As of Friday, May 23, 2008, all electronic claims which are sent to government or commercial payors must contain only the physician's NPI. Unless there is a last minute decision by Congress to delay the implementation of the NPI-only claim submissions, as of Friday, no legacy numbers will be permitted on any electronic or Medicare claims. CMS continues to state that only the NPI may be used after May 23, 2008, and that claims that are received with legacy numbers will not be forwarded.
Although there have been requests to delay the implementation, no such decision has yet been made. 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.
As always, 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.
The American Medical Association recently released information regarding how the July 1, 2008, Medicare cuts will affect WV physicians. During the 18 months from July 2008 through December 2009, WV physicians stand to lose an average of $19,000 each. This is due to the 10.6% cut in Medicare payments in July 2008 and the additional 5% cut in 2009.
Compared to the rest of the country, West Virginia has the highest proportion of Medicare patients of any state (19%) and an above average proportion of disabled beneficiaries (22%). Our state also has one of the lowest ratios of physicians to Medicare beneficiaries (13 practicing physicians per 1000 beneficiaries), even before the cuts take effect. In addition, 44% of West Virginia's practicing physicians are over 50, an age at which studies show that many physicians consider reducing their patient care activities.
In July, 2008, West Virginia physicians face cuts of an additional 1.5% in addition to the 10.6% cuts across the country. The 2003 Medicare law provided a temporary increase in geographic payment adjustments for certain states, including West Virginia. Under the current law, this increase will expire on June 30, 2008.
What can physicians do to stop these reimbursement cuts? Senate Bill 2785, the Save Medicare Act of 2008, has been introduced in the Senate. This bill would stop the Medicare physician payment cuts for 18 months, long enough to begin working on a long-term solution to the broken payment system. In addition, the bill will not increase the cost of permanently fixing the fatally flawed Medicare physician payment system. Urge your U.S. Senators to co-sponsor this legislation.
A new fee schedule for Worker's Compensation care has been issued by the WV Office of the Insurance Commissioner. The new schedule is based on 135 percent of Medicare rates.
It appears that the new fee schedule is positive for primary care physicians and not so for surgeons. The WVSMA is soliciting input from physicians on these new fees, particularly from family physicians, radiologists, anesthesiologists and surgery specialties.
It is important to note that only the payments and not the treatments will be based on Medicare guidelines. Additionally, medical services delivered under managed health care plans are exempt from the WV state fee schedule. The schedule will be reviewed annually and revised as needed.
Listed below are the proposed changes to the fee schedule.
Offices of the Insurance Commissioner (OIC)
SUMMARY of PROPOSED METHOD CMS Medicare + 35% Workers' Compensation Maximum Medical Reimbursement Fee Schedules
RBRVs Non Facility (NF) and Facility (F) calculated independently
(Adjusted Work RVU + Adjusted Mal Practice RVU +Adjusted PE RVU) x Medicare Conversion Factor x 135% = OIC Maximum Medical Reimbursement
AMBULATORY SURGICAL CENTER
Medicare Payment Amount fee x 135% = OIC Maximum Medical Reimbursement
HCPCS Level II
Medicare West Virginia Durable Medical Equipment fee x 135% = OIC Maximum Medical Reimbursement
CLINICAL LAB
Medicare West Virginia Clinical Laboratory Fee x 135% = OIC Maximum Medical Reimbursement
ANESTHESIA
Medicare Anesthesia Base Unit + Time (15 min increments) x WV Medicare conversion factor x 135% = OIC Maximum Medical Reimbursement
If you have questions or comments, please contact Barbara Good at the WVSMA (Barbara@wvsma.com).
Medical doctors whose last names begin with the letters A through L are required to renew for the year 2008-2010. The Board of Medicine will not be mailing a paper renewal application to all the medical doctors who are renewing their licenses. Beginning May 15, 2008, licensees who meet the criteria for online renewal may go to the Board's website (www.wvdhhr.org/wvbom) and complete the online renewal process.
The criteria are as follows:
1. MDs who currently hold an ACTIVE medical license; 2. MDs who have obtained the required continuing medical education; 3. MDs who answer "no" to all questions on the Board of Medicine website's "Renewal FAQs" 4. MDs who desire to pay via credit/debit card.
You may only renew online if you meet ALL of the above criteria.
To renew a license online, physicians must have a West Virginia medical license number; a social security number; and credit/debit card. There is a small credit/debit card convenience fee for renewing online.
If a licensee is unable to use the online renewal service, he or she must request a paper renewal application to complete and return to the Board offices. A request form for a paper renewal application is available on our website under the "FORMS" section and is also available in the March, 2008, Board of Medicine Newsletter.
The Board will not be able to finalize the processing of any application that is not complete. Completion of the renewal application is the responsibility of the licensee.
Every application is computer-generated to include personalized information previously reported by the licensee. However, each licensee will need to review this information to ensure that it remains accurate. Each licensee MUST provide a telephone number. The Board of Medicine anticipates that this method of renewal will reduce the time necessary for the physician to complete the application.
The online application or paper application must be completed BEFORE June 30, 2008, at 5:00 p.m.
BrickStreet has announced a special HealthCare Seminar entitled "Best Practices in Compensation Management for the Healthcare Industry" which will be held on Wednesday, June 11th, from 8:00 AM - 4:00 PM at the BrickStreet Corporate Headquarters (400 Quarrier Street, Charleston, WV). Topics include Incident Reports, Accident Investigations, Claims Reporting, Patient Handling, Safety Programs and Best Practices.
Whether your office is just getting started with Aetna or is a seasoned participating office, don't miss this chance to learn how working with Aetna can be easier than ever. Join other office managers, referral specialists and billing administrators for this free, live, interactive webinar. Topics to be covered include:
Aetna benefits plans Aetna's secure provider website via NaviNet
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