity of Care and Prior Authorizations. Some out-of- network providers report being instructed that a PA was needed for all services, including office visits. This is not accurate. The state updated the Continuity of Care document clarifying this by adding, "During the first 90 days of KanCare, participating and non-participating providers alike should follow the plans' PA/notification policies for participating providers." The document also makes clear that established provider-member relationships during the transition to KanCare, in or out of network, will be paid at 100 percent of the Medicaid fee-for-service rate for the first 90 days.

When checking the KMAP website for eligibility there may not be a plan assignment because of some beneficiaries who are excluded from KanCare e.g. SOBRA, QMB. As a reminder, beneficiaries in an excluded category will continue in the current Medicaid fee-for-service program and claims for services should be sent to KMAP for processing and payment. A list of excluded beneficiaries can be found here.

The MCO credentialing process has not been completed for many who have decided to participate. In some instances, beneficiaries contact the plan wanting to change their PCP, only to be told that provider is not contracted therefore assignment can't be changed. Unfortunately, there is no work-around for this yet, but the state is looking in to it. Meanwhile, if you have questions about credentialing, you should contact the MCO directly.

Billing and claims issues are beginning to surface, and for some plans if you don't have a provider number you can't access their system to check claims status. The state and each MCO now have issue logs:

The KanCare website has a list of FAQs, upcoming education and Daily Rapid Response calls.

KMS will host three teleconferences, one with each MCO. For more information check out the KMS Events Calendar or contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance.

Medicare update

CMS log_blueOn January 1, 2013, Congress passed the American Taxpayer Relief Act of 2012. This bill extends the current Medicare Physician fee schedule through the end of 2013. WPS has the current physician fee schedules available on their website.

CMS has extended the 2013 Annual Participation Enrollment program. The participation enrollment period will now end February 15, 2013, instead of December 31, 2012. Additional information can be found here.

Denied Claims

WPS Medicare identified some electronic claims with the 2013 dates of service submitted between January 1, 2013 and January 4, 2013 that automatically denied for invalid zip code. WPS implemented the zip code file on January 7, 2013 as required by CMS. This automatic denial affected claims with 2013 dates of service and a place of service other than home submitted January 1, 2013 through January 4th. WPS will perform a mass adjustment of these denied claims. You do not need to resubmit claim(s) affected by this issue.

Deadline to request exemption from ePrescribing penalty is January 31

Physicians who were unable to file for a Medicare ePrescrbing hardship exemption by the original deadline have until January 31, 2013 to avoid the 1.5 percent payment penalty in 2013. CMS has re-opened the Communications support web page to allow physicians who missed the June 30, 2012 deadline to file for an exemption.

  • Physicians may request a waiver of the 2013 penalty under any of the following categories:
  • Unable to ePrescribe as a result of local, state or federal law or regulation.
  • Wrote fewer than 100 prescriptions during the period of January 1 – June 30, 2012.
  • Practices in a rural area that doesn't have sufficient high-speed internet access.
  • In an area that doesn't have enough pharmacies that can do ePrescribing.

CMS also added two hardship categories for those participating in Medicare's electronic health record meaningful use program. Physicians do not need to apply for an exemption related to these meaningful use hardship categories; CMS will automatically determine whether physicians mean those requirements.

Visit the CMS ePrescribing webpage to learn more or contact the QualityNet Help Desk at: 866.288.8912 or by email at This email address is being protected from spambots. You need JavaScript enabled to view it. with questions or assistance.

Quality and Resource Use Reports

The Medicare 2011 QRUR is available for groups of 25 or more eligible providers. The report will give you an indication of how you will fare when the value based modifier is implemented in 2015. If you want your group's report in one electronic file, you may submit a request to This email address is being protected from spambots. You need JavaScript enabled to view it..

CMS has scheduled a teleconference on February 4, 2013 for providers with 25 or more eligible professionals in KS, MO, IA and NE from 9:00 – 10:00 a.m. This teleconference is intended for Medicare Part B providers and/or billing staff who have accessed a 2011 QRUR report. The call information can be found on the QRUR website.

New legislative session convenes

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The 2013 Legislative Session officially began on Monday, January 14 with the swearing in of all 165 newly elected legislators and their leaders, nearly 60 first-time legislators among them. In his State of the State address on Tuesday, Governor Brownback outlined his expectations for the session with an optimistic vision for economic growth, a change in the way appellate judges are selected and improved benchmarks for Kansas students. He also voiced support for increasing the number of physicians trained at the University of Kansas Medical Center and made general comments about the importance of ensuring the availability of the highest quality of health care for Kansans that is possible.

Committees have already begun to educate members about state agencies regulating their issues, budgetary impacts and top priorities. House and Senate Health committees provided members with a brief overview of the impact of the Affordable Care Act, and in particular, the unresolved questions of how the state will respond to the issues of the health insurance exchange and potential Medicaid expansion.

Already, physical therapists have resumed efforts to achieve self-referral or so-called "direct access," and nurse practitioners have begun meeting with legislators to discuss their pursuit of independent practice. Though we have yet to see proposed language from the APRN's, the message they've communicated to legislators has been that rural healthcare is threatened by the current model requiring physician oversight and protocols. The nurses' solution is to eliminate the requirement of team-based protocols between physicians and APRNs, particularly as it relates to prescribing drugs, and ordering labs, imaging services and medical devices. KMS believes that patient safety and quality are best served by supporting the current physician-directed, team-based approach that makes the most of the respective education and training of physicians and APRNs.

There are many significant policy decisions that this new legislative body will weigh and work to resolve in the coming months. As both a constituent and a health care provider, you have expertise and information that is relevant and necessary for legislative consideration. Your communication with us and with your elected Senator and Representative is valuable. Please watch KP in the coming weeks for updates on key issues, and help us by communicating with your legislators about those issues.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

President's message: Change is a way of life

Synovec MarkMark Synovec, MD
KMS President

As I continue providing a list of challenges to the membership and KMS to consider, maintaining and strengthening the quality of health care in our state, I would like to concentrate in this column how each of us must address change.

We are currently being besieged with requests to change. Whether it be in our practice environment, relationships with the hospitals, health information technologies (including that ever favorite CPOE--computerized provider order entry), the use of complex molecular diagnostic testing or the newest venture capitalist-sponsored widget that is promised to revolutionize the treatment of "X" (add your favorite disease), it seems that everyone is wanting us to modify the way we practice our profession.

Although overwhelming, we must remember that we as a profession have historically embraced positive change. Change has resulted in many dramatic revolutions in patient care in the recent past such as rituximab for lymphoma, conservative breast cancer therapy with sentinel lymph node sampling, and endoscopic ultrasonography. When the data convincingly shows efficacious improvement in patient care and system improvement, we must be willing to change.

We also need to cautiously embrace other evolutionary tools such as information technologies-- learning to use these as ways to better our care to patients. I am not however suggesting that we passively accept so-called advances that detract from patient safety.

Sometimes, most difficult to those grey-hairs, like me, is the need to place the goal of optimal efficacious patient care above our own self-interests and/or engrained practice habits. Unnecessary variability within our methods of practice has been used to fuel the fire of those critical of the American healthcare system. When appropriately validated procedures and protocols exist that can allow us to better patient care, we need to be willing to move away from what is comfortable.

As Meryl Streep noted in a recent commencement speech: "This is your time and it feels normal to you, but really, there is no normal. There's only change and resistance to it and then more change". Our goal should be to only resistant based for the right reasons!

Legislative session off and running

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Undeterred by the learning curve facing the historically large class of freshman legislators, the session is off to a speedy start with several committees already hearing and working bills and aiming towards concluding legislative business in just 80 days.

This week brought the introduction of SB 46, the physical therapist self-referral bill. Senate Bill 46 re-proposes the language that passed out of the House of Representatives last session, stipulating that a patient may self-refer to a PT but must see a physician after 10 treatments or 15 business days should the patient fail to meet documented treatment goals and functional improvement. Identical language was also introduced on the House side as HB 2066. A hearing on SB 46 has been scheduled for Monday, January 28; House Health and Human Services will hear HB 2066 on Wednesday, January 30.

Another issue of importance is the APRN independent practice proposal. Though it has not yet materialized in bill form, we have heard from several legislators who are already being lobbied by the APRNs to support their pursuit of a broadly expanded scope of practice. KMS believes that patient safety and quality are best served by supporting the current physician-directed, team-based approach that makes the most of the respective education and training of physicians and APRNs. We need your help communicating with legislators that there is not a compelling reason to change the current structure and the impact the proposed change would have.

It is our understanding that the following is included in the APRN proposal:

  • Nurses would be granted "global signature authority" for APRNs, which means that any time a physician's signature or certification is required, that requirement may be legally fulfilled by an APRN.
  • Nurses would be allowed to independently prescribe all drugs and order any medical test, treatment or intervention, without a practice protocol or any supervisory involvement by a collaborating physician.

While nurse practitioners are valuable members of the health care team, they simply do not have the same training and clinical experience as physicians and it is critical that we communicate this to the legislative body. Please contact your legislator today and voice your opposition to the APRN independent practice bill.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

Healing Arts Board studying laser, ultrasound for fat reduction

BOHAlogoA special committee appointed by the Healing Arts Board to study the use of certain low level lasers and focused ultrasound devices for the purpose of non-invasive fat reduction met this week and made a preliminary determination that the use of such devices for aesthetic purposes constituted surgery, and was therefore only within the scope of practice of MDs and DOs. A chiropractor had asked the Board whether using these devices for fat reduction was within his scope of practice.

The committee, chaired by Kim Templeton, MD, KUMC, board president, discussed the issue at length and considered statements submitted by concerned parties, including KMS. The committee also considered a statement submitted by KMS executive committee member, Mark McCune, MD, a Shawnee Mission dermatologist and former Healing Arts Board member. Dr. McCune made the point that the destruction or alteration of human tissue by any means constituted surgery, as it is defined by existing regulations of the Board. He also urged the committee to develop policies addressing new, emerging devices and technologies which emit energy that alters the structure or function of human tissue.

The committee's recommendation will be forwarded to the full Board for consideration at its next meeting.

Teleconference scheduled on QRUR reports

CMS has scheduled a teleconference on February 4, 2013 for providers with 25 or more eligible professionals in KS, MO, IA and NE from 9–10am. This teleconference is intended for Medicare Part B providers and/or billing staff who have accessed a 2011 QRUR report. The call information can be found on the QRUR website.

The Medicare 2011 QRUR is available for groups of 25 or more eligible providers. The report will give you an indication of how you will fare when the value based modifier is implemented in 2015. Reports may be accessed here.

KanCare progress update

KanCare-LogoThe transition to KanCare, the state's new Medicaid program continues, and with it, as expected with any transition of this size, are some frustrations. Practices continue to grapple with prior authorizations (PA), contracting, credentialing, and now payment issues are beginning to surface as some claims deny or reimburse inappropriately. Transition-related problems have created some administrative burdens for a number of practices, as the physician community gets to know and experience for the first time the operational policies of the three new managed care organizations.

To assist with provider concerns the state has published a Contact List for information and phone numbers to call to get your questions answered. The state has also released a couple of Bulletins: 13015 KanCare MCO PA Information provides direct links to the MCOs PA requirements, and 13014 Submission of KanCare Claims to KMAP for those using the KMAP front end billing service. The state has also announced another round of consumer education, designed to assist beneficiaries with questions they have regarding the ongoing transition, including the 90-day choice period for health plan coverage.

The state continues to have Daily Rapid Response calls where many are able to get their issues addressed. To help address our member's concerns, KMS planned three teleconferences, one with each MCO. For more information on the remaining conference calls, check out the KMS Events Calendar or contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance.

You can also visit the KanCare and MCO websites: Amerigroup, Sunflower State Health Plan, UnitedHealthcare Community Plan of Kansas.

PTs, APRN bills heating up

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Both the House and Senate health committees held hearings on physical therapy self-referral ("direct access") bills this week. As introduced, SB 46 re-proposes the language that passed out of the House of Representatives last session, stipulating that a patient may self refer to a PT but must see a physician after ten treatments or fifteen business days if the patient fails to meet documented treatment goals and functional improvement. SB 46 includes the amendments proposed last year by KMS, limiting the number of treatment days and requiring written notification to the patient that a PT diagnosis is not a medical diagnosis. Our testimony before the committee can be found here. SB 46 is likely to run on the floor of the Senate next week. House Health and Human Services Committee also heard HB 2066, which contains identical language to SB 46. The House committee has not yet scheduled a time to work the bill.

Though the advanced practice nurses have communicated with us about their intent to introduce a bill dissolving the collaborative practice agreement requirement and allowing for APRNs to serve as primary care providers in independent practice, the bill has yet to be introduced before the legislature. We are expecting the bill early next week and it is possible that committee hearings will be scheduled soon. Your help communicating with legislators that there is not a compelling reason to change the current physician-directed, team-based approach is vital. As you know, more than a third of the Legislature is comprised of individuals serving in their first term. Many have a limited understanding of the different roles of health care professionals and how the delivery of high quality patient care will be impacted by a fragmented team. For more information on the APRN proposal and how to communicate our concerns to your legislator, please click here.

The House committee on Military and Veterans affairs heard HB 2077, extending state licensure to military personnel with equivalent training in regulated professions. The bill will impact impact virtually all health care providers and regulated professionals. The bill does provide flexibility for licensing boards to affirm that the training is equivalent to Kansas' standards prior to the issuance of a state license.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

Editorial: KUMC in good hands

JerrySlaughtercolorJerry Slaughter
Executive Director

KU Chancellor Bernadette Gray-Little's selection of Doug Girod, MD, as KUMC's new executive vice chancellor will probably end up being one of the best decisions of her tenure. She couldn't have made a better choice, at a time when the enormously complex academic and clinical enterprise needed someone with a clear vision and a high degree of credibility. Dr. Girod, who serves as KU's chair of the Department of Otolaryngology-Head and Neck Surgery, has been a member of the medical center's faculty for nearly 20 years. He is well-liked and respected by his peers and regarded as a skilled clinician, educator and administrator.

Dr. Girod takes the reins at a time when KUMC has great challenges, but also great opportunity ahead of it. He intends to intensify KUMC's commitment to educational and clinical excellence, to expanding the health care workforce and to continuing the institution's commitment to establishing KU as a leader in biomedical research. He seems to be the right person, in the right place, at the right time. That is good news for KU and for the State of Kansas.

BOHA addresses use of laser, ultrasound for fat reduction

BOHAlogoThe Kansas State Board of Healing Arts adopted a policy statement that the use of ultrasound and laser devices for the purpose of fat reduction constitutes the practice of surgery. KMS supported adoption of the new policy. A chiropractor had asked the Board whether using these devices for fat reduction was within his scope of practice. A special subcommittee of the Board had studied the use of low-level lasers and focused ultrasound devices for the purpose of non-invasive fat reduction. Based upon their review and findings, the Board adopted the policy, which follows:

"It is the position of the Kansas State Board of Healing Arts that the use of ultrasound and laser devices for the purpose of fat reduction constitutes the practice of surgery. Such use is limited to physicians holding a license to practice medicine and surgery and to individuals to whom such a physician has lawfully delegated such practice. Prior to engaging in any laser or ultrasound procedure for the purpose of fat reduction, a physician shall receive appropriate training in the indications for, performance of and complications from such procedures. All such procedures shall be performed in a setting which meets the requirements of K.A.R. 100-25-2. All delegation of and supervision of such procedures shall comply with K.S.A. 65-28,127. All delegation of and supervision of laser procedures shall further comply with K.A.R. 100-27-1. All laser and ultrasound devices used for fat reduction shall be FDA-approved for that use."

PT bill passes Senate; APRN expansion introduced

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Committees have just two more weeks to consider bills introduced in their respective houses of origin before the first major legislative deadline. Next Friday is the deadline for bill introductions. If a bill has not passed out of a committee in the house it was introduced by the following week, it will be dead for the remainder of the session. The only bills not subject to legislative deadlines are those originating or passing through the so-called "exempt" committees of Appropriations, Taxation or Federal and State Affairs committees.

The House Health and Human Services Committee held a hearing on HB 2066, the physical therapist direct access bill, and passed it out of committee the following day. The bill was amended to strike language requiring the physical therapist to provide a treatment outline to the patient's physician within five days of initiating treatment. The language was stricken in an effort to ensure that the bill did not create legal complications for physicians if they received notice that one of their patients self-referred to a PT for treatment. The bill now moves to the full House for debate. The Senate's version of the PT bill, SB 46, passed the full Senate 39-0 without any additional amendments.

As expected, the Advanced Practice Registered Nurse Task Force finally introduced HB 2251, their proposal to dissolve the legally-required collaborative practice structure with physicians and allow APRNs to independently prescribe drugs, and serve as primary care providers and health team leaders. A hearing has not yet been scheduled, but we are communicating daily with legislators about the importance of maintaining high quality patient care delivered through physician-led teams. There is concern among legislators that the implementation of ACA will exacerbate access problems for rural Kansans - a point which the APRNs have used to advocate for their pursuit of independent practice.

The topic of ACA implementation remains extremely controversial at the statehouse and has generated concerns that have led to legislation in a number of areas. One example is HB 2199, the Second Amendment Protection Act, which includes a section that would prohibit physicians, with the exception of psychiatrists, from inquiring about firearms within the home of a patient. It is our understanding that the provision is primarily aimed at protecting privacy in the event that the government would ever try to access to patients' health records without their authorization. With that in mind, KMS has offered to redraft the language so as to reinforce the patient privacy protections outlined in HIPAA, rather than interfering with a physician's ability, within the privacy of the physician-patient relationship, to discuss any issues that are relevant to the patient's well-being without interference from government. Hearings have not yet been scheduled on the bill.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

KanCare news

KanCare-LogoThe Kansas Department of Health and Environment has scheduled a series of meetings for both beneficiaries and providers. Beneficiaries will have 16 locations to choose from beginning February 18 – 25. A schedule for these events can be found here. The provider meetings will be held February 26 – March 1, 2013 from 10am–noon. Registration is required and space is limited. The schedule and registration for providers can be found on the KanCare website.

KDHE has been hosting daily operated-assisted stakeholder calls. Beginning on February 15, the schedule for the calls will change; they will take place on Monday and Thursday for the last two weeks in February. After February 28, the state will reassess the need to continue. Information about these calls can be found here.

Prescription for a healthier practice

AMAlogo-betterThe AMA Practice Management Center has developed a series of resources to help your practice examine the health of your everyday administrative processes. The new series, "Prescription for a healthier practice" will provide practices with monthly check-ups to help examine the health of your everyday administrative processes in areas that include; automating your practice, fair contracting, ensuring accurate payment, physician efficiency and clinical quality issues.

The series began in January with "Claims revenue cycle check-up" which evaluates your practice's capability to submit claims efficiently and accurately; analyze health insurer payments for accuracy; and effectively address delays, denials and reductions in payment.

This month's program, "Streamline your overpayment recovery processes," identifies how to reduce manual workflows and creating efficiencies in your claims revenue cycle. The program begins with "Questions to consider when addressing payer overpayment recovery request on individual claims."

For additional information contact This email address is being protected from spambots. You need JavaScript enabled to view it. KMS Director of Health Care Finance.

Legislature moves closer to first deadline

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The Legislature is one week away from its first significant deadline of the session. February 22 represents the date on which most bills must be passed out of committee in their chamber of origin. With the exception of spending, tax and certain other bills, those not passed out of committee by the deadline are considered "dead" for the remainder of the 2013 session. The impending deadline will mean a significant amount of work will take place next week, some of it likely focusing on issues of importance to medicine. Below is a brief overview of some issues KMS is following on your behalf:

HB 2066, the physical therapist direct access bill, passed the full House on final action 98-16. The bill allows patients to self refer to a physical therapist for up to fifteen business days or ten treatments before a demonstrated lack of functional improvement would require a physician referral for continued treatment. The measure now moves to the Senate.

The House Federal and State Affairs Committee will hear HB 2199 next Tuesday. The so-called Second Amendment Protection Act contains language prohibiting physicians from asking their patients about the presence of firearms in the home. KMS has drafted amendments to strike this provision or to replace it with a restatement of the confidentiality protections guaranteed patients under the federal privacy rule which is a part of HIPAA. Either amendment would preserve the ability of physicians to freely communicate medically appropriate information with their patients without government interference.

Discussion about the massive expansion in scope of practice proposed by the APRN task force and contained within HB 2251 has decreased in intensity if not in regularity. The nurses are ever present and working hard to lead legislators to believe that dissolving the collaborative practice agreement will result in more access for rural patients, while improving quality care. Despite this push, the APRN bill is not currently moving and has not yet been scheduled for a hearing. Thank you for your calls, letters and emails to the committee. Hearing about how legislative proposals impact their constituents is crucial for any good legislator.

A senate budget subcommittee removed an appropriation of $10 million from next year's KU Medical School budget that that was a critical piece of KU's plans to build a much needed, state-of-the-art education facility. The appropriation was recommended and had the support of Governor Brownback. KMS submitted a letter of support to the Ways and Means Committee for reinstating the appropriation.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

Save the date: KMS Annual Meeting 2013

Mark your calendars now for the 154th KMS Annual Meeting on May 3-4, 2013; the meeting will be held at the Hyatt Regency Hotel (400 W. Waterman) in Wichita. The KMS Alliance 88th Annual Session will also convene on May 3-4.

The KMS House of Delegates provides the opportunity for KMS members to participate in the development of policy positions which govern the direction of the medical society in areas relating to health care issues, governance and medical ethics. We invite you to take this opportunity to become better informed and involved in the process that benefits not only the physicians in the state of Kansas, but the citizens as well. Enjoy social activities including the annual joint presidents' installation dinner and dance on Friday evening and the joint luncheon on Saturday. Be a part of the policy making process by attending the KMS House of Delegates meeting on Saturday. Registration information and more details will follow soon.

Medicare "place of service" code changes

CMS log_blueCMS has released new instructions regarding place of service codes. Previously CMS instructed physicians to use the POS code that described where the physician was physically located when the services was provided. Effective April 1, 2013 CMS instruction, Change Request 7631, establishes that the POS code to be used by the provider will be assigned as the same setting in which the beneficiary received the face-to-face service for all services (with two exceptions) paid under the Medicare Physician Fee Schedule.

In cases where the face-to-face requirement did not take place such as those when a physician provides the professional component/interpretation of a diagnostic test from a distant site, the POS codes assigned by the physician will be the setting in which the beneficiary received the technical component of the service.

The two exceptions are when the beneficiary receives care as a registered inpatient or outpatient of a hospital. The POS used would then be POS 21 for inpatient hospital or POS 22 for outpatient hospital.

These changes are the result of an Office of Inspector General finding identifying improper payments made by the Medicare program.

WPS will host a 2-hour teleconference on March 21, 2013 from 9-11am CST to discuss these changes. KMS encourages you or a member of your staff participate in this educational opportunity. Information about this teleconference can be found here.

Winter storm slows legislative progress

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The last full week for committee work was interrupted by this week's "Blizzard of Oz," effectively shuttering legislative business on Thursday and leaving committee work to the discretion of the chairmen on Friday. Senate Public Health and Welfare spent its final days hearing from the Kansas Health Institute and the Kansas Policy Institute on Medicaid expansion.

Weather not withstanding, House Appropriations also scheduled a hearing on Friday to consider HCR 5013, a resolution urging the Legislature not to expand Medicaid. Proponents of the measure are concerned that the Federal government's commitment to fully cover the cost of expansion for the first three years cannot be trusted and will lead to an unsustainable cost for the state in the future. The Kansas Hospital Association testified that the resolution wasn't necessary, and urged lawmakers to keep their options open about expanding Medicaid. KMS submitted testimony asking the committee to carefully consider the impact of expansion and the fiscal sustainability of such a proposal, as well as the impact of maintaining current Medicaid eligibility.

House Federal and State Affairs held a hearing but has not yet worked HB 2199, the Second Amendment Protection Act. KMS submitted testimony expressing our concerns about section nine of the bill, which prohibits physicians from inquiring about firearms within the home of a patient. The bill's supporters believe that patients' medical history records do not have adequate protection from the federal government and fear that information about firearm possession could be used by the government to identify gun owners and confiscate their firearms. Furthermore, there is widespread belief that the Affordable Care Act stipulates that a physician must inquire and inform about firearms with every patient. Additionally, the executive orders discussed by President Obama following the Newtown tragedy have been interpreted as further instruction to require physician inquiry, rather than a re-iteration of the physician's right to discuss safety with their patients - something that others believed to have been prohibited by the ACA. KMS testimony cited specific references in the ACA that dispell this misinformation, but the distrust of the federal government is palpable and central to the bill's support. The bill is exempt from normal legislative deadlines and has not yet been scheduled to be worked, though the chairman has indicated his intention to do so. Our testimony and suggested amendment, clarifying the privacy of the patient/provider relationship and affirming the first amendment, can be found here.

When the Legislature returns on Monday, they will have just two days to work non-exempt bills. The remainder of the week is scheduled for both chambers to convene as committee of the whole and to pass bills out ahead of the "turnaround" deadline. Non-exempt bills which have not been passed out of their originating chamber by this Friday will be considered dead for the session.

The APRN scope of practice bill was pulled by its proponents and will not advance further this session. However, because it was introduced in an odd numbered year, it is considered "alive" through the 2014 session.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

President's message: KMS goes to Washington

Synovec MarkMark Synovec, MD
KMS President

Last week, I was fortunate to represent you in KMS' annual trek to Washington, DC. We heard from key Washington insiders about the big issues in health care. The speakers were from both sides of the aisle and from both ends of Pennsylvania Avenue. HHS Secretary Sebelius expressed her agency's openness to hear problems with the implementation of the Affordable Care Act, noting that they are learning along the way with this significant Act. We heard that the gridlock between the right and left continues. Prospects of any significant "middle ground" likely rest, in part, on President Obama's willingness to compromise on budgetary issues. According to the speakers, once those issues are laid to rest, the President can move on to his personal agenda– noting that essentially second-term presidents have less than 18 months after their re-election to forge a legacy in the history books.

We also took the opportunity to express the concerns of Kansas physicians to our state's Congressional delegation. Our message was much the same as last year. Our primary concern was the flawed-SGR Medicare payment update system. The only bright spot in the discussion was that it seems that after more than 10 years of our explaining our disgust with the SGR we are all fatigued–physicians, Congress and the Administration. We did hear from Rep. Fred Upton (R-Michigan), Chairman of the House Energy & Commerce Committee, on the genesis of a bill that in three phases will: repeal the SGR; provide a finite time of annual positive physician payment updates; and provide a transitional model to a sustainable physician payment system. In the past, we have been temporarily heartened to hear of attempts to move beyond SGR. However, in light of fatigue, the Presidential legacy effect and the fact that Rep. Upton is working to secure bipartisan support for the bill (and working with the Senate to draft similar legislation) this time it just might stick!

Your delegation also highlighted physicians' concerns over the implementation of ICD-10, the concerns of the freeze and potential additional threats to graduate medical education funding (especially for primary care) and its effects on rural health care, the 2 percent Medicare cut due to the sequester, ACA implementation and potential federal tort reform legislation that could either strengthen or harm the current stability in the medicolegal environment in our state. Each member of Kansas' congressional delegation was receptive to our concerns and engaged in our conversations.

You were most fortunate to also be ably represented by Drs. Mike Machen (Quinter) and Lynn Fisher (Plainville), as well as Drs. Bart Grelinger and Donna Sweet from the Medical Society of Sedgwick County, and Dr. James Wetzell, from the Medical Society of Johnson & Wyandotte Counties, not to mention Kay Brada from AMPAC, and our always resourceful staff. I thank them all for their help in our quest.

Automatic federal spending cuts take effect

The automatic sequestration of federal spending–which had been scheduled to take effect on January 1, 2013–began today. The spending cuts were adopted as part of the Budget Control Act of 2011, which charged a Joint Select Committee on Deficit Reduction (the so-called "super committee") with developing a plan to achieve $1.2 trillion in federal spending cuts over 10 years to avert automatic, across-the-board cuts. That process failed. Legislation signed into law on January 2, 2013 delayed the cuts for two months to provide time for developing an alternative savings plan, but at this point it does not appear that Congress and the White House will reach an agreement to stop the cuts.

The $85.4 billion 2013 sequester includes: a 7.9 percent cut in defense spending, for savings of $43 billion; a 5.3 percent cut in domestic discretionary cuts, for savings of $29 billion; a 2 percent cut in Medicare provider payments, for savings of $10 billion; and 5.8 percent cuts to defense and non-defense mandatory programs to achieve $4 billion in savings. Certain safety net programs, including Medicaid, are exempt from the cuts, as are military personnel salaries.

The precise impact on specific public health and other programs will vary, although widespread federal agency staff furloughs are likely. The savings targets for the defense and domestic discretionary programs are based on the federal fiscal year, which began October 1, so the impact severity for the remainder of FY 2013 depends on what steps individual agencies and programs may have taken since last October to reduce spending.

The Medicare provider cuts are treated differently under the law, and will be limited to 2 percent regardless of how much time has passed since the beginning of the fiscal year. And, although the official sequester order is to be issued on March 1, we have been informed that the Medicare provider payment cuts will not take effect until April 1.

A number of key issues related to the payment cuts have yet to be finalized and it is likely that additional details of the Medicare sequester will be made public in the coming months.

For additional information, contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance.

Legislature passes turn-around deadline

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This week marks the passing of the first significant portion of legislative session. Non-exempt bills that did not pass their house of origin are now considered dead for the remainder of the legislative session. As we move in to the second portion of the session, we will be monitoring the resolution of HB 2066 and SB 46, the Senate and House versions of the physical therapist self-referral bill. We also await action on the Medicaid Resolution, HCR 5013, and further development of the physician inquiry on firearms issue, HB 2199.

House Appropriations passed HCR 5013, the concurrent resolution urging the Governor not to expand Medicaid. The measure passed out of the committee on a voice vote, though all six democrats on the committee requested their Nay votes be recorded. KMS offered testimony to the committee based on our health care reform principles, which encourages the Legislature to give serious consideration to the expansion if it can be done in a way that is fiscally sustainable and doesn't jeopardize the state's ability to properly fund its commitments, including provider payment levels, in the existing program. The measure has not yet been scheduled for debate on the floor of the House.

HB 2199, the Second Amendment Protection Act, was heard and worked by the House Federal and State Affairs committee this week. The underlying bill states that any personal firearm, accessory or ammunition that is owned or manufactured commercially or privately in Kansas and that remains within the borders of Kansas is not subject to federal firearms laws. As introduced, the bill also included in section 9 a prohibition against physician inquiry about the presence of firearms within the home of a patient. KMS offered testimony in opposition to that section, and suggested amendments to address the concerns expressed by the bill's sponsors. Proponents argued that the privacy protections of the physician-patient relationship under HIPPA are inadequate to guard against government seizure of medical records. Proponents also expressed concern about physicians recording and reporting information about patient's firearms possession. Ultimately, the desire to see the underlying bill advance outweighed the desire to address the physician portion of the bill, and the entire section was stricken before being passed out of committee and on to the full House for consideration. The bill's sponsors have agreed to work towards keeping the physician portion out of the bill as it advances, but the issue is far from resolved. KMS testimony on HB 2199 can be found here.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

Future of KMS to be discussed at Annual Meeting

Established by the KMS Executive Committee, the Future Directions Task Force has been convened to make recommendations on how to ensure that KMS remains relevant and provides value for the physician community in the future. The task force has been working for the past several months in its review of KMS' governance & policy development processes, as well as core organizational functions. The task force will present its some of its recommendations to the House of Delegates in May.

We invite you to participate in the discussion of the future of your medical society. Contact your county medical society or the KMS office to sign up to serve as a delegate. The meeting will be held at the Hyatt Regency Hotel (400 W. Waterman) in Wichita on May 3-4. Registration information and more details will follow soon.

KanCare transition update

The KanCare managed care organizations have extended the continuity of care transition period for certain non-participating providers. The continuity of care deadline is April 4, 2013 and allows a provider to be reimbursed at 100 percent of the Medicaid fee schedule regardless of their participation status. It is also the deadline for beneficiaries who were enrolled as of January 1, 2013 to switch to one of the other two MCOs. The timeframes and conditions vary by MCO. If you are not het contracted with an MCO, please review the detailed information provided by each MCO in the state's bulletin.

Additional notes

  • For at least two weeks starting April 2, the KanCare Rapid Response call will be held three times per week starting at 9am on Tuesdays, Thursdays and Fridays. Providers and stakeholders are welcome to join the call and ask questions about issues you are experiencing. Information regarding the Rapid Response Calls can be found here.

CMS releases CERT findings

The latest Comprehensive Error Rate Testing (CERT) findings have been released. CMS implemented the CERT program to measure improper payments in the Medicare fee-for-service program. CERT audits and requests for documentation are no stranger to physicians. The latest report details errors assessed October 2012 through December 2012 for the J5 states (IA, MO, NE and KS). The findings are reported based on the type of error assessed by the CERT contractor.

As a reminder, when responding to an audit you should consider submitting all related documentation for the service provided. For example, for a hospital visit consider submitting the order, H&P, for an office visit; x-ray, lab report or any additional paperwork reviewed. Supporting documentation should be submitted timely - if not, the audit will likely result in a recoupment of funds.

Details about this audit may be found here. To see how Kansas stacked up against neighboring states click here.

Additional information regarding the CERT program can be found on the CMS website.

KDHE improves online death certification

Online cause of death certification is available through the Kansas Department of Health and Environment (KDHE). Enhancements have been made to Kansas' Electronic Death Registration System (EDRS), which improves security and makes it easier to use with existing office software and equipment.

Using KDHE's electronic system reduces paperwork and decreases the time for processing death certificates by an average of five days. Participating funeral homes complete the personal information of the decedent and electronically forward the record to the physician for completion of the cause of death. Physicians complete the cause of death and certify the record. Then the record is electronically returned to the funeral home.

For more information, contact Shane Morris at 785.296.0791 or Diana Baldry at 785.296.1431 at the KDHE Office of Vital Statistics.

Legislature nears first adjournment

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Next Friday, April 5, is slated for "first" adjournment of the 2013 legislative session. This means when the Legislature begins work next week, they will have just five days to complete most of the work on regular session business, and find agreement on those items remaining in conference committees. Assuming the legislature adjourns as planned next week, they will then recess until the first week of May, when legislators will return to wrap up any remaining work on major unresolved issues, which could involve key decisions on taxes and the state budget.

SB 210, which contains several necessary amendments to the Health Information Technology Act is currently in conference committee, after having passed the Senate this week. The principal focus of the legislation is to transfer regulatory and administrative oversight for health information exchange to the Kansas Department of Health and Environment. Joe Davison, MD (Family Medicine-Wichita), who serves as Chair of the statewide board that has overseen the development of HIE in Kansas, testified in support of the bill. SB 210 will probably be amended into another bill in conference committee, most likely HB 2183, which amends several of the infectious and contagious disease statutes. KMS supports both bills.

HB 2199, the Second Amendment Protection Act, has passed out of the Senate Federal and State Affairs committee without amendments and could be debated by the full Senate next week. The bill deals with regulation of firearms manufactured within the state, and originally included a provision prohibiting physicians from inquiring about firearms within the home of the patient. Language prohibiting such inquiries was stricken from the bill in House committee after KMS testified in opposition to that section. Although there was no attempt to re-insert that language in Senate committee, a number of Second Amendment enthusiasts have indicated that they plan to amend the bill on the floor to re-insert the prohibition on physician inquiries. KMS continues to cite the privacy protections provided under HIPAA as well as the importance of protecting the First Amendment free speech rights of physicians and patients. A summary of KMS' position and concerns can be found here. We encourage you to contact your Senator early next week and urge him or her to oppose any amendment that would attempt to prohibit physicians and patients from discussing such issues within the confines of the confidential physician-patient relationship.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

Registration open for KMS Annual Meeting

Join your colleagues from across the state for the 2013 KMS and KMS Alliance Annual Meeting being held at the Hyatt Regency Hotel in Wichita on May 3-4. The KMS Future Directions Task Force has been working for the past several months in its review of KMS' governance & policy development processes, as well as core organizational functions; the task force will present some of its recommendations to the House of Delegates.

Go to www.kmsonline.org for complete meeting details and to register for the meeting. Contact This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it. if you have questions.

ICD-10 implementation: October 2014

Despite efforts to halt, or abandon the implementation of ICD-10, CMS has announced ICD-10 will take effect in October 2014. To help practices prepare CMS recently released new checklists and timelines for small, medium, and large provider practices. CMS will also host a national provider call on transitioning to the ICD-10 coding system. The call will take place on Thursday, April 18 at 12:30pm. To register for the call click here.

Additional information and tools you can use regarding ICD-10 are available at the CMS and AMA.

Legislature resolves KMS issues favorably

The 2013 regular session adjourned just before midnight on Friday, April 5 with most, but not all, legislative business complete. KMS had two important issues which were favorably resolved, including the health information technology act amendments (SB 210), and the firearms bill (HB 2199) which does not include a prohibition on physicians asking patients about firearms in the home. The legislature is now on break until May 8 when they return for several days to wrap up their work and deal with contentious budget and tax issues which remain unresolved.

For more information about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

CMS ordering, referring edit to begin May 1

CMS has announced that, effective May 1, 2013, physicians who order or refer Medicare services will be required to be enrolled in Medicare, if not, claims will be denied. This new edit will be applied to claims submitted on or after May 1. Physicians who have a valid opt-out affidavit on file are not required to enroll in Medicare. CMS has a special enrollment form for providers who just refer and order services but do not bill Medicare directly, known as the 855-0 form. CMS has a file containing the NPIs and the names of physicians who have current enrollment records in PECOS and are eligible to order and refer. The report can be accessed here; however, this is a large file and may take time to download.

KMS to consider changing governance, elections process

At the upcoming Annual Meeting, delegates will be considering approving some changes to the KMS' governance, nominations and elections process. The recommendations are the work product of the Future Directions Task Force which was appointed by the KMS Executive Committee to evaluate how to ensure KMS remains viable, relevant into the future. If adopted, the bylaws amendments would establish a 14-member Board of Trustees, about half of which would be at-large representatives from around the state; it would also establish specific guidance for the Nominating Committee to ensure the Board of Trustees is representative of the KMS membership.

The Task Force's proposal is included in Resolution 2013-19. All of the resolutions to be considered at the Annual Meeting may be accessed here.

KMS to evaluate new governance, elections process

At the upcoming Annual Meeting, KMS members will consider approving some changes to the KMS' governance, nominations and elections process. The recommendations are the work product of the Future Directions Task Force which was appointed by the KMS Executive Committee to evaluate how to ensure KMS remains viable, relevant into the future. If adopted, the bylaws amendments would establish a 14-member Board of Trustees, about half of which would be at-large representatives from around the state; it would also establish specific guidance for the Nominating Committee to ensure the Board of Trustees is representative of the KMS membership.

The Task Force's proposal is included in Resolution 2013-19. All of the resolutions to be considered at the Annual Meeting may be accessed here.

Last week to register for Annual Meeting

Time is running short on the opportunity to register for the KMS Annual Meeting. This year's meeting will be held in Wichita on May 3-4 at the Hyatt Regency Hotel. During the meeting, delegates representing their county/component medical societies will evaluate adoption of statements which will guide KMS policy. This meeting will also see consideration of the report of the KMS Future Directions Task Force–a group which has been working for the past several months to review of KMS' governance & policy development processes, as well as core organizational functions. The task force will present the first phase of its recommendations to the 2013 House of Delegates.

Go to www.kmsonline.org for complete meeting details and to register for the meeting. Contact This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it. if you have questions.

KMS adopts new governance model

At its meeting last weekend, the KMS House of Delegates voted to change the organization's governance structure. Delegates approved restructuring the Council, with its 37 voting members, into a smaller Board of Trustees with 18 voting members. The amendments to KMS' governing documents also restructure the Executive Committee and establish specific guidelines which the Nominating Committee will utilize to help maintain a balanced and representative Board of Trustees. (Learn more)

Recommendation for the changes originated with the Future Directions Task Force which is halfway through its two-year comprehensive effort to ensure KMS is well-positioned to remain a strong, relevant advocate for physicians well into the future. In the coming year, the Task Force will continue its work and review a number of other important issues including the future of the House of Delegates, structure of KMS membership, cost of membership and KMS' relationship with county medical societies. The final report will be considered at the 2014 Annual Meeting in Kansas City.

Delegates also elected new officers and installed Michael Machen, MD, a family physician from Quinter, as KMS President. A complete listing of the resolutions adopted at the meeting is available online. Please direct questions about any of the resolutions or the new governance model to This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it..

KaMMCO's Annual Report available online

KMS' endorsed professional liability company, KaMMCO, has produced its Annual Report in a unique video format. Click here to learn more about their efforts to shape the future of health care and their long-standing commitment to supporting Kansas physicians.

HIPAA education available for small practices

The Office for Civil Rights and the Workgroup for Electronic Data Interchange (WEDI) is launching a series of webinars on various aspects of the Omnibus HIPAA Rulemaking. The 90-minute webinars are specifically designed for small health care providers, with a focus on practical strategies for implementing the Rule changes within a small clinical practice. The sessions are scheduled for June 14, June 28, July 17 and July 26, 2013 from noon–1:30pm (CST). These webinars are free but registration is required.

KHC seeks proposals for Summit on Quality

The Kansas Healthcare Collaborative invites providers to submit proposals for breakout and poster sessions to be presented at its upcoming Summit on Quality on October 18, 2013 in Topeka. Breakout sessions focus on creating and sustaining culture change in health care, engaging and inspiring leadership, and quality improvement in the medical practice and hospital setting. The poster session allows providers to share best practices in patient safety, health care associated infections/conditions, culture and leadership, engaging patients and families, student research, reducing readmissions, and patient health literacy. The deadline for applications is June 14, 2013.

The Call for Presentations can be downloaded, or you can learn more about the Summit by visiting KHC's website.

2013 Legislative session finally ends

The Kansas Legislature made history yet again, extending its wrap-up session into the month of June for the first time since 1861, before passing a constitutionally-required budget or resolving tax proposals. At issue between the two chambers was extension of the 6.3 percent sales tax rate imposed in 2010 and whether or not financing its return to the 5.7 percent rate was fiscally responsible. Though the House opposed the Governor and the Senate's position of extending the sale tax rate in order to replace revenue lost while the income rates trigger downward, the upper chamber's position ultimately prevailed with agreement to impose a 6.15 percent rate. In exchange, the House successfully negotiated to further reduce the Governor's recommended budget by $67 million.

Among the reductions is a 3 percent cut over two years to higher education. A stipulation specific to KUMC was included, stating that enrollment and programs could not be reduced at the campuses in Salina, Wichita, Lawrence or Kansas City as a result of the reduction in appropriations for FY 2014. The practical application of this proscribed implementation remains to be seen.

Aside from taxes, the budget and one bill dealing with K-12 curriculum, no other legislative issues re-surfaced for debate during the four week so-called "Veto" Session. SB 210, the KMS-supported Health Information Technology Act, was signed by the Governor on April 17 and will become law effective July 1. The attempt to restrict physicians from talking with their patients about firearms did not advance.

The 2013 Legislative Session was one of a kind, as each session proves to be. 2013 brought an historic number of new faces, a record-setting Veto Session and a first-of-its-kind conservative Republican brand and leadership. Despite the changes, the goal of KMS' advocacy remains the same: to improve the environment in which Kansas physicians practice medicine and to protect the health of Kansas' citizens.

For legislative questions, please contact This email address is being protected from spambots. You need JavaScript enabled to view it., Director of Government Affairs.

A.M. Best upgrades KaMMCO's rating

A.M. Best Co. has upgraded the financial strength rating to A (Excellent) from A- of KMS' endorsed professional liability company, Kansas Medical Mutual Insurance Company (KaMMCO).

KaMMCO's rating is reflective of its very strong capitalization, long-term and consistent record of underwriting and overall earnings performance, and its dominant market position in providing medical professional and hospital professional liability insurance in the state of Kansas. These positive rating factors are primarily derived from the company's long-term pricing and underwriting discipline, strong retained earnings and sound capital management.

This rating upgrade from A.M. Best better positions KaMMCO to help improve the health care landscape in Kansas. For the full A.M. Best press release, visit www.ambest.com.

Health care finance updates

Contact This email address is being protected from spambots. You need JavaScript enabled to view it. at KMS for more information on any of the following issues:

  • Blue Cross contract changes for 2014 and information about provider credentialing requirements for health plans on the insurance exchange
  • Medicare recoupments involving incarcerated patients
  • Medical audits: what physicians need to know about audits and how to appeal adverse findings

KMS to seek nominations for Board of Trustees

As members may recall, in May the KMS House of Delegates adopted several recommendations of the Future Directions Task Force (click here for summary). One of the most important changes involves the establishment of a new nominations and elections process for KMS officers. Beginning with the elections in May 2014, KMS officers and trustees will for the most part be elected directly by the membership, from a slate of candidates recommended by the Nominating Committee. Previously, only members of the House of Delegates could cast votes for candidates.

Under the new process, the Nominating Committee will seek and consider recommendations for nominees from the general membership, component societies and specialty societies. The Committee is charged with the task of nominating candidates who possess the integrity, skills and commitment necessary to enable the Board to properly exercise its governance and oversight role in the best interests of the Society. In making its nominations the Committee is directed to work towards a Board composition that is broadly representative of the Society membership, particularly in experience, geographic location, specialty and practice type.

The official call for nominations from counties, specialty societies and the general membership will be sent out next month. However, if you have an interest in being nominated, or would like to nominate someone, or just have a question about the process, please contact Allison Peterson (This email address is being protected from spambots. You need JavaScript enabled to view it.) at the KMS office (800.332.0156).

SGR repeal legislation moving

In an important first step, at the end of July a congressional committee voted unanimously to advance legislation which repeals the Medicare physician payment formula (SGR), which for years has produced unrealistic recommendations for steep cuts in physician payments. The legislation, H.R. 2810, replaces the SGR with five years of 0.5% increases, as well as penalties and incentives under a new quality reporting system that would be implemented in 2019. The bill also provides incentives for physicians to participate in alternative payment models.

While the action by the committee is generally welcomed by the medical community, there are concerns that the proposed updates are inadequate and do not keep pace with inflation. Additionally, there are other concerns about the potential complexity and administrative burdens of the new quality reporting system and metrics. Final action by Congress on this issue probably won't come until the end of the year, and it will most likely be a part of a larger budget package. A summary of the legislation can be found here.

Supreme Court opinion on damages cap studied

In preparation for the upcoming 2014 legislative session, KMS has convened a broadly-based group of organizations that were affected by the recent Kansas Supreme Court decision which upheld the $250,000 cap on noneconomic or "pain and suffering" damages in personal injury lawsuits (Miller v. Johnson). The group is reviewing and discussing the Court's decision, and its implications for the adequacy and long term sustainability of the cap on damages. Although the Court upheld the cap, it also cautioned that it was "possible for a...remedy that was adequate when originally enacted to become inadequate over time...." The cap was enacted by the legislature over two decades ago in response to a medical malpractice crisis that threatened access to care.

The stakeholder group will also be discussing a number of related issues, including some mostly technical amendments to the Health Care Stabilization Fund and insurance laws, and some possible revisions to general tort reform laws.

KaMMCO announces dividend, rate reductions

The KaMMCO Board of Directors has approved a 12.5 percent dividend for members insured with KaMMCO as of September 6, 2013. The dividend will be based upon the 2013 premium paid. As requested by the Board, members will soon receive a special notice indicating the dividend amount to be applied toward their 2014 policy renewal in the form of a premium credit. This amount will also be itemized on the premium quotation. Kansas hospitals will either receive a check or a premium credit applied to the next renewal year based upon policy renewal date.

The KaMMCO Board also announced for policies issued or renewed on and after January 1, 2014, a 7 percent reduction in premium rates for Kansas physicians and surgeons and a 2.5 percent reduction for Kansas hospitals. Missouri physician premiums will remain unchanged.

Policy renewal applications have been mailed for all individual policies set to renew January 1, 2014. The deadline for renewal application return is October 15, 2013. The KaMMCO Underwriting Department will then prepare the 2014 premium quotations. New this year -- the Declarations Page, certificate(s) of insurance, Health Care Stabilization Fund Notice of Basic Coverage Form(s), and all other policy documents will be mailed along with the renewal premium quote. 2014 policy payment or payment arrangements must be made no later than December 20, 2013 or the coverage may lapse.

This board action is subject to approval by the Kansas Insurance Department.

For questions, please contact the KaMMCO Underwriting Department at 800.232.2259.

Secretary Moser: Provider input vital to KanCare improvement

A message to Kansas physicians from Robert Moser, MD; Secretary and State Health Officer, Kansas Department of Health and Environment

moser-robertOn behalf of the Kansas Department of Health and Environment and the KanCare program, I am grateful to the providers across Kansas and their membership organizations, particularly the Kansas Hospital Association and the Kansas Medical Society, for providing suggestions and recommendations on the design and implementation of KanCare. We value your continued input to identify issues, concerns and solutions as we move past implementation and into full operational status of KanCare. We remain committed to the ambitious goal of improving outcomes for Kansans receiving care through the State Medicaid program while also controlling the cost growth of these important services. While KDHE carries out the responsibilities of program oversight, we would be remiss if we were not continually aware that the desired level of success in KanCare depends upon the provider and patient relationship.

Kansas providers have been actively engaged in KanCare from the beginning, helping to ensure a smooth transition for patients. We recognize this transition to a new delivery system has not been easy or without the need to make adjustments along the way. We also recognize that during this time, there has been an impact to administrative operations, and we continue to work with all parties in finding ways to improve processes and reduce administrative burden.

In July, KDHE and the Kansas Department for Aging and Disability Services conducted an on-site review of our managed care companies with our attention on the primary issue that needed to be addressed: more focus on customer service for our providers and consumers. We requested that our health plans develop action plans and implement improvements to become more responsive to provider concerns, strengthen communications, and make certain that once a problem was resolved the funds followed soon thereafter.

As a result, the managed care organizations have hired additional provider relations and customer service staff, and they have enhanced and targeted their training to ensure consistent information is shared. At our request, they have also instituted regular provider calls to allow direct access to plan leadership on critical issues. We have also directed the plans to maintain robust issues logs that can be dependable resources for providers to research known issues and their resolution.

We also want to see an improvement in processes through standardization across the three managed care partners; for example, we have asked the plans to work on a uniform process for providers to expedite authorizations for services provided to clients with retroactive eligibility.

I look forward to continuing to update you on progress in the operational status of KanCare and appreciate being able to use this forum in doing so.

CMS schedules call on QRURs

CMS will make available confidential feedback reports based on 2012 data to all group practices with 25 or more eligible professionals. CMS has scheduled a call from 3 -4pm on September 24th to discuss the reports. Officially known as Quality and Resource Use Reports (QRURs), these reports will show a group how it would fare under the policies CMS has finalized for the Physician Value-Based Payment Modifier. This call will provide an overview of the QRUR and how to interpret and use the data in the reports. Registration for the call is required. Additional information regarding the Physician Feedback/Value-Based Payment Modifier Program can be found here.

HIPAA compliance deadline nears

In January HHS issued the HIPAA omnibus rule, revising and extending required safeguards for protected health information and expanding individual rights of patients. The updated law also tightens requirements on physicians when patient information is breached. As a result, physician practices could face more legal scrutiny and higher fines in the event of a breach.

To help physicians comply with the new HIPAA rules, the AMA recently released a HIPAA toolkit that provides a sample Notice of Privacy Practices and Business Associate Agreements. The AMA has also sent a letter to the Office for Civil Rights requesting an enforcement delay of at least six months to allow additional time for education. The September 23 deadline comes at a time when physicians are trying to keep up with other substantial changes to federal programs, such as Meaningful Use, Physician Quality Reporting System, and Value-based Modifier.

KMS opens nominations for new Board of Trustees

As members may recall, in May the KMS House of Delegates established a new nominations and elections process for KMS officers. Under the new process, the Nominating Committee will seek and consider recommendations for nominees from the general membership, component/county societies and specialty societies.

The Committee is charged with the task of nominating candidates who possess the integrity, skills and commitment necessary to enable the Board to properly exercise its governance and oversight role in the best interests of the Society. In making its nominations the Committee is directed to work towards a Board composition that is broadly representative of the Society membership, particularly in experience, geographic location, specialty and practice type. Physicians nominated to serve on the Board of Trustees must be members-in-good standing of KMS and their county medical society.

The online nomination form is available here. KMS members may be nominated by a colleague, component/county medical society or state specialty society; self-nominations will also be accepted. 

If you have questions or would like additional information, please contact Allison Peterson via email at This email address is being protected from spambots. You need JavaScript enabled to view it. or by phone at the KMS office (800.332.0156). Paper nomination forms are also available by request.

KanCare: KMS advocacy ongoing

KMS continues to meet with KDHE staff and the MCOs to ensure KanCare issues–both new and historic–are addressed. KDHE is aware of the issues and continues to monitor the MCOs, and as a result, all three MCOs are hosting Provider Forums for all provider types to ask MCO representatives questions on operational issues. Details regarding these calls may be found at each MCO's website:

If you not able to participate on these calls and are experiencing issues please contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance.

KHIN: one million patients and counting

KHIN (Kansas Health Information Network) hit a significant milestone in early August 2013. Kansas health care providers can now access critical health information on over one million Kansas patients. This means that more than 1/3 of all Kansas residents have a portion of their health information available in KHIN. 

KHIN is a non-profit, provider-led, statewide health information exchange that is connecting physicians, hospitals and other health care providers through a secure, interoperable technology platform. KHIN was established in 2010 by the Kansas Medical Society, the Kansas Hospital Association and the Wichita Health Information Exchange. KHIN's operating principles are to ensure that:

  • the focus of health information exchange is on protecting patient privacy while facilitating the improvement of patient care coordination and quality;
  • the costs of operating the HIE are fairly and appropriately shared by all stakeholders and structured to minimize barriers to participation by all providers; and
  • health information exchange is available to and serves the needs of all providers and patients, including those in rural and medically underserved areas of the state.

To get more information about how your clinic or organization can become a KHIN member, and in less than one week begin accessing critical health information on your patients, contact Laura McCrary at This email address is being protected from spambots. You need JavaScript enabled to view it..

Preparations for Legislative session well underway

columnsThe legislative session is a mere month away and much of the posturing, politicking and policy development is well underway. First and foremost, in the wake of last year's Kansas Supreme Court decision, KMS will be introducing legislation to modestly adjust the $250,000 cap on non-economic damages so as to ensure that it remains intact for years to come. Though advocating for an adjustment in the cap seems like an unusual move for KMS, the goal remains the same: to ensure the cap continues to remain on the right side of the constitutional line without jeopardizing the stability of our medical malpractice environment.

Earlier this year the vice-chair of the House Health and Human Services Committee resigned his legislative seat. House Speaker Ray Merrick appointed KMS Alliance past president and spouse of KMS member Craig Concannon, MD, Rep. Susan Concannon (R-Beloit) as the new vice chair. We welcome the opportunity to work with Rep. Concannon in her new role, knowing she understands the challenges facing physicians and others in the health care community.

As you know, the APRNs have resumed their push for independent practice, and have a draft proposal that would dissolve the requirement for collaborative practice agreements, establish APRNs as primary care providers and would essentially eliminate any distinction between physicians and nurses by removing any limitations on their practice. The nurses, now joined by the economic organization Americans for Prosperity, have been active during the interim, meeting with legislators across the state to curry favor for their proposal. It is crucial that legislators also continue to hear from physicians in their communities about the significant differences in training between physicians and nurses and how proper training impacts quality care and patient safety. Though the APRNs assure that their intent is to practice within the bounds of their training, nothing in their proposal limits their scope of practice or fosters collaboration with physicians. Instead, moving to independent practice serves to further fragment care and to jeopardize patient safety under the guise of providing greater access at a reduced cost. Your communication with legislators makes a difference. To contact legislators from your community, click here.

Other issues are also beginning to take shape as well. During the past few months we have been working with the business community on a proposal to refine and improve the process for setting the workers compensation medical fee schedule, and hope to have draft legislation that all parties agree to soon.

KMS and the Kansas Orthopaedic Society have also met with representatives of the podiatry community who would like to create a new, tiered licensure structure, which allows residency-trained podiatrists to have an expanded scope of practice involving the medical and surgical care of structures of the ankle, in addition to the foot.

These are just a few of the issues we are expecting, and 2014 is slated to be a busy and productive legislative session. Your involvement matters. Legislators have just 90 days to consider and shape hundreds of legislative matters. When issues impacting the practice of medicine are emerging, contacting your legislator makes a difference. Thank you for being available and engaged.

For questions about legislative issues, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

Editorial: Pay it forward

JerrySlaughtercolorJerry Slaughter
Executive Director

"We have been warmed by fires we did not build,
And drunk from wells we did not dig" ~Anonymous

There is a generation of physicians practicing in our fair state whose only experience with the medical malpractice environment has been one of relative tranquility. For many, it doesn't even make their top ten list of practice-related matters that worry them. Insurance is plentiful, the marketplace is competitive, and costs are reasonable and stable.

It wasn't always that way. Not so long ago, physicians labored under the considerable personal and financial burdens of a persistent medical malpractice crisis that lasted more than a decade and threatened access to medical care in many areas of our state. After several bitter legislative battles with trial lawyer groups, at KMS' urging the legislature finally enacted laws that represented a careful balancing of the interests of individuals to have an adequate remedy for injuries they sustain because of another's negligence, with the need for society as a whole to have access to essential health care services. The centerpiece of those laws, which was enacted in 1989, limits what juries can award for non-economic ("pain and suffering") damages.

Despite what its detractors (mostly plaintiff lawyers) say, our 25 years of experience with the cap, compared to states that have not had its stabilizing influence, underscores the value of this particular legal reform. It is essential to the continued stability of our medical liability insurance environment. It in essence turns down the temperature on the liability environment by providing a measure of insurance predictability for highly subjective and unpredictable noneconomic losses, while at the same time allowing injured patients to be fully compensated for all of their actual economic losses (wages, medical and related costs, etc.).

A little over a year ago the Kansas Supreme Court issued a long-awaited ruling which upheld the constitutionality of the damages cap. However, in upholding the law, the Court made a point of noting its concern that the cap's value had eroded over its 20+ years since enactment, and if not adjusted at some point, it could render the cap constitutionally inadequate. Which is another way of saying that if the cap isn't adjusted, the Court is likely to revisit the law and strike it down in a future case. That would be disastrous. Medical malpractice premiums would explode, probably doubling or perhaps tripling in a matter of years. Access to care in rural areas and high-risk medical services would be in jeopardy. There is no assurance that a cap struck down by the Court could be re-enacted in the future.

After spending most of my professional life first working to enact the cap, and then protecting it from attack, it feels more than a little odd to be in a position advocating that KMS take the lead in a legislative effort to adjust it. However, I believe that if we want to ensure the cap survives future constitutional challenges, it is essential that we heed the Court's admonition. It is my belief that it can be done in a way that continues to balance the rights of patients with the state's interest in preserving access to care and maintaining a stable liability insurance system. The current generation of physicians has the opportunity to preserve, for the physicians that follow them, this critical legal reform that has provided so much benefit to them and their patients.

Medicare: free teleconference, new ordering and referring edits

The Kansas Medical Society and KaMMCO are partnering to offer a free teleconference on important Medicare topics; the event will be held on January 14, 2013 from 9-11am. WPS Medicare Part B will join the call as well. Topics include: What's New for 2014, Physician Quality Reporting System (PQRS); Quality Resource Use Report (QRUR) and Comprehensive Error Rate Testing (CERT).

This is a free teleconference, but registration is required by January 10, 2014. Dial-in information and handouts will be e-mailed prior to the call.

Ordering and referring denial edits

On January 6, 2014, CMS will turn on the edits to deny Part B clinical laboratory and imaging, DME, and Part A HHA claims that fail the ordering/referring provider edits. These edits will check the following claims for a valid individual National Provider Identifier (NPI) and deny the claim when this information is missing or invalid:

  • Claims from clinical laboratories for ordered tests;
  • Claims from imaging centers for ordered imaging procedures;
  • Claims from suppliers of DME
  • Claims from Part A Home Health Agencies (HHAs)

Additional information about the ordering and referring edits can be found here.

Resources to prepare for the Sunshine Act

The Physician Payments Sunshine Act (Sunshine Act) requires manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals.

Manufacturers are required to collect and track payment, transfer and ownership information beginning Aug. 1, 2013. Manufacturers will submit the reports to the Centers for Medicare & Medicaid Services (CMS) on an annual basis. In addition, manufacturers and group purchasing organizations (GPOs) must report certain ownership interests held by physicians and their immediate family members.

The majority of the information contained in the reports will be available on a public, searchable website. Physicians have the right to review their reports and challenge reports that are false, inaccurate or misleading.

The AMA offers a toolkit so you can make sure you're prepared when it's time to review your 2013 financial data before it's published online next year.

Task force continues study of important issues for future of KMS

The KMS Future Directions Task Force has convened for the last phase of its two-year evaluation of the organization; the task force is engaged in a comprehensive effort to ensure KMS is well-positioned to remain a strong, relevant advocate for physicians well into the future.

At its last two meetings, the task force has reviewed the future of the House of Delegates/Annual Meeting and begun discussing KMS' relationship to county medical societies; the task force will also study the structure and cost of KMS membership. The task force's final report will be considered at the 2014 Annual Meeting in Kansas City. If you have questions about the task force's work, please contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Communications & Membership. She can be reached by phone at 800.332.0156.

KMS seeks nominations for Board of Trustees

Under KMS' new nominations process–a part of the comprehensive reforms adopted by the KMS House of Delegates–the Nominating Committee will seek and consider recommendations for nominees from the general membership, component/county societies and specialty societies.

The Committee is charged with the task of nominating candidates who possess the integrity, skills and commitment necessary to enable the Board to properly exercise its governance and oversight role in the best interests of the Society. In making its nominations the Committee is directed to work towards a Board composition that is broadly representative of the Society membership, particularly in experience, geographic location, specialty and practice type. Physicians nominated to serve on the Board of Trustees must be members-in-good standing of KMS and their county medical society.

The online nomination form is available here. KMS members may be nominated by a colleague, component/county medical society or state specialty society; self-nominations will also be accepted. 

If you have questions or would like additional information, please contact Allison Peterson via email at This email address is being protected from spambots. You need JavaScript enabled to view it. or by phone at the KMS office (800.332.0156). Paper nomination forms are also available by request.

KanCare improvements continue; important survey

A message to Kansas physicians from Robert Moser, MD; Secretary and State Health Officer, Kansas Department of Health and Environment

moser-robertSince our last update on KanCare systems resolutions, we have made progress on billing issues that some providers have experienced this year during our transition into the new Medicaid program.

The Kansas Department of Health and Environment continues to work closely with the Kansas Hospital Association and the Kansas Medical Society to address critical issues with the health plans. For example, we are working with the plans on a more standardized approach to prior authorizations, drilling down to specific iterations such as newborns eligible for KanCare whose mothers have coverage other than Medicaid.

We have also seen improvement in timeliness of claims processing overall. These improvements are due in large part to the providers who take time out of their demanding schedules to give the State and plans a facility-level understanding of the KanCare issues affecting them. KDHE and the Kansas Department for Aging and Disability Services continue to engage and monitor weekly reports from the managed care organizations on critical projects to systematically resolve provider issues.

Still, we recognize some providers are concerned that the progress achieved might not be sustained once the KanCare contracts' pay-for-performance metrics switch from Year 1 operational measures to Year 2 outcomes measures in 2014. We will always measure claims processing times and reimbursement. Because of the strong partnership with KHA and KMS, I have asked the team at KDHE to work with them on an approach to prompt-payment protection that will ensure those gains are sustained and improved.

And last but not least, KDHE launched a KanCare provider experience survey on December 6. The survey will close at midnight on December 20. It's the first in a series of surveys that will provide us with feedback from a wide range of providers. The survey is intended for the provider agency's CEO, COO, CFO or other senior leader who is able to respond with the most comprehensive perspective of the organization. We want every KanCare provider organization to take this short survey, and we encourage those same providers to continue participating in the rapid response calls hosted by each of the health plans.

If you are the appropriate provider representative to take this survey, please use this link here: http://www.kancaresupport.org/survey

Thank you to our KanCare providers for your support in helping make our transition year as smooth as it can be for provider staff and, most importantly, our patients.

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