Coding

The American Medical Association provides information on how CPT codes are maintained, new codes scheduled for implementation, and answers to frequently asked questions from coding professionals. Click here for coding resources.

Contracting

To assist physicians in their negotiations with health plans, the American Medical Association has developed the AMA Model Managed Care Contract. This contract is designed to provide alternatives to what are often one-sided contracts. The AMA’s approach suggests obligations for the health plan and the physician, and protects the patient-physician relationship.  Click here for contracting resources.

HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires physicians to protect the privacy and security of patients’ medical information and use a standard format to submit electronic transactions, such as claims, to payers. Learn more about HIPAA regulations and access resources developed by SDSMA to assist South Dakota physicians with compliance. Click here for more information on HIPPA.

Legal Information

Look here for guidance on South Dakota health laws, as well as working with attorneys and the media on requests for medical information. Click here for more information on legal information.

"Never Events"

On April 14, the Centers for Medicare and Medicaid Services (CMS) posted the Hospital 2009 IPPS Notice of Proposed Rulemaking (NPRM), which includes an expansion of the list of its Hospital Acquired Conditions (HAC) for non-payment (so called “never events”). While the rule affects hospital DRG payments only, there are significant implications for physician documentation on admission and patient care. The SDSMA will be drafting comments for the AMA and would welcome input from South Dakota physicians. The SDSMA also requests specific clinical input on these conditions to inform our comments on their appropriateness for inclusion for nonpayment in 2009. The SDSMA’s comments are due June 13, so please contact Mark East at meast@sdsma.org or 605.336.1965 with any comments or questions by June 6.

• Click here to read the proposed rule
• Click here to link to the CMS Web site for even more information on this issue

Physician Data Restriction Program (PDRP)

Physicians who want to stop pharmaceutical sales representatives from accessing their prescribing data now have that ability. The AMA Physician Data Restriction Progragm (PDRP) allows physicians the opportunity to opt out of sharing prescribing data with pharmaceutical reps, but it keeps the data available for researchers to advance important public health benefits, such as evidence-based medical research. Click here for more information on PDRP.

Practice Issues

These resources and links provide information related to practice issues that include Medicare updates, information regarding scopes of practice, and pay for performance initiatives, including the CMS physician quality reporting initiative (PQRI). Click here for more information on practice issues.

Prescription Practices

American Medical Association (AMA) policy recognizes that generic drugs can be less costly alternatives to brand-name products. The same policy also states that physicians should be free to use either the generic or brand name in prescribing drugs for their patients, and physicians should supplement medical judgments with cost considerations in making this choice. Recently, the AMA has learned that some health insurers are offering to pay physicians to switch patients from brand-name drugs to generic. The AMA has received numerous inquiries from the Federation of Medicine concerning the legality or ethical propriety of accepting this type of compensation.  This question-and-answer document attempts to address these legal and ethical considerations. Click here to read the kickback Q & A.

Reimbursement

These resources and links provide information related to reimbursement from a variety of sources including Medicare, Medicaid, worker’s compensation, and health plans. Click here for more information on reimbursement.

Risk Management

Risk management is a style of practice to prevent and control patient injuries, malpractice claims, and malpractices losses.  Developing effective risk management requires a great deal of time and commitment.  Look here for resources to assist you in focusing your efforts. Click here for more information on risk management.

iHealth Services

Address patient demand for online access to their physicians by learning how you can set up a Web site for your practice.  As an SDSMA member benefit, you have access to a personalized practice Web site built for you by Medem, an E-health network supported by the nation’s leading medical societies.  Take advantage of Medem’s interactive services such as Secure Messaging, Online Consultation, and patient appointment reminders to cost-effectively serve your patients. Click here for more information on iHealth Services.