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Medicare News
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Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC) and Medicare Remit Easy Print (MREP) Update
Change Request (CR) 7369 announces the latest update of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs) that are effective on July 1, 2011, for Medicare. Please be sure your billing staff is aware of these changes.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8D9HLQ0643?opendocument
E-Prescribing Update
The June 30, 2011, deadline for E-prescribing is rapidly approaching. In order to meet this deadline, all providers, including non-physicians with prescribing privileges, must e-prescribe for at least 10 unique Medicare patients. If you fail to meet the deadline, you are faced with a 1% pay cut in 2012.
Physicians may earn a 1% payment bonus by e-prescribing 25 times before December 31, 2011. This must be done for 25 different patients. E-prescribing is reported by using the code G8553 which is “at least one prescription created during the encounter was generated and transmitted electronically using a qualified e-prescribing system” on claims that include an e-prescription.
For purposes of determining which eligible professionals or group practices are subject to the payment adjustment in 2012, CMS will analyze claims data from January 1, 2011- June 30, 2011 to determine if the eligible professional has submitted at least 10 electronic prescriptions during the first six months of calendar year 2011. Group practices reporting as a GPRO I or GPRO II in 2011 must report all of their required electronic prescribing events in the first six months of 2011 to avoid the payment adjustment in 2012.
If an eligible professional or selected group practice wishes to request an exemption to the eRx Incentive Program and the payment adjustment, there are two “hardship codes” that can be reported via claims should one of the following situations apply:
G8642 - The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.
G8643 - The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.
A third code may also be utilized for reporting. G8644—The eligible professional practices may indicate that they do not have prescribing privileges. Reporting this G code will prevent the practitioner from being subjected to a payment adjustment in 2012.
If you need additional information on any of the programs listed above, visit the official Medicare website www.cms.gov/erxincentive
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WVSMA Partners with The State Journal
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The West Virginia State Medical Association (WVSMA) is pleased to announce that we are again partnering with The State Journal in the Direct Message Program. Last year’s publication received rave reviews and was a big success!
The WVSMA provides pertinent articles to inform West Virginians of the critical issues impacting the state’s medical community. To help cover the cost of publication The State Journal will sell advertising and your support is needed to make this project possible.
Since it was founded in 1867, the WVSMA has been dedicated to improving the health of West Virginians and is our State’s largest physician advocacy organization with more than 2,500 members. The WVSMA believes strongly that increased public awareness of key issues impacting the practice of medicine is needed and our partnership with The State Journal is an excellent opportunity for the voice of medicine to be heard.
The publication process will be as follows:
The WVSMA will develop all articles, data and graphics for inclusion in the publication.
The State Journal will sell advertising in the publication to members and friends of the WVSMA to support production and distribution costs.
The State Journal will design and assemble the publication with the supporting advertising.
The State Journal will print the publication and insert it as a special advertising supplement in its weekly distribution to 10,000 decision-makers across West Virginia.
The State Journal’s Direct Message Program is an efficient and affordable way to reach The State Journal’s readership consisting of West Virginia business, government and community leaders. The State Journal offers a highly appealing and cost-effective vehicle to carry the healthcare message and promote your services.
The WVSMA must make a financial commitment in advertising sales to participate in the Direct Message Program. A sales representative of The State Journal will contact you to further explore your interest in advertising. The WVSMA would greatly appreciate your support.
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Register Now for the Special June Classes!
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The WVSMA, through our exclusive partnership with the Practice Management Institute (PMI), is offering physicians and staff some new options for education!
We are excited to be able to offer classes in the Huntington and Morgantown area 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.
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. Additional 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.
To register, visit the WVSMA’s website, www.wvsma.com. You may also contact Karie Sharp at (304) 925-0342 ext 12, or via email, Karie@wvsma.com.
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American Medical Association News
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(Information supplied by the AMA)
Physicians Can Test HIPAA Version 5010 Transactions with Medicare on June 15
The Centers for Medicare and Medicaid Services (CMS), in conjunction with the Medicare fee-for-service contractors, has announced a national testing day for the HIPAA version 5010 transactions: Wed., June 15, 2011. National 5010 Testing Day is an opportunity for physicians and others to test their implementation efforts with the added benefit of real-time help desk support and direct and immediate access to Medicare Administrative Contractors.
CMS encourages all physicians and those with whom they do business electronically (clearinghouses, vendors, Medicare contractors) to participate. By participating, physicians can help identify any problems they may have with sending or receiving 5010 transactions and correct these problems prior to the compliance date. More details concerning transactions to be tested are forthcoming from each Medicare contractor. Several state Medicaid agencies will be participating in the National 5010 testing day, and they will also be providing more details.
Physicians who submit claims and other HIPAA health care transactions electronically must meet the Jan. 1, 2012 deadline to comply with the HIPAA version 5010 transactions, which is less than eight months away. On the compliance date of Jan. 1, 2012, physicians (or the clearinghouses they use) must be able to send and receive their health care transactions according to the updated standards.
Failure to be prepared for the deadline puts physicians at risk for cash flow interruptions. Even if a physician is using a clearinghouse to send transactions to payers, there are still changes that will impact his/her practice.
Physicians can visit www.CMS.gov/Versions5010andD0 or www.ama-assn.org/go/5010 to prepare their practices for testing and implementation.
Prepare for Jan.1 HIPAA Compliance Date
If you use HIPAA electronic standard transactions (such as claims submission), you are required to comply with the Jan. 1, 2012 deadline of moving to version 5010 of these transactions. Make sure your practice is ready so you can avoid rejected claims and cash-flow interruptions.
The AMA offers two new resources to help you prepare:
• “5010 data reporting changes tips” provides five quick and easy actions you can take now
• “Be 5010 compliant to prevent claim rejections” outlines the steps you should take to prepare for compliance
Physicians may access these and other free resources at www.ama-assn.org/go/5010 to make sure your practice is ready.
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Palmetto GBA Update
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J11 South Carolina and West Virginia Part B Welcome Letter and Implementation Guide
Palmetto GBA has posted important transition information for providers on their website. Check out the ‘J11 South Carolina and West Virginia Part B Welcome Letter’ and ‘Implementation Guide’ for South Carolina and West Virginia Part B providers.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8GWKG52010?opendocument&utm_source=J1BL&utm_campaign=J1BLs&utm_medium=email
New Contact Information for WV Part B J11 Implementation
On Monday, May 16, 2011, Palmetto GBA sent information about the upcoming J11 Part B implementations for West Virginia Providers. They also posted this information on their website at www.palmettogba.com/J11B under "implementation".
Effective June 18, 2011, at 12:01 a.m. ET, the Contractor/Payer ID will change to 11402 for West Virginia Part B. Important note: New Payer Identification numbers will be effective June 18, 2011. The new Payer ID for West Virginia Part B is 11402. You should begin to submit claims using the new Payer IDs beginning June 18, 2011.
Listed below are the new telephone numbers and mailing address effective June 18, 2011.
Please note that the contact number for the Palmetto GBA Technology Support Center is (866) 749-4301.
The mailing address for Palmetto GBA EDI Operations, which will be used after implementation, is:
Palmetto GBA J11 EDI Operations, AG-420 PO Box 100145 Columbia, South Carolina 29202-3145
Provider Contact Center
The Provider Contact Center will not be operational on Friday, June 17 and Monday, June 20. Please use the dedicated Interactive Voice Response (IVR) telephone number, (888) 414-8592, for questions concerning beneficiary eligibility and claim status.
Beginning Tuesday, June 21, 2011, if you have a question that cannot be handled through the IVR, please call the Customer Service Representative (CSR)-only telephone number at (866) 830-3043. The PCC hours of operation will be 8:00 a.m. – 4:30 p.m. ET Monday through Friday.
Physicians Can Test HPAA Version 5010 Transactions with Medicare on June 15
The Centers for Medicare and Medicaid Services (CMS), in conjunction with the Medicare fee-for-service contractors, has announced a national testing day for the HIPAA version 5010 transactions: Wed., June 15, 2011. National 5010 Testing Day is an opportunity for physicians and others to test their implementation efforts with the added benefit of real-time help desk support and direct and immediate access to Medicare Administrative Contractors.
CMS encourages all physicians and those with whom they do business electronically (clearinghouses, vendors, Medicare contractors) to participate. By participating, physicians can help identify any problems they may have with sending or receiving 5010 transactions and correct these problems prior to the compliance date. More details concerning transactions to be tested are forthcoming from each Medicare contractor. Several state Medicaid agencies will be participating in the National 5010 testing day, and they will also be providing more details.
Physicians who submit claims and other HIPAA health care transactions electronically must meet the Jan. 1, 2012 deadline to comply with the HIPAA version 5010 transactions, which is less than eight months away. On the compliance date of Jan. 1, 2012, physicians (or the clearinghouses they use) must be able to send and receive their health care transactions according to the updated standards.
Failure to be prepared for the deadline puts physicians at risk for cash flow interruptions. Even if a physician is using a clearinghouse to send transactions to payers, there are still changes that will impact their practice.
Physicians can visit www.CMS.gov/Versions5010andD0 or www.ama-assn.org/go/5010 to prepare their practices for testing and implementation
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United HealthCare Update
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Reminder: New Medical Policy Update Bulletin
Effective May 1, a new monthly Medical Policy Update Bulletin summarizing recently approved and/or revised Medical Policies, Drug Policies and Coverage Determination Guidelines (CDGs) was made available on UnitedHealthcareOnline.com.
This communication will provide online notice of Medical Policy, Drug Policy and CDG updates. By accessing the monthly Medical Policy Update Bulletin, you may view new and/or revised Medical Policies, Drug Policies and CDGs, in their entirety, along with an overview or summary of changes.
The monthly Medical Policy Update Bulletin replaces the bi-monthly Network Bulletin as the official communication vehicle for Medical Policy, Drug Policy and CDG updates to be effective on or after July 1, 2011. The Network Bulletin will no longer provide a detailed summary of Medical Policy, Drug Policy and CDG updates. Instead, it will feature a list of recently approved and/or revised Medical Policies, Drug Policies and CDGs only, as a supplemental reminder to the detailed policy update summaries provided in the monthly Medical Policy Update Bulletin.
This monthly bulletin is a separate document from the Network Bulletin and will be published the first calendar day of every month. The Network Bulletin is still in publication with its next edition planned for July 2011.
The Medical Policy Update Bulletin can be found online at UnitedHealthcareOnline.com > Tools & Resources > Policies & Procedures > Medical & Drug Policies and Coverage Determination Guidelines > Medical Policy Update Bulletin.
If you have questions about the new Medical Policy Update Bulletin, please contact Mia Rosenberg, Director, Advocate Consistency, by email mia_rosenberg@uhc.com or phone 717-232-1940
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Order Your Coding Books Now!
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It may seem early to order coding books, but we have a great deal for you! The WVSMA has partnered with Contexo Media to bring you the CPT and ICD coding books that your practice needs at a guaranteed best price.
If you are interested in ordering your books through Contexo, please contact Barbara Good (Barbara@wvsma.com) for information and an order form.
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Alzheimer's Association News
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Jane Marks, Executive Director for the West Virginia Chapter of the Alzheimer’s Association, has announced a new video program for physicians and other medical professionals.
Alzheimer’s Disease: Diagnosing, Treating, and Matching Patients to Clinical Trials video program is now available at alz.org/cme. Through this free continuing medical education (CME) program, physicians, nurse practitioners, and physician assistants can earn 0.5 AMA PRA Category 1 Credit(s)™.
For additional information, you may contact Jane (304) 343-2717 or jane.marks@alz.org
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May 25, 2011
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