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The West Virginia State Medical Association (WVSMA) has secured a $300,000 grant from the West Virginia Division of Criminal Justice Services to fund the purchase of an estimated six-month supply of tamper-resistant prescription pads or paper for 500 West Virginia licensed physicians. The free prescription pads or laser paper are available to any physician in West Virginia.
Committed to helping you meet the new tamper resistant requirements for prescriptions, the WVSMA has secured this funding and made arrangements with Standard Register, our endorsed manufacturer of tamper-resistant pads and paper, to ease your transition and to ensure you are compliant with guidelines set by the Centers for Medicare and Medicaid Services (CMS). Those practitioners who don’t comply are likely to have their patient prescriptions refused by the pharmacist.
Although a number of physicians have already requested and received their prescription pads, there are still some funds available. Please don’t wait to place your order, for once the $300,000 grant is spent, this special funding opportunity will end.
An order form is available online at the WVSMA website, www.wvsma.com or by contacting the WVSMA office.
If you have questions about the order form, you should contact Standard Register’s toll free prescription line (1-866-741-8488). If you have other questions about this grant program, please contact Barbara Good, WVSMA Physician Practice Advocate and Tamper Resistant Prescription Pad Project Manager, at (304) 925-0342, ext. 11, or via email (Barbara@wvsma.com).
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The recently held Physician Practice Management Conference was a great success. Physicians and staff attended sessions on the AMA’s “Heal the Claim” campaign, Office Protocol and Etiquette, 2009 Medicare PQRI and E-Prescribing, and The Medical Office Managers Guide to Prescription Security.
The large attendance at the conference demonstrated the need for educational events of this caliber. The WVSMA plans to hold a similar conference in the spring of 2009 so watch for information and plan to attend!
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The West Virginia Office Managers Association held its annual conference in October. “Fiesta” was the theme for the conference and attendees were treated to a fiesta-style learning environment while listening to a wide variety of speakers. Those attending the conference were able to learn additional skills in order to better manage their offices, with the ultimate goal being better patient care.
The OMA recognized Barbara Good, Physician Practiced Advocate for the WVSMA, with an honorary membership for her dedication, persistence and fortitude in the promotion and support of the OMA.
The West Virginia Medical Group Managers Association also met during October for their fall conference. This group’s keynote speaker was Karen Zupko, a nationally known healthcare consultant. Other speakers included Robert Bennett of the MGMA National legislative office in Washington, DC, and Patricia Clark of Suttle and Stalnaker, CPAs.
If your office administrator or office manager is not a member of one of these associations, he/she is missing a tremendous opportunity to become more knowledgeable about healthcare practice management. Educational seminars are provided throughout the year so that managers may be up to date with the latest information.
Networking is another important part of being a member of associations such as these organizations. Managers have an opportunity to interact and discuss common office problems and solutions. The information gleaned from conferences that are held by these groups is of tremendous value both to managers and physicians.
To obtain additional information about membership in the OMA or the WVMGMA, contact Barbara Good at the WVSMA (Barbara@wvsma.com)
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Beginning October 1, 2008, physician Medicare payments could be reduced if the Internal Revenue Service (IRS) needs to collect overdue taxes owed by physicians.
The Taxpayer Relief Act of 1997, Section 1024, authorizes the IRS to reduce certain federal payments, including Medicare payments, to allow collection of overdue taxes. Should you owe such taxes and your payments are reduced, your remittance advice will reflect a provider level adjustment code (PLB) of “WU” in the PLB03-1 data field. For more information, please see MLN Matters Article #MM6125 available at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6125.pdf
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The standard Medicare Part B monthly premium will be $96.40 in 2009, the same as the Part B premium for 2008. This is the first year since 2000 that there was no increase in the standard premium over the prior year.
The 2009 Part B premium of $96.40 is the same as the amount projected in the 2008 Medicare Trustees Report issued in March. This monthly premium paid by beneficiaries enrolled in Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.
By law, the standard premium is set to cover approximately one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over. The remaining Part B costs are financed by Federal general revenues. The income to the program from premiums and general revenues are paid into the Part B account of the Supplementary Medical Insurance trust fund, and Part B expenditures are drawn from this account.
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Medicare has issued new rules to enforce marketing requirements during the open enrollment period for Medicare Advantage health and drug plans.
The two latest regulations issued include prohibitions on telemarketing and other unsolicited sales contacts. The new rules also prohibit financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or churning, beneficiaries from one plan to another each year. Plans were forced to be in compliance with these provisions when they began their marketing activities on October 1, 2008.
The CMS Marketing Guidelines limited nominal gifts to prospective enrollees to $15 or less. This provision is now being codified in the Medicare Advantage and prescription drug plan (PDP) regulations. The regulation allows for CMS to adjust the nominal gift amount in guidance based on inflation and other factors. The nominal gift amount must be calculated based on retail value, not actual price paid. Examples of nominal gifts include items like pens, pencils, and calendars.
The CMS Marketing Guidelines prohibited the use of the name or logo of a co-branded network on MA and PDP membership cards. In addition, if a co-branded network name or logo is used on marketing materials, the plan must include a disclaimer that other providers are available in the network. MA plans may include provider names and/or logos on the member identification card related to member selection of specific providers or provider organizations. These provisions are being codified in the MA and PDP regulations.
In addition, agents and brokers must receive initial training and testing on the products they sell as well as annual retraining and retesting.
The final rule implementing MIPPA marketing requirements may be viewed at http://www.cms.hhs.gov/HealthPlansGenInfo/.
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This information is for physicians and other practitioners who have obtained National Provider Identifiers (NPIs) and have records in the National Plan and Provider Enumeration System (NPPES). The Centers for Medicare & Medicaid Services (CMS) recommends that each health care provider, including individual physicians and non-physician practitioners:
• Know and maintain their NPPES User Ids and passwords.
• Reset their NPPES passwords at least once a year. See the NPPES Application Help page regarding the ‘Reset Password’ rules. Those rules indicate the length, format, content and requirements of NPPES passwords.
• Review their NPPES records in order to ensure that the information reflects current and correct information.
Maintaining NPPES Account Information for Safety and Accessibility
Health care providers, including physicians and non-physician practitioners, should maintain their own NPPES account information (i.e., User ID, Password, and Secret Question/Answer) for safety and accessibility purposes.
Viewing NPPES Information
Health care providers, including physicians and non-physician practitioners, can view their NPPES information in one of two ways:
(1) By accessing the NPPES record at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created. *
* If the health care provider has forgotten the password, enter the User ID and click the “Reset Forgotten Password” button to navigate to the Reset Password Page. If the health care provider enters an incorrect User ID and Password combination three times, the User ID will be disabled. Please contact the NPI Enumerator at 1-800-465-3203 if the account is disabled or if the health care provider has forgotten the User ID.
OR
(2) By accessing the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do. The NPI Registry gives the health care provider an online view of Freedom of Information Act (FOIA)-disclosable NPPES data. The health care provider can search for its information using the name or NPI as the criterion.
Updating NPPES Information
Physicians can correct, add, or delete information in their NPPES records by accessing their NPPES records at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created.
Please note that information cannot be deleted from an NPPES record; however, required information can be change or updated to ensure that NPPES captures the correct information. Certain information is inaccessible via the web, thus requiring the change or update to be made via paper application. The paper NPI Application/Update Form can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.
Applying for an NPI
Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
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WV Medicaid implemented the following clinical changes effective Monday, November 3rd, 2008:
As of November 3rd, 2008, Trileptal and Depakote EC brand products will be made non-preferred on the WV Medicaid Preferred Drug List (PDL). Their generic equivalents, oxcarbazepine and divalproex EC, will become preferred drugs on the PDL. If the member needs to remain on a brand version of these products, for audit purposes please make certain that the face of the original prescription contains the words "Brand Medically Necessary" in the prescribing physician's handwriting. To comply with federal regulations, please submit a new prescription for these products if necessary. Note: Depakote ER will remain a preferred product on the PDL.
Early Refills for ALL claims processed under the WV Medicaid Pharmacy POS system will be denied.
Ingredient Duplication for claims of several classes of medications, including ACE inhibitors, ARB's, HMG CoA reductase inhibitors, metformin, benzodiazepines, SSRI's, SNRI's, metoprolol, calcium channel blockers, insulin-release stimulant antihyperglycemics, glucocorticoids, trazodone, lipotropics, PPI's, skeletal muscle relaxants, and NSAIDS, will be denied.
Overrides are available based upon medical necessity by calling the WV Medicaid Rational Drug Therapy Program at 1-800-847-3859, Option 1, then Option 2.
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PUBLIC NOTICE AND COMMENT PERIOD
November 21, 2008
Effective January 1, 2009, the West Virginia Children’s Health Insurance Program (WVCHIP) will expand its health coverage for children by increasing the upper income limit for participation from 220% to 250% of the federal poverty level (FPL). Families with incomes above 200% FPL must agree to participate through premium payment at a rate of $35.00 per month per single child or at a rate of $71.00 per month for two or more children. Children that currently have other individual or group health coverage are not eligible and cannot be eligible unless they have been without coverage for a period of 12 months (a six month waiting period applies to those at 200% FPL or lower). There are some dental and vision benefit limits that apply to WVCHIP Premium (201% FPL – 250% FPL). WVCHIP will accept applications for eligibility at the new income levels beginning January 1, 2009. In the WVCHIP Premium program, however, coverage begins in the month following the receipt of the initial premium payment. The chart below shows the qualifying income limits for families for both regular CHIP plan (at 200% FPL) and the new upper limit for WVCHIP Premium (at 250% FPL)*.
Family Size Limited Copays Apply All Copays Apply WVCHIP Premium
2 $21,000.00 $28,000.00 $35,000.00
3 $26,400.00 $35,200.00 $44,000.00
4 $31,800.00 $42,400.00 $53,000.00
5 $37,200.00 $49,600.00 $62,000.00
*Income guidelines are indexed annually; these guidelines will be adjusted to the new index by March 2009.
Questions concerning any additional details such as benefits, copayments, requests for applications can be directed to the WVCHIP Helpline at 1-877-982-2447. Copies of this notice and State Plan Amendment with additional details are made available and posted in all county DHHR offices no later than December 1, 2008. A copy of this notice is also available at www.wvchip.org. WVCHIP will accept and review comments concerning this change for a 30-day period. Any comments concerning this change can be sent via email through the website listed above or by mailing comments to: Executive Director, WVCHIP, 1018 Kanawha Boulevard East, Suite 209, Charleston, WV, 25301. |
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December 01, 2008
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