IPMA Newsletter

Lead Article May Newsletter

INSURANCE COLUMN MAY 2023

Jondelle B Jenkins, DPM and Patrick McEneaney, DPM

DOES MEDICARE PAY FOR ORTHOTICS??

This question comes up routinely---the simple answer is NO! You can submit a claim with a KX Modifier but with that modifier you are attesting to the fact that the orthotic is part of a brace, if you attended a seminar and heard you should add this modifier, PLEASE BE CAREFUL with the exception of Diabetic insoles with the Diabetic shoes, Medicare does not pay for Orthosis!!!!

WHY AM I GETTING ALL OF THESE PRIOR AUTHORIZATION REQUESTS FOR MEDICATION?

It has become an additional burden for most office facilities, it seems like everything suddenly needs a prior authorization the AMA and APMA have recognized this as a concerning issue. The process can take anywhere from 5-10 minutes for each medication. I suggest, you collect them and complete at the end of the day, make sure you indicate in your office notes that you had to fulfill this process and it was part of your E/M for that patient visit.

WHAT IS THE LATEST ON THE CIGNA-25 MODIFIER ISSUE?

APMA recently joined a large number of medical specialty organizations spearheaded by the AMA signing a letter asking Cigna to immediately rescind its policy requiring submission of office notes with all claims including evaluation and management (E/M) CPT codes 99212, 99213, 99214 and 99215 and modifier 25 when a minor procedure is billed. They cited the negative impact this policy presents with administrative costs and burdens across many medical specialties and will eventually affect patient care. This policy is unjust and extraordinarily onerous for providers. Compliance guidelines and updates on this issue are available on www.apma.org/25modifier

UPDATE ON THE CMS 11750 RESTRICTIONS

APMA reported that CMS has modified its Surgical Treatment of Nails Policy to now allow medically reasonable and necessary repeat submissions of CPT 11750 for the same toe without having to submit for redetermination. Just make sure your medical records clearly indicate which toe/which border and the necessity for the procedure.

PLEASE FAMILIARIZE YOURSELF WITH ALL OF THE INFORMATIVE WEBINARS AVAILABLE ON www.apma.org/webinars- REIMBURSEMENT CONCERNS HAVE BEEN EXTREMELY CHALLENGING AND KNOWLEDGE IS KEY!!!!

Please also take advantage of the Blue Cross Blue Shield Webinars/Workshops

Availity Webinars available on BCBSIL-website-orient your front office staff on how to read eligibility documentations and reconcile deductibles and how much you can specifically ask a patient to pay up front-since guideline/requirements constantly change, it is strongly suggested that your personnel sign in at least twice/year.

Submit all insurance questions/concerns by emailing Kristy Radcliffe the IPMA office at [email protected]

Lead Article April Newsletter

The year the APMA House of Delegates (HOD) was held March 17-19 in Washington, DC. Below you will find the highlights of the 2023 HOD followed by a recap of the APMA Summit on Board Certification held March 20.

House of Delegates

The House of Delegates (HOD) is the legislative and governing body of APMA and is composed of certified delegates and alternates from each component society and APMSA.

Representing Illinois at the House of Delegates:

Chief Delegate: Dr. Jondelle Jenkins

Dr. Ada Paolucci, Delegate, who also served on the Credentialing Committee

Dr. Marlene Reid, Delegate

Dr. Diana Rogers, Delegate

Dr. Frank Rottier, Delegate

Dr. David Yeager, Delegate

Dr. Patrick Sanchez, Alternate

Dr. Sev Hrywnak, Alternate

Ms. Kristy Radcliffe, Executive Director

Also Representing Illinois, Chair of APMA Bylaws Committee, Dr. John Wray. Dr Matt Garoufalis received this Year’s Award of Excellence. Celebrating the end of her stellar year as President of the APMA was our own Dr Laura Pickard. On Friday March 17^th, The Illinois Delegation attended her Formal Presidential Celebration at the Willard Hotel.

The House officially opened on Saturday March 18, some of the highlights include:

Committee Reports included: Financial Reports and APMA Budget, DEI, Legislative, APMA PAC, Educational, Student Recruitment, Membership, Committee on Physician Parity, Affiliate Review and JAPMA

Policy Propositions:

1. Supporting Uniformity for all Medicare Beneficiaries regardless of coverage and minimizing burdens for physicians.

2. Encouraging Communication and Collaboration among organizations serving the Podiatric Community for Effective Advocacy and Patient Care.

3. Indigenous Land Acknowledgement

4. Adequate Healthcare for all Americans

Budgetary Actions:

APMA sponsorship of non-delegate young physician attendance to the House of Delegates
Student Recruitment Task Force to seek corporate/vendor funding.

Bylaws:

Governance Documents and Code of Ethics Modifications/including DEI statements to be inserted in all APMA Governance Documents.

Our new President was installed, Dr. Sylvia Virbulis from North Carolina. Two incumbent trustees to the APMA Board of Trustees were re-elected. Dr Alan Block (non-ascending) and Dr Scott Hughes. The new member to the Board of Trustees is Dr. Robert Sage from Wisconsin.

Our Own Dr. David Yeager announced that he will be running for the APMA Board at the 2024 House of Delegates. We will give him all our support.

Please visit www.apma.org search “House of Delegates” for the detailed reports and policy propositions. It was a very productive House, IPMA was well represented.

Report submitted by Jondelle Jenkins, DPM, Chief Delegate

Summit on Board Certification

The APMA hosted a Summit to discuss Board Certification following the House of Delegates in Washington, D.C. on March 20, 2023. Approximately 120 people participated while another 75 attended virtually. The Summit was moderated by Dr. Timothy Tillo, Speaker of the House. Dr. Jim Christina, Executive Director, APMA and Dr. Sylvia Virbulis, President, APMA presented the agenda which included two main topics of discussion:

Are podiatrists having trouble getting hospital privileges or on insurance panels related to board certification.
What are the possible solutions? The summit kicked off with the presentation of recent APMA survey results asking members if they had any of the above listed issues.

The results of approximately 963 respondents revealed 22% had an issue, and of that, 25% had resolved.

The age distribution was:

25-34 <10%,

35-44 ~25%,

45-54 ~30%,

55-64 ~25%,

65+ ~20%.

Over 80% had completed residency prior to 2013.

The Summit participants, representing various boards, physicians of all ages as well as non-physician interested parties, were divided into groups to discuss the agenda topics. A summary from each group was presented followed by an "open mic" forum in which everyone was afforded the opportunity to speak. The issues at hand were multi-faceted and affected everyone differently:

Those that were outside the certification time frame,
Those that did not pass an exam,
Those being limited based on which board certification they possess.

It was clarified that the Council on Podiatric Medical Education (CPME) and the Specialty Board Recognition Committee (SBRC) recognizes two certifying boards: surgical certification administered by the American Board of Foot and Ankle Surgery (ABFAS) and podiatric medicine certification administered by the American Board of Podiatric Medicine (ABPM). Various "single board" models were discussed and presented with the goal of inclusivity of all practicing podiatrists. While there was no clear consensus regarding solutions, one message was clear - the APMA is listening to all voices. The APMA has provided a complete summary of the summit along with the survey results, click on the following link for a more detailed recap.

https://www.apma.org/boardsummit

Report submitted by IPMA Delegates, Diana Rogers, DPM and David Yeager, DPM

Lead Article for the March Newsletter

Our team, comprised of Matthew O’Shea, Sarah Kuhn and Ben Lazare, has had the honor and privilege of representing the IPMA in Springfield starting in February of last year. The initial goals were to pick up where the other lobbying team left off but build additional legislative ambassadors, coordinate with the Illinois State Medical Society and have a presence on the political side.

Last legislative session a number of medical licensed professionals received a fee waiver, however the Podiatrists did not receive a fee waiver. We organized a legislative strategy for the House, Senate and Executive side that began this past veto session and continued into lame duck session. Our legislative ask was a fee waiver for 2023 or to be given a credit if it was already paid. This was truly a team effort as we had to convince the Legislative Medicaid Working group and Executive side that we should have been included in the original fee waiver. At one point the Executive side was opposed due to the budget concerns and we were able to work through their concerns and legislative concerns to ultimately pass HB 240 in lame duck session. We were the only additional group to be added as a fee waiver. State Representative Fred Crespo and Leader Theresa Mah were very helpful in our efforts.

We have started the 103rd legislative session with democrat supermajorities in the house and senate. We have a brand new House Republican Minority Leader Tony McCombie (first Republican woman) in House and Senate Republican Minority Leader, John Curran, in Senate. There are 20 new members in the House and 7 in the Senate. With the new year, we have started on our path of continuing to build our relationship with the Illinois State Medical Society (ISMS). We asked to present before the ISMS to educate their group on our training and where we could work togehter. We were invited to participate in a meeting before their Health Care Committee. On January 11, Dr. Sanchez, Dr. Norquist and Dr. Hryanek appeared before the Health Care Committee of the ISMS. We were the second group to ever appear before the ISMS. The feedback I received was that the team did a great job led by Dr. Hrywnak. The goal was not only to add additional responsibilities for Podiatrists but also to find common area where we could work in a collaborative effort with ISMS. We are finalizing a bill that will allow for vaccinations. Our legislative champions are Assistant Majority Leader Theresa Mah and Senator Julie Morrison.

The legislature is set to adjourn Friday, May 19th. Our efforts will be focused on this legislative effort, partnering with ISMS, and continuing to build legislative champions.

Matthew O’Shea
President
Matthew O’Shea Consulting, Inc.

Newsletter Article for January 2023 From IPMA President

Dear IPMA Members,

As the new year arrives, exciting times remain ahead for the Illinois Podiatric Medical Association. On behalf of the Board of Directors, I would like to say thank you for your support and we will continue to serve the membership and promote our great profession. It is an honor to serve as your President for the upcoming year.

Full licensure remains a top priority for our organization as insurance companies move away from fee for service and reimbursements continue to decline. It is important to note that our goal is not to expand our scope of practice per se; we want to simply be on the same playing field as other providers. As podiatrists, we have a limited license; however, MDs, DOs, NPs, and PAs all have full, or plenary, licensure which could potentially affect insurance inclusion as value-based care becomes more prevalent. Being cut out of insurance plans would obviously be devastating to our profession so it is important to get ahead of this issue. Thus, it continues to be a top line item for our profession at a state and national level. The IPMA will continue to work with Scholl College and the Illinois State Medical Society to pave a path more clearly to full licensure and mitigate this risk.

As most are aware, the Illinois Department of Financial and Professional Regulation modified license renewal requirements this upcoming cycle in January 2023. Podiatrists are now required to have an additional hour of training in Alzheimer’s and other dementias as well as an hour of training in implicit bias. The IPMA is proud to provide these webinars free of charge to our members. Dr. Janet Simon presented a wonderful and informative lecture to our members last month on bias training. Please be sure to sign up for the Alzheimer’s lecture on Tuesday, January 10 presented by the IPMAs own Dr. Hrywnak to make sure to have all new requirements satisfied for the upcoming renewal. In the same vein, we are very close to receiving our renewal fee waiver with the hard work of our new lobbyist, Matt O’Shea. This language has been included in HB 240, which has passed both chambers, it now awaits the Governor’s signature. Please note that should this pass, and a podiatrist has already paid the renewal fee, the podiatrist will be credited for the next renewal cycle in 2025. We will alert the membership via an email blast as soon as the Governor has signed the bill.

The IPMA's affiliation with the Guild is up for renewal this year as well. There are a great number of benefits to continue the affiliation. For example, the Guild works with members of the Blue Cross Blue Shield Labor office which makes it easier for our organization to meet with BCBS. The sheer number of members of the OPEIU/Guild is helpful for our lobbying efforts. Additionally, there are a number of members who have health insurance offered through the OPEIU. There are numerous other benefits including free roadside assistance, identity protection, death benefits, student debt reduction programs, selective loan programs, AT&T, and other company discounts. This is not all inclusive, but please go to the IPMA website to take a deep dive into all the member benefits. Information will be forthcoming regarding the vote.

Young member involvement is as important as ever for the IPMA. We remain focused on recruiting talented and motivated students to our field. The youth is the future of our profession and organization, and we must nurture our incoming leaders. Earlier this year, myself and other members of the Board of Directors spent a day at Scholl College speaking with podiatry students. We gave a lecture and had the opportunity to have lunch with the students. They were very appreciative of our support. The IPMA will continue its commitment to academic excellence and support scholarships for our hardworking students.

The IPMA still has a lot in store for the next year including more free CE webinars, an in-person meet and greet, and a virtual town hall! Stay tuned for more details.

Happy New Year to you and your family. Thank you for your continued support of the IPMA.

Sincerely,

Patrick Sanchez, DPM

IPMA President

IPMA CME Offerings

The IPMA will be offering members the following complimentary webinars:

Sexual Harassment 101 Hosted, on demand by PICA, click the link below, listen to the presentation, and answer the required questions to receive your CE Certificate from PICA.

https://info.picagroup.com/video-sexualharassment-101

Alzheimer’s Disease and Other Dementias, Tuesday, January 10, 2023

Presented by Sev Hrywnak, DPM

Click Here to register

License Renewal Information

License renewal occurs preceding January 31 of each odd- number year (01/31/2023). For additional information follow the below links

https://idfpr.illinois.gov/default.asp

https://idfpr.illinois.gov/renewals/apply/forms/f1494po.pdf

https://www.ilga.gov/commission/jcar/admincode/068/068013600000700R.html

Continuing Education Hour Requirement

Every renewal applicant who applies for renewal of a license as a podiatric physician must complete 100 hours of continuing education (CE) relevant to the practice of podiatric medicine.
A prerenewal period is the 24. Months preceding January of each odd- numbered year.
A renewal applicant is not required to comply with CE requirements for the first renewal.
Podiatric physicians licensed in Illinois by residing and practicing in other states must comply with the CE requirement set for in this section.
OPIOD Requirement- 3 hours on safe opioid prescribing practices Illinois Department of Financial and Professional Regulation

Podiatric Administrative Code: Podiatric Medical Licensing Board - State of Illinois