On May 26, 2011, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule, CMS-3248-P, on changes to the Medicare Electronic Prescribing (eRx) Incentive Program.  The proposed rule would address concerns that stakeholders have expressed about implementation of the 2012 electronic prescribing payment adjustment.  Specifically, CMS has received requests to better align the eRx Incentive Program with the Medicare & Medicaid Electronic Health Records (EHR) Incentive Programs, as well as suggestions to expand the significant hardship exemption categories. 

To address these concerns, the proposed rule would do the following:

1) Modify the existing 2011 electronic prescribing measure to also recognize certified EHR technology as defined at 45 CFR 170.102 as a “qualified” eRx prescribing system.

2) Provide additional significant hardship exemption categories for the 2012 e-Rx payment adjustment. 

The eligible professional or group practice would need to, in its significant hardship exemption request, demonstrate that one of the following situations applies to the respective practice:

Eligible professionals who register to participate in the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program and adopt certified EHR technology;

Inability to electronically prescribe due to local, state, or federal law or regulation;

Limited prescribing activity;  or

Insufficient opportunities to report the electronic prescribing measure due to limitations of the measure’s denominator.

CMS proposed that eligible professionals would have until October 1, 2011 to submit a request for a hardship exemption from the 2012 eRx payment adjustment.   

The proposed rule may be viewed at 2011 eRx Proposed Rule -- CMS-3248-P [PDF 224KB]. The public has until July 25, 2011 to provide comments on the proposed rule.  Upon consideration of the public comments received, CMS will need to publish a final rule before these proposed changes would go into effect. 

For an overview of this proposed rule, plan to attend the Physician Quality Reporting System and Electronic Prescribing Incentive Program National Provider call.  This toll-free call will take place from 1:30 p.m. – 3:00 p.m., EDT, on Tuesday, June 21, 2011.

To register for this informative session, go to http://www.cms.gov/PQRI/04_CMSSponsoredCalls.asp on the CMS website. Registration will close at 1:30 p.m. EDT on June 20, 2011, or when available space has been filled. No exceptions will be made. Please register early.

The WVSMA will continue to keep you updated on this proposed rule.

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Early Payments for West Virginia Part B

To ensure that cash flow is not negatively impacted by the upcoming Jurisdiction 11 (J11) implementation, claims scheduled to be paid to West Virginia Part B on June 21 and 22 will be paid early and will be included in the payments issued on June 20, 2011. Palmetto GBA will not issue payments or remittance advices on June 21 or 22. Normal payment cycles will resume on June 23, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8HPNJ51566?opendocument

West Virginia Part B Redetermination Requests: New Address

West Virginia Part B providers should begin submitting all redetermination requests to the new J11 Palmetto GBA redetermination address beginning June 13, 2011. You may complete the J11 Part B Redetermination Form electronically, then print the form, and mail or fax the form along with any supporting documentation.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8HMS7S7183?opendocument&utm_source=J1BL&utm_campaign=J1BLs&utm_medium=email

Include NPI or PTAN on Any Checks You Submit

Wonder how your check can be processed in a timely manner? It's simple.
Just remember to include your NPI and PTAN on any checks submitted. If you are submitting a check in response to a letter you received from Palmetto GBA or the Recovery Audit Contractors (RACs), always attach a copy of the letter when sending the check.

http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8HGKBC0324?opendocument
 

CMS Physician Quality Reporting System & Electronic Prescribing Incentive Program National Provider Teleconference

The Centers for Medicare & Medicaid Services (CMS) will host a national provider teleconference on the Physician Quality Reporting System & Electronic Prescribing Incentive Program on June 21, 2011. Subject matter experts will provide an overview of the proposed rule, CMS-3248-P, released on May 26, 2011, which addresses the proposed changes to the Medicare Electronic Prescribing (eRx) Incentive Program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8HKNBH0325?opendocument&utm_source=J1BL&utm_campaign=J1BLs&utm_medium=email

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The Texas based Practice Management Institute (PMI), the WVSMA's partner for education, held its annual conference recently in New Orleans. Three West Virginia CMOMs (Certified Medical Office Managers), Jamie Ray, Karen Lavery and Barbara Good, attended the event.  Each had high praise for the conference.  Registrants attended key note addresses each morning and then were able to choose from many break out sessions during the remainder of the day.  There were many excellent sessions and it would have been great to have attended all of them.

One session of particular interest to all participants was taught by best selling author, Judy Capko, author of the book, Secrets of the Best-Run Practices.  Ms. Capko provided valuable insight into practice management issues.  During her smaller breakout session, she focused on the specific needs of various size medical practices. 

Another issue of practice management which was discussed at length and will involve all offices is compliance.  This will be a big emphasis in the next few months and years.  The WVSMA is working to prepare and provide programs to meet this educational need.  

Karen Lavery, Office Manager for Womens Health Care in Morgantown, summed up the experience this way—“I learned so much at the PMI conference and definitely plan to attend future conferences.  The speakers were excellent and the topics were exactly what we needed to hear."

While on the subject of conferences, the WVSMA provides many educational offerings for your practices and we plan to increase the locations for classes in our state.  Examples of this are the "ICD-10" and "Collecting In a New Economy" classes that we are offering this week in Morgantown and Huntington.  

There are also many opportunities for education available from other sources.  We recommend that you familiarize yourself with the organization who is offering the classes or courses, for some are more professional than others.

After receiving a number of calls about certain educational opportunities that are being promoted, I caution you to look at the bottom of the information/enrollment form you may have received (often faxed to your office).   If it says “This is not approved or endorsed by Medicare or C.M.S.” than you may want to save your money.   Caveat emptor!

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All Medicaid providers will be participating in Provider Enrollment/Re-Enrollment in the next few months.  This is a federal requirement, not a state requirement.   The re-enrollment is scheduled to begin in the fall of 2011.  Providers will be notified via mail when it is time to renew and will receive a web access code to re-enroll.

All re-enrollment will be done electronically through the web portal.  Providers who do not respond and re-enroll within 30 days may be placed on pay hold. 

There is also a new requirement that providers be “screened”, based on the risk of fraud, waste and abuse.  Examples of screening tools include the use of the OIG’s List of Excluded Individuals and Entities, State Medicaid Exclusion List, State Licensing Boards, and Criminal Background checks. 

Questions about the re-enrollment process may be directed to Molina’s Provider Enrollment Department, 1-888-483-0793. 

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BMS has created a new website that provides new navigation features---www.dhhr.wv.gov/bms.   Both providers and members may subscribe to feeds related to the changes within Medicaid. 

Information available on the website includes Medi/Web Portal, Mountain State Choices information and State Medicaid Plan information.

Updated provider manuals are available now for 30 day comment.   Physicians may check the manuals and make comments during this time.
 

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The Charleston OMA will meet next week for an education session.   The details are listed below:

DATE:   Tuesday, June 21, 2011               
11:30am -Social time and lunch     12:00 – 1:00 Speaker
There will be a short board meeting following the speaker

PLACE: Thomas Hospital, So. Charleston
Education Center, Classroom 3
Enter Thomas through the Division St entrance (the Thomas Wing entrance).  Turn left and find the elevators.  Take the elevators to the basement.  Turn left and go to the end of the hall.  The classroom is in the Education Center.  (Old cafeteria location).

PARKING: Free if you park in the main parking garage

SPEAKER:
Eric Kinder from Spilman, Thomas and Battle, P.L.L.C.

TOPIC:
What Every WV Employer Needs to Know About Labor and Employment Law or How to Avoid Making an Employment Law Mistake Without Even Knowing It.

COST: free to OMA members       $20.00 for non-members

RSVP to:    Connie Frazier       eyeconnie@gmail.com   304-343-4124

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• • Proposed Changes to the 2011 Electronic Prescribing Incentive Program
• • Palmetto GBA Updates
• • Conference Update
• • Molina Medicaid Solutions Update
• • BMS Update
• • 2011 Healthcare Summit Update
• • Charleston Office Managers Association Plans Meeting