Template

	Medicaid Preferred Drug List Modifications
	The West Virginia Medicaid Preferred Drug List has been updated on the Bureau for Medical Services' website, www.wvdhhr.org/bms. Changes for the therapeuctic classes reviewed at the February 2007 P & T meeting are effective April 2, 2007. Click here to go directly to a PDF of the updated PDL.
	Top

Palmetto GBA Ultimate Partnership Educational Event

The Palmetto GBA Ultimate Partnership Educational Seminar will be held on Thursday, April 12, 2007, and is open to physicians, residents, non-physician practitioners, compliance officers, office managers, billing and coding staff. The all day seminar will be held at the Robert C. Byrd Health Sciences Center Auditorium, 3100 MacCorkle Avenue, SE, Charleston, WV 25304. There is no charge for the seminar and the program has been approved by the Charleston Chapter of the AAPC for a total of 6.5 CEUs (attendance at all sessions required to receive CEUs).

This seminar will be offered in 5 different sessions over the day. The event is sponsored by Charleston Area Medical Center and presented by Palmetto GBA (West Virginia Medicare Carrier) staff.

The sessions for this unique event will include:

Evaluation/Management (E/M) documentation guidelines
Medical Necessity, usage of Medicare 25 modifier, and "Incident-to" Guidelines
Teaching Physician Guidelines
Non-Physician Practitioners: Scope and Guidelines
Medicare "Hot-on-the-Spot" Update, including information on clinical trials, preventive services, Medicare contracting reform, and National Provider Identifiers

Registration information for the Ultimate Partnership Event is available online. Click here to register. The deadline for registration is Wednesday, April 4, 2007. If you do not have Internet access, you may register for this event by faxing your registration form to 614-473-6812.

If you have any additional questions, you may contact Palmetto GBA at 1-877-567-9232. For faster service, select option 3 and then option 7.

Top

NPI Reminder

It is now less than two months until the NPI number will be required on all claim submissions!

Many physicians have obtained NPI numbers and have begun to use them. If you still have not gotten an NPI, you must act quickly, as the May 23, 2007 deadline is rapidly approaching. As of May 23, Medicare contractors, as well as most payors, will only accept NPI numbers on claims. Once you have received your NPI, you should notify all payors of the unique 10 digit number.

The NPI is a HIPAA (Health Insurance Portability and Accountability Act) requirement, which states that physicians who transmit claims and other HIPAA transactions electronically will be required to use an NPI as of May 23, 2007. While HIPAA applies only to physicians who do business electronically, Medicare has made the business decision to require those who bill with paper to obtain and use an NPI.

Visit the National Plan and Provider Enumeration System to obtain your NPI online. If you prefer, you may also download and complete a paper application.

NPI applications are also available from the WVSMA office (304) 925-0342 or from NPPES at 1-800-465-3203.

The Centers for Medicare & Medicaid Services (CMS) announced that it is implementing a contingency plan for covered entities (other than small health plans) who will not meet the May 23, 2007, deadline for compliance with the National Provider Identifier (NPI) regulations under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Details are contained in a CMS document entitled, "Guidance on Compliance with the HIPAA National Provider Identifier (NPI) Rule" on the CMS website.

Top

Physician Quality Reporting Initiative

The Centers for Medicare and Medicaid Services (CMS) has posted the detailed specifications for the 74 measures included in the 2007 Physician Quality Reporting Initiative (PQRI).

PQRI establishes a financial incentive for physicians and other health practitioners to participate in a voluntary quality reporting program. Eligible professionals who successfully report data for a designated set of quality measures may earn a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare physician fee schedule services provided during the reporting period of July 1, 2007 to December 31, 2007.

To view the entire press release, click here.

Physicians may want to consult your software vendors and test your systems to ensure that claims containing the codes associated with the new measures will be processed. Some of the quality codes are new and will be rejected by Medicare claims processing systems prior to the July 1, 2007 HCPCS update. CMS will be issuing further information about which measures may be used for testing systems prior to the July 1, 2007, start date.

Top

PEIA Immunizations Reimbursement Update

As reported in an earlier WESGRAM Online, all immunizations and vaccine claims for PEIA insureds had been pended since January 1, 2007 due to issues with the 2007 fee schedule. The WVMSA worked diligently with PEIA officials on this issue and as a result PEIA expedited work on the new fee schedule. The new fees were sent to Wells Fargo on Thursday, March 15, so that the claims could be processed and reimbursement sent to physicians.

As of April 2, 2007, the fees were loaded at Wells Fargo and claims are scheduled to be paid on this week's check run.

WVMSA pledges to stay on top of this issue and advise you of any changes in payments. Please let us know if you are having any problems with payment as soon as you discover them, whoever the payor, so that we can promptly help you resolve these issues.

Top

Blue Cross Blue Shield Physicians Advisory Committee

The inaugural meeting of the Mountain State Blue Cross Blue Shield Physician Advisory Committee will be held on Friday, May 4, 2007. The committee is composed of eight physicians, three ancillary members, and nine Blue Cross Blue Shield representatives. WVSMA will be represented on the committee by Evan Jenkins, Barbara Good and Michele Grinberg, Esq.

If you have issues or concerns that you would like to have discussed at this first Physician Advisory Committee (PAC) meeting, please contact Evan (Evan@wvsma.com) or Barbara (Barbara@wvsma.com)

Top

Volume IV

April 04, 2007


	Inside this issue
	Medicaid Preferred Drug List Modifications Palmetto GBA Ultimate Partnership Educational Event NPI Reminder Physician Quality Reporting Initiative PEIA Immunizations Reimbursement Update Blue Cross Blue Shield Physicians Advisory Committee


	Feedback Welcomed! The WVSMA wants to serve you, our physicians, to the best of our ability. If you have comments or suggestions about the WESGRAM Online, please feel free to contact us and let us know how we can improve. You may contact Barbara Good, Physician Practice Advocate, at (304) 925-0342, ext. 11, or via email Barbara@wvsma.com.