The West Virginia State Medical Association’s 2011 Healthcare Summit will be held August 26th--28th at The Greenbrier, White Sulphur Springs, WV.  The agenda includes a special program, “New Tools for Physicians in Fighting Prescription Drug Abuse”, as well as a presentation by the AMA President, Peter W. Carmel, MD. Gubernatorial candidates from the major parties will also be speaking. 

For a listing of the complete Healthcare Summit program, as well as registration information, click here www.wvsma.com/meetings_conferences/default.asp 

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The Palmetto GBA transition appears to have been fairly seamless for West Virginia physicians.  Below is a listing of upcoming conference calls and webinars that may be of value to your practice.  Also, as a reminder, the following new mailing addresses became effective June 19, 2011. 

Paper claims (including Medicare Secondary Payer claims) must be mailed to the following address:
Palmetto GBA – J11 MAC
P.O. Box 100190
Columbia, SC 29202-3190

General Inquiries (written) must be mailed to the following address:
Palmetto GBA – J11 MAC
P.O. Box 100238
Columbia, SC 29202-3238

Redeterminations (first-level appeals) must be mailed to the following address:
Palmetto GBA – J11 MAC
P.O. Box 100190
Columbia, SC 29202-3190

Financial correspondence and checks must be mailed to the following address:
Palmetto GBA Finance
P. O. Box 100128
Columbia, SC 29202-3128

Reporting of Recoupment for Overpayment on the Remittance Advice (RA)

The article about recoupments related to the Recovery Audit Contractor (RAC) program was revised on June 10, 2011, to reflect the release date, transmittal number, implementation date for FISS, and the Web address for accessing Change Request 6870. All other information is the same.

http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~84GHSD3422?opendocument&utm_source=J1BL&utm_campaign=J1BLs&utm_medium=email

Electronic Prescribing (eRx) Incentive Program 2011 Updates

It is not too late to start participating in the eRx Incentive Program to potentially qualify to receive a full-year incentive payment. Eligible professionals may begin reporting the electronic prescribing measure at any time throughout the 2011 program year of January 1, 2011, through December 31, 2011, to be incentive eligible.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8JBM3G3258?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email
 

Register Now: National Provider Call on Medicare and Medicaid EHR Incentive Program Basics for Eligible Professionals

Did you know that providers have received over $190 million in Medicare and Medicaid EHR incentive payments through May? Don’t be left behind. Learn what you need to do to be eligible for an incentive. Join CMS for a national call Thursday, July 14, 2011, at 1:30 p.m. ET for eligible professionals on Medicare and Medicaid EHR incentive program basics.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8J9NHR8824?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email


Palmetto GBA Hosts Free Webinar - National Provider Call on Medicare & Medicaid
EHR Incentive Program Basics for Eligible Professionals
Thursday, July 14, 1:30 p.m. - 3:00 p.m. ET

Providers across the U.S. have received more than $190 million in Medicare and Medicaid EHR incentive payments through May.  And, the first EHR incentive payments in West Virginia are expected to be made very soon. Don’t be left behind.  Learn what you need to do to be eligible for federal EHR incentive payments.  Join CMS for a national call for eligible professionals on “Medicare & Medicaid EHR Incentive Program Basics.” The call will be on Thursday, July 14 from 1:30 p.m. to 3:00 p.m. The target audience for this call includes Doctors of Medicine or Osteopathy, Doctors of Dental Surgery or Dental Medicine, Doctors of Podiatric Medicine, Doctors of Optometry, Chiropractors, Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants (PA) who practice at an FQHC/RHC led by a PA. (Medicaid-eligible professionals must meet patient volume criteria, providing services to those attributable to Medicaid or, in some cases, needy individuals.)

The agenda for this call will include:
Who is eligible?
How much are the incentives and how are they calculated?
How does one get started?
What are major milestones regarding participation and payment?
How does one report on meaningful use?
Where can helpful resources be found?
A question and answer session.

In order to receive the call-in information, you must pre-register for the call at http://www.eventsvc.com/palmettogba/071411.
 

Medicare Made Easy: Basic Billing for Beginners

Don’t delay! Register today to attend the “Medicare Made Easy: Basic Billing for Beginners” educational Webinar event. This Webinar will be held July 19, 2011, at 10 a.m. Topics discussed will include Medicare plans and patient eligibility, Medicare participation, claims filing and Web site navigation.
.http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8J9LH94824?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email

Medicare: Beyond the Basics

Mark your calendar and join Palmetto GBA on July 26, 2011, at 10 a.m. ET, as they host a Webinar called “Medicare: Beyond the Basics”. The purpose of this training event is to provide Medicare information useful to experienced billing staff. This session is free to all participants.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8J8SQN6556?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email

Teleconference: Comprehensive Error Rate Testing and Clinical/Medical Review Findings

Palmetto GBA will host a special Ask the Contractor Teleconferences (ACTs) on Thursday, July 28, 2011. The call will be held at 2 p.m. ET. This ACT is designed to share information with the Jurisdiction 11 Part B providers regarding error identified by the Comprehensive Error Rate Testing Contractor and other errors identified by Palmetto GBA during clinical medical review. The focus of the information shared will be to bring forward identified billing errors, how to prevent those errors in the future and documentation requirements related to these errors.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8J8SLX2448?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email

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(information supplied by the AMA)

New AMA Health Insurer Report Card Finds Increasing Inaccuracy in Claims Payments

The overall rate of inaccurate claims payments increased since last year among leading commercial health insurers, according to American Medical Association’s (AMA) fourth annual National Health Insurer Report Card. Claims-processing errors by health insurance companies waste billions of dollars and frustrate patients and physicians.
 
According to the AMA’s latest findings, commercial health insurers have an average claims-processing error rate of 19.3 percent, an increase of two percent as compared to last year. The increase in overall inaccuracy represents an extra 3.6 million in erroneous claims payments compared to last year, and added an estimated $1.5 billion in unnecessary administrative costs to the health system. The AMA estimates that eliminating health insurer claim payment errors would save $17 billion.
 
 Most of the health insurers measured by the AMA failed to improve their accuracy rating since last year. UnitedHealthcare was the only commercial health insurer included in this year’s report card to demonstrate an improvement in claims-processing accuracy. UnitedHealthcare came out on top of seven leading commercial health insurers with an accuracy rating of 90.23 percent. Anthem Blue Cross Blue Shield had scored the worst of those measured with an accuracy rating of 61.05 percent.
 
To encourage a more efficient claims payment system, the AMA’s National Health Insurer Report Card provides an annual check-up for the nation’s largest health insurers and benchmarks the systems they use to manage process and pay claims. Key findings from this year’s report card include:
 
Insurer Non-payment--Physicians received no payment at all from commercial health insurers on nearly 23 percent of claims they submitted. There are many reasons a legitimate claim may go unpaid by an insurer. Claims may be denied, edited or deferred to patients. During February and March of this year, the most common reason that the insurers didn’t issue a payment was due to deductible requirements that shift payment responsibility to patients until a dollar limit is exceeded. Real-time claims processing would save time and money.
 
Denials--Dramatic reductions in denial rates have occurred since last year at Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation and UnitedHealthcare, which cut its denial rate by half to 1.05 percent. CIGNA maintained its industry leading low denial rate of .68 percent. Lack of patient eligibility for medical services continues to be the most frequent reason for denials.
 
Administrative Requirements--For the first time the report card measured how frequently claims included information on insurers requiring physicians to ask permission before performing a treatment or service. CIGNA had the highest rate of claims requiring prior authorization, with more than six percent of claims indicating physician work associated with these requirements. A recent AMA survey of physicians indicated that insurers’ requirements to preauthorize care delayed or interrupted medical services, consumed significant amounts of time and complicated medical decisions.
 
Accuracy-- In addition to measuring overall claims-processing accuracy, the report card examined how accurately insurers reported the correct contract fees to physicians. UnitedHealthcare has shown consistent improvement during the last four years in reporting correct contract fees. Other commercial health insurers showed progressive improvement over four years, but had slight declines this year. The exception was Anthem Blue Cross Blue Shield, which scored 14 percent lower on this measure than it did four years ago.
 
Timeliness--The report card found that CIGNA and Humana have cut their median claims response time in half during the last fours years. Response time varied for commercial health insurers from six to 15 median days.
 
The National Health Insurer Report Card is the cornerstone of the AMA’s Heal the Claims Process campaign. Launched in June 2008, the campaign’s goal is to spur improvements in the industry’s billing process so physicians and patients are no longer at the mercy of a chaotic payment system.
 
The findings from the 2011 National Health Insurer Report Card are based on a random sampling of approximately 2.4 million electronic claims for approximately 4 million medical services submitted in February and March of 2011 to Aetna, Anthem Blue Cross Blue Shield, CIGNA, Health Care Service Corporation, Humana, The Regence Group, UnitedHealthcare and Medicare. Claims were accumulated from more than 400 physician practices in 80 medical specialties providing care in 42 states.

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(includes some information from the AMA)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) included a section on administrative simplification and mandated the adoption of regulations for privacy, security, unique health identifiers, electronic transactions and code sets. The Transactions and Code Sets Final Rule was issued in 2000 by HHS and named standard transactions to be used by “covered entities,” defined as health care providers (including physicians), payers, and clearinghouses, when conducting specific administrative transactions electronically. Although HIPAA doesn’t require physicians to do any of the below listed transactions electronically, the law does require physicians who choose to do these transactions electronically to comply with the HIPAA standards.

The following transactions were named in the Transactions and Code Sets Final Rule:

    Health claims or equivalent encounter information
    Enrollment and disenrollment in a health plan
    Eligibility for a health plan
    Health care payment and remittance advice 
    Health plan premium payments
    Health claim status
    Referral certification and authorization

Although HIPAA does not require physicians to use electronic transactions, the Administrative Simplification Compliance Act (ASCA), does impose such a requirement for physicians who bill Medicare. ASCA requires that all claims submitted to the Medicare program must be submitted in electronic form, with some limited exceptions. The implication of this requirement is that because the claims are submitted electronically, they are also required to comply with HIPAA. The compliance date for the requirement to submit Medicare claims electronically was October 16, 2003. Physicians who are considered “small providers” (defined as those having fewer than 10 full-time equivalent employees in their practice) may continue sending paper claims. The law provides for a few other limited exceptions. More information on these can be found on the CMS Web site www.cms.gov.

If you electronically submit administrative transactions, such as checking a patient’s eligibility, filing a claim, or receiving a remittance advice, either directly to a health insurance payer or through a clearinghouse, the version of the transactions currently in use will be updated. On January 16, 2009, the Department of Health and Human Services (HHS) announced that updated versions of the HIPAA transactions will be required for use by physicians and others on January 1, 2012. The Centers for Medicare and Medicaid Services (CMS), is the agency within HHS charged with overseeing compliance with the standards.

The best way to prepare for 5010 is to talk to your practice management software vendor, clearinghouse and/or billing service.   Test with all your trading partners and obtain a statement in writing that your vendors are ready for 5010. You don’t want to take a chance on not getting paid beginning on January 1, 2011.  Ensure now that the vendors are ready.

You may also want to have your vendors participate in the next 5010 National Testing Date, scheduled for August 24, 2011.   A previous test was done on June 15, 2011.   These tests will demonstrate readiness on the part of your vendor and help put your mind at ease. 

The AMA has prepared a toolkit to assist practices in preparation for 5010.  This toolkit also explains the differences you should expect in Version 5010, how to test your readiness for the Version 5010 transactions, and steps you can take to prevent interruptions to your cash flow.  You may view the toolkit here-- new 5010 toolkit.
 

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Accreditation Deadline for Advanced Diagnostic Imaging Approaching

Any Medicare provider or supplier who furnishes the technical component of advanced diagnostic imaging (ADI) services must be accredited by January 1, 2012.  (ADI procedures include MRI, CT, nuclear medicine imaging, and positron emission tomography.  X-ray, ultrasound, fluoroscopy, and Hospital Outpatient procedures are excluded.)

As directed by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), all providers and suppliers of the technical component of ADI who bill Medicare under the Physician Fee Schedule for these services must be accredited by Jan 1, 2012.  Those not accredited by that deadline will not be able to bill Medicare until they become accredited.  (The technical component of ADI services includes the performance of such imaging procedures and not their subsequent interpretation.)

CMS has selected three organizations to perform the accreditation of Advanced Diagnostic Imaging providers and suppliers.  Those seeking accreditation should note that the process may take up to five months to complete, so should be sure to begin the process as soon as possible.

For more information about ADI Accreditation, including the three accrediting organizations, please visit http://www.CMS.gov/MedicareProviderSupEnroll/03_AdvancedDiagnosticImagingAccreditation.asp.

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The National Uniform Claim Committee (NUCC) has announced the opening of a 45-day public comment period, ending July 21, 2011, for proposed revisions to the 1500 Health Insurance Claim Form (1500 Form).  The proposed revisions to the 1500 Form will accommodate data reporting changes in the Version 005010 837 professional electronic claim transaction and other business needs.  The NUCC is conducting this survey to receive feedback on the proposed revisions and the costs and benefits of implementing the proposed revised 1500 Form.  The NUCC will use this feedback in making its decision on moving forward with revising the 1500 Form.  The timeframe for when a revised form would be required is not yet known.

Use the following link to access the survey. 
 
http://www.surveymonkey.com/s/75WVJFJ

Draft mock-ups of the proposed revised form are available on the home page of the NUCC’s website, www.nucc.org.  Three draft versions of the mock-up form are being made available for evaluation – a “clean”, a “grid” and a “byte” version.

The NUCC will review the results of the survey at its in-person meeting in Baltimore, MD on August 10, 2011.  Additional information about the meeting is available on the NUCC’s website.

For two years, the NUCC has been researching potential changes to the 1500 Form to accommodate data reporting changes in the Version 005010 837 professional electronic claim transaction.  After considering several options for revising the 1500 Form, the NUCC decided to proceed with making “minor changes” to the existing form.  The NUCC has defined “minor changes” as no physical changes to the existing form lines or underlying layout of the form.  All proposed revisions will be accommodated within the current fields.  The NUCC limited the scope of changes based on feedback from NUCC members and their constituents, which emphasized the need to limit the amount of work and costs that would be required to implement a revised 1500 Form.

The 1500 Form is maintained by the NUCC.  The NUCC is a voluntary organization of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors.  Additional information about the NUCC is available on its website.
 

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Gov. Earl Ray Tomblin recently announced the appointment of  Michael D. Riley to serve as Acting Insurance Commissioner of the West Virginia Offices of the Insurance Commission effective July 1, 2011, following the retirement of Commissioner Jane L. Cline as of June 30, 2011.

Riley first joined the Offices of the Insurance Commissioner in October 2001 as an Administrative Services Manager and rose to become Assistant Commissioner of Regulation. During his tenure, Riley served as project manager for the privatization of the state's workers' compensation system.

Riley is a graduate of Marshall University with a Masters of Business Administration
 

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(information supplied by BrickStreet)

The word “audit” often causes panic and worry in the workplace. However, unlike an audit by the IRS, a BrickStreet premium audit should be a positive experience for you and your practice. BrickStreet is committed to producing audits that represent your practice’s risk exposures accurately and reflect premium levels that are appropriate to ultimately benefit you and your business.

A premium audit can help reduce the potential for fraud and verify your business is properly classified.  If you receive notification of an audit, it is important that you respond quickly to inquiries to avoid paying additional premium or cancellation of current coverage.

When preparing for your audit, refer to this list of needed records:

Federal and State Tax Reports
Payroll Journal or Register
General Ledger
Cash Disbursement Journals
Job Cost Reports
Certificates of Insurance for Your Subcontractors
Other information that will be needed:
A comprehensive description of your business operations (may include brochures or other promotional items)
A detailed explanation of the job duties of each employee
Access to a responsible financial officer or representative during and after the audit

If you have questions concerning the premium audit process, please contact your agent or BrickStreet representative.
 

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(information supplied by UnitedHealthcare)

UnitedHealthcare continues to support transparency in health care administration and appreciates external evaluation from national societies and administrative organizations to capture feedback for our continuous efforts to enhance and improve service to network providers.

In two recently published external surveys of health plan transactional performance, the American Medical Association (AMA) 2011 National Health Insurance Report Card (NHIRC) and the athenahealth PayerView 2011 study, UnitedHealthcare improved its results for transactional transparency focused on easing administrative burden.

The fourth annual AMA NHRIC evaluated seven national health insurance companies and Medicare on the timeliness and accuracy of claims processing based on a variety of payment, approval and process metrics. UnitedHealthcare moved into the top spot among its industry peers on two metrics, Contracted Fee Schedule Match Rate, indicating how often an insurer's claim payment matches the contracted fee schedule; and Electronic Remittance Advice (ERA) Accuracy, measuring the rate at which the insurer's allowed amount equals the physician practice's expected allowed amount.

For the sixth year, athenahealth issued its study on claim payment performance among national health insurers. UnitedHealthcare (as represented by all its entities) maintained its #3 ranking overall out of 8 major payers, showing improvements year-over-year in all categories, with solid improvements in denial rate, the percent of claims requiring back-end rework (includes pended and denied claims) and eligibility accuracy. In the national commercial payer category, UnitedHealthcare finished first in Eligibility Accuracy and First Pass Resolve (percent of claims that are resolved on the first submission).
Results for both the AMA NHRIC and athenahealth PayerView study are available online for review.

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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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The West Virginia Medical Group Managers Association (MGMA) will hold their fall conference at Stonewall Jackson Resort, Roanoke, WV, on Thursday, October 6th and Friday, October 7th.   Additional details will be forthcoming.

The West Virginia Office Managers Association (OMA) will hold their annual conference at Pullman Plaza in Huntington, WV, on Thursday, October 20 and Friday, October 21st.  A detailed schedule will be available soon.

Both these groups are excellent resources for your office administrator/manager.  
 

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The Charleston OMA will meet on Tuesday, July 19, 2011, at 8:30 AM for breakfast and a speaker. 

The meeting will be held in the Education Center, Classroom 3, of Thomas Hospital, South Charleston.    (Enter Thomas Hospital through the Division Street entrance Thomas Wing entrance. Turn left and take the elevators to the basement.  The classroom is in the Education Center on the right side of the hallway, which is the old cafeteria location).

The speaker will be Michael Harmon from the West Virginia Mutual Insurance Company, who will be discussing Recent Changes Related to the HIPAA Privacy and Security Rules.

The program will inform and update attendees on recent changes related to the HIPAA Privacy and Security Rules.  Actual case examples will be used to reinforce the requirements and attendees should leave with a practical approach to complying with the rules.

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The Charleston WV Chapter of the AAPC is hosting an Education Day on September 20, 2011 at the Charleston House Holiday Inn.  The event will begin at 9:00 AM and conclude at 4:00 PM.  Breakfast and lunch will be served for participants.

The cost is $65.00 and attendees may receive up to 5.5 AAPC approved CEUs.  

For additional information, please contact Maggie McCabe, 304-881-4633
maggie@mccabemedicalcoding.com or www.mccabemedicalcoding.com.
 

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• • 2011 Healthcare Summit Rapidly Approaching
• • Palmetto GBA News
• • News from the American Medical Association
• • CPT Errata Posted
• • Are You Ready for 5010?
• • CMS News Regarding Advanced Diagnostic Imaging
• • National Uniform Credentialing Committee Announces a 45 Day Public Comment Period for Revisions to HICF 1500
• • New Acting Commissioner of the WV Offices of the Insurance Commissioner
• • West Virginia Medicaid Pharmacy News
• • BrickStreet News
• • UnitedHealthcare News
• • Molina Medicaid Solutions Update
• • Save the Date for These Conferences!
• • Charleston OMA Schedules Educational Meeting
• • American Association of Professional Coders (AAPC) News