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We Want Your Opinion!
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Watch for upcoming communications to solicit your opinions regarding topics of interest for the 2011 WVSMA Healthcare Summit. We want input from you, our physicians, to ensure that the Healthcare Summit provides information regarding important issues relative to your practice.
The survey will take only minutes and will provide the WVSMA with valuable information for our planning purposes.
Thank you in advance for your participation! |
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Medicare Incentive Programs Update
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Physician Quality Reporting System
The Physician Quality Reporting System (PQRS), which was formerly known as PQRI, incentive payments are available until 2014. Beginning in 2015, eligible providers who do not satisfactorily report Physician Quality Reporting System measures will be subject to payment adjustments.
eRx Incentive Payments
The eRx incentive payments are available until 2013. Beginning in 2012, payment adjustments will take effect for eligible providers who are not successful e-prescribers.
Electronic Health Records (EHR)
The Electronic Health Records Incentive Program begins in calendar year 2011. Eligible providers can earn incentive payments for up to five years if they elect to receive their incentive payment through Medicare, or up to six years if they elect to receive their incentive payment through Medicaid. No Medicare EHR incentive payments will be made to eligible providers whose first year of participation in the Medicare EHR program is 2015 or later. Beginning in 2015, payment adjustments will take effect for Medicare fee for service eligible providers who cannot successfully demonstrate meaningful use of certified EHR technology. Eligible providers can begin to participate in the Medicaid EHR program until 2016 and there are currently no penalties Medicaid providers for not demonstrating meaningful use.
For additional information, visit the CMS website: http://www.cms.gov/EHRIncentive Programs or http://healthit.hhs.gov
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Medicare Primary Care Incentive Program (PCIP)
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(Information provided by CMS)
The Affordable Care Act authorizes CMS to make incentive payments equal to 10% of the provider’s allowed charges for primary care services furnished by certain physician and non-physician specialties that are designated as primary care practitioners. This provision begins in 2011.
Primary care practitioners are defined as physicians who have a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine, as well as nurse practitioners, clinical nurse specialists and physician assistants; and for whom primary care services accounted for at least 60% of the practitioner’s allowed charges under Part B for a prior period as determined by the Secretary of Health and Human Services.
To find out if you are eligible, go to the Palmetto GBA website, www.PalmettoGBA.com/WV and select “Primary Care Incentive Eligibility Tool” under the self service tools. Enter your NPI number and view the information.
To find out the percentage of data gathered from January 2009 through June 2010, contact the Palmetto Call Center at 866-332-7025.
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Additional News From Palmetto GBA
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Palmetto GBA Announces New Provider Representative for J11
Palmetto GBA recently announced that Kathy Boehm will be the Provider Outreach and Education Representative for West Virginia. Kathy, who will work from Richmond, Virginia, formerly was with Trailblazer. She is beginning to work with West Virginia groups to set up speaking engagements.
If your group is interested in having Kathy speak, her contact information is below:
Kathy Boehm
Provider Outreach and Education
J11 MAC
(804) 440-8366
Notice of New Interest Rate for Medicare Overpayments and Underpayments:
Third Notification for FY 2011
The Department of the Treasury has notified the Department of Health and Human Services that the private consumer rate has been changed to 11 percent effective April 19, 2011, for Medicare overpayments and underpayments.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8DFGLY2184?opendocument
Affordable Care Act Claims Reprocessing Requirements and Retroactive Corrections to the 2010 Medicare Physician Fee Schedule
This article provides additional information about the reprocessing requirements for claims affected by the retroactive nature of various provisions of the Affordable Care Act as well as retroactive corrections to the 2010 Medicare Physician Fee Schedule (MPFS).
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8GBNUG3770?opendocument
Palmetto GBA Preparing to Implement Medicare A/B MAC Workload in West Virginia
On May 16, 2011, Palmetto GBA will assume responsibility for all fee-for-service Medicare claims processing, customer service and payments for West Virginia’s Part A providers who currently submit claims to National Government Services (NGS). Palmetto GBA will begin work as the Part B MAC for West Virginia on June 18, 2011. West Virginia’s Part B providers already submit their claims to Palmetto GBA and will continue doing so.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8G5KGA3532?opendocument
Medicare Electronic Health Record (EHR) Incentive Payment Process
The American Recovery and Reinvestment Act (Recovery Act) of 2009 provides for incentive payments beginning in 2011 for Medicare eligible professionals, eligible hospitals (including Medicare Advantage affiliated
hospitals) and critical access hospitals (CAHs) that are meaningful users of certified EHR technology. This article includes information on eligibility, when payments will be made and how to get more information about payment calculations.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8G6GA62636?opendocument
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Register Now for Classes In Morgantown and Huntington!
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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! Classes are now scheduled in Morgantown and Huntington, 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.
CEU credits are available 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, 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.
Information about both classes is listed below. You may choose to take one or both classes on either day.
ICD-10 Coding Proficiency 9:00 AM -Noon
This class will explain the steps you can take now to improve your understanding of ICD-10. The new codes will be much more descriptive, requiring a good understanding of both anatomy and medical terminology. Participants will leave this class with valuable tips for a smooth transition to ICD-10.
Collecting in a New Economy 1:00 PM- 4:00 PM
This is an intermediate-level course appropriate for physicians, practice managers, coders and billing staff. Attendees will explore the stages of the collections process beyond payment at time of service. Participants will learn how to set up a manageable, traceable system that gets results without negatively affecting patient relations. The course also includes tips on dealing with difficult collection situations.
Participants will also learn how to determine the effectiveness of their billing procedures, the steps to take before you start to collect on an account, and how to streamline reimbursement and collection policies.
Registration information is available on the WVSMA’s website, www.wvsma.com. For additional information, please contact Karie Sharp (304) 925-0342, ext 12 or via email Karie@wvsma.com.
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Ordered/Referred Services Update
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As of now, there is no date set for Medicare expanded ordering/referring provider claims edits. CMS has not yet determined when it will begin to apply the ordering/referring provider claim edit to ordering/referring providers who do not have a record in the Provider Enrollment Chain and Ownership System (PECOS). As previously stated, CMS will give providers ample notice before the ordering/providing claim edit is applied.
Recent revisions to the rules require that claim rejecting be delayed until receiving further direction from CMS.
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News from the American Medical Association (AMA)
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(Information supplied by the AMA)
The American Medical Association (AMA) has introduced a new series of online tutorials to help physicians in their quest for the most appropriate IT systems for their practices.. The series of six short narrated modules provides step-by-step instructions to help physicians choose, purchase and implement the best technology systems for their practice.
The CME-accredited series enables physicians and their staff to align health IT with their patient and practice needs. The tutorials last about eight minutes each and cover all aspects of health IT adoption, including adoption strategy and needs assessment, workflow analysis, technology selection, training and implementation.
The use of health IT can help physicians make better decisions about appropriate treatment plans, provide timely access to patients’ complete medical histories and enable them to determine the best treatment plan for their patients. Physicians who meet meaningful use requirements for health IT can also begin receiving federal incentives this year.
Additional health IT resources, including information on the federal incentives and demonstrating meaningful use, are available on the AMA web site.
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Aetna Update
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Aetna Appeals
Aetna reminds physicians that all claims must be filed within 120 days of the service rendered.
Reconsiderations must be received within 180 days of the initial claim
decision. Reconsideration can be requested by calling the Provider Service Center (PSC) at 888-632-3862 or requesting the claim be reconsidered via NaviNet.
Level 1 Appeals must be received within 60 days of the reconsideration decision. The Appeal should include the member name, member ID, Date of Service, Date of Birth, and claim ID. The letter should provide detailed documentation.
Level 2 Appeals must be received within 60 days of the Level 1 decision. The appeal should include the member name, member ID, Date of Service, Date of Birth, claim ID and Appeal Level 1 ID. The letter should provide more detailed documentation than the Level 1 Appeal.
Level 3 Appeals must be received within 60 days of the Level 2 Appeal decision. Level 3 should only be used if further documentation can be provided. All member information should be supplied as for Level 1 and Level 2 Appeals.
Appeals of all three levels should be mailed to:
Aetna Appeal
PO Box 981106
El Pason, TX 79998-1106
The Aetna Provider Service Center (888-632-3862) handles the following issues:
All claims inquires of any kind
Status of provider
Request for data changes
Member Information
Referral/Precertification Information
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BrickStreet's First Script Program
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(Information supplied by Brickstreet)
BrickStreet is proud to offer First Script, their pharmacy benefit management program through the Coventry network.
The program is designed specifically for workers’ compensation and enables a claimant to receive initial prescription medication as soon as it is prescribed.
More specifically, claimants can receive their first-fill prescription for up to 14 days from the date of the injury without a pharmacy card or financial risk. This helps the claimant receive the medication they need immediately, eliminates multiple trips to the pharmacy and out-of-pocket expenses for the claimant, and starts the recovery process as soon as possible.
For policyholders, First Script can help promote an earlier return to work for claimants, cutting down on both direct and indirect costs of the injury.
First Script has approximately 523 pharmacies in West Virginia. The program offers an extensive pharmacy network and other resources claimants and policyholders can use throughout the life of a claim.
When an injury occurs, the policyholder must fill out a form and give it to their injured employee. The employee gives the form to the pharmacy when the prescription is filled.
For more information, visit www.coventrywcs.com
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Molina Heathcare Update
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Molina Healthcare has scheduled Regional Training Sessions during June. Agenda items include Re-Enrollment of All Providers, Provider HER Incentive Plan, Updates/Changes-5010 Healthcare Transaction Standards, and more.
Announcements were recently mailed to physician offices. If you did not receive one, they are available on the website, www.MolinaHealthCare.com.
Below are the dates of the workshops. Sessions will run from 9:00 AM-Noon and 1:30 PM- 4:30 PM.
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
Sign up for the workshops will begin at 8:15 AM for the morning sessions and 1:00 PM for the afternoon session. Registration is limited to 2 persons per office. Registration forms for the workshops must be returned by Friday, May 27, 2011.
Registration forms should be mailed or faxed to:
Attn: 2011 Provider Workshops
Molina Medicaid Solutions, 1600 Pennsylvania Avenue, Charleston, WV 25302
Fax: 304-348-3380 or 304-348-3211
For questions, you should contact the Provider Relations Department at 1-888-483-0793.
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PEIA Update
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PEIA has announced the following updates that will be effective July 1, 2011.
The Health Plan of the Upper Ohio Valley is the only managed care option available for PEIA members this year. The Health Plan now has an expanded service area.
As of July 1, Eastern Panhandle members will now be charged copays and coninsurance for West Virginia providers.
The lifetime maximum has been removed for PEIA beneficiaries as of July 1. Also, dependent children are now covered through age 26. The children may be married and are not required to live in the home; however, they cannot have other insurance available to them and still be covered by PEIA.
PEIA also has WVU as the provider of choice for Bone Marrow Transplants and
Charleston Area Medical Center (CAMC) as the provider of choice for Kidney Transplants.
The River Valley Health Alliance is no longer a participating provider with PEIA and is considered out of network. This includes Marietta and Selby Hospitals.
For more information about PEIA, visit www.wvpeia.com or www.wellsfargo.com/tpa.
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Mon General Named One of the "100 Best Places to Work in Healthcare"
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(information supplied by Becker ‘s Hospital Review)
Monongalia General In Morgantown, WV, has been named one of the “100 Best Places to Work in Healthcare” by Becker’s ASC Review/Becker’s Hospital Review. The 2011 list was developed through nominations and research, and the organizations were selected for their demonstrated excellence in providing a work environment that promotes teamwork, professional development and quality patient care. Mon General was the only West Virginia entity to be named in this announcement.
Type of facility: Hospital/health system
What makes it a Best Place to Work: Mon General Hospital, a 189-bed community hospital, is the cornerstone of the Mon Health System. The hospital recently completed a considerable expansion project, upon completion of which, the facility provided a celebration for staff and families. Open houses and tours of the new facility were offered, as well as live entertainment, refreshments, prizes and giveaways. In addition, over 80 employees with more than 30 years of service with MGH were honored at the grand opening's ribbon-cutting ceremony.
In the last few years, the hospital has implemented a recognition program called Wonderful Opportunities Working that recognizes exceptional performance. When an employee sees another employee giving exceptional service, they can recognize the employee with a gift card that can be redeemed in the hospital gift shop or cafeteria. The hospital's "department of the quarter" program recognizes a winning department with an engraved plaque, recognition from administration and small reception for department members. Employees can participate in a wellness program that grants employees points for participation throughout the year. At the end of the year, those who meet the point requirements in three categories are eligible for a wellness cash payout. Staff and their spouses and children can also take part in biometric wellness
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Charleston Area Office Managers Association Meeting
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The Charleston OMA will meet on Tuesday 10, 2011 at 11:30 AM at the Education Center in Thomas Hospital, South Charleston, West Virginia.
Rogher Hargus, Administrative Director of Behavioral Health Services of Thomas Hospital will present a program on “Managing Stress in the Workplace”.
All office managers (stressed or non-stressed) are invited to attend. The cost is free for OMA members and $20.00 for non-members.
Please RSVP to Connie Frazier, (304) 343-4124) or via email, eyeconnie@gmail.com
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WV AAPC Meeting Scheduled
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The Charleston Chapter of the AAPC will meet on Tuesday, May 17, 2011, at 8:00 AM at Shoney’s Restaurant, 116 Kanawha Blvd. East, in Charleston.
The program, May Mania, will include
Ride the Wave; Free buffet breakfast; Anatomy, medical terminology; H&P word search, crossword, and other games. AAPC bucks and other raffles will be available.
Attendees are eligible to receive 2 CEUs.
Contact Maggie McCabe (maggie@mccabemedicalcoding.com) for reservations.
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WVRHITEC Presents Webinars
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The WVRHITEC (West Virginia Regional Health Information Technology Extension Center) wants to help physician practices decide which EHR system is right for their practices. The group is hosting a series of webinars to help physicians and staffs with this important decision. Information regarding the webinars is listed below:
WVRHITEC Education Webinar
Webinar Topic: “EHR 101 – Strategies for Selecting an EHR: Beginning with the End in Mind”
May 12, 2011 – 11 a.m. to 12 noon
Webinar Presenter: Dwayne Edwards, WVRHITEC Director
This 60-minute webinar will provide information and insights on what to keep in mind when selecting an electronic health record system, negotiating with a vendor, setting appropriate goals, planning for the EHR implementation and evaluating overall results. The webinar also will highlight the WVRHITEC’s five-star EHR vendors, share information on benefits and possible return-on-investment of a successful EHR adoption and outline how the WVRHITEC can provide additional help and service.
EHR Vendor Product Demonstration Webinars
The West Virginia Regional HIT Extension Center will host a series of demonstrations of the electronic health record solutions offered by each of the WVRHITEC’s Five-Star EHR Vendors. During each webinar session a different EHR vendor will showcase its respective electronic health record product/application and discuss unique capabilities and benefits. These web-based seminars will be offered from 12 noon to 1 p.m. on these dates:
May 13 – GE Healthcare
May 16 – NextGen
May 18 – Greenway
May 19 – Allscripts
May 23 – e-MDs
May 25 – eClinicalWorks
May 26 – athenahealth
May 27 – Sage
To learn more about the EHR products offered by the companies, please go to: http://www.wvrhitec.org/EHRs/5StarVendorRecognition/tabid/236/Default.aspx
These webinar sessions are free and open to any interested health care provider, administrator, office manager, or technology support person. Pre-registration is required in order to receive the webinar connection instructions. All participants will need a computer with Internet access and a telephone.
To register or to learn more, go to: http://www.wvrhitec.org/Calendar/WebinarRegistration/tabid/230/Default.aspx
or call 1-877-775-7535 (toll-free)
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May 09, 2011
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