The WVSMA Mid-Winter Conference is scheduled for Friday, January 25th, 2008 through Sunday, January 27th, 2008, at the Charleston Marriott Hotel in Charleston, West Virginia. Information was recently sent to your practices about this important upcoming meeting.
A new addition to the Mid-Winter Conference is a special all day seminar on Friday, January 25th, for physicians, office managers, medical assistants and other office personnel. The morning session will include a workshop on front office skills, designed to enhance your medical practice by maximizing the professionalism of your staff. Some of the topics to be discussed include telephone etiquette, billing and collections, effective communication between staff members and patients, time management and teamwork. The WVSMA is bringing in a nationally known consultant to conduct this special session. Any staff member in your office who has contact with patients should plan to attend this seminar. Attendees will not only enhance their customer service skills during the session, but they will also learn basic principles that can help reduce the risk and liability associated with staff/patient interactions.
The afternoon session will include a payor workshop with all major payors participating. This will be an excellent opportunity to learn about the 2008 changes that various payors have implemented. There will also be time available to network with the payor representatives.
Make plans and reservations now for the special Friday seminar. For additional information and to register, you may contact the WVSMA at (304) 925-0342, or click here.
The announcement of the expected Medicare payment cuts took a step toward becoming reality as CMS issued a final rule calling for a 10.1% reduction in payment for 2008. This rate cut has been anticipated for nearly a year. The fee cut is a result of the budget neutrality of the SGR formula, which is the methodology for reimbursing Medicare Part B services.
The response to this announcement from physician groups, including the WVSMA, was immediate and understandably negative. As a result of the request issued by WVSMA in a Legislative Update on November 5, 2007, many of our physicians acted and contacted Senators Byrd and Rockefeller, urging them to include positive Medicare physician payment updates for the next two years in the Medicare bill that they are drafting.
At this point, only Congress can make a change. For the last five years, Congress has intervened to temporarily suspend requirements of the SGR; however, the fact that Congress deferred the 5% cut to Medicare reimbursement at the last minute last year increased the likelihood that the 10.1% cut might occur for 2008.
The AMA has expressed concern that physicians may limit the number of Medicare recipients that they see as patients if the reimbursement cut is not stopped.
As always, the WVSMA will keep your practices updated as to any changes that may occur with the impending cut in reimbursement.
CMS is conducting a 5 year demonstration project that is intended to encourage the adoption of EHR (Electronic Health Records) by small to medium sized physician groups. CMS will soon begin to offer financial incentives to physician groups who use EHR systems and meet certain clinical quality measures. The participating groups will also be awarded an annual bonus based on the group's performance. The demonstration project, which will begin in the spring of 2008, will be open for up to 1,200 physician practices for participation.
Many physician practices have reported claim problems when submitting Medicare claims with NPI numbers on them. Effective October, 8, 2007, Palmetto GBA began editing the NPI/legacy ID (also called the PTAN) combinations for validity against the NPI crosswalk file. When a match is unable to be located on the crosswalk, the claims are rejected or returned to the physician.
If you receive a returned claim, you should first verify that the correct NPI was submitted. If an incorrect NPI was submitted, the claim should be resubmitted with the correct NPI. If the NPI is correct, you should verify that the PTAN (PIN) corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES). The NPPES website is: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do
If the NPPES data is correct and All Medicare PTANS have been appropriately matched in the NPPES, but there are still identifier problems with claims that contain an NPI, you should contact the Palmetto GBA office at 1-866-308-5439. You may need to complete a new Medicare enrollment application (i.e. the CMS-855) in order to ensure that claims with NPIs will process and pay correctly.
Here's a tip that may help with your claims submission. You should not put the NPI in Box #32 of the HCFA form unless it is for a purchased diagnostic service. Box #32 should only contain the name of the servicing facility location.
New information is continually added to the most reliable source of information about PQRI, the CMS website: http://www.cms.hhs.gov/PQRI. Here you will find new and revised Frequently Asked Questions (FAQ), updates on issues related to both the 2007 and 2008 PQRI, new educational products, and access to the latest information you need to successfully participate in PQRI. Many of the FAQs have been recently updated, so be sure to check the website if you have any questions.
Two of the newest FAQs are:
Question: Where do I place the Physician Quality Reporting Initiative (PQRI) quality-data codes on the CMS-1500 claim form?
Answer: The 2007 PQRI quality-data codes are HCPCS codes and reporting requirements for these codes follow current rules for reporting other HCPCS codes (e.g. CPT Category I codes). For additional information, see FAQ #8255.
Question: Are Medicare patients who are covered under Railroad Retirement Benefits and Postal Worker benefits included in the Physician Quality Reporting Initiative (PQRI)?
Answer: Yes.
If you are not currently participating in the PQRI program but wish to participate in 2008, please see the next article regarding an upcoming conference call about the new 2008 PQRI program.
The Centers for Medicare & Medicaid Services' (CMS) Provider Communications Group announces the first in a series of national provider conference calls on the 2008 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 3:00 p.m. - 5:00 p.m., EST, on Wednesday, November 28, 2007.
The call will cover the 2008 provisions of the Physician Quality Reporting Initiative that were included in the 2008 Medicare Physician Fee Schedule Final Rule. This will include a discussion of the 119 PQRI measures available for eligible professionals to select for 2008.
Information on the 2007 and 2008 PQRI programs are posted to the PQRI web page located at http://www.cms.hhs.gov/PQRI, on the CMS website. The website is continually being updated, so check it often for the most current information available. There are many educational resources available on the webpage, so feel free to download the available resources prior to the call. This toll-free question and answer teleconference will provide eligible professionals the opportunity to ask questions of CMS subject matter experts.
Conference call details:
Date: November 28, 2007 Conference Title: 2008 Physician Quality Reporting Initiative National Provider Call Time: 3:00-5:00 p.m. EST
In order to receive the call-in information, physician practices must register for the call. It is important to note that, if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation. For those who cannot attend the call, replay information is available below.
Registration will close at 3:00 p.m. EST on November 27, 2007, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
3. Verify that your time zone is displayed correctly in the drop down box.
4. Click "Register."
5. You will be taken to the "Thank you for registering" page and will receive a confirmation email shortly thereafter. Note: Please print and save this page in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there. For those who are unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible from 5:30 p.m. EST 11/28/2007 until 11:59 p.m. EST 12/05/2007. The call-in data for the replay is: 800-642-1687 and the passcode is 24215922.
On December 8, 2003, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was signed into law. The Act affected the entire Medicare program. In addition to beginning a new voluntary prescription drug program that became available to Medicare beneficiaries on January 1, 2006, the Medicare Modernization Act changed the name of the Medicare+Choice program to Medicare Advantage (MA). Under the Medicare Advantage program, Medicare beneficiaries have many new types of plans to choose from for their health care coverage. The Medicare Advantage program enrollment is from November 15 to December 31 annually.
Physician enrollment and participation in the original Medicare fee for service (FFS) program has not changed; however, with the Medicare Modernization Act and the resulting numerous healthcare plan choices for beneficiaries, physicians may find themselves with many unanswered questions. In an attempt to educate physicians about the changes and in turn assist you with educating your patients, the WVSMA has decided to provide a special physician advocacy session for physicians during the Mid-Winter Conference.
During the session, physicians will learn all about the Medicare Advantage Private Fee For Service Plans (PFFS) from management and representatives of each plan. They will learn the terms and conditions of participating in each plan so that they may better educate their patients about plan requirements. Patients will benefit from this session because the physician will be much more knowledgeable and aware about the PFFS plans.
Unisys has announced a change in the billing and payment schedule for Thanksgiving week, November 19th-23rd. For this week, the billing deadline will be Monday, November 19th, at 5:00 PM. Payment will be made on Wednesday, November 21st. The Bureau for Medical Services and Unisys will be closed on November 22nd and 23rd but will reopen on Monday, November 26th at 8:00 AM.
Unisys is also advising of an upcoming change for billing for drugs for Medicaid recipients. Effective for dates of service January 1, 2008 and after, drugs must be billed with the appropriate NDC number. The NDC number is not required for Inpatient Services, Immunizations and Radiopharmaceuticals. These claims may be billed electronically through the Web Portal "only for the 837P" and also on paper. The 837I on the Web Portal is currently being configured and developed to accommodate this requirement. For more information regarding NDC, please visit the "NDC Information" section listed under the Documents page.
Effective January 1, 2008, all physicians and other providers will be required to submit claims on the new CMS 1500, UB04 and ADA 2006 forms. Claims will be returned to the physician if they are submitted on the old billing forms after 1-1-08. Please refer to the updated billing instructions on the website (www.wvmmis.com) for correct billing procedures.
Modifications have also been made to the eligibility transaction on the Web Portal. Those modifications will now report if a Medicaid Member is participating in the Basic or Enhanced benefit. For additional assistance, please contact Unisys Provider Relations at 888-483-0793.
The new Medicaid formulary began on October 1, 2007 and is posted on the Bureau for Medical Services website (www.wvdhhr.org). Both Lexapro and Evista became non-preferred drugs as of October 1; however, those patients already on these two drugs are being grandfathered. The recently approved indications for Evista have been added to the Prior Authorization criteria. Levaquin has been added to the preferred macrolides and Invega has been added to the preferred atypical antipsychotics.
Any additional changes to the Medicaid formulary may be viewed online at the BMS website www.wvdhhr.org.
CMS has announced that it will be changing its drug pricing mechanism from the Average Wholesale Price (AWP) to the Average Manufacturing Price (AMP). The new AMP rule sets a new federal limit on the amount that CMS will reimburse pharmacies for generics under Medicaid. CMS is scheduled to use AMP for basing its Medicaid reimbursements for generics, beginning in early 2008.
The new AMP rule, which was mandated by the 2005 Deficit Reduction Act, was written partially because government reports in 2004 found that Medicaid payments to pharmacies for generic drugs were much higher than what pharmacies were actually paying for those drugs.
Under this new rule, reimbursement rates are set at 250% of the lowest AMP reported (known as the federal upper limit or FUL). CMS estimates that using AMPs for drug pricing will save states and the federal government over $8 million dollars over the next five years.
West Virginia Medicaid will be using the new AMPs in 2008. The deadline for implementation of the new FUL prices based on AMP methodology is February 1, 2008. Since WV Medicaid will not receive the prices until 12/30/07, they will have only one month to determine how to adjust the pricing if necessary. Pricing for some drugs may be adjusted as long as in the aggregate, the program does not exceed the FULs.
Aetna recently held provider training sessions to assist practices as they begin seeing new enrollees in the Aetna Medicare Advantage plans. They will begin offering their Medicare Advantage plan as of January 1, 2008. The Private Fee for Service (PFFS) plan provides all the benefits of original Medicare and more, including unlimited hospitalization and full coverage of preventive services. Most plan options also include Medicare prescription drug coverage. There will be copays for most services, although many preventive benefits will not require copay.
Physicians will receive Medicare allowable rates for their services. Claims will be processed in accordance with Medicare billing rules, using the Medicare fee schedule. Aetna will also be using the Correct Coding Initiative (CCI). There is no Aetna contract required to participate in Aetna Medicare, no precertifications or referrals are required, and the billing is simplified. There is no need to submit a second or third bill to Medigap or a Medicare supplement. Claims may be submitted by using Aetna's electronic Payor ID #60054.
The majority of beneficiaries enrolled in the new Aetna Medicare plan will be retired Carbide (Dow) employees. These employees are being offered a choice of Aetna Medicare or traditional Medicare with Aetna secondary.
Brickstreet is currently implementing improvements in reimbursement rates and requirements for providers of work conditioning and work hardening services.
In order to acquaint physicians with the new requirements, Brickstreet will be hosting two seminars to address the changes taking place:
December 4, 2007, 10 a.m. to 1 p.m. BrickStreet Mutual Insurance 400 Quarrier Street, Charleston, WV
December 6, 2007, 10 a.m. to 1 p.m. HealthWorks Rehab and Fitness 923 Maple Drive, Morgantown, WV
Physicians who wish to continue to provide work conditioning and work hardening services to BrickStreet injured workers at the increased rates must attend one of these sessions. At this time WVPTA continuing education units are pending.
Space is limited so Brickstreet requests reservations. To attend the seminar, you may register via email at: ProviderInquiries@BrickStreet.com.
An injury is any event requiring treatment by a licensed medical professional which is expected to result in an expense of any type, and must be reported.
BrickStreet accepts the requirement for reporting a claim within five days, however, prefers injuries to be reported within 24 hours to better support positive outcomes.
All workplace injuries must be reported to BrickStreet by the policyholder. It is not only the policyholder's responsibility, but it is to their advantage to report as quickly as possible. Early reporting can help manage claim costs, return the injured worker to his/her job faster, and even positively impact your experience modifier.
There is no downside to early reporting, even if it never results in payment of medical or indemnity benefits. Reporting claims that do not result in payment of medical or indemnity benefits does not adversely impact your experience modifier.
It is important to reiterate the five different ways that policyholders can file a claim. The most effective way is to call BrickStreet at 304-941-1000 or 1-866-452-7425; select policyholder and then option 1.
