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Beginning April 1, 2008, physicians are required to write Medicaid prescriptions on tamper-resistant prescription pads. Written prescriptions must have at least one feature to prevent unauthorized copying, erasure or modification, or counterfeiting. The law, adopted by Congress as part of a military spending act in May 2007, does not apply to electronic, faxed or phoned prescriptions.
According to the ruling, physicians who use computer generated prescriptions for Medicaid patients will also need to ensure that the paper being used in their printers is compliant and tamper resistant. The Centers for Medicare & Medicaid Services has agreed to allow these practices an extension date of Oct. 1, 2008, to incorporate the security features.
Over the past few months, the WVSMA has been actively involved with obtaining price quotes from print vendors for tamper resistant prescription pads. We have found a company who can not only supply quantity pricing for both the tamper resistant prescription pads and the tamper resistant printer paper for computer generated prescriptions, but also has committed to supplying physicians with the highest level of tamper resistant prescription pads. The company has pledged to meet and exceed the requirements set by WV State Medicaid for the tamper resistant prescription pads
In addition to providing the tamper resistant paper/pads, all West Virginia pharmacies will be contacted and advised that any prescription written on this vendor's prescription pads or paper will be compliant with any state requirements, thereby reducing the number of phone calls and questions from pharmacists who are filling prescriptions for Medicaid patients.
If you are interested in receiving information about ordering tamper resistant prescription pads or paper, please contact Barbara Good (Barbara@wvsma.com).
The WVSMA has received a number of questions regarding the status of the grant that was received to assist physicians to comply with the new law. As soon as the grant money is available, we will communicate to our physicians the process for obtaining a complimentary supply of tamper resistant prescription pads and paper.
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Effective May 23, 2008, the Centers for Medicare and Medicaid (CMS) requires that all prescriptions contain the National Provider Identifier (NPI) number of the prescriber. According to the WV Bureau of Medical Services, as of that date, the NPI must appear on the prescription and may be hand-written or stamped on the prescription. If you are ordering new prescriptions in order to meet the tamper resistant prescription pad/paper requirement, it is suggested that a space for an NPI or a preprinted NPI be a part of the design for any prescription pads ordered.
Also, as of May 23, 2008, physicians will be required to use only their NPI numbers on all electronic claims sent to government or commercial payors. As of May 23, 2008, no legacy numbers will be permitted on any electronic claims or on any Medicare claims.
As of March 1, 2008, physicians billing Medicare were no longer permitted to submit paper or electronic claims using just their legacy (old) number. All Medicare claims must now include the physician's NPI or the physicians NPI plus the legacy number.
It is also recommended that physicians begin using only their NPI numbers immediately by sending a few claims through to ensure they process correctly. If claims are rejected, check to see that the correct legacy number is on file with CMS by visiting their website https://hppes.cms.hhs.gov or call (800) 465-3203. If the information that appears in the "other provider identification numbers" field is correct, then contact your Medicare contractor (Palmetto GBA) and ask Palmetto to validate what is appearing in their system.
By checking your NPI information early, physicians should have ample time to make corrections so that reimbursement is not delayed by the upcoming deadlines.
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The AMA Physician Data Restriction Program is available to physicians who do not want their prescribing information shared with pharmaceutical representatives. Under the program, physicians may determine how their prescribing data will be used. Some of the many uses of the program include evidence-based medical research, structuring clinical trials, efficient drug recalls, and aiding the FDA's ongoing post-approval assessment of drug benefits vs. risks. The Physician Data Restriction Program keeps the data available for researchers to advance important public health benefits and also gives physicians an opportunity to register complaints if their data is mis-used.
The AMA's Physician Data Restriction Program (PDRP) provides physicians a choice while ensuring that vital information on prescribing patterns continues to be available for beneficial public health purposes. To date, 12,585 physicians have enrolled in the PDRP, with 57 of those being West Virginia physicians. It is important for physicians to know that the AMA does not collect, sell or have access to prescribing data.
For more information or to register for the PDRP program, visit www.ama-assn.org/go/pdrp.
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BrickStreet encourages physicians to become members of their PPO network, StreetSelect. Providers who participate in the StreetSelect network have had special training in the treatment and care of workplace injuries and have agreed to follow professional treatment guidelines and standards required by BrickStreet's StreetSelect. Participants in the StreetSelect network receive additional benefits including a reduced number of procedures requiring authorizations. They also receive a PPO Administrative Medical Case Management Fee.
Physicians may register to become a participating provider by contacting BrickStreet's customer service, or by calling Kevin Ramey, Provider Relations Recruiter, at 304.941.1000 ext. 5227. You may also contact Kevin via email at Kevin.Ramey@BrickStreet.com.
In an emergency situation necessary care should be rendered promptly as medically indicated. BrickStreet will establish vendor status as a priority after the patient is medically stable and will assist physician practices to insure prompt handling of the case and payment for services.
A list of participating providers may be located by contacting BrickStreet's Customer Service at 1-866-45BRICK, option 2, or by calling StreetSelect at 1-866-426-6763.
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As first reported last year, Mountain State Blue Cross Blue Shield launched a five-year program to enhance many core administrative functions within its information systems structure. The goal is to offer state-of-the-art efficiency in servicing all providers. The next phase, effective April 11, 2008, involves making additional edit checks for data completion and accuracy on claims prior to adjudication. With the additional upfront edits, the goal is to prevent incomplete and inaccurate electronic claims from entering the system, thus allowing for more efficient processing. For electronic claim submitters, these new edits will be reported on the X12 277 Claim Acknowledgement (277 CA) Transaction or 277 CA printable report.
In addition to the upfront edits, Mountain State will no longer attempt to correct or retrieve missing information. Instead, these situations will result in a rejection of the claim, and practices will need to resubmit the claim with corrected data. For paper claim submitters, these new edits will result in claim denials reported on the Explanation of Benefits Notice. Trading Partners using the X12 835 Electronic Remittance Advice will receive the standardized Claim Adjustment Reason Codes and Remittance Advice Remark Codes. Overall processing will be enhanced due to the reduction of claim suspensions and an increase in the timeliness of claims processing. Your practice will be notified more quickly if a claim cannot be processed due to missing or inaccurate data and time consuming status inquiries may be eliminated.
When a claim rejects, it's important for the billing staff and/or vendor to understand exactly what was wrong and what's needed to correct it. They should not submit an additional claim without identifying the problem and making corrections on the claim.
For more information on this topic and other MSBCBS issues, visit the website at www.msbcbs.com.
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West Virginia physician and hospital billing staffs are invited to participate in a Medicare Boot Camp presented by Palmetto GBA on Friday, May 16, 2008, at Mountain State University in Beckley. The program is offered free of charge and is sponsored by Palmetto GBA, West Virginia Medical Institute, the Beckley Chapter of the Office Managers Association of Health Care Providers, Inc. and Mountain State University.
Medicare Boot Camp is a full day multi-track educational session relating to physician services rendered and billed to the Medicare Part B contractor. The Boot Camp offers learning sessions for new and experienced billing staff in either the physician office or hospital setting. Participants can choose a Medicare Basics course designed for new staff or a Medicare Advanced course for experienced staff. An Evaluation and Management (E & M) course for physician staff is offered in the morning and an E & M course for hospital and outpatient services staff is scheduled in the afternoon.
Course presenters include Tim Allman, Jennifer Jolley and Carrie Weiss with Palmetto GBA's Provider Education and Quality Improvement staff. All sessions will be held in Carter Hall on the campus of Mountain State University, 609 South Kanawha Street in Beckley.
Medicare Boot Camp is offered free of charge, but registration is required. For information and registration details, contact Julie Lejeune, West Virginia Medical Institute, at 1-800-642-8686, ext. 4382 or jlejeune@wvmi.org. Registration information is also available at www.palmettogba.com/bwv/education, select "Workshops."
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UniCare is sponsoring the CME Lecture series entitled "Off the Charts: The Epidemic of Pediatric and Adolescent Overweight". The increasing prevalence of obesity has quickly pushed it to the top of the list of major health problems in the country. Former Surgeon General Richard Carmona has called obesity "the fastest-growing, most threatening disease in America today."
The obesity series is CME accredited and will feature as speaker Adolescent Medicine Specialist Stephen Sondike, MD, from West Virginia University - Charleston Division. The target audience will be local and regional physicians (including PAs and NPs) in the primary care practice, family medicine and pediatrics; as well as nurses and other allied health providers. Offered at the same time will be a Body Mass Index (BMI) workshop for clinical staff (RN, LPN, LVN, MA, etc.)
Meetings will be held throughout the state at various locations. In some regions, UniCare is working with local hospitals to accommodate these workshops. Other programs are being held at various conference facilities.
Events will be held in the following cities at the dates and times indicated:
Martinsburg April 7 6-8 p.m. Holiday Inn, Foxcroft Avenue
Bluefield April 14 6-8 p.m. Holiday Inn, Laurel Highway
Logan April 15 6-8 p.m. Chief Logan Conference Center
Parkersburg April 21 6-8 p.m. Camden Clark Memorial Hospital
Clarksburg April 22 6:30-8:30 p.m. United Hospital Center
A buffet dinner will be available for attending physicians and clinical staff.
For locations and registration information, physicians may call UniCare at 304-347-1961 or toll-free at 1-888-611-9958.
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The WVSMA recently participated with the Internal Revenue Service in a round table discussion of tax law requirements and changes that could potentially affect our members. Meeting topics included explanation of the recent economic stimulus act's benefits to small business owners, information as to avoiding "phishing" schemes which could lead to identity theft, changes regarding Health Savings Accounts, resources available through the IRS website, and ways for tax preparers to report system-based problems when filing returns.
The following information, which was provided to the WVSMA by the Social Security Administration, may be of particular interest to physicians with Medicare patients who need extra help with prescription costs.
Physicians can help patients determine if they are eligible for extra help with their Medicare prescription drug costs. Anyone who has Medicare can get Medicare Prescription Drug coverage. Extra help is available through the Social Security Administration for some people with limited income and resources. It will pay for all or most of the monthly premiums and annual deductibles. It will also lower the prescription co-payments related to their plan. The extra help could be worth up to $3,600 per year. Many people with limited income and resources qualify for these big savings and don't even know it.
To find out if someone is eligible, Social Security will need an application which is available by calling (800) 772-1213. You can instruct your patient to ask for the Application for Help with Medicare Prescription Drug Plan Costs (Form SSA-1020).
For more information on any of the topics covered during this roundtable meeting, please contact the Dan Hager at the West Virginia State Medical Association, (304) 925-0342 or via e-mail dan@wvsma.com.
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March 31, 2008
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