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From time to time, the WVSMA receives requests for information from both regional and national news publications regarding various healthcare issues, including Medicaid and Medicaid Re-Design. Often, a reporter will ask for a contact to interview regarding the issue. Currently, American Medical News, the AMA publication is planning a fall visit to West Virginia and would like to visit some physician offices.
If you would be willing to speak with a reporter or even have a reporter visit your office for a story, please let us know. Please contact Barbara Good (304)-925-0342, ext. 11 or Barbara@wvsma.com to express your interest or to obtain more information.
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The WVSMA has planned a special educational event for physicians, office management and staff. The conference will be held on Wednesday, November 19, 2008, at the Bridgeport Conference Center, in Bridgeport, WV.
The Conference will include sessions on:
o “Getting Your Claim Paid the First Time”—AMA Advocacy staff members will give an update on the AMA “Heal That Claim” campaign and tell you how to receive reimbursement for your claims.
o Medicare Update on PQRI and E-Prescribing—Dr. Barbara Connors, CMS Medical Director, Region III.
o “2009 Medicare Changes”--Tim Allman of Palmetto GBA will give an update on Medicare
o “Office Protocol and Etiquette”---by a nationally certified protocol consultant
Mark your calendars and plan to attend this educational event! More details, including information about CME, will be forthcoming.
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The Advance Beneficiary Form (ABN) is a notice that is given to Medicare beneficiaries indicating that Medicare is unlikely to provide coverage for a specific service or procedure. When physicians complete the ABN and inform the patient that he/she will be financially responsible for the service, the patient then is able to consider options and make an informed decision.
CMS released the new ABN form in March, 2008, and allowed a six month transition period for physicians to begin using the new form for all situations where Medicare payment is expected to be denied. All physicians and providers must begin using the new ABN form (CMS-R-131) no later than September 1, 2008.
Some of the features of the new ABN include:
It has a new official title, “Advance Beneficiary Notice of Noncoverage (ABN)” which clarifies the purpose of the notice.
It replaces both the existing ABN-G and ABN-L so that you don’t have to use a separate form for laboratory services.
It may also be used for voluntary notifications, in place of the Notice of Exclusion from Medical Benefits.
It has a mandatory field for cost estimates for the items or services.
It includes a new beneficiary option, where an individual may choose to pay for the service out of pocket, rather than having a claim submitted to Medicare.
Instructions for using the new ABN, as well as both English and Spanish versions of the form may be downloaded from the CMS website (www.cms.hhs.gov\bni). Physicians also have an option of downloading a form that can be customized.
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The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that 2007 Physicians Quality Reporting Initiative (PQRI) Final Feedback Reports are now available on a secure website. The reports are organized by Tax Identification Number (TIN). For eligible professionals reporting measures for 2007 PQRI under a group practice TIN, the group practice determines who can access the Feedback Report for the group practice or organization.
CMS reports that the average PQRI bonus for individual physicians was over $600. Group practices averaged payments of over $4700.00. The largest physician incentive payment nationally was $205,000.
As previously reported, there are additional reporting measures for 2008, including five measures that are specifically for EHR-based submission. The financial incentives for participating in 2008 will be paid in mid-2009.
Two MLN Matters articles on accessing the reports are now available that can assist individual eligible professionals and group practices that reported valid 2007 PQRI quality measures data to Medicare.
The first article, “Steps for Individual Eligible Professionals to Access Their 2007 PQRI Feedback Reports Personally”, MM SE0830, can be accessed at, http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0830.pdf
The second article, “Steps for Organizations to Access Their 2007 PQRI Feedback Reports”, is available at, http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf.
Once physicians have registered in the Individuals Authorized Access to CMS Computer Services (IACS) system and have access to the PQRI feedback report application, any questions about the Feedback Report should be directed to the Report Delivery System Help Desk referenced at the end of the end of the MLN Matters articles. Additional educational resources and information about the PQRI program is available at, http://www.cms.hhs.gov/PQRI.
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Medicare is starting a new program to encourage physicians to adopt e-prescribing systems. Beginning in 2009, incentive payments will be available for physicians who meet the requirements of the program. The initiative is part of the Administration’s broader efforts to accelerate the adoption of health IT and the establishment of a health care system based on value.
Starting in 2009, and during the next four years, Medicare will provide incentive payments to eligible physicians who are successful electronic prescribers. Physicians who are successful will receive a 2 percent incentive payment in 2009 and 2010, a 1 percent incentive payment in 2011 and 2012, and a one half percent incentive payment in 2013.
Beginning in 2012, eligible professionals who are not successful electronic prescribers will receive a reduction in payment. Eligible professionals may be exempted from the reduction in payment on a case-by-case basis if it is determined that compliance with the requirement for being a successful prescriber would result in significant hardship for the physician and practice.
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As reported in the last edition of the Wesgram, the West Virginia Bureau for Medical Services recently notified the WVSMA that duplicate payments were sent to physicians and other providers during recent claims processing cycles. It has been determined that duplicate payments occurred during the claim processing cycles beginning in December, 2007, and continuing through June, 2008. The Bureau for Medical Services (BMS) and Unisys have been working together to build safeguards to prevent these errors from re-occurring in the future.
In the meantime, physicians who received duplicate payments are being contacted via mail and sent a report that provides a listing of all claims that were paid in error. These duplicate payments will be reversed by Unisys in thirty days. This means that the duplicate payments will be taken from future remittances.
What you need to do:
If you disagree with the findings, you must contact the Unisys Research Department at (304) 348-3200. After discussion and research, Unisys will issue a written reconsideration, either upholding, reversing or modifying the original finding. If you disagree with the reconsideration, you may appeal within thirty (30) days from receipt of the reconsideration.
If you disagree with the decision following the reconsideration, you may request an administrative review within thirty days of receipt of the determination. The request for administrative review must be in writing and signed, with the details of the items in contention included. You must also identify the provider representatives who will be present at the review conference.
Letters must be addressed to:
Commissioner, Bureau for Medical Services
350 Capitol Street, Room 251
Charleston, WV 25301-3707
If you receive a letter stating that you have received duplicate payments and have additional questions, you may contact Barbara Good, WVSMA Physician Practice Advocate, at (304) 925-0342, ext. 11, or via email Barbara@wvsma.com.
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Mountain State Blue Cross Blue Shield will hold Provider workshops during August and September in different areas of the state. The meetings will be held from 9:00-Noon. Mark your calendars now and plan to attend.
You may register by mail, by fax (304) 347-7743, or online (www.msbcbs.com).
Training sessions have already been held in the Parkersburg, Martinsburg and Bridgeport areas. The locations and facilitators for the remaining workshops are listed below:
September 18, 2008
Holiday Inn
Bluefield
Facilitated by Mary DeLaRosa
September 19, 2008
Tamarack
Beckley
Facilitated by Mary DeLaRosa
September 23, 2008
Charleston Civic Center
Charleston
Facilitated by Tifaney Rader
September 25, 2008
Ramada Inn - Hal Greer Blvd.
Huntington
Facilitated by Tifaney Rader
September 30, 2008
McLure Hotel
Wheeling
Facilitated by Melanie Clyde
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Humana is holding two complimentary seminars, in Charleston and Huntington, on Tuesday, September 30, 2008. The seminars are designed to increase health care providers' awareness of Humana's products and services in West Virginia.
The seminars are designed for both hospital and physician practice administrators. Topics discussed will include simplifying the eligibility, benefits and authorization processes; increasing collections at the time of service; and reviewing the 2009 ICD-9 coding updates.
The locations and times are:
Charleston--
Tuesday, September 30, 2008
8:00 a.m. to 10:00 a.m. (Continental Breakfast served)
Embassy Suites
300 Court St.
Charleston, WV 25301
To register or request additional information about this seminar, visit https://meetings.humana.com/Charleston or call 1-304-565-3476.
Huntington--
Tuesday, September 30, 2008
11:30 a.m. to 1:30 p.m. (lunch will be served)
Pullman Plaza Hotel (formerly Radisson)
1001 Third Ave.
Huntington, WV 25701
To register or request additional information, visit https://meetings.humana.com/Huntington or call 1-304-565-3476.
Both events are free, but an RSVP is required by September 19, 2008.
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The WV MGMA conference is scheduled for October 9th and 10th at Stonewall Resort in Roanoke, WV.
The conference will begin on Thursday evening, October 9, at 6:00 p.m. with a brief tour of Lambert’s winery located near Stonewall Resort. After the tour, there will be a wine and cheese tasting followed by dinner and Lambert’s famous blackberry wine cake.
Friday’s agenda features several speakers on topics of interest to all medical offices. Speakers include Karen Zupko, of Karen Zupko & Associates, Robert Bennett of the MGMA National Legislative office in Washington, DC, and Patricia Clark of Suttle and Stalnaker, CPAs.
The WV MGMA has reserved a block of rooms with the resort at a rate of $163 per night which includes the daily resort fee. Room reservations can be made by calling the resort directly at 888-278-8150 and telling them you are with the WVMGMA conference. The room block will be released on September 9, 2008.
If you have any questions about the WV MGMA or the conference, contact Diana Williamson, Administrator at Neurological Associates, Charleston, WV (304) 344-3551 or via email (diana@wvneuro.com).
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The WV OMA will hold their annual fall conference on Thursday and Friday, October 16-17, at the Bridgeport Conference Center, Charles Pointe, in Bridgeport, WV. As in the past, the conference will feature both national and local speakers. This year’s theme is “Fiesta”.
Special lodging rates have been arranged for the conference, room availability guaranteed until September 15, 2008. Be sure to state that you are with the Office Managers Association when reserving your room. Lodging information is listed below:
WINGATE INN & SUITES (Connected to Conference Center)
350 Conference Center Way
I-79 Exit 124 and Route 279
Bridgeport WV 26330
Phone: 304-808-1000
MICROTEL INN & SUITES (Across parking lot from Conference Center)
201 Conference Center Way
Bridgeport WV 26330
Phone: 304-808-2000
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The AMA’s Physician Data Restriction Program (PDRP), offers physicians the opportunity to restrict their prescribing information from pharmaceutical sales representatives.
According to a Gallup poll, 84 % of physicians surveyed said either they were not concerned about the release of their prescribing data or that the ability to opt-out of the release of their data to pharmaceutical sales representatives would alleviate their concerns.
In response, the AMA created the PDRP which gives physicians the option to restrict their prescribing data from sales reps. PDRP also allows doctors to register a complaint or concern about a sales rep or a pharmaceutical company’s use of their prescribing data.
The Physician Data Restriction Program bean in July, 2006, and is available to all doctors—AMA members and nonmembers alike. In order to educate and make more physicians aware of the program, the AMA has created several promotional pieces. These materials are available on the AMA website.
The AMA has the following promotional materials available for your use:
For more information on the PDRP, including the promotional materials, please visit www.ama-assn.org/go/prescribingdata
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The West Virginia Chapter of the American College of Cardiology has scheduled its 3rd Annual Meeting to be held on Saturday, November 22, 2008, at the Charleston Marriott Town Center.
For additional information about the meeting, including the preliminary agenda, you may visit http://accwv.org/11.html.
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September 08, 2008
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