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May 7, 2008 has been designated as "Legacy Free" Day. CMS, in collaboration with the Healthcare Information and Management Systems Society (HIMSS) has requested that all clearinghouses that submit claims to Medicare participate in a special NPI preparation exercise. On Wednesday, May, 7, 2008, participating clearinghouses should submit Medicare claims with the NPI-only in all provider identifier fields for which you use NPI/legacy pairs. On May 8, 2008, participating clearinghouses will revert back to sending Medicare NPI/legacy pairs as received by the providers.
This trial date will enable you to obtain feedback from your Medicare contractor on your readiness and preparedness for the May 23, 2008 NPI implementation date.
If you participate in this exercise, one of two things will happen. If your claims are successfully processed and paid by Medicare, you may feel confident that your cash flow will not be affected as of May 23, 2008. If your claims are rejected or suspended, you will know in advance if there are problems that need to be resolved prior to May 23rd. Fixing the problem may include making a change to the NPESS data or to the 855 enrollment information. You may check to see that the correct legacy number is on file with CMS, either by visiting the CMS website, www.cms.hhs.gov, or by calling CMS Customer Service at (800) 465-3203.
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The American Medical Association has joined with other specialty societies to request that CMS delay enforcing the use of the NPI alone on claims and other HIPAA standard transactions and permit transactions to be conducted with both legacy and NPI numbers for a minimum of 6 months following the proposed May 23, 2008 date. This would change the compliance date until November 23, 2008.
In a letter to Secretary Michael Leavitt of the U.S. DHHR, the associations and organizations expressed concern that Medicare needs more time to facilitate the ability to appropriately match a physician's legacy identifier to the new NPI number (s). The associations feel that if the NPI-only date is not pushed back, the claims processing system may be interrupted and patient access impacted.
The WVSMA will continue to keep our physicians apprised of any changes that might occur as a result of the request to delay the implementation date.
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The WV Pharmaceutical Cost Management Council has upgraded its website to simplify the process for physicians and patients to obtain information about free and discounted prescription drug programs. The website also gives information as to how consumers may obtain assistance getting discounted healthcare, along with information on how consumers may obtain help with healthcare coverage.
The newly upgraded web site, www.pharmacycouncil.wv.gov links visitors to the site with all the drug assistance programs available in WV, as well as to most retail pharmacy chains that offer $4.00 generics or other discounted generic drug plans.
Using the new website, consumers can access and compare eligibility requirements for programs including West Virginia Rx, the new state-managed central-fill pharmacy; the Partnership for Prescription Assistance, the pharmaceutical industry's free and discount drug program; all state primary-care centers featuring discounted 340B pharmacies; as well as other program sites.
The new website can be used for physicians to assist patients with formulary choices. The site includes the preferred drug lists for the three major state-managed health-care plans, including Medicaid, the Public Employees Insurance Agency, and the Children's Health Insurance Plan.
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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 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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The Centers for Medicare and Medicaid (CMS) issued new CMS-855 enrollment forms in March 2008. During the past year, CMS received many suggestions and comments regarding proposed changes to the enrollment applications and incorporated many of the suggested revisions. The changes and revisions were made in order to clarify the enrollment process and to reduce the burden imposed on providers.
Although Medicare contractors will continue to accept the June 2006 version of the enrollment form until June of 2008, physicians and other providers should begin to use the new Medicare application immediately. The enrollment applications are available on the CMS provider enrollment website.
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The Centers for Medicare and Medicaid finalized the new (ABN) on March, 3, 2008. The form actually has a new name-Advance Beneficiary Notice of Noncoverage-but the 3 letter acronym will remain the same. Although physicians are not required to use the new form until September 1, 2008, they may begin using the new form now.
The new ABN form consolidates and replaces two existing forms, the ABN-G (for general services) and the ABN-L (for lab services). It can be used instead of the NEMB from (Notice of Exclusion from Medicare Benefits) and contains a mandatory field for cost estimates of the services being performed.
The ABN also includes a new option for beneficiaries which allow them to choose to pay out-of-pocket for some services rather than having a claim submitted to Medicare. As a reminder, the ABN cannot be altered for any reason.
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May 02, 2008
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