REPORTSREPORTSMonday, February 2, 2009 www.ismanet.org

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The ISMA met again Jan. 26 with officials from Anthem to determine the status of ongoing issues reported by our members. (See Dec. 15, 2008 ISMa Reports.) Anthem repre-sentatives continue to say processes have improved, but ISMA members are still reporting problems.

Currently, the biggest issue is tied to the inquiry backlog created by the insurer’s computer system migration and inquiries filed by medical practices to learn what happened to their claims. Anthem officials said their deadline to process the backlog of 296,000 provider inquiries is April, and their goal is to process inquiries in less than 30 days.

Right now Anthem is working on inquiries received in October; these claims will be paid in February. This was the second meeting the ISMA has held with the insurer, represented by VP of Health Services David Lee, M.D.; RVP Network Contracting and Education Linda Barra-bee; VP of Commercial Service OP Laureen McCrae; and other provider service and operations staff.

As with the earlier meeting, the ISMA presented specific examples of problems identified by members and sought answers from the insurer.

“One of the ISMA’s top priorities is to resolve ongo-ing issues with Anthem,” said David Welsh, M.D., ISMA president. “At this second meeting with Anthem leaders and at the Wellpoint Physician Advisory Council meeting, the ISMA staff and I have worked vigorously to bring reso-lution. At this time, some problems have been corrected but others remain.”

Some processing errors have been resolved, staffing problems have been identified and still other problems are being worked on but will not be resolved until summer. For example, a problem with insureds changing employers and causing wrong profiles to be pulled from the system awaits resolution with a fix target of July. Other issues discussed appear below.

AppealsConcerns raised by medical practices regarding appeals

not forwarded for review – unless or until practices call Anthem about them is a training issue, according to the insurer. Representatives suggested that physicians could check on the status of an inquiry and learn if it is pending by visiting the Anthem’s secure portal. They said pending claims would be worked on a first-in-first-out basis.

Customer ServiceAnthem Customer Service staff has been re-trained to

search for records prior to requesting documentation, in response to complaints that the insurer was asking for information practices had already attached to the

The ISMA concludes second meeting with Anthemclaim. Another train-ing issue concerns the need to match lines on claims rather than deny claims due to lack of an Explanation of Benefits (EOB).

Anthem clarified that home plans follow Anthem medical policy, available on the Anthem Web site.

If you have problems with Customer Service, ask to be transferred to the “on-shore rep.” Also, get the last initial of the Customer Service rep you talked to and give it to the on-shore rep so more training can be initiated.

Provider RepresentativesAccording to Barrabee, provider relations representa-

tives are available to educate practices about the Web site and Anthem products; they do not fix claims. Physicians’ claims issues will not get resolved more quickly by going through a provider rep. Customer service should be used for this purpose, Barrabee said.

Co-paysAnthem officials said the co-pay issue is mostly resolved,

but work continues on improperly processed co-pays whereby a specialist co-pay is charged when a primary care physician provides the service.

InterestConsistent with past notices in ISMA Reports, practices

should be receiving interest payments on claims paid late. Provide the ISMA with examples if you have not received interest on late-paid claims.

CommunicationBoth the ISMA and the WellPoint Physician Advisory

Council stressed the need for Anthem to communicate with physicians and insureds by letter and in face-to-face meetings to clear the air over these continuing problems.

The ISMA understands Samuel Nussbaum, M.D., executive vice president and chief medical officer for Well-Point is considering further communication. Dr. Welsh will follow up with him regarding outreach to physicians.

Barrabee noted that Anthem schedules meetings around the state once a year in September and plans to do so again this year. Anthem did communicate about the computer migration problems in meetings last September. Anthem currently has no plans to communicate addi-tional information on the claims processing situation in statewide meetings, as requested by the ISMA.

Dr. Welsh advised, “In addition to our continuing face-to-face meetings with Anthem leaders, the ISMA Executive Committee will review the situation and consider addi-tional steps.” The Executive Committee will meet Feb. 4.

WellPoint Physician Advisory Council

The Council’s mission is to discuss regional or national issues regarding the relationships and inter-actions between physicians, patients and the insurer. The 14 Council members represent diverse geogra-phies, practices and perspectives. Its 14 members include ISMA Presi-dent David Welsh, M.D., and its chairman is Sam Nussbaum, M.D., executive vice president and chief medical officer for WellPoint, Inc. At is biannual meetings, the Council considers issues deemed appropriate by a majority of the Council’s mem-bers and makes recommendations to WellPoint.

PCF payoutLearn about payout amounts and the balance

Service expands Nine counties – and soon more – to access clinical data

Big news on lawsuitsAction over interpreters and Ingenix

AMA and PQRIAMA surveys and meets with CMS

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“One of the ISMA’s top priorities is to resolve ongoing

issues with Anthem.”David Welsh, M.D.

ISMA President

The ISMA will be monitoring Anthem’s progress. Continue advising the ISMA staff of new issues or further delays in resolving past claims by going to www.ismanet.org/forms2/ anthemform.asp on the ISMA Web site, or calling (317) 261-2060 or (800) 257-4762.

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PCF Payout Date

Total Amount Paid

Number of Claims Paid

PCF Balance Remaining

Jan. 15, 2009 $50,758,312 74 $177,762,102

July 15, 2008 $59,041,775 80 $182,977,738

Jan. 15, 2008 $50,610,371 78 $151,040,414

July 15, 2007 $42,956,884 63 $122,567,120

Jan. 15, 2007 $43,223,546 67 $92,802,229

July 15, 2006 $53,485,690 84 $49,964,014

Jan. 15, 2006 $38,553,616 57 $50,114,005

The balance in the PCF fol-lowing this month’s payout was $177,762,102.45. The current healthy balance in the PCF has netted physicians a 19.6 reduction

Insurance department makes the first 2009 payout from PCFThe Indiana Department of

Insurance (IDOI) made the first of two annual payouts from the Pa-tient’s Compensation Fund (PCF) for 2009, as required by law, on Jan. 15. The IDOI made payment on 74 claims; two claims were closed with no payment.

The total amount paid was $50,758,312.23. In a breakdown by case type, the IDOI advised 20 claims were for wrongful death of an adult, 4 were wrongful death of a child, 34 were personal injury to an adult and 16 were personal injury to a child.

A provider breakdown indicated 29 percent of claims were against hospitals, 56 percent against physi-cians and 15 percent were for all other health care provider types.

in PCF surcharge pay rates over the last two years. (See the Jan. 20, 2009, issue of ISMa Reports.)

Established in 1975, the PCF provides compensation to patients

injured by medical malpractice. The fund is administered by the IDOI and funded solely through sur-charge payments by Indiana health care providers.

The Quality Health First (QHF) program, run by the Indiana Health Information Exchange (IHIE), is now available to all primary care physicians in the nine county India-napolis metropoli-tan area -- with plans to expand in 2009. This year, it will also be offered to specialties, includ-ing cardiology and orthopaedics.

QHF is a chronic disease and preven-tive health service designed to simplify how physicians and quality mana- gers gather and organize clinical data. It provides an actionable, multi-payer report with current clinical information from multiple, unconnected sources along with claims information. The program helps improve patients’ health and care management.

“The Quality Health First pro-gram represents a profound leap into the future of health care,” said J. Marc Overhage, M.D., president and CEO of the Indiana Health

Unique – no cost – physician service expanding in central IndianaInformation Exchange. “We are able to offer a practical tool that can turn silos of information that are scattered across an entire region

into meaningful, patient-specific care information to ad-dress patients’ most common and basic health care needs.”

The goal of the QHF program is to reduce patients’ experiences of com-plications and help physicians adhere to evidence-based medi-cal practice, while

increasing satisfaction. Specifically, the QHF program:• Provides doctors with reminders

for patients who need preventive health screenings, such as colonoscopies and mammograms

• Highlights patients who require follow-up care to manage chronic diseases like diabetes and asthma

• Includes disease-based summaries based on the physician’s patient population and comparisons to the physician community as a whole

Approximately 800 physicians, mainly from central Indiana’s large hospital physician groups, already participate in QHF, which is avail-able to paper-based or electronic-based physician offices. IHIE is actively working to increase physi-cian participation.

What physicians say about QHF

“Primary care physicians have more pressure to see more patients in less time,” said Timothy L. Hobbs, M.D., CEO of Community Physicians of Indiana, a group of 178 physicians participating in QHF. “Increasingly, these patients have complex health histories, with one or more chronic diseases. The key to this program is that the information follows the patient, providing a much more accurate view of patients’ health and well-ness needs.”

John Ralph Collip, M.D., in Morristown, Ind. uses QHF reports in his practice.

“As a single provider practice, I see the value in the Quality Health First program reports,” said Dr. Collip. “I review a one-page report

which alerts me to any health screenings or tests that are needed for that particular patient. It saves me time and enables me to be more proactive so that I can provide even better care to my patients.”

IHIE was selected by the Centers for Medicare & Medicaid Services as a Physician Quality Reporting Initiative (PQRI) registry. Physicians who participate in PQRI voluntar-ily collect and report their practice data in relation to a set of perfor-mance measures. As an approved registry, IHIE is able to offer this service to physicians at no cost for a select group of measures included in both QHF and PQRI.

The Quality Health First program is made possible through IHIE’s partnership with the Regenstrief Institute, Inc., which runs the nation’s most advanced and secure community health record system. Called the Indiana Network for Patient Care, the system powers the data used in QHF reports.

Learn more about QHF at www.qualityhealthfirst.org.

J. Marc Overhage, M.D.

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A New Jersey jury handed down a $400,000 award Oct. 9, 2008, against a rheumatologist who refused to provide a sign language interpreter for a deaf patient. The award was half compensatory dam-ages, half punitive damages.

The detailsIn May 2004, Robert Fogari,

M.D., began treating Irma Gerena for lupus. The patient claimed that over 20 office visits she repeatedly asked Dr. Fogari for a sign language interpreter. She also had an inter-preter contact the doctor.

Dr. Fogari indicated that as a solo physician he could not afford the interpreter’s estimated charge of $150-$200 per visit when Medicare only reimbursed him $49 per visit. Instead, he communicated with Gerena and her family through written notes.

Ultimately, Gerena transferred her care to another physician and

sued Dr. Fogari in November 2005 for violations of the Americans with Disabilities Act (ADA) and New Jersey’s anti-discrimination law. Gerena claimed that without an interpreter she never had “any real understanding” of her diagno-sis, treatment or prognosis.

She also claimed Dr. Fogari told her to find a new physician because of her repeated requests for an interpreter.

Important reminders“Notably, Gerena never made any

allegations of medical negligence,” said Julie Reed, ISMA legal coun-sel. “Unfortunately, that meant that the doctor’s malpractice insurance would not offer coverage and the doctor was personally liable for his defense and the damages award.”

State and federal laws prohibit physicians and other entities from discriminating on the basis of dis-ability and require them to provide

– and pay for – reasonable accom-modations to ensure “effective com-munication” with patients.

Although interpreters are one means of accommodating patients, doctors can also use less costly options like note-taking, written materials and transcription devices.

The ADA includes an “undue burden” exception based on factors such as cost of the accommodation, provider’s overall financial resources, provider’s employee count, safety requirements, impact on provider’s resources and opera-tion, and difficulty in providing the accommodation.

“Unfortunately, the fact that the cost of the accommodation exceeds the physician’s reimbursement does not generally constitute an undue burden,” Reed noted.

Whether coincidental or not, the award was equivalent to Dr. Fogari’s annual income. His motion for a

new trial is now pending. If the new trial is not granted, the AMA and the Medical Society of New Jersey have indicated they may assist the physician on appeal.

“Although the ultimate decision about what accommodation to make supposedly rests with the phy-sician, this case is a strong reminder for physicians to make this decision cooperatively with the patient,” said Reed. “Dr. Forgari’s case is not the first of its kind, but the amount of the award and the punitive damages are very concerning.”

Help us with this issueThe ISMA Board of Trustees

recently requested a survey of mem-bers on the challenge of accommo-dating deaf and foreign language patients. Your input on this issue is valuable. Please take a few moments to give us your feedback at http://ismanet.informz.net/ survistapro/s.asp?id=2364.

NJ physician liable for $400,000 for failure to provide interpreter

The AMA began the year with a big win for patients and physi-cians. Settlement of a class action lawsuit will have national impact since it involves the whole insur-ance industry. Two days before that announcement, New York Attorney General Andrew Cuomo reached an agreement with UnitedHealth Group (UHG) and Aetna.

Both actions involved Ingenix, a database operated by UHG and used by the insurance industry to determine usual, reasonable and customary charges for medical care and treatment. And both actions represent the advocacy efforts the AMA undertakes on behalf of all physicians, action that pays an invaluable return on investment for AMA membership costs.

Cuomo settlementAttorney General Cuomo found

that the UHG-owned Ingenix data-base had been understating the true market rates of medical care by up to 28 percent. As a result, patients

were made to pay a higher portion of their medical bills than they should have.

The agreement requires UHG to pay $50 million and Aetna to pay $20 million to establish a new database run by an independent non-profit organiza-tion, such as a university. However, UHG admit-ted no wrongdoing under the settle-ment.

“The AMA calls upon all health insurers to immedi-ately reject the fatally flawed Ingenix database,” said Nancy Nielsen, M.D., AMA president. “The Ingenix database has corrupted the system for pay-ing out-of-network medical bills,

AMA wins long court battle over insurance database Ingenixresulting in patients and physicians being cheated by health insurers.”

AMA leaders support creation of a new independent entity to establish usual, reasonable

and customary charges.The AMA held multiple

meetings and had many phone calls

with the New York Attorney General’s office last year, alerting officials there to the

inherent conflict of interest cre-ated by UHG’s owner-ship of Ingenix. The

AMA advised the database was used by a majority of health insurers to set reimbursement rates for out-of-network physicians and other providers.

AMA settlementUHG announced a Jan. 15 settle-

ment of a class action lawsuit pur-sued over the course of nine years by the AMA, the Medical Society of the State of New York and the Missouri State Medical Association – again involving Ingenix. The suit alleged UHG used flawed data to defend low reimbursement to out-of-network providers.

The $350 million settlement en-sures UHG is held accountable for reimbursing patients and physicians shortchanged through reliance on the insurer’s flawed database.

“By agreeing to the settlement, UnitedHealth Group has recog-nized the importance of restoring its relationship with patients and physicians by ending use of a rigged database,” said AMA President Nielsen. “We must hold insurers accountable to their obligations.”

The settlement is subject to pre-liminary approval by federal district court in New York.

Insurance department makes the first 2009 payout from PCF

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Answers for Action offered by Medical Assurance, Inc.

Your practice, the Internet and liability risksI am interested in developing a Web site for my practice. Are there any guidelines I should follow to help reduce liability risks?

Increasing numbers of physicians are gaining confidence in the Internet as a way to communicate with patients. With so many physicians online, an explosion in the number of practice-related Web sites has occurred. Such Web sites offer patients and visitors a number of benefits, including immediate access to general informa-tion such as maps and directions to the office, answers to

frequently asked questions, practice policies regarding care, accepted managed care plans, and even new patient information packets. However, risk management experts suggest physicians be aware of the liability risks when putting a practice online. Potential liability may involve patients and visitors who: • Use information to self-treat or self-diagnose without seeing a medical

professional• Perceive a patient-physician relationship has been established• Send sensitive information through the site

If you are currently operating or considering developing a practice- related Web site, risk management experts suggest you:• Include a disclaimer stating you are not responsible or liable – directly

or indirectly – for any form of damages resulting from the use or misuse of information contained in or implied by the site.

• Add another disclaimer stating that no patient-physician relationship exists by virtue of visiting the site.

• Review all “links” to your site carefully before agreeing to add them to your site.

Indiana’s medical malpractice law has information regarding the ap-propriate use of the Internet in a medical practice. Find the guidelines at www.in.gov/pla/files/Internet_Medicine_Rules_2003.pdf. Physicians insured by Medical Assurance, ISMA’s endorsed profes-sional liability carrier, or ProNational, its sister company, may contact ProNational’s Risk Management Department for prompt answers to liability questions by calling (800) 292-1036 or via e-mail at okemosoperator@ProAssurance.com.

QA

The Jan. 20 issue of ISMa Reports, Hoosier State Stats incorrectly reported the number of physicians who are part of Community Health and Vascular’s merger. The merger includes 31 physicians and more than 600 employees.

CORRECTION

At a January meeting, Centers for Medicare & Medicaid Services (CMS) and AMA officials discussed physicians’ experiences with the Physician Quality Reporting Initia-tive (PQRI) and next steps for the program.

CMS indicated “modified analytic approaches” are being implemented to address problems with PQRI. By the fall of 2009, the agency expects to correct delayed incentive payments and reports to physicians.

The AMA voiced opposition to CMS’s decision to post names of PQRI participants on the Medicare Web site since this action was not made known to physicians prior to the program’s launch.

Survey reveals issuesIn October, the AMA reported

results of a physician survey about the first year of PQRI. Key elements of the initiative must be improved, said survey participants. More than six in 10 called the program “difficult” and less than a quarter of respondents were able to download a feedback report for their practices.

Less than half of those who ac-cessed their reports found them useful. Physicians who asked for help from CMS often didn’t get it. Fifty-nine percent rated their satisfac-

AMA puts the focus on PQRI tion with CMS’s responsiveness as none to low. Physicians did not get feedback reports for up to 12 months after reporting for the year ended, making it impossible to initiate ef-forts to improve for the second year. Only about half the 2007 participants received bonuses.

“Physicians need to be confident that the effort they put into partici-pating in the PQRI is worthwhile for both their patients and their prac-tice,” said Ardis Hoven, M.D., AMA Board member.

AMA resources to help The AMA has new resources to

help physicians report data for the six measure groups and the 131 individual quality measures that can be reported through claims-based submission. Tools include a data collection sheet that incorporates all individual measure-specific informa-tion in one step-by-step worksheet for clinical use and office staffs.

Visit www.ama-assn.org/go/ toolsMedicarePQRI to access these resources.

The AMA has an online educa-tional program on 2009 PQRI at http://eo2.commpartners.com/us-ers/ama/session.php?id=1846.

To learn more about PQRI, see www.cms.hhs.gov/pqri.

Tobacco mortality study offers good, bad news for Indiana

A new report from the Centers for Disease Control and Prevention shows a decrease in the number of deaths due to smoking in Indiana. The state-specific report compared data from 1996-1999 to the years 2000-2004.

However, a closer look at the statistics revealed that smoking–related deaths have increased among women by 1.7 percent, which is a concern to the Indiana Tobacco Prevention and Cessation (ITPC). Smoking mortality rates for men declined 43.7 percent.

The ITPC attributed the higher rates for women to increased marketing by the tobacco industry.

For Indiana, the report also revealed:• A 14 percent overall decline in deaths due to cigarette smoking and

exposure to secondhand smoke.• Smoking attributable mortality rates are 17 percent higher in Indiana

than the U.S. median.• About 138,915 years of potential life lost occurs annually in Indiana due

to smoking.Read the full report at www.cdc.gov/mmwr/preview/mmwrhtml/

mm5745a3.htm.

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David J. Welsh, M.D.

James G. McIntire

Adele M. Lash

Kathleen Hopper

Rhonda Bennett

Nicholas Peetz

Daniel Springer

PRESIDENT

EXECUTIVE VICE PRESIDENT

COMMUNICATIONS DIRECTOR

MANAGING EDITOR

ASSOCIATE EDITOR

PRODUCTION AND GRAPHICS EDITOR

COMMUNICATIONS ASSISTANT/WEB EDITOR

Published for member physicians. Nonmember subscriptions are $75 per year.

ISMAREPORTS

Comments? WRITE ISMa Reports 322 Canal Walk Indianapolis, IN 46202-3268

CALL (800) 257-4762 or (317) 261-2060 or VISIT www.ismanet.orgAdvertisements appearing in ISMa Reports do not necessarily represent the position of nor an endorsement from the ISMA.Copyright 2009 Indiana State Medical Association

Athens group acquired

St. Clare Medical Center and Sisters of St.

Francis Health Services have acquired Athens Medical Group in Crawfordsville. Athens’ nine practices specializing in occupational medicine, sports medicine, primary care and family care will be added to St. Clare. The merger includes 16 physicians and 128 staff members.

Wellpoint trimming workforce WellPoint, the Indianapolis parent company of Anthem, has decided to cut approximately 1,500 jobs, including about 900 open positions. The cuts come after computer problems have plagued WellPoint since late 2007, resulting in billing errors. The federal government recently banned the company from enrolling new patients in its Medicare Advantage and Medicare Part D plans.

None of the positions eliminated will impact staff in the compliance process for the Medicare Advantage and Part D programs.

Winona now city property With nearly a $2 million tax lien, Winona Memorial Hospital in Indianapolis was not sold at a second tax sale in January and now belongs to the city. The property has had several proposals for its use including an interactive park site, a hotel or a maternity clinic, but had no bids.

Columbus Hospital gets FEMA aid Columbus Regional Hospital in Bartholomew County has received $6.93 million from FEMA to repair flood damage from June 2008. The hospital’s insurance did not cover all the damages. The aid is about 80 percent of the cost to remove debris and dry, dehumidify and clean contaminated areas of the basement and first floor.

February 2, 2009Page 5

HappENINgSS TAT SHoosier State

ISMA Seminars• Coding Symposium, Feb. 26-27, Thursday-Friday, The Fountains Banquet and Conference Center, Carmel• Indiana Medicaid Update - March 4, Wednesday, Airport Marriott, Evansville - March 5, Thursday, Radisson Hotel, Bloomington - March 11, Wednesday, Hilton Garden Inn, South Bend - March 25, Wednesday, Fishers Conference Center, Fishers• The Independent Medical Practice, April 8, Wednesday, Renaissance Indianapolis North, Carmel• Basic CPT Coding, April 15-16, Wednesday-Thursday, ISMA headquarters* approved for CME ** approved for CEUCall the ISMA to register or e-mail seminars@ismanet.org.

Other events • ISMA’s Medicine Day at the Statehouse, Feb. 4, Wednesday, Indianapolis. Contact Sally Pierson at the ISMA

for information.• Medicare Coalition meeting, 10 a.m., and Medicaid Coalition meeting, 1 p.m., March 13, Friday, ISMA

Headquarters. For information, contact the ISMA, (800) 257-4762 or (317) 261-2060.• National Public Health Week Conference, April 7-8, Tuesday-Wednesday, IUPUI, Indianapolis. Sponsored by

Indiana MAPHTC. For information, visit www.publichealthconnect.org or contact Kate Nicholson at (317) 274-3178 or e-mail katlnich@iupui.edu.

Unless noted, all Happenings are held at the ISMA, 322 Canal Walk in Indianapolis (Canal Square Apartments at New York and West streets). Call the ISMA at (317) 261-2060 or (800) 257-4762 for more information.

See video about Medicare, insurance frustrations

Dublin, Ind. physicians and senior citizens describe the roadblocks to care they experience under Medicare and other health insurers in a video posted online.

The clip highlights remarks made at meetings at-tended by U.S. Department of Health and Human Services (HHS) Secretary-designate Tom Daschle. The secretary acknowledged physicians’ frustrations and stressed the need for reforms.

See the video at www.youtube.com/watch?v=5BcNh0YsM6o.

Understanding the new Medicare rates

The AMA has a new resource, “2009 Medicare Physician Payment Rates: What to Expect in Your Practice,” to help you better understand new rates and policies. The four-page document describes factors affecting rate changes and provides links to information about the 2009 incentive payment programs for electronic prescribing and quality reporting.

Find it at www.ama-assn.org/ama/pub/ category/14332.html.

Get news and information about Medicare

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ISMA REPORTS322 Canal WalkIndianapolis, IN 46202-3268

PRESORTEDFIRST-CLASS MAIL

U.S. POSTAGE PAIDINDIANAPOLIS, IN

PERMIT NO. 952

Indiana is the home of David Letterman, champion of having Top 10 Reasons to do anything!

So, in the spirit of that famous native son, the ISMA gives you our Top 10 Reasons to subscribe to e-mail news from your state association. One or two reasons from this list will surely convince you to send us your current e-mail address today!

TOP 10 REASONS to subscribe to ISMA e-mail news:

10. Giveyourfaxmachinearest.9. Impressthekidswithyouruseofe-mail.8. Savetreesand“gogreen.”7. Increaseyourpersonalcomfortwithtechnology.6. Getinformationinaquick-read,time-savingformat.5. SharenewswithstaffjustbyclickingForward.4. HelptheISMAmaximizeyourduesdollars.3. Knowwhatyourcolleaguesknowatthetimethey

knowit.2. Protectyourpatientswithaccesstoimmediate

safetyandsecuritybulletins.

AND the TOP reason to ensure the ISMA has your e-mail address:

1. Learnnewsofimportancetophysicians assoonit’savailable.

To make sure you, like your colleagues, are getting e-mail news and bulletins of importance to Indiana physicians, send an e-mail message to vriley@ismanet.org. If your e-mail has changed – or whenever it changes – make sure you send your new address to the ISMA.

ISMA Annual Coding SymposiumThe Fountains Banquet and Conference Center

502 East Carmel Drive • Carmel, IN 46032

ThursdayFebruary 26

Morning Session8:30 - 11:30 am

Afternoon Session1 - 4 pm

Urology Code: 090226A

OB/GYN Code: 090227A

PulmonologyCode: 090226B

Bundling/ModifiersCode: 090227B

E/MCode: 090226C

Family PracticeCode: 090227C

FridayFebruary 27

Morning Session8:30 - 11:30 am

Afternoon Session1 - 4 pm

Lab/PathologyCode: 090226D

CardiologyCode: 090227D

PediatricsCode: 090226E

Bundling/ ModifiersCode: 090227E

Minor Office ProceduresCode: 090226F

OrthopaedicsCode: 090227F

Fees: Member/Staff — $129 • Additional Staff — $109Attend any two sessions and receive a $30 discount.

For more information or to register, call (317) 261-2060 or (800) 257-4762 or e-mail seminars@ismanet.org.

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