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The West Virginia State Medical Association has scheduled a Physician Practice Management Conference for Thursday, May 14th, 2009, at the Charleston Marriott Hotel in Charleston, WV. More details will be coming soon about this exciting education event.
If you’ve attended a conference in the past, you know that it is an event that you don’t want to miss. Mark your calendars now and plan to attend this conference!
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If you’ve not yet ordered your free tamper resistant prescription pads or laser paper, you should do so now while there are still grant funds available. An order form is available online at the WVSMA website, www.wvsma.com or by contacting the WVSMA office.
IIf 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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CMS recently announced the award of several Medicare Administrative Contracts (MACs), including Jurisdiction 11 (West Virginia, Virginia, North Carolina, and South Carolina) and Jurisdiction 15 (Ohio and Kentucky).
Palmetto GBA has been awarded the contract for Jurisdiction 11 and will continue to administer West Virginia Part B as well as Part A.
Palmetto GBA partnered with another organization in a bid for Jurisdiction 15, and this bid was not successful. Palmetto GBA will not be the administrator for Medicare Part B or A in Ohio. Transition dates have not yet been established.
More details regarding these most recent MAC awards are available in the CMS press release dated 1/7/2009:
www.cms.hhs.gov/apps/media/press_releases.asp
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Identity theft is a national problem affecting both individuals and groups of individuals. It is also becoming a factor in health care fraud. Identity theft is now much more frequently being used to defraud physicians, as well as healthcare plans, including Medicare.
At a recent Medicare carrier advisory committee meeting, attendees were warned of recent occurrences of fraud methods which have affected medical practices. In some instances, imposters have posed as Medicare representatives and have gained access to personal information. Imposters have also placed fraudulent employment ads in papers and magazines, such as ads that advertised for a medical director. The respondents’ personal information was then used unlawfully.
If a physician leaves a group practice or changes an address, he/she should make sure to notify the Provider Enrollment department. Remember that Medicare requires an application (which can now be completed online) for any addition, deletion or change of information.
The carrier’s presentation addressed specific instances when physicians had been contacted for additional information by non-Medicare personnel. Physicians and practices should be aware that Medicare generally does not solicit for additional information via fax. If you should receive a phone call, letter or fax from the West Virginia Affiliated Medicare Contractor (Palmetto GBA) or a Medicare representative, you should confirm the identity of the source before responding. If you receive what appears to be a fraudulent inquiry, inform the Provider Enrollment department of the affiliated contractor.
If you receive inquires or complaints from individuals who are not your patients about services you supposedly performed, you should immediately inform the Medicare contractor or private insurer.
In order to avoid fraudulent usage of personal identity information, physicians and practices are advised to know to whom they are sending personal or professional background information. They should also perform due diligence before providing background information when responding to an employment opportunity.
Finally, if an employee leaves your practice, you should take immediate steps to deactivate their access to both your information and that of your patient population. A recent data security incident that occurred at the Kanawha-Charleston Health Department demonstrates how easily an ex-employee can compromise the integrity of patient data.
These are only a few suggestions to help you avoid identity theft issues in your practice. There are new theft methods being devised constantly. It is always wise to be vigilant about personal information, whether it is your own information or that of patients in your medical practice.
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Online Medicare enrollment and change of enrollment information is now available in all 50 states and it’s fast, secure and easy. The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will allow physicians and non-physician practitioners to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, or check on the status of a Medicare enrollment application via the Internet.
As of now, physicians are able to do online enrollment, but CMS plans to make the internet-based PECOS enrollment system available to all organizational providers and suppliers (except durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers) later this year.
By submitting the initial Medicare enrollment application through Internet-based PECOS, a physician or non-physician practitioner’s enrollment application can be processed as much as 50 percent faster than by paper. This means that it will take less time to enroll or make a change in an existing enrollment record. For additional information about the types of changes that must be reported, go to the download section of www.cms.hhs.gov/MedicareProviderSupEnroll.
Internet-based PECOS meets all required Government security standards in terms of data entry, data transmission, and the electronic storage of Medicare enrollment information. Only authorized individuals can enter enrollment information into PECOS or view PECOS data from the Internet. Authorized individuals include physicians and non-physician practitioners. Their user IDs and passwords protect the access to their enrollment information. After physicians or non-physician practitioners create user IDs and passwords or change their passwords, they should keep this information secure and not share it with anyone. By safeguarding their user IDs and passwords, they are taking an important step in protecting their enrollment information. CMS does not disclose Medicare enrollment information to anyone except when authorized or required to do so by law.
Internet-based PECOS is a scenario-driven application process with front-end editing capabilities and built-in help screens. The scenario-driven application process will ensure that physicians and non-physician practitioners complete and submit only the information necessary to enroll or make a change in their Medicare enrollment record.
There are three basic steps to completing an enrollment action using Internet-based PECOS. Physicians and non-physician practitioners must have an NPPES User ID and password to use Internet-based PECOS.
For security reasons, physicians and non-physician practitioners should change passwords periodically, at least once a year. For information on how to change a password, go to the NPPES Application Help page available at https://nppes.cms.hhs.gov/NPPES/Welcome.do and select the “Reset Password Page” under the NPPES Application help page.
In order to enroll online, physicians should go to Internet-based PECOS at https://pecos.cms.hhs.gov and complete, review, and submit the electronic enrollment application via Internet-based PECOS.
Physicians should then print, sign and date the Certification Statement (blue ink recommended) and mail the Certification Statement and all supporting paper documentation to the Medicare contractor.
Please note: A Medicare contractor will not process an Internet enrollment application without the signed and dated Certification Statement and the required supporting documentation. In addition, the effective date of filing an enrollment application is the date the Medicare contractor receives the signed Certification Statement that is associated with the Internet submission.
For information about Internet-based PECOS, including important information that physicians and non-physician practitioners should know before submitting a Medicare enrollment application via Internet-based PECOS, go to www.cms.hhs.gov/MedicareProviderSupEnroll.
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Unisys has recently received and loaded the Medicaid RBRVS for 2009 and hopes to release the pended Medicaid claims before February 1, 2009.
As of today, the Medicaid managed care plans have not confirmed when their fee schedules will be loaded into their systems. All 2009 Medicaid claims are currently pended by the managed care healthcare plans.
The 2009 PEIA RBRVS fees have been loaded for several weeks. Physicians should not experience fee schedule delays or claims that are pended for fees.
Please contact Barbara Good (Barbara@wvsma.com) if you are experiencing any payor fee schedule issues. |
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CMS has announced a 2009 update to the pricing files. The Centers for Medicare & Medicaid Services (CMS) has condensed all 56 Physician Fee Schedule (PFS) carrier specific pricing files into one zip file. This file is found in the list on the CMS web page at http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp. It is labeled as “All States” in the state field, and “2009” in the calendar year field. Because the list is listed alphabetically by state name, “All States” appears after the Alaska files. If you sort by most recent calendar year, the file will appear at the top of the list. |
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The AMA Therapeutic Insights is an online program that offers disease-specific newsletters with unique prescribing information and evidence-based treatment guidelines. The newsletters are written in case study format, and continuing medical education (CME) credit is available for each issue. Some physicians will also have access to their own personal prescribing profile showing their actual prescribing patterns for the featured diseases. This aspect of the program is being rolled out on a state by state basis. This program is intended for primary care physicians and a new therapeutic topic is offered every quarter.
The AMA Therapeutic Insights program is unique because, while most treatment-oriented CME programs focus solely on disease management, AMA Therapeutic Insights takes it one step further by providing actual prescribing data for the conditions. With these data, physicians have an unprecedented capability to see exactly which medications are being prescribed for the selected diseases on a state, national, specialty and individual level.
The prescribing data are provided by IMS Health, a healthcare information organization (HIO). It is important to note that the AMA does not compile or have access to individual physician prescribing data in any form.
Through AMA Therapeutic Insights, physicians may gain secure and confidential access to their own personal prescribing profiles for each of the featured diseases. The profile shows the physician’s prescribing activity alongside state and national prescribing patters as well as the top three specialties treating the condition. These statistics are updated on a monthly basis, so physicians are encouraged to check back periodically to see if treatment trends have shifted. As an additional benefit, since these data are based on filled prescriptions, they also serve as an overall marker for compliance in the physician’s patient population.
The AMA Therapeutic Insights program helps physicians help their patients by providing physicians the most current treatment recommendations, up-to-date overviews of the classes of drugs used, current prescription data and the treatment approaches of their peers, AMA Therapeutic Insights helps physicians to effectively evaluate their therapeutic approach to each disease condition.
The prescribing data are provided by IMS Health. The HIOs routinely obtain prescribing data from pharmacies, claims processors, and Pharmacy Benefit Managers (PBMs). Prescribing data purchased by HIOs, which are subject to HIPAA privacy requirements, do not contain patient identifiable information.
The AMA’s extensive editorial board of top experts permits the AMA to collaborate with leading disease specialists in the development of AMA Therapeutic Insights newsletters. In many cases the physician author of a newsletter was also involved in the development of the treatment guidelines for that disease topic.
Each program is certified for AMA PRA Category 1 creditTM. The CME self-assessment may be taken online or the completed answer sheet provided with the newsletter may be faxed or mailed to the AMA. The program can be accessed online at www.ama-assn.org/go/therapeuticinsights.
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Both the West Virginia Medical Group Managers and the West Virginia Office Managers Associations are currently recruiting new members. Each of these associations offers tremendous educational and networking benefits for practices managers in medical practices. If your practice administrator or manager doesn’t currently belong to an association, please encourage him/her to join one or both of these associations.
To obtain additional information about membership or receive a membership application for the OMA or the WVMGMA, contact Barbara Good at the WVSMA (Barbara@wvsma.com)
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The West Virginia Bureau for Medical Services has announced changes to the Preferred Drug List (PDL) which are effective as of January 1, 2009. Changes of note include:
Analgesics, Narcotics-Long-Acting
Duragesic Patches (brand)-Preferred
Fentanyl patches (generic)-Non-Preferred
Opana ER-Preferred
Angiotensin Modulators
Altace-Non-Preferred
Ramipril-Preferred
Cozaar 25 mg.-Preferred
Cozaar 50 mg, Cozaar 100 mg.-Non-Preferred
Hypoglemics, Insulin
Humalog Pens/Kwikpens/Cartridges-Non-preferred
Humalog Mix Pens-Non-preferred
Humulin Pens-Non-Preferred
Patients currently established on insulin therapy using these delivery systems will have their prescriptions grandfathered. (Humalog and Humalog vials remain preferred.)
BMS has conferred with David Potters, Executive Director and legal counsel for the West Virginia Board of Pharmacy, and he is in agreement that it is permissible for a pharmacist to dispense two (2) Cozaar 25 mg. tablets upon receipt of a prescription that reads Cozaar 50 mg. and four (4) Cozaar 25 mg. tablets upon receipt of a prescription for Cozaar 100 mg. without consultation with the prescriber. Because of the significant cost difference in the 25 mg. tablets and the other available strengths, we are asking pharmacists to dispense the 25 mg. tablets whenever possible. If swallowing an increased number of tablets presents a hardship for the patient, an override can be obtained by calling the Rational Drug Therapy Program at 1-800-847-3859 or sending a fax to them at 1-800-531-7787.
The completed Preferred Drug List with prior authorization criteria can on the Bureau for Medical Services Website at http://www.wvdhhr.org/bms/sPharmacy/PDL/bms_PDList_PageRV.asp
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As of January 6, 2009, the names of physicians and other health care professionals who reported quality information under the Physician Quality Reporting Initiative (PQRI) in 2007 became available at www.medicare.gov\physician, the Physician and Other Healthcare Professional Directory located on www.medicare.gov. This information includes all eligible professionals identified by their National Provider Identifier (NPI) who submitted at least one quality data code on their Medicare claims for services furnished between July 1, 2007 and December 31, 2007.
The PQRI is a voluntary reporting program. A physician or other healthcare professional can choose whether to report quality information to Medicare under the PQRI program. Reporting quality information by professionals is an important means to promote improved quality of care to Medicare beneficiaries. For more information on the PQRI and the instructions for reporting and requirements for satisfactory reporting, go to http://www.cms.hhs.gov/pqri.
Detailed information on the 2009 PQRI may be found in the 2009 Medicare Physician Fee Schedule final rule with comment period (73 FR 69817 through 69847) that was published in the Federal Register on November 19, 2008. The final rule with comment period can be found in the “Related Links Outside of CMS” section of the Physician Quality Reporting Initiative website at: http://edocket.access.gpo.gov/2008/pdf/E8-26213.pdf on the CMS website.
Reporting for the 2009 PQRI began on January 1, 2009. There is no need to sign up or pre-register in order to participate in the PQRI program. Physicians are eligible to receive an incentive payment of 2% of Medicare allowed charges. This amount is up from the 1.5% incentive for 2007 and 2008. It is important to note that the 2% incentive payment for PQRI reporting is in addition to the 2% that physicians may earn for e-prescribing.
For additional information about e-prescribing, please see Medicare’s website, www.cms.hhs.gov/EPrescribing/.
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As of February 28, 2009, you will have to dial all local numbers using the new, 10-digit local dialing procedure or your call will not be completed. Local calls will require that the three digit area code be dialed in addition to the seven digit phone number. A recording will instruct you to hang up and dial again. The new area code, 681, is being added to the entire state of West Virginia in order to ensure that there is a continuing supply of telephone numbers.
Any services that are currently programmed with a seven digit number will need to be reprogrammed with a 10 digit number. Some of these include call forwarding, fax machines, internet dial-up numbers, speed dialers and other communication features.
The good news is that your current phone number will remain the same and you will not be charged additionally even though the calls must be dialed using 10 digits. The emergency number, 911, and information number, 411, may still be dialed with only three digits.
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January 30, 2009
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