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The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with a 0.5 percent update, retroactive to July 1, 2008.
Physicians, non-physician practitioners and other providers of services paid under the MPFS should begin to receive payment at the 0.5 % update rates in approximately 10 business days or less. Medicare contractors are currently working to update their payment system with the new rates.
In the meantime, to avoid a disruption to the payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, the Medicare contractors (Palmetto GBA for West Virginia physicians) will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6% update level. After Palmetto GBA begins to pay claims at the new 0.5% rate, to the extent possible, the company will begin to automatically reprocess any claims paid at the lower rates. Physicians should not have to resubmit a claim. The system should automatically reprocess the claim.
Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1 - June 30, 2008, fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact Palmetto GBA for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced nonparticipation amount also will need to request an adjustment.
More information on physician pay issues is available at http://www.cms.hhs.gov/PhysicianFeeSched/.
The Palmetto GBA website is being updated with the new rates and these should be available shortly. Be aware that any published articles from the Medicare Learning Network Matters affected by the new law will be revised or rescinded as appropriate.
Finally, be on the alert for more information about other legislative provisions which may affect you. Further instructions regarding other provisions of Medicare Improvement for Patients and Providers Act (MIPPA) will be forthcoming.
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If you renewed your West Virginia medical license in June, please ensure that a copy of the new license was sent to Unisys so that your Medicaid claims may continue to be paid without any disruption.
The Medicaid policy for licensing, which was put into effect in December of 2005, states that physicians must send an updated copy of their licenses to Medicaid whenever a license is renewed.
According to Unisys, the procedure is as follows:
Sixty (60) days prior to the date of the license expiration, physicians are sent a letter requesting a copy of their updated licenses. The letter states that if the licenses updates have not been received by the expiration date, the physician will be placed on "pay hold" and no monies are released to the physician.
Thirty (30) days after the expiration date, the physician is terminated from the WV Medicaid program and a letter is sent to him/her, informing him/her of that fact. The physician must then re-enroll with Medicaid.
In order to avoid possible disenrollment from the Medicaid program, physicians are urged to respond to Medicaid’s requests for license information as soon as the request is received.
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Palmetto GBA will no longer accept paper claims printed on dot matrix printers. Paper claims are scanned and electronically entered into the processing system, and dot matrix printers produce type that is very light, which causes delays in processing your claims.
Even if you qualify to submit paper claims, consider submitting electronically. Electronic claims are processed more quickly, and you will generally receive reimbursement sooner than if you submit paper claims. Please contact the EDI Technical Support Team at 1-866-308-5438 for more information.
The font should be:
• Legible (computerized or typed claims, laser printers are recommended)
• In black ink
• Courier or Arial in 10, 11 or 12 point font
• CAPITAL letters
The font must NOT have:
• Dot matrix print (Claims processed on dot matrix printers through OCR, compromise accurate information and clarity. Palmetto GBA has chosen to no longer accept claims processed on Dot Matrix Printers).
• Bold, script, italic or stylized font
• Broken characters
• Red ink
• Mini-font
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The Centers for Medicare & Medicaid (CMS) has announced payment of more than $36 million in bonus payments to many of the more than 56,700 health professionals who satisfactorily reported quality information to Medicare under the 2007 Physician Quality Reporting Initiative (PQRI).
Physicians, physician group practices, and other PQRI eligible professionals should receive their payments by August 2008. The national average incentive amount for individual professionals is over $600 and average incentive payment for a physician group practice is over $4,700, with the largest payment to a single physician group practice totaling over $205,700.
More information about the PQRI program, including how eligible professionals can participate and the criteria to qualify for an incentive payment, is available at www.cms.hhs.gov/PQRI.
To read the entire CMS Press release click here:
http://www.cms.hhs.gov/apps/media/press_releases.asp
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This message is targeted to Family Physicians and Pediatricians. Others may disregard.
IMPORTANT OPPORTUNITY TO INFORM POLICYMAKERS ABOUT THE IMPACT OF CHILDHOOD OBESITY AND LEGISLATION ON YOUR PRACTICE!
If you see children and youth in your practice, please participate!
The Health Research Center at West Virginia University is conducting an important survey about the impact of House Bill 2816 (the “West Virginia Healthy Lifestyles Act”) on your practice as a health care provider. As you know, our Association was instrumental in developing and supporting this legislation which passed in 1995. The law mandates certain requirements for physical education, physical activity, and nutrition in the schools. Your participation in this survey is very important! It is critical that policymakers hear about the day-to-day experiences of providers who regularly face the problem of childhood obesity in our state.
This project is being conducted with support from the Robert Wood Johnson Foundation, and includes surveys and interviews with school personnel, parents, and children throughout the state. The results of the surveys will provide important information to track the impact of this legislation and provide feedback to policymakers as they examine their efforts to address this critical health problem.
To access the survey, please click on this link:
http://www.surveymonkey.com/s.aspx?sm=wLOKgwROMy_2ficsZx4gERmA_3d_3d
This survey takes approximately 10 minutes to complete. We ask that you complete it by July 25, 2008.
Please be assured that your responses will be confidential and that all data from this survey will be reported in aggregate.
Should you have any questions or problems accessing the survey, please contact Laurie Abildso at 304-293-6284 or Jessy Coffman at 304-293-6283. You may also email your questions to HB2816SURVEY@hsc.wvu.edu.
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In order to accommodate the growing need for telephone numbers in the State of West Virginia, the Public Service Commission of WV (WV PSC) has approved the addition of a new area code. The new 681 area code will cover the entire state as the 304 area code currently does.
The following is some information that may help to address questions that you may have regarding the new area codes.
How will this affect me?
If you who currently have a 304 area code, you will not need to change the existing phone number when the 681 area code numbers are introduced. All customers within the 304/681 geography, which includes the entire State of West Virginia, will need to dial the appropriate area code followed by the 7-digit telephone number when dialing a local call.
What will be the New Dialing Procedure?
Because of the addition of the 681 area code, you will be required to dial 10-digits (area code + 7 digit phone number.) Operator assisted calls will continue to require 0+10 digit dialing. Remember to use the new 681 area code as needed.
When will the Change Begin?
Effective July 26, 2008, you should begin using the new dialing procedure whenever you place a local call from the 304 area code. If you forget and use the old dialing 7 digit dialing procedure, your call will still be completed. This period is designed to be a time of training to use the new dialing procedure.
Beginning February 28, 2009, you MUST use the new 10-digit dialing procedure for all local call and 7-digit dialing will no longer be allowed.
Beginning March 28, 2009, new telephone lines or services in West Virginia may be assigned a number with the new 681 area code.
What will you need to do?
• You will need to dial 10 digits (area code + 7-digit phone number) for all local calls.
• You may need to reprogram or upgrade your equipment if you use specialized communications equipment like a PBX, electronic telephone sets, auto-dial systems or multi-line key systems.
• Some automatically dialed calling may require reprogramming to 10 digits, especially any machine that has pre-programmed speed dial numbers. These may include but are not limited to: life safety systems, fax machines, Internet dial-up numbers, alarm and security systems, speed dialers, call forwarding settings, voice mail services, and similar factions.
• Check your business stationery, prescription pads or any other advertising materials to be sure they include the area code.
What will remain the same?
• Your 7-digit telephone number, including current area code will not change.
• The price of a call, coverage area, or other rates and services will not change due to the overlay of the new area code.
• All local calls now will remain local calls regardless of the number of digits dialed. You will still dial just three digits to reach 911 (emergency services).
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Aetna has introduced a new online tool which allows Aetna members to make more informed decisions about their healthcare and its related costs. Patients are now able to view a medical procedure by facility cost. This tool enables patients to review and compare costs for a specific procedure, based on the type of setting in which the procedure is performed.
Only Aetna members who are registered users of the secured member website can view this information. It is not available on the Aetna public website.
The procedures and services featured in the tool are common elective procedures, such as cardiac procedures, colonoscopy, hysterectomy and ear tube insertions. Using the online feature, patients may select a procedure and see a list of Aetna participating facilities in their area that perform the procedure. Actual contracted cost ranges for that procedure, based on claims data for the past two years, are displayed as well.
Most consumers have little or no idea what the true cost of employer-provided health care is. With the rise of membership in consumer-directed health plans, patients are taking more responsibility for health care decision making. They are also paying more attention to the financial aspects of their care. Aetna is assisting their members in this endeavor by providing access to cost information on which to base their health care decisions.
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The WV Medical Group Management Association has set the date and location for the fall meeting. It will be held at Stonewall Resort on Thursday, October 9, and Friday, October 10. There will be a reception held on Thursday evening, with the educational meeting on Friday, October 10. More details will be forthcoming. |
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The WV Office Managers Association will hold its annual conference on October 16th and 17th at the Bridgeport Conference Center in Bridgeport, WV. The OMA conference is always an excellent educational event for office managers, as well as other physician office staff. The conference offers a wide range of topics with outstanding speakers for each session.
Room reservations may be made now at the Bridgeport Conference Center (the conference location) or at the Wingate Inn (across the parking lot from the Conference Center). In order to receive the special discounted rate, be sure to mention the OMA Conference when making reservations.
Watch for future details about the conference and plan now to attend this great educational and networking opportunity. If you are interested in attending the conference, you may contact either your local chapter for additional information, or contact Pam Shafer, Vice President of Conference at (304) 840-4529.
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The WVSMA was saddened by the death of John E. "Jack" Jenkins Jr., the father of WVSMA Executive Director Evan Jenkins. Mr. Jenkins passed away on July 4, 2008 and his funeral was held on July 9, 2008.
All of us at WVSMA express our deepest sympathy to the Jenkins family. |
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July 18, 2008
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