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2011 Healthcare Summit Drawing Near!
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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 presentations by the AMA President, Peter W. Carmel, MD, and seven other visiting state association presidents. Gubernatorial candidates from the major parties will also be giving presentations.
Join us Friday, August 26 at The Greenbrier for a special “Evening of Memories…Medical Liability Reform 25 Years in the Making.” The recent West Virginia Supreme Court decision upholding our hard-fought reforms will have a significant positive impact on our state’s practice environment. It will be an evening to show your support for this achievement and remember with past presidents of the WVSMA and our healthcare partners memories and lessons learned during our more than two decades of work.
The “black-tie encouraged” Gala dinner will be held Friday evening in conjunction with the 2011 Healthcare Summit. The Gala will immediately follow the reception sponsored by the West Virginia University School of Medicine and the Joan C. Edwards School of Medicine at Marshall University.
Register today to attend this great event and the 2011 Healthcare Summit, August 26-28 at The Greenbrier. For more information click here or contact Karie Sharp at (304) 925-0342 ext. 12 or karie@wvsma.com. For a listing of the complete Healthcare Summit program, as well as registration information visit the WVSMA’s website, www.wvsma.com.
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Maximize Your Reimbursement With a Certified Medical Coder!
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In today's economy, every practice needs to receive the maximum reimbursement possible for the services provided. A Certified Medical Coder (CMC) plays an integral role in the reimbursement process, ensuring that proper documentation guidelines are followed while submitting codes to the highest degree of specificity.
The WVSMA is proud to offer the first Certified Medical Coder (CMC) class in West Virginia! Through our exclusive partnership with Practice Management Institute (PMI), we are able to bring this exciting course to Physicians and Office Personnel in September, 2011.
The course is a certification designed for physician-based coding professionals. Classes will cover Medical Terminology, ICD-9-CM Diagnostic Coding, ICD-10-Coding Conversion, HCPCS/CPT Procedural Coding, Ancillary and Advanced Coding.
The program includes “hands on” classroom instruction, a course manual, homework exercises, an exam preparation handbook and the certification exam. Individuals who are able to demonstrate by exam a superior level of physician-based coding knowledge will be awarded the Certified Medical Coder (CMC) certification.
The CMC classes will be held from 8:30 AM- 4:30 PM at St. Francis Hospital, Charleston, WV, on the following dates:
Friday, September 9
Friday, September 16
Friday, September 23
Thursday, September 29
Friday, September 30
If you have additional questions, contact Karie (304-925-0342, ext.12) or via email (karie@wvsma.com).
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West Virginia Carrier Advisory Committee (CAC) Holds Meeting
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The WV Carrier Advisory Committee (CAC) for Palmetto GBA met for the first time as the new J-11 committee. This committee is comprised of one representative from each medical specialty, who meet regularly to review current local coverage decisions (LCDs) for Palmetto GBA
The J-11 Medical Director, Elaine Jeter, MD, led the group through discussions of a number of LCDs which had been requested, revised or retired. She also gave updates on the Palmetto news releases, medical reviews, provider communication and education.
Physicians who need to bring issues before the CAC may do so by contacting the representative for their specialty or by contacting the committee liaison, Tim Deer MD.
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CMS News
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(Information Supplied by CMS)
Further Details on the Revalidation of Provider Enrollment Information
All providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to revalidate their enrollment under new risk screening criteria required by the Affordable Care Act (section 6401a). (Providers/suppliers who enrolled on or after Friday, March 25, 2011 have already been subject to this screening, and need not revalidate at this time.)
In the continued effort to reduce fraud, waste, and abuse, CMS implemented new screening criteria to the Medicare provider/supplier enrollment process beginning in March 2011. Newly-enrolling and revalidating providers and suppliers are placed in one of three screening categories – limited, moderate, or high – each representing the level of risk to the Medicare program for the particular category of provider/supplier, and determining the degree of screening to be performed by the Medicare Administrative Contractor (MAC) processing the enrollment application.
Between now and March 2013, MACs will be sending notices to individual providers/suppliers; please begin the revalidation process as soon as you hear from your MAC. Upon receipt of the revalidation request, providers and suppliers have 60 days from the date of the letter to submit complete enrollment forms. Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges. The easiest and quickest way to revalidate your enrollment information is by using Internet-based PECOS (Provider Enrollment, Chain, and Ownership System), at https://pecos.CMS.hhs.gov.
Section 6401a of the Affordable Care Act requires institutional providers and suppliers to pay an application fee when enrolling or revalidating (“institutional provider” includes any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A; CMS-855B, not including physician and non-physician practitioner organizations; CMS-855S; or associated Internet-based PECOS enrollment applications); these fees may be paid via www.Pay.gov.
In order to reduce the burden on the provider, CMS is working to develop innovative technologies and streamlined enrollment processes – including Internet-based PECOS. Updates will continue to be shared with the provider community as these efforts progress.
For more information about provider revalidation, review the Medicare Learning Network’s Special Edition Article #SE1126, titled “Further Details on the Revalidation of Provider Enrollment Information.”
In summary, all providers and suppliers enrolled with Medicare prior to March 25, 2011, must revalidate their enrollment information after receiving notification from their Medicare Administrative Contractors (MAC). When you receive notification from your MAC to revalidate, you must: update your enrollment through Internet-based PECOS or complete the CMS-855; sign the certification statement on the application; and if applicable, pay your fee thru pay.gov. Also, please be sure to mail your supporting documents and certification statement to your MAC.
National Provider Call on Medicare and Medicaid EHR Incentive Programs: Understanding Meaningful Use
Providers have received more than $273 million in Medicare and Medicaid EHR incentive payments. You may be eligible for a payment, too. Join CMS on August 18, 2011, for a National Provider Call on the Medicare and Medicaid EHR Incentive Program meaningful use requirements.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8JYG2C7380?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email
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5010 Transition Update
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Six Month Check-in: Act Now for the Version 5010 Transition
The Version 5010 transition is less than six months away for all HIPAA covered entities. This means that to submit transactions electronically, all covered entities must upgrade from Version 4010/4010A to Version 5010.
Before the compliance deadline of January 1, 2012, you should conduct internal and external transactions within your organizations and with your billing partners, including payers, vendors, and clearinghouses.
External testing should take place now in order to make sure that you are able to send and receive compliant transactions effectively. Testing now will help identify any potential issues that may arise and allow the necessary time to address them.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8JZHKF4857?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email
CMS Announces National Version 5010 Testing Week: August 22 through August 26
The Version 5010 compliance date, January 1, 2012, is fast approaching. All HIPAA covered entities should be taking steps now to get ready, including conducting external testing to ensure timely compliance. To assist in this effort, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the Medicare FFS Program, announce a National 5010 Testing Week to be held August 22 through August 26.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8JYFUU3230?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email
ANSI v5010: Second National 5010 Testing Day
Get prepared for version 5010 compliance! CMS encourages all to participate in the National 5010 Testing Day on August 24, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8JXJUB4087?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email
ANSI v5010 Webinar: Troubleshooting with Your Contractor
If you missed the ANSI v5010 Webinar 'Troubleshooting with Your Contractor'
conducted on July 20, don't despair. Check out a copy of the presentation.
Please make sure to join our listserv to receive specific instructions on how to attend any future Webinars and other pertinent EDI information.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8KDHE57773?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email
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Palmetto GBA News
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(Information supplied by Palmetto GBA)
Palmetto GBA Online Provider Services
Physician practices can save time and money by verifying your patients’ Medicare eligibility electronically, before filing claims. Register for Palmetto GBA’s free Online Provider Services (OPS) tool for Internet access to eligibility information, claim status, duplicate copies of remittance notices, and some financial information. You can participate in OPS if you have a signed electronic data interchange (EDI) Enrollment Agreement on file with Palmetto GBA.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/87UKMP4665?opendocument
Medicare Made Easy: Basic Billing for Beginners Handout
The Medicare Made Easy: Basic Billing for Beginners handout provides information about the following topics: Medicare plans and patient eligibility; overview of provider enrollment and Medicare participation; claims filing and Palmetto GBA Web site navigation.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8JZN9L8840?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email
2011 Electronic Prescribing (eRx) Incentive Program Update: 2012 Payment Adjustment
The reporting period for reporting the eRx measure for purposes of the 2012 payment adjustment ended on June 30, 2011. All applicable claims for dates of service between January 1, 2011, and June 30, 2011, must be processed by July 29, 2011. However, on May 26, 2011, CMS released a proposed rule entitled 'Proposed Changes to the 2011 Electronic Prescribing Incentive Program' to address concerns stakeholders have expressed regarding the implementation of the 2012 eRx payment adjustment.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8JZF848553?opendocument&utm_source=J11BL&utm_campaign=J11BLs
Medicare Record Authentication: Tips for Physicians
Medicare requires that health care providers ordering or documenting the medical necessity for items or services received by Medicare beneficiaries must be identifiable. The Comprehensive Error Rate Testing (CERT) contractor notes that the majority of CERT errors are related to inability to identify the author of a medical record. Signature logs or attestation statements are two acceptable methods to authenticate a record. Please share with appropriate staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8JWNB70745?opendocument&utm_source=J11BL&utm_campaign=J11BLs&utm_medium=email&utm_medium=email
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CIGNA Update
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CIGNA has announced that, in an attempt to standardize processes and procedures across all CIGNA business, they will adopt a common time frame for health care professionals to follow for submitting claims to CIGNA. Except where state law requires a longer time frame, the claim filing limit will change from 180 days to 90 days for participating health care professionals. Currently, over 99 percent of CIGNA claims are already submitted within this time frame.
The changes to the claim filing time frame will occur in phases, with the initial phase effective on August 1, 2011. You will be notified in writing of any changes and receive an amendment to your agreement, or you will be contacted by a CIGNA representative. The claim filing time change also applies to health care professionals whose CIGNA contract includes GWH-CIGNA business. Certain states have regulatory requirements that supersede the CIGNA time frames, and health care professionals in these states will have a claim filing limit that meets state requirements. Refer to the Implementation Schedule for state-specific effective dates and claim filing limits.
When CIGNA is the primary payer, claims must be received by CIGNA within 90 days of the date of service to be considered for payment. When CIGNA is the secondary payer, the claim must be submitted within 90 days of the receipt by the health care professional of the Explanation of Payment from the primary payer.
Only participating health care professionals who receive a notification and amendment to their agreement from CIGNA, or who are newly contracted with CIGNA, are affected by this change on August 1 and November 1. There will be additional phases in 2012, and affected health care professionals will be notified in advance of any changes.
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PEIA Offers Premium Discounts for Patients
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It's not too late for PEIA members to qualify for the premium discounts offered to them in order to offset the $14 premium increase for Plan Year 2012.
PEIA is offering two discounts: Improve Your Score ($10 monthly) and Advance Directive/Living Will ($4 monthly).
Improve Your Score
Active members covered by PEIA PPB Plans A, B or C who report their Improve Your Score measures to PEIA are eligible for the $10 monthly discount. Improve Your Score is designed to make the member and his/her doctor aware of individual health risks, including cholesterol, glucose or blood sugar, blood pressure and waist circumference. Participants receive a color-coded report card, which grades each of the measures as “green” (healthy), “yellow” (moderate risk) or “red” (high risk) while also providing an aggregate color-coded score. The premium discount is based upon participation and not the color-coded outcome.
Advance Directive/Living Will
Active members covered by PEIA PPB Plans A, B or C and retirees covered by PEIA PPB Plan A, Humana or the Special Medicare Plan who notify PEIA by affidavit they have executed an Advance Directive/Living Will are eligible for the $4 monthly discount. An Advance Directive/Living Will is a legal document for making known your wishes about end-of-life care or what medical treatments the member desires. It also can be referred to as a health care directive or physician’s directive. Patients do not need to send PEIA a copy of their Advance Directive/Living Will.
The Health Plan HMO members are not eligible for either discount.
PEIA members may check their status, by logging on to Manage My Benefits on the PEIA Web site. Go to "Policyholder" and "Coverage for the Next Plan Year." The status of the member’s discounts appears after the insurance coverages.
For additional information, contact:
Customer Service
1-304-558-7850, 1-888-680-7342
peia.help@wv.gov
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UnitedHealthcare Update
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UnitedHealthcare Medical Director Dr. Ed Kosa will be meeting with the WVSMA on Thursday morning, September 8th, 2011, at 9:00 AM at the WVSMA office. He will be discussing the plan’s new programs and other issues of importance to your medical practice.
Physicians and staff are welcome to attend this meeting. If you or your office staff are interested in attending this meeting, please RSVP to Barbara Good (Barbara@wvsma.com) or Karie Sharp (karie@wvsma.com).
The previous meetings with Dr. Kosa and his staff have been very productive. The WVSMA is pleased to be able to provide this opportunity to our physicians.
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August 12, 2011
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