© Copyright San Juan Independent Practice Association, 2016. All Rights Reserved.
San Juan IPA SPECIAL Alert!
ALL Providers: Health and Human Services (HHS) Office of Inspector General (OIG) Scam
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently confirmed that the HHS OIG Hotline telephone number is being used as part of a telephone spoofing scam targeting individuals throughout the country. These scammers represent themselves as HHS OIG Hotline employees and can alter the appearance of the caller ID to make it seem as if the call is coming from the HHS OIG Hotline 1-
It is important to know that HHS OIG will not use the HHS OIG Hotline telephone number to make outgoing calls and individuals should not answer calls from 1-
More information is available on the OIG Consumer Alerts webpage.
URGENT – PROPOSED GRT TAX DEDUCTION CHANGE WILL IMPACT ALL NEW MEXICO PROVIDERS:
GRT Repeal Tax Deduction for Doctors:
The legislature has a bill that will have what we think a huge impact on the financial profit of private practice doctors. The bill repeals the GRT deduction for Medicare and Manage Care Contracts. We have sent out a number of requests for members for data so we can fight this bill in the senate. HB 202 passed the house on party lines and has a tax increase for doctors and hospitals. This is an example of the impact:
A practice with Medicaid, Medicare, Managed Care, Private Pay, Co-
WE have heard from one radiology group, the tax would be $700,000 greater than they currently pay, orthopedic $100,000, but we need many practice examples. The bill will fund the general appropriation act.
We need to hear if this has a positive or negative impact and data from your practice. We will redact the information so individual practices are not named but we need examples ASAP. Thank you so much, really appreciate getting as many practices to participate.
Please submit your responses to:
Annie Jung via email at: firstname.lastname@example.org
Randy Marshall via email at: email@example.com
Action Request -
HB 202 -
SB 202 will be the funding bill for the general appropriation act and will repeal the Managed Care and Medicare tax deduction for all health care providers. The bill allows 60% deduction and then apply your local GRT rate to the remaining 40% to arrive at tax owed.
Contact Senators and ask that they OPPOSE CS/HB 202.
Senator Phone List
Senate Emails with pre-
All Senators need to be contacted as the bill will be heard on the Senate floor in no time. It is harmful to Medicine, business, and patients. There are constructive ways to fix budget woes and this bill is not one of them.
NMMS Brief is available to download.
If you have any questions, please contact me directly, NMMS Executive Director Randy Marshall at firstname.lastname@example.org, or reply to this email.
With best regards always,
William Ritchie MD
NMMS President 2016-
ALL Presbyterian Health Plan Providers: 2017 Annual Education Conferences & Webinar Series:
The next Provider Education Conference webinar will be on March 28 and 30.
Webinar Topics will cover:
1) Recent changes in the health plan.
2) Current policies and procedures.
3) The Centennial Care program.
4) Requirements from the New Mexico Human Services Department, Center for Medicare & Medicaid Services, and the National Committee for Quality Assurance.
You may register to attend at: http://phs.swoogo.com/PHP17
ALL United Healthcare Providers: New 2017 Cumulative Opioid Quantity Limitations
If you are unable to read this message or see the images, view it online.
New for 2017:
Cumulative Opioid Quantity Limitations
We wanted to share with you our new safety limit on opioid medications for UnitedHealthcare Medicare Advantage and Prescription Drug plan members. As you may know, the Centers for Medicare & Medicaid Services (CMS) now requires Part D plans to limit the cumulative morphine equivalent dose (MED) of opioid medication(s) that a patient receives over a period of time. Our new cumulative MED limit is 360 mg for members who may be taking more than one opioid drug for pain management from one or more prescribers.
High doses of opioids, even when used as directed, can contribute to overdose or lead to opioid abuse in some people. That's why we ask for your help in following this new limit -
1. Review your patient's cumulative opioid regimen and consider tapering opioid doses as appropriate.
2. Calculate your patient's cumulative MED, keeping in mind that prescriptions from other prescribers may be contributing. For help calculating a drug's MED, please review the information in the following list of resources. If you prescribe more than the allowed limit of 360 mg MED, your patient's prescription will be rejected at the pharmacy. The rejection can only be resolved by an OptumRx coverage review. To reach the OptumRx prior authorization department, please call 800-
3. If your patient needs a higher dosage than the limit, please complete our prior authorization form. The form will be faxed to your office once your prior authorization request is initiated. Please submit the form along with chart documentation and an attestation that a cumulative opioid dose greater than 360 mg MED is medically necessary.
4. Encourage your patient to only see one prescriber for their opioid medication and to use the same pharmacy when filling their prescription.
Below is some helpful information about opioid management, including online tools and resources. We truly appreciate your attention to this important matter and for the care you provide our plan members. If you have questions, please contact OptumRx at 800-
Opioid Medication -
The Centers for Disease Control and Prevention (CDC) issued their opioid guidelines in the March 2016 Morbidity and Mortality Weekly Report (MMWR). Here are key takeaways from that report:
Start low and go slow. Prescribe the lowest possible effective dosage and start with immediate-
Follow up. Regularly monitor patients to make sure opioids are improving pain and function without causing harm. If you have a patient with continually increasing dosing or who isn't receiving much benefit from continued opioid use, please consider tapering and discontinuing the medication. Monitor patients for opioid dependence disorder and comorbid mental health conditions.
Review PDMP Data. Review a patient's history of controlled substance prescriptions using state prescription monitoring program (PDMP) data. This can help you determine whether your patient is receiving opioid dosages or dangerous combinations that place them at risk.
For more information on these CDC guidelines and how to calculate the total daily dose of opioids, please visit the CDC Guideline for Prescribing Opioids for Chronic Pain.
Online Tools & Resources
Interagency Guideline on Prescribing Opioids for Pain
National Center for Biotechnology Information: "The Role of Psychological Interventions in the Management of Patients with Chronic Pain"
Patient Substance Use Treatment Helpline
If you have a patient who is our member and may be struggling with opioid abuse, please ask them to contact our free and confidential treatment service.
Specialized licensed clinicians provide treatment advocate services 24 hours a day, 7 days a week.
Insurance coverage provided by or through UnitedHealthcare Insurance Company, All Savers Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc. and UnitedHealthcare of Washington, Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc.
Doc #: PCA-
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