LAtest News

  • 03/27/2020 1:31 PM | Bree Clarksen (Administrator)

    For urgent prior authorization requests for fee‐for‐service members, contact ForwardHealth Provider Services at 800‐947‐9627 for assistance with expediting the prior authorization process. An urgent, medically necessary situation is one where a delay in authorization would result in undue hardship for the member or unnecessary costs for Wisconsin Medicaid as determined by the Division of Medicaid Services. In general, urgent requests will receive a response within five business days. Additional information regarding urgent services is available (link).

    Note: Prior authorization is not required for emergency services, defined as services that are necessary to prevent the death or serious impairment of the health of the individual. Reimbursement is not guaranteed for services that normally require prior authorization that are provided in emergency situations; those services still must meet all ForwardHealth coverage requirements, including medical necessity.

    This Action Alert 08 and others are available on the ForwardHealth website (link).


  • 03/27/2020 1:30 PM | Bree Clarksen (Administrator)

    In response to the COVID‐19 pandemic, ForwardHealth is temporarily altering certain procedures in order to prevent further spread of the disease and effectively treat existing cases. These altered procedures will only be in effect during the public health emergency declared by Governor Tony Evers for the State of Wisconsin under Executive Order 72.

    Temporary Phone Number Change for Urgent Prior Authorization Requests

    For urgent prior authorization requests for fee‐for‐service members, contact ForwardHealth Provider Services at 800‐947‐9627 for assistance with expediting the prior authorization process. An urgent, medically necessary situation is one where a delay in authorization would result in undue hardship for the member or unnecessary costs for Wisconsin Medicaid as determined by the Division of Medicaid Services. In general, urgent requests will receive a response within five business days. Additional information regarding urgent services is available.

    Note: Prior authorization is not required for emergency services, defined as services that are necessary to prevent the death or serious impairment of the health of the individual. Reimbursement is not guaranteed for services that normally require prior authorization that are provided in emergency situations; those services still must meet all ForwardHealth coverage requirements, including medical necessity.


  • 03/23/2020 1:30 PM | Bree Clarksen (Administrator)

    Governor Evers announced today that he be issuing a “Safer at Home” order effective Tuesday, March 24.  Organizations and individuals providing essential care and services will be allowed to continue travelling to and from work.  This includes healthcare professionals, grocers and family caregivers.  The full details of the order to be announced by the Governor’s office.  Everyone else is asked to not take any unnecessary trips, and to limit travel to essential needs such as getting medications and groceries.

    This order is based on the advice and counsel of public health experts, healthcare providers and first responders on the front line of our state’s response to the pandemic.  These unprecedented measures are necessary to reduce rate of spread in COVID-19 cases.  We must do everything we can to keep our healthcare systems from becoming overwhelmed, and protect both the public and essential healthcare workers who are taking care of the critically ill.


  • 09/30/2019 4:26 PM | Bree Clarksen (Administrator)

    WSP continues to advocate on behalf of members regarding Anthem's fee schedule. In addition to previously contacting the office of the commissioner of insurance, WSP has directly contacted Anthem.  WSP urges all members to review their Anthem contracts and discuss any fee change concerns directly with Anthem.

    Read full letter here.
  • 08/12/2019 9:04 AM | Bree Clarksen (Administrator)

    In response to member feedback, WSP sent a letter to the Wisconsin Office of the Commissioner of Insurance over recently proposed rate cuts by Anthem. The rate cuts to Wisconsin pathologists are part of a multi-state rate cut strategy by Anthem that has garnered national attention. CAP has also weighed in by contacting Anthem for clarification on the pathology service changes. WSP expressed concern over the magnitude of the rate cuts and the subsequent impact on potential in-network status and patient access to health care. WSP also expressed concern over the rationale for the cuts as well as the notification and response process. 

    Click here to read the letter.
  • 06/05/2019 4:08 PM | Bree Clarksen (Administrator)

    Dear WSP members,

    The following alert was recently forwarded by CAP regarding out of network billing legislation.  This is a critical time period and our field needs all pathologists to participate in grass roots efforts to inform our congressional representatives about our concerns. Please take a few minutes to read the alert below and follow the link to CAP's PathNET action center to email your congressional representative. From this link, CAP members should be able to enter their email and zip code that will generate a pre-populated letter that can be customized if desired and subsequently forwarded to your congressional representatives.

    WSP has also partnered directly with CAP drafting a written response to congress about our concerns.  In addition, Wisconsin Medical Society is working on the issue on behalf of Wisconsin hospital based physicians, including pathologists.

    Thank you for your time. Please forward any questions or concerns.

    From CAP:

    You may have seen Congress is quickly advancing surprise medical billing legislative proposals at an alarming rate without properly vetting the potential consequences it could have on your ability to treat patients. Below is a quick recap:

    • There were several bills and drafts introduced to address surprise billing in both the House and Senate that the CAP has significant concerns with. These legislative proposals include the use of an out-of-network payment methodology exclusively tied to median in-network-rates which is unnaceptable to the CAP. It allows health plans to unilaterally determine the value of physician services and will turn the physician component of hospital care over to their financial control. That is a solution that will only benefit the health insurance industry to the detriment of the health care delivery system, and as such, is opposed by the CAP. The CAP cannot support any proposal that supports that provision.
    • Physician members of Congress, led by Reps. Raul Ruiz (D-CA) and Phil Roe (R-TN), released an outline for legislation that is a positive step in the right direction. As we’re encouraged by the direction of the outline by Reps. Ruiz and Roe, we need you to support them by using the buttons below to contact your member of Congress.

    The solutions as proposed by Dr. Ruiz and Dr. Roe would take necessary steps to accomplish our goals of holding patients financially harmless from surprise medical bills while creating a fair reimbursement system that keeps patients out of the middle of billing disputes. In particular, the CAP is pleased to see inclusion of a baseball-style arbitration process that allows consideration for a range of factors, including the usual and customary rate that reflects the market value of physician services. 

    While we are still hopeful that any final proposal will include network adequacy provisions, this is a far better starting point than other proposals we have seen.

    Make your voice heard on this important issue that may permanently affect your payment and potentially limit patient access to your services. We look forward to advocating for the Ruiz-Roe proposal to be adopted in place of legislation adverse to pathologists. 

    To contact your legislatures, click on the following link: https://capactioncenter.aristotle.com/SitePages/Homepage.aspx


  • 05/14/2019 10:30 AM | Bree Clarksen (Administrator)

    WSP member Kristina Matkowskyj, MD, PhD recently presented on a video series from UW-Madison called Carbone Classroom. This series features UW-Madison faculty presenting on a variety of cancer topics to try to educate their patients. Dr. Matkowskyj's presentation focuses on how Pathologists diagnose cancer. Make sure to check out the video linked below! 

    Carbon Classroom: How Pathologists Identify Cancer

  • 05/02/2019 3:55 PM | Bree Clarksen (Administrator)

    Doctor Day provides a unique opportunity for physicians to come together to advocate on behalf of patients and the medical profession. It features a wide range of hosts representing state medical and specialty societies, county society, health care organizations and strategic partners.

    Doctor Day was held May 1, 2019 at the Monona Terrace with over 350 physicians. Event attendees started their day listening to issue updates by Governor Tony Evers, DHS Secretary-Designee Andrea Palm and Attorney Guy DuBeau. These issues focused on vaccines and the “personal conviction” exception for vaccinating children. The speakers also presented on Medicaid access and focused on ensuring more access to important Medicaid services by addressing historically low physician reimbursement rates, especially in psychiatry, emergency medicine and family practice.

    Pictured below is WSP's very own secretary, Dr. Shelly Cook and member Dr. Rashmi Agni visiting the legislators at the capitol. If you would like more information about Doctor Day, please email the WSP office at WSP@badgerbay.co.


  • 04/29/2019 10:19 AM | Bree Clarksen (Administrator)
    Congratulations to Kimberly Johnson, MD from the Medical College of Wisconsin for winning the Resident Case Presentation competition at this year's Annual Conference! Four pathology residents presented a case and were judged on the clarity of presentation, significance, and relevance to practice. All four  did a great job and we would like to thank them for their hard work and participation!



  • 07/16/2018 9:18 AM | Bree Clarksen (Administrator)

    July 12, Wisconsin Health News

    Workers’ compensation premiums for businesses are set to decline by 6.03 percent this October, according to a statement from the Department of Workforce Development.

    That could result in an estimated $134 million in annual savings for businesses, the Tuesday statement noted. It’s the third year that workers’ compensation rates have declined, following an 8.46 percent decrease last year and a 3.19 percent decline in 2016.

    “A safe workplace results in a more productive and profitable one for employers,” Ted Nickel, insurance commissioner, said in a statement. "Employers are recognizing the relation between their employees' safety and the savings that ensue as premiums continue to decline."

    Mark Grapentine, senior vice president of government relations for the Wisconsin Medical Society, said the report shows that “good news keeps coming” for the state’s workers’ compensation program.

    “We’re already a national model, with faster return to work, fantastic patient satisfaction and ready access to the highest-quality healthcare in the nation – all at a cost per claim that is below the national average,” he wrote in an email. “Another significant insurance rate reduction is just more evidence that Wisconsin’s system is win-win for both businesses and their employees.”

    Grapentine added that there’s room for improvement, pointing to a need for the state’s on-the-job injury rate drop below the national average. He added that healthcare providers are “always striving to find better ways to improve care.”

    Chris Reader, director of health and human resources policy, also lauded the announcement. He said the reduction follows a national trend as employers and workers have invested in and focused on safety. But he noted that costs for medical treatment for workplace injuries are on the rise.

    “Had Wisconsin enacted a medical fee schedule like almost every other state, medical costs also would have been kept in check and the insurance reduction today would have been even greater," he wrote in an email.

    Reader also argued that the rate reduction doesn’t mean much to fully-insured employers who don’t pay insurance costs and are left footing “incredibly high medical bills.”

    Proposals to establish a fee schedule haven't gained traction with lawmakers.


 
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