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The WVSMA is Bringing Educational Opportunities to You!
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The WVSMA, through our exclusive partnership with the Practice Management Institute (PMI) is bringing some new educational opportunities to your area! We are excited to be able to offer classes statewide and bring the education to you so that more practices may take advantage of these great courses! We also are making the class schedule more flexible by splitting the day into two classes in case you are only available for ½ day.
Classes are now scheduled in Morgantown and Huntington, with additional classes being planned for Parkersburg, Beckley, Bluefield, Martinsburg and Wheeling. Many of the classes will offer CEU credits for Certified Medical Office Managers (CMOMs) or other certified professionals.
On Thursday, June 16, 2011, we will host two programs in Morgantown. The next day, Friday, June 17, 2011, the classes will be repeated in Huntington. The instructor for both days will be Maxine Inman Collins, a well known consultant and educator from Texas. “Max” was the instructor for the most recent CMOM course and received outstanding evaluations from the course attendees.
The class schedule for both days is listed below. You may choose to take one or both classes.
9:00 AM -Noon ICD-10 Coding Proficiency
1:00 PM- 4:00 PM Collecting in a New Economy
Watch for more information, including registration information, on the WVSMA’s website, www.wvsma.com!
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The WVSMA Advocates for YOU!
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The WVSMA recently scored another victory for our physician membership. During the last few years, many physicians had contacted the WVSMA with concerns about Medicaid’s ongoing audit by Health Watch Technologies (HWT). Physicians who felt their claims were being audited in error contacted the WVSMA for assistance with appeals. There seemed to be no end to the outstanding issues related to the Correct Coding Initiative (CCI) reviews and the HWT audit.
Following numerous conversations and correspondences with West Virginia Medicaid, the WVSMA is pleased to announce that Cabinet Secretary Michael J. Lewis, MD, Ph.D, has decided that the Bureau for Medical Services (BMS) will not pursue any remaining balances related to the CCI reviews. Furthermore, all cases remaining in the appeal status will be removed from the hearing docket and refunds are being processed to physicians who had previously paid their appealed balances.
This action is largely the result of advocacy by WVSMA Physician Practice Advocate, Barbara Good, who continues to work daily advocating for the issues affecting our physicians. She is committed to the physicians of West Virginia. This is just another example of how your WVSMA serves you, our physicians.
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Palmetto GBA News
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Upcoming Changes at Palmetto GBA
As most are aware, the Medicare contract for Jurisdiction 11 was awarded to Palmetto GBA and implementation is now underway. West Virginia is to be fully implemented on June 18, 2011. At that time, Palmetto GBA will be the contractor for West Virginia, Virginia, North Carolina and South Carolina.
According to Palmetto GBA, there are to be only minimal changes for West Virginia physicians. These include some changes in the Local Coverage Decisions (LCDs) and a new payor number for electronic claims. Virginia (formerly with Trailblazer) has already been transitioned and Palmetto reports that the transfer was “seamless”. They expect the same to be true when West Virginia is fully implemented.
The new Medical Director will be Elaine Jeter, MD, a Board Certified Pathologist from Columbia, South Carolina. Dr. Jeter was introduced to physicians at the recent Medicare Carrier Advisory Committee (CAC). She has spent the past six years with Medicare and plans to be both available and accessible to physicians. The WVSMA is excited to work with Dr. Jeter and her new staff.
Important Information on the Timely Claims Filing Requirement
All claims for services furnished on or after January 1, 2010, must be filed with your Medicare contractor (Palmetto GBA) no later than one calendar year (12months) from the date of service or Medicare will deny them.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8FEGA30726?opendocument
2011 Electronic Prescribing Incentive: Avoiding the Adjustment
Beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011, through June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8F6L3J2125?opendocument
April Update to the 2011 Medicare Physician Fee Schedule Database
Effective April 4, 2011, the Centers for Medicare & Medicaid Services (CMS) has made changes to four codes on the 2011 Medicare Physician Fee Schedule Database (MPFSDB). These changes are effective for services performed on or after January 1, 2011. The codes are for external electrocardiographic recording.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8FPJPC5748?opendocument
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AMA News
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(Information supplied by the AMA)
The American Medical Association (AMA) has introduced its first ever app designed specifically for physicians. The app allows physicians to quickly find CPT (Current Procedural Terminology) billing codes and is now available free through the i-Tunes store. The AMA also launched the 2011 AMA App Challenge to find the next great medical app idea.
Open to all U.S. physicians, residents and medical students, the 2011 App Challenge calls on those on the front lines of medicine to submit their unique app idea for a chance to have the AMA bring it to life. Participants can submit their app ideas easily through the online form. Submissions will be accepted through June 30th, 2011. Two winners will be selected, one from the resident/fellow or medical student category, and one from a physician category. The winners will each receive $2500.00 in cash and prizes, plus a trip for two to New Orleans for the grand unveiling of their winning idea at the AMA’s meeting in November.
Developed by the AMA for physicians, the CPT evaluation and management quick reference app is an on-the-go reference guide that helps physicians determine the appropriate CPT code to use for billing. Compatible with the Apple iPhone, iPod Touch and the iPad, the app features both decision-free logic and quick search options, allowing physicians to digitally track CPT codes and email them anywhere. Physicians can also save their most frequently used codes by location or type of service to allow for even more ease of use.
Errata Listing
The Errata listing the corrections to the 2011 CPT Book was revised on April 1, 2011, and posted to the AMA Web Site, www.ama-assn-org.
The Errata listing the corrections to the ACC Coding Guide was prepared on March 31, 2011, and posted to the AMA Web site.
To view the updated corrections, please go to
http://www.elabs10.com/ct.html?rtr=on&s=x8pbgr,gci5,2kdv,c237,d0de,h6p4,50z9
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CMS News EHR Update
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(Information provided by CMS)
The Medicare Electronic Health Record (EHR) Incentive Program Attestation began on Monday, April 18, 2011.
Attestation for the Medicare EHR Incentive Program
This means that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) can attest through the CMS web-based attestation system and be on their way to receiving Medicare EHR incentive payments.
Several new CMS resources can help you successfully navigate the Medicare EHR Incentive Program:
1. A new attestation page on the CMS EHR website, where participants in the Medicare EHR Incentive Program can find important information on attestation.
2. The Meaningful Use Attestation Calculator allows EPs and eligible hospitals to check whether they have met meaningful use guidelines before they attest in the system. The calculator prints a copy of each EP's or eligible hospital's specific measure summary.
3. The Eligible Professional User Guide and the Eligible Hospital and Critical Access Hospital User Guide provide step-by-step guidance for EPs and eligible hospitals on navigating the attestation system.
Coming Soon!
Attestation Worksheets for EPs and eligible hospitals allow users to fill out their meaningful use measure values, so they have a quick reference tool to use while attesting.
Attestation Video Webinars will provide a video version of the user guides for EPs, eligible hospitals and CAHs. The videos show EP and eligible hospital representatives completing the attestation process.
If your practice is not ready to attest, follow these steps to participate in the programs:
1. Make sure you're eligible for the EHR Incentive Programs. View eligibility guidelines at our Eligibility page and select the program in which you want to participate.
2. Get registered. Registration is open for EPs, eligible hospitals, and CAHs. Visit the Registration page for more details.
3. Use certified EHR technology. To receive incentive payments, make sure the EHR technology you're using or are considering buying has been certified by the Office of the National Coordinator for Health Information Technology. Visit our Certified EHR Technology page for details.
4. Be a Meaningful User. You have to successfully demonstrate "meaningful use" for a consecutive 90-day period in your first year of participation (and for a full year in each subsequent years) to receive EHR incentive payments. Visit the CMS Meaningful Use page to learn about meaningful use objectives and measures.
5. Attest for incentive payments. To get your EHR incentive payment, you must attest through Medicare's secure website that you've demonstrated meaningful use with certified EHR technology.
For information about the EHR Incentive Programs visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
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WV Board of Medicine License Renewal Information
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(Information provided by the WV Board of Medicine)
Medical Doctors Who Must Renew
Only those medical doctors whose last names begin with the letters M through Z are required to renew for the years 2011—2013. For the years 2011—2013, the Board of Medicine will not be mailing a paper renewal application to all the medical doctors who are renewing their licenses. Beginning May 12, 2011, licensees who meet the criteria for online renewal may go to the Board’s website at www.wvbom.wv.gov and follow the
online renewal directions. The criteria are as follows:
1. currently hold an ACTIVE medical/podiatric license; or
2. currently hold an INACTIVE medical license and will renew in an INACTIVE status; and,
3. have obtained the required continuing medical education;
4. answer “no” to all questions (see “Renewal FAQ’s” currently on the Board’s website); and
5. desire to pay via credit/debit card.
If a licensee is unable to use the online renewal service, he or she will need to request a paper renewal application to complete and return to the Board offices. A request form for a paper renewal application is available on our website under the “FORMS” section. Paper renewal applications will be mailed on May 12, 2011. The online application or paper application must be completed and submitted BEFORE Thursday, June 30, 2011, at 4:30 p.m.
Drug Dispensing
On April 12, 2011, those medical doctors and podiatrists who are currently registered with the Board as dispensing physicians will be able to renew their drug dispensing certificates online. These dispensing physicians may go to the Board’s website at www.wvbom.wv.gov and follow the online renewal directions. If a drug dispensing physician is unable to use the online renewal service, he or she will need to request a paper renewal application to complete and return to the Board offices. The licensee may call the Board offices at 304-558-2921, ext. 224 to request a drug dispensing renewal
application.
The online application or paper application should be completed and submitted BEFORE Thursday, June 30, 2011, at 4:30 p.m. There is a $30 fee for each West Virginia office location where drugs are dispensed. There is also a small credit/debit card convenience fee for renewing online.
Changes to the Upcoming Renewal Process
• Medical doctors who currently hold an inactive license and will remain in an inactive status now renew online, provided they meet the above-outlined criteria.
• Page three of the renewal application pertaining to continuing education requirements has been changed include two separate certifications of compliance—one for the 50 hours of continuing education and one for the 2 hours of continuing education coursework in end-of-life care, including pain management. The Board hopes this change will alleviate the misrepresentations found during random audits of continuing education.
• Beginning July 1, 2008, at least thirty (30) hours of the required fifty (50) hours of continuing education must be related to the physician’s or podiatrist’s area or areas of specialty.
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New Pre-Existing Condition Insurance Plan Information
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(Information supplied by CMS)
The Pre-Existing Condition Insurance Plan (PCIP) was established by the Affordable Care Act. The PCIP is administered by either your state or the U.S. Department of Health and Human Services and provides a health coverage option for children and adults in all 50 states and the District of Columbia who have been locked out of the health insurance market because of a pre-existing condition. This transitional program will continue until 2014 when Americans, regardless of their health status, will have access to affordable health insurance when the nation transitions to a new marketplace.
Eligibility criteria for PCIP:
• A U.S. citizen or residing here legally
• Uninsured for at least the last six months
• Have a pre-existing condition or have been denied health coverage because of a health condition
For more information and how to apply, go to “Find Your State” at www.pcip.gov and click on West Virginia from the map of the United States or select a state from a drop-down menu, You will see information about how to apply for the PCIP.
You can also call a toll-free line at: 1-866-717-5826 (TTY 1-866-561-1604). The Call Center is open from 8 AM to 11 PM Eastern Time. A brochure is available online that can be printed and distributed to patients and others at http://www.healthcare.gov/center/brochures/pcip.pdf
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Molina Schedules Provider Workshops
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Molina Healthcare has scheduled provider workshops during June. These important workshops will provide updates on all aspects of the WV Medicaid program. Additional information is forthcoming but here are the scheduled dates. There will be two workshop sessions on each day.
2011 Provider Workshops
June 6: Comfort Inn, Martinsburg
June 7: WVU Hospital, Morgantown
June 8: Oglebay Park, Pine Room, Wheeling
June 9: Blennerhasset Hotel, Parkersburg
June 13th – Beckley at the Tamarack
June 14th – Charleston at the Municipal Auditorium
June 15th – OPEN
June 16th – Huntington at the Big Sandy Arena
June 17th – Flatwoods at the Days Hotel
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Highmark Blue Cross Blue Shield West Virginia (Highmark WV) Update
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Fee Schedule July 2011 Update
Highmark WV has finalized the review of the changes made by CMS to its 2011 RBRVS schedule. As the result of this review, Highmark WV has concluded that adopting the changes would have a negative financial impact to the provider network. Consequently, Highmark WV will not adopt the 2011 CMS RVUs for July 1, 2011. The current Highmark WV Fee Schedule (using CMS 2009 RVUs) will continue in effect. For Highmark WV to adopt the 2011 CMS RVUs and maintain budget neutrality, it would have required a decrease in the market conversion factors.
The Highmark WV Fee Schedule will continue to use the 2009 CMS RBRVS value to include the West Virginia Geographic Practice Cost Index (GPCI) for all professional network providers in West Virginia and bordering counties.
An example regarding the RBRVS calculation for our commercial business using the CMS WV GPCI related to the RVU work, practice expense and malpractice component is provided below.
The GPCI values for West Virginia are:
Work = 1.0
Practice Expense = 0.827
Malpractice = 1.353
The formula for 2009 fee schedule payment amount is as follows:
2009 Non-Facility Pricing Amount =
[(Work RVU * Work GPCI) + (Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU *
MP GPCI)] * Highmark WV Market Factor
2009 Facility Pricing Amount = [(Work RVU * Work GPCI) + (Transitioned Facility PE RVU *
PE GPCI) + (MP RVU * MP GPCI)] * Highmark WV Market Factor
If you have any questions regarding this information, please contact your assigned External Provider Relations Representative or visit the Highmark WV website at
www.highmarkbcbswv.com.
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United Healthcare Update
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National Drug Codes Submission Process
As a result of feedback from local providers, UnitedHealthcare has developed a billing guide for submitting National Drug Codes (NDCs). The document aims to help providers understand the requirements and procedures to follow, providing details on:
How to Submit NDC Claims
Types of NDC Claims
NDC Claims Submission Details
NDC Claim Inquiry
Using the Patient's Health Care ID Card to Obtain Correct Information (Plan ID code, mailing address, customer care phone number, etc.)
Additional Resources
This document is available at UnitedHealthcareOnline.com > Claims & Payments and was detailed in the March 2011 UnitedHealthcare Network Bulletin (Vol. 42).
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WVU Schedules Palmetto GBA Seminar
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The West Virginia University Physicians of Charleston has announced that the annual Palmetto GBA Seminar will be held on April 26th. In order to better accommodate attendees' schedules, there will have 2 identical sessions: 9:00 am-12:00 (noon) and 1pm-4pm. This will be the Spring 2011 update and Palmetto will be discussing the Preventative Medicine changes, MAC update, CERT issues, and general updates.
If you plan to attend one of the sessions, you should RSVP to Laura Sullivan by April 15, 2011 at sullivanl@wvuhealthcare.com.
Participants will receive a certificate of attendance that will be sufficient to submit to your organization for 3 CEUs. This event is free of charge, and open to the public.
Please choose one of the sessions to attend:
Morning 9:00 am-12:00 (noon)
Afternoon 1:00 pm-4:00 pm
For additional information you may contact Laura Sullivan, RBA, CPC
West Virginia University Physicians of Charleston
Coordinator, Corporate Compliance Auditing and Education
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Free ICD-10 Code-a-Thon with AAPC and CMS
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The Centers for Medicare and Medicaid Services (CMS) is collaborating with the American Academy of Professional Coders (AAPC) on a “code-a-thon” event to help physicians and other health care providers and industry professionals prepare for the ICD-10 transition.
The code-a-thon will take place on Tuesday, April 26, 2011, from 1:00 p.m. to 3:45 p.m. Eastern Time, beginning with an overview presentation, followed by a live two-hour Q&A with ICD-10 trainers from AAPC.
To register for the code-a-thon, please visit https://www.livemeeting.com/lrs/8000055450/Registration.aspx?pageName=v9wcnckk2r2zwzkl. Space is limited, so register now to ensure you don't miss this event.
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April 20, 2011
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