The West Virginia State Medical Association 2008 Annual Meeting and Physician Practice Conference was held during the weekend of January 25th -27th at the Charleston Marriott. Attendees were able to obtain CME hours for participation in the conference.
As a new addition to this year's conference, a special Physician Practice Seminar was held on Friday, January 25th. Attendees, both physicians and medical staff personnel, were provided with two very different educational opportunities during the day long seminar.
The morning session opened with great enthusiasm as R. Austin Wallace MD, President of the WVSMA and Barbara Good, WVSMA Physician Practice Advocate, welcomed the large group. The enthusiasm continued with the introduction of the speaker for the morning session, Rose Moore, the Physician Practice Advocate for the Medical Society of Virginia. Ms. Moore's topic, "Front Office Skills for Medical Practices", focused on techniques designed to enhance the medical practice by maximizing the professionalism of the office staff. Her unique style and presentation kept the audience alert and excited throughout the morning. Some of the topics that were discussed included telephone etiquette, billing and collections, effective communication between staff members and patients, time management and teamwork. Attendees not only learned how to enhance their customer service skills during the session, but they also learned basic principles that can help reduce the risk and liability associated with staff/patient interactions.
The afternoon session was a 2008 Payor Update. Ten of the major insurers participated in the session, providing an overview of updates and policy changes for 2008. Following the individual presentations, a question and answer time ensured that all participants' concerns were addressed. Payor representatives and managers stayed after the seminar ended and spoke individually with physicians and office staff in order to answer more specific questions. Those attending expressed appreciation for the opportunity to network with so many representatives in one location.
Door prizes were won by Kristie Green of Beckley Area Surgical Associates, Beckley, WV, and by Andrea Price from the medical practice of Tom Linger MD in Charleston, WV.
It is hoped that the Physician Practice Conference will become an annual event. Please let us know any feedback and suggestions you may have.
If you did not receive a certificate for attending the conference and would like to have one, please contact Barbara Good (Barbara@wvsma.com) so that a certificate may be sent to you. We also have a limited number of handouts from the conference. One handout that may be of special interest to you is entitled "Medication Alternatives for the Elderly". Please contact the WVSMA office if you would like a copy of this laminated handout.
Another opportunity for physician and staff education occurred on Saturday afternoon when a second physician practice session was held. The seminar, entitled "Medicare Advantage Plans: What Do They Mean For Your Practice?" helped to acquaint physicians and staff with some of the new Medicare Advantage plans. In an attempt to educate physicians about the changes and in turn assist them with educating patients, payor reps from the various Medicare Advantage plans presented and addressed issues and concerns.
During the session, physicians heard about the Medicare Advantage Private Fee For Service Plans (PFFS) from management and representatives of each plan. Much discussion developed as the various representatives explained the new plans. Although there is still much confusion about the plans, attendees were given more knowledge and awareness about both the traditional and the new PFFS Medicare plans.
Additional information about the Medicare Advantage plans will continue to appear in the Wesgram Online. Below is some very helpful information that can enable your office to verify the specific Medicare plan that your patients have selected.
Identifying the correct Medicare plan for filing claims is a challenge for many offices, particularly in the first few months of each calendar year. The Medicare.gov website, which is the "Official U. S. Government Site for People with Medicare," is a valuable resource that you can use to verify the specific Medicare plan selected by your patients.
Before using this website, you will need several pieces of information from your patients that you are already gathering as part of the administrative claims filing process:
Medicare Health Insurance Claim number (HIC)
Part A or B effective date, from the red, white and blue Medicare card
Birthdate
Last name
Zip code
Steps to verify Medicare plan information for a specific patient:
Select "Medicare Prescription Drug Plans- 2008 Plan Data" from the middle area of the page
Click on "Find & Compare Plans"
Begin Personalized Search"
Complete the form with the patient's information described above (HIC, Part A or B effective date, last name, and zip code)
Results:
If the patient IS enrolled in a Medicare Advantage (MA) plan, or HMO, this Web site will identify the plan by name and the effective date of the patient's enrollment in this plan. File your claim with the MA plan.
If the patient is NOT enrolled in an MA plan but DOES have a prescription drug plan, only the prescription drug plan will show. This signifies that the patient has original Medicare. File your Part B claim with Palmetto GBA.
Note: always verify the eligibility information displayed on this Web site with the patient. There can be a lag between a change in the patient's plan election and this site being updated. If there is a discrepancy between the information shown on this site and information you are receiving from your patient, suggest that the patient call 1-800-MEDICARE to verify his/her plan election.
March 1st, 2008 is a critical date for physicians and all other providers who bill Medicare. Prior to March 1, 2008, claims with both an NPI and a Medicare legacy number are rejected if the pair is not found on the Medicare NPI Crosswalk. Claims submitted with just a Medicare legacy number are being paid (unless of course, they have other errors that cause them to be rejected). As of March 1, 2008, claims with both an NPI and a Medicare legacy number will continue to be rejected if the pair is not found on the Medicare NPI Crosswalk. Claims without an NPI in the primary provider field will be rejected and claims with only a Medicare legacy number in the primary provider field will be rejected.
What this means for physicians is nonpayment for any Medicare services until an NPI is provided to Medicare and entered in the Primary Provider field. If there is incorrect information causing an NPI/legacy mismatch on the NPI crosswalk, information needs corrected in order to receive reimbursement. The correction might require the physician to file a CMS-855 Medicare Provider Enrollment form with the Medicare carrier (Palmetto GBA).
Physicians are urged to test the NPIs-only NOW. Each physician office needs to test his/her ability to get paid using only an NPI by submitting one or two claims with just the NPI and no Medicare legacy number. If the Medicare NPI Crosswalk cannot match the NPI to the Medicare legacy number, the claim with an NPI-only will be rejected. It is highly recommended that physicians test their claims now. If the claim is processed and paid, continue to increase the volume of claims sent with only an NPI. If the claims are rejected, call your Medicare carrier enrollment staff for advice right away. The enrollment number is likely to be quite busy after the March 1 deadline, so don't wait.
The Centers for Medicare & Medicaid Services (CMS) has announced that the Physician Quality Reporting Initiative (PQRI) website has been reorganized to facilitate access and navigation to 2008 PQRI information and educational resources, including a 2008 PQRI Tool Kit. Important documents related to 2008 measure specifications have been placed as downloadable documents within their corresponding sections. In addition, new documents that further inform eligible providers about 2008 PQRI have been added to the website.
Information about the 2007 PQRI program, which ended on December 31, 2007, has also been reorganized with relevant documents pertaining to 2007 measures retained for reference. CMS encourages participation in the PQRI program. All eligible providers are encouraged to visit the website http://www.cms.hhs.gov/PQRI/.
The Centers for Medicare and Medicaid Services (CMS) implemented the Payment Error Rate Measurement (PERM) program to meet the requirements of the Improper Payments Information Act of 2002. Federal agencies are required to annually review and estimate the amount of improper payments identified for Medicaid and SCHIP programs. Under PERM, CMS will conduct reviews in three areas of Medicaid and SCHIP programs: Fee-For-Service (FFS), Managed Care, and Program Eligibility. The results of these reviews will be used to produce both national and state specific error rates. States are measured once every three years, and West Virginia Medicaid and SCHIP have been selected for review for Fiscal Year 2007.
CMS has awarded contracts to a statistical contractor (who will calculate error rates), a documentation/database contractor (who will collect state specific policies and medical records directly from Medicaid providers), and a review contractor (who will perform the medical and data processing review to determine if each claim was medically necessary and paid properly).
Livanta is the assigned data documentation contractor who has the responsibility of requesting and collecting provider's medical records to be used in the review process. Physicians can expect to receive Livanta's documentation request letters beginning in February 2008.
All Medicaid providers should be aware that they may be included in the records request process. If a provider receives a request of documentation for Medicaid billings, please be advised that it is imperative that he/she send in all supporting documentation within the time frame stated by Livanta. Any requested documentation from providers which is not received by Livanta for review will be counted as an error against WV Medicaid. This will result in a money payback for WV Medicaid.
If a provider does not provide all documentation to support his/her billings within the timeframe stipulated by Livanta, that provider will have all outstanding Medicaid payments withheld until he/she has fully cooperated with Livanta's documentation request. Therefore, all Medicaid providers' full cooperation with the PERM process is requested by BMS.
If any WV Medicaid providers have questions or concerns about the PERM process or their responsibility regarding the Livanta documentation requests, please contact Scott Winterfeld at 304-558-6039.
Governmental payors have made a number changes for 2008. Representatives from the governmental payors gave presentations at the Physician Practice Conference and explained many of the new initiatives. The following information is a brief summary of the payor information.
Palmetto GBA
Tim Allman, Community Education Administrator for Palmetto GBA OH/WV Medicare Part B, discussed the recent changes in Medicare. As you are aware, the Medicare, Medicaid and SCHIP Extension Act of 2007 replaced the scheduled 10.1% reduction in the Medicare Fee Schedule conversion factor with a .5 % increase for dates of service from January 1, 2008 through June 30, 2008. The new fee schedule was posted on the website on January 8, 2008. Due to the late change in the fee schedule and concerns that physicians might drop their participation with the Medicare program, Medicare has extended the physician participation enrollment period by an additional 45 days. This means that physicians have until February 15, 2008, to enroll or change their Medicare participation status.
The 2008 Medicare Physician Fee Schedule Final Rule also extends the Physician Quality Reporting Initiative through the end of 2008. The number of reportable measures has increased from 74 in 2007 to 119 in 2008. The Rule also extends the Physician Scarcity Bonus through June 30, 2008.
PEIA
Gloria Long, Deputy Director of Insurance Programs and Services, presented information regarding upcoming PEIA changes for 2008. Effective February 1, 2008, the Resource Based Relative Value Units (RBRVS) will be updated to reflect the CMS January 2008 fee schedules. The new conversion factor will be $43.46.
There were also some changes announced for the Medicare Advantra (PEIA retirees) program. The Medicare Advantage Prescription Drug (MAPD) plan has several benefit changes, including a pharmacy change which changes the tier 3 drugs to a tier 2 copay ($15.00), effective March 1, 2008. The medical plan changes which will be in effect as of July 1, 2008 include no coinsurance on services, copays only for some services, and 100% coverage for some services. PEIA will be sending additional information to physicians and patients prior to the July 1, 2008, implementation date.
West Virginia Medicaid
West Virginia Medicaid changes were presented by Christy Thomas, Deputy Account Manager for Unisys. One of the biggest concerns at Unisys is ensuring that physicians have submitted their National Provider Identifier numbers (NPI) to Unisys and that they are correctly utilizing the NPIs. Physicians who have not yet sent their NPIs to Unisys should do so immediately. Physicians may still submit claims with their Medicaid Legacy identifier numbers until May 22, 2008.
As of January 1, 2008, only the new claim billing forms are being accepted by Unisys. Claims which are submitted on the old claim forms are being returned to physicians. Unisys is returning claims weekly due to NPI billing errors or the usage of incorrect billing instructions on the new billing forms.
An update was given about the Medicaid Redesign initiative. As of January 1, 2008, Mountain Health Choices is now available in 49 of West Virginia's 55 counties. The counties which are not yet with the Mountain Health Choice Program are Cabell, Grant, Hardy, Mason, Pendleton and Wayne. Physicians may bill for the review/completion of the member agreement by billing CPT code 99420. All claims should be submitted to Unisys, even if the patient is enrolled in a Medicaid HMO. The completed member agreement should be faxed to Automated Health Services.
Finally, for Medicaid claims billed on January 1, 2008 and after, the NDC number must be billed with any drug claim that is billed. Please note that this requirement is for all drugs, except those drugs required for inpatient services, immunizations or radiopharmaceuticals.
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 is now using the new AMPs. The deadline for implementation of the new FUL prices based on AMP methodology was February 1, 2008. Pricing for some drugs may be adjusted as long as in the aggregate, the program does not exceed the FULs.
The AMA, as well as the AmericanAcademy of Pediatrics, recently requested that ABC cancel the premiere episode of "Eli Stone," which featured a lawyer who argues in court that a vaccine caused a child's autism.The episode also contained misleading medical information pertaining to the safety of influenza vaccines. Although the show aired as scheduled on Jan. 31, ABC ran a disclaimer about the plot line of the episode and directed viewers to the Centers for Disease Control's web page on autism.
The AMA wrote letters to various individuals at ABC and to people involved with the production of the show to voice the concern that the episode perpetuates the myth that vaccines can cause autism. In these letters, the AMA urged ABC to remind its audiences that the content of this episode is fictional, and that numerous well-conducted scientific studies by respected medical and scientific authorities have shown no link between vaccines and autism.
A similar Letter to the Editor signed by Dr. Catherine Slemp, Acting WV Health Officer, and others involved with immunization safety, appeared in the Sunday, February 3, 2008 edition of the WV Gazette.
Those who attended the WVSMA's Vaccine Safety Conference, "Pediatric and Adult Immunization:Benefits, Safety and Perceived Risks", in September, 2007, heard from nationally renown experts about the misconception that vaccines cause autism.William Atkinson MD, MPH, Medical Epidemiologist at the Center for Disease Control, National Immunization Program in Atlanta, Georgia; and Gary S. Marshall MD, Professor of Pediatrics and Chief of the Division of Pediatric Infectious Diseases at the University of Louisville School of Medicine both addressed the issue and demonstrated conclusions that vaccines do not cause autism.
The Mountain State Blue Cross Blue Shield Physicians Advisory Committee (PAC) met during the recent Mid-Winter Conference.In addition to reviewing new and existing policies and procedures, the committee was given a MSBCBS 2008 Business Update.
The PAC is composed of physicians from various geographic areas of the state.Also included on the PAC are provider representatives who deal with billing, coding and administration issues. The PAC rosters are listed on the MSBCBS website (www.msbcbs.com).There are 2 separate rosters, one of MSBCBS committee members and one listing of the physician committee members.Barbara Good serves as the WVSMA representative on the PAC.
The purpose of the PAC is to give physicians a mechanism to offer advice, recommendations and comments to MSBCBS regarding provider billing, coding and administrative issues.These issues may include improvement of health care delivery, clinical quality, cost-effectiveness of services, communication and cooperation.
The PAC does not have jurisdiction to consider any of the following issues:
MSBCBS clinical polices concerning medical necessity, investigational or experimental service determinations, or criteria for coverage,
Scope of coverage,
Eligibility,
Level of fees or plan reimbursement,
Individual provider billing, payment or coverage disputes or appeals,
Legal interpretation of MSBCBS's contracts, policies or manuals.
Physicians who have issues that they wish to be addressed by the PAC may send an email to PAC@MSBCBS.com.
Mountain State Blue Cross Blue Shield has announced a change in network credentialing policies and procedures. The new policy, which became effective January 1, 2008, requires that all providers will be required to be credentialed prior to contracting. Providers must be credentialed and contracted in order to receive reimbursement for any services provided to MSBCBS members. This policy was already in effect for the Medicare Advantage Network.
Also, Mountain State will no longer credential or contract with practitioners who are still involved in a training program (i.e. residency or fellowship). Practitioners may apply for network participation when Mountain State is able to verify completion of training.
Beginning in 2008, Highmark's Credentialing Department will be doing all primary source verifications for practitioner credentialing information. All credentialing applications should be sent to Highmark at:
Highmark Provider Data Services Department P.O. Box 898842 Camp Hill, PA 17001 (866) 763-3224
For more information regarding MSBCBS credentialing, you may visit their website at www.msbcbs.com.
As of January 2, 2008, CIGNA began reimbursing physicians for online visits through a service called RelayHealth. The online visit service is only being offered to self-insured employers with OAP, OAP In, PPO, EPO, Indemnity, or CIGNA Choice FundSM products. These "virtual house call" services include reimbursable eVisits, online prescription refills and renewals, laboratory results, and the ability to schedule appointments. Patients describe their problems and symptoms in an online consultation with RelayHealth, where all communication between a physician and patient is encrypted and password protected.
Physicians who wish to participate in CIGNA's new online visit plan should call RelayHealth customer service at 866.RELAYME (866-735-2963) for information about joining. In order to participate in this online initiative, physicians must subscribe to RelayHealth, at a cost of $100 a month.
CIGNA patients are responsible for their usual copays online and may pay with a credit card at the RelayHealth website when the visit is complete (i.e. when the physician responds). Members with coinsurance plans will receive a bill from the physician after the online visit indicating their responsibility based on their benefit plan. The member does not have to pay up-front. RelayHealth will send a claim to CIGNA for the total charge. Cigna will then forward payments directly to the Physician. The physician office may have to bill the member any un-reimbursed amounts.
For members with copayment plans, RelayHealth will collect the member's copayment via a credit card/debit card which will then be forwarded directly to the physician by RelayHealth. RelayHealth will send a claim to CIGNA for the remaining reimbursable component. Cigna will then forward payments directly to the Provider.
The American Medical Association (AMA) has recently established a permanent CPT-4 code, 99444, to enable reimbursement for online physician consultations. This replaced the temporary code, 0074T and will only be reimbursed for RelayHealth webVisits
