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Free Tamper Resistant Prescription Pads and Laser Paper
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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. The deadline for ordering under the grant funding is rapidly approaching, so you must place your order soon.
Good news! If you have ordered prescription pads and paper already, you may now place a second order for free tamper resistant prescription pads or paper. 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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Learn How to Access Federal Stimulus Funds at Foundation Conference
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Are you and your practice ready to access federal stimulus funds? Will your practice qualify to receive incentives from Medicare or Medicaid? Learn the specifics on how you can qualify for federal health information technology stimulus funds at the West Virginia Medical Foundation's conference, "Advancing Excellence In Healthcare and Health Information Technology" October 15 (begins at 3 p.m.) and October 16th at Stonewall Resort centrally located just off Interstate 79 at Exit 91. The conference offers eight hours of CME. For more information and to register, click here.
To reserve a lodge room at the conference rate of $99, call Stonewall Resort at (304) 269-7400 no later than this Friday, September 25.
Conference highlights will include:
• Remarks by Martha Walker, Director, Governor's Office of Health Enhancement and Lifestyle Planning (invited)
• "Achieving Meaningful Use from Your EHR Using HIT and Care Teams", Sarah Chouinard, MD
• "Evaluating Return on Your Investment (ROI) for EHR--Stimulus vs. Reality", James L. Comerci, MD
• "Remote Neurological Presence in Rural Areas", Carl F. McComas, MD
• "Using Data as a Driver for Quality Improvement", Martha Carter, MBA,RN, CNM and Mary Buffington Jenkins, MD
• National Committee for Quality Assurance (NCQA) Nine Criteria for Medical Home Certification
• "Broadband Implementation in West Virginia: An Update on the West Virginia Telehealth Alliance"
• "The Role of Privacy and Security of Information in the Doctor/Patient Relationship"
This conference is for physicians, nurses, community health center staff, hospital administrators, office managers and practice group managers. The event is co-sponsored by CAMC Health Education and Research Institute.
For a preliminary agenda and registration form, click here or visit www.wvsma.com/foundation. For more information, contact Helen Matheny at Helen@wvsma.com or call (304) 925-0342 Ext. 13.
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RAC Update
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Connolly Consulting and the WVSMA are partnering to ensure that our physicians receive any new information about the RAC in an expeditious manner. Connolly has committed to notifying the WVSMA prior to any new initiatives with the RAC program. As of this date, Connolly has not yet initiated the RAC program for physicians in West Virginia. We will keep you informed and updated on changes or additions to the RAC program.
Here are some important ways to prepare your office for the RAC implementation. First, physicians should know identified “risk areas” for improper payments. These can be found on by reviewing the OIG and CERT reports (www.oig.hhs.gov/oas/cms.asp and also www.cms.hhs.gov/CERT.
Secondly, you should appoint a specific person for the RAC to contact. This person should be knowledgeable about what to send to the RAC if information is requested.
Thirdly, you should respond to medical record requests fully and promptly. Keep a record of all dates and the number of requests received.
Finally, your practice should learn from experience. If you observe a pattern of denied claims, you should examine the billing practice. You will also want to examine your billing in order to avoid improper payments. If this is occurring, consider having internal audits.
For more information about the RAC, please visit the CMS and Connolly websites,
www.cms.hhs.gov/RAC and www.connollyhealthcare.com/RAC.
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Medicare Participation Options
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As of this date, CMS is projecting a 21.5% decrease in reimbursement for 2010. Although the final rule will not be issued until November 1, 2010, some physicians are questioning continuing their participation in the Medicare program. Included below is information that you should know when considering your participation or non-participation in the program.
For 45 days at the end of each year, physicians have an opportunity to notify Medicare whether they will be a “participating” or a “non-participating” physician in the coming year. Participating physicians agree to accept assignment on all their Medicare claims. Non-participating physicians can make assignment decisions on a claim-by-claim basis. Medicare payment rates for non-participating physicians are 5 percent lower than payment rates for participating physicians, but non-participating physicians can balance bill patients for more than the Medicare rate, up to a “limiting charge” amount.
Physicians also have the ability to “opt out” of Medicare and privately contract with their patients, but neither they nor their patients can submit any claims to Medicare for their services for a two-year period.There are three Medicare contractual options for physicians. Physicians may sign a PAR (participation) agreement and accept Medicare’s allowed charge as payment in full for all of their Medicare patients. Alternatively, they may elect to be a non-PAR physician, which permits them to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims. Lastly, they may become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves.
Physicians who wish to change their status from PAR to non-PAR or vice versa will need to do so before Jan. 1, 2010. Once made, the decision will be binding throughout calendar year 2012 except where the physician’s practice situation has changed significantly, such as relocation to a different geographic area or a different group practice. To become a private contractor, physicians must give 30 days notice before the first day of the quarter the contract takes effect. Those considering a change in status should first determine that they are not bound by any contractual arrangements with hospitals, health plans or other entities that require them to be PAR physicians. In addition, some states have enacted laws that prohibit physicians from balance billing their patients.
Participation
PAR physicians agree to take assignment on all Medicare claims, which means that they must accept Medicare’s approved amount (which is the 80 percent that Medicare pays plus the 20 percent patient copayment) as payment in full for all covered services for the duration of the calendar year. The patient or the patient’s secondary insurer is still responsible for the 20% copayment but the physician cannot bill the patient for amounts in excess of the Medicare allowance. While PAR physicians must accept assignment on all Medicare claims, Medicare participation agreements do not require physician practices to accept every Medicare patient who seeks treatment from them.
Medicare provides several incentives for physicians to participate:
- The Medicare approved amount for PAR physicians is 5 percent higher than the Medicare approved amount for non-PAR physicians
- Directories of PAR physicians are provided to senior citizen groups and individuals who request them.
- Carriers provide toll-free claims processing lines to PAR physicians and process their claims more quickly.
Non-participation
Medicare approved amounts for services provided by non-PAR physicians (including the 80 percent from Medicare plus the 20 percent copayment) are set at 95 percent of Medicare approved amounts for PAR physicians, but non-PAR physicians can charge more than the Medicare approved amount.
Limiting charges for non-PAR physicians are set at 115 percent of the Medicare approved amount for non-PAR physicians. However, because Medicare approved amounts for non-PAR physicians are 95 percent of the rates for PAR physicians, the 15 percent limiting charge is effectively only 9.25 percent above the PAR-approved amounts for the services.
When considering whether to be non-PAR, physicians should consider whether their total revenues from Medicare, including amounts the program pays, patient copays and balance billing, would exceed their total revenues as PAR physicians, particularly in light of collection costs, bad debts, and claims for which they do accept assignment. The 95 percent payment rate is not based on whether physicians accept assignment on the claim, but whether they are PAR physicians. When non-PAR physicians accept assignment for their low-income or other patients, their Medicare approved amounts are still 95 percent of the approved amounts paid to PAR physicians for the same service. Non-PAR physicians would need to collect the full limiting charge amount roughly 35 percent of the time they provide a given service in order for the revenues from the service to equal those of PAR physicians for the same service. If they collect the full limiting charge for more than 35 percent of the services they provide, their Medicare revenues will exceed those of PAR physicians.
Assignment acceptance, for either PAR or non-PAR physicians, also means that the Medicare carrier pays the physician the 80 percent Medicare payment. For unassigned claims, even though the physician is required to submit the claim to Medicare, the program pays the patient, and the physician must then collect the entire amount for the service from the patient.
For additional information about Medicare participation, you may go to the CMS website (www.cms.gov) or visit www.ama-assn.org for a document that describes the various Medicare participation options.
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New PEIA Contract Effective January 1, 2010
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PEIA has signed a contract with Humana, Inc. to provide Medicare Advantage benefits for the majority of the PEIA Medicare-eligible population, effective January 1, 2010. The mid-year change is coming due to Coventry Healthcare’s withdrawal from the Medicare Advantage business. Coventry will no longer be offering Advantra Freedom medical plan as of January 1, 2010. Coventry will still offer the Medicare Part D plans. PEIA members will now have two cards, one card for medical and one for prescription coverage.
Even though Humana will be assuming the contract in mid-year, PEIA members will not have a new deductible starting in January. The same enrollment period (July-July) will be in effect under the Humana plan.
Your practice staff will want to be aware that as of January 1, 2010, the PEIA Medicare-eligible patients should have a Humana insurance card; however, they will not have a new deductible.
In order to provide an easier transition for this program, Humana is holding free webinars for physicians and staff. The webinars are designed to help increase awareness of the plan and how it will be administered by Humana.
The first webinar is this Friday, September 25, from Noon – 1:00 PM.
The other webinars are as scheduled:
- Thursday, October 8, 8:00 AM-9:00 AM
- Wednesday, October 28, from 4:00 PM – 5:00 PM
- Tuesday, November 11, from Noon – 1:00 PM
The webinars are free but an RSVP is required. Please reply to Sherry Brown at sbrown33@human.com or call 1-800-664-2366. You will be given log in information when you register.
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West Virginia Office Managers Association Plans October Conference in Huntington
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The 2009 West Virginia Office Managers Association State Conference will be held on Thursday, October 22 and Friday, October 23 at the PullmanPlaza in Huntington, West Virginia. This conference is always a great educational opportunity for office managers. Not only are the sessions jam packed with outstanding speakers, but the networking opportunities are abundant. Managers are able to share experiences and assistance with others who may be experiencing the same issues. This is also a good place for new managers to form mentoring relationships with more seasoned managers.
Physicians and their practices can benefit greatly from the knowledge and practical information that their office managers gain at a conference such as the OMA meeting.
For additional information, please contact Toni Charlton, OMA President (Antoinette.Charlton@sw-rmc.com) or your local chapter of the OMA.
Register today and don't miss out on this great educational opportunity!
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BrickStreet Update
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BrickStreet is always on the lookout for ways to save money and better serve policyholders. The company has begun issuing a new type of medical identification card to claimants.
The cards guarantee approved medical payments and include billing information to ensure correct billing takes place. One change on the card is the elimination of the diagnosis code. This makes the cards more versatile as there is no need to issue a new card when a claimant's diagnosis code changes.
StreetSelect, the BrickStreet Preferred Provider Organization (PPO) began in 2006. The PPO has proven to be a valuable asset, allowing for BrickStreet to forge strong relationships with the medical community. Medical providers can perform necessary and appropriate medical care with far less paperwork and administrative restrictions.
Since its inception, the number of participating providers has grown to more then 3,000. Providers are available in West Virginia, Ohio, Kentucky, Pennsylvania, Maryland and Virginia.
More information about StreetSelect can be found on the BrickStreet website (www.brickstreet.com). . Also, there are three manuals on the publications page explaining more for employers, claimants and providers.
In June, BrickStreet recently began utilizing First Script, a new Pharmacy Benefit Management (PBM) Program through Coventry Healthcare. First Script is a preferred pharmacy program designed specifically for workers' compensation.
Part of this new program gives claimants the ability to receive a first-fill prescription for up to 14 days from the date of injury without a pharmacy card. In order for claimants to receive this benefit, employers must fill out the BrickStreet First Fill Form available on brickstreet.com. The claimant then takes this form and the prescription to the pharmacy of their choice.
To deal with problems, the First Script Customer Service Center is available 24/7 to assist pharmacists and claimants 1-800-791-2028. For general questions, contact BrickStreet at 866-45BRICK
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Mountain State Blue Cross Blue Shield Update
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The recent statewide MSBCBS trainings provided physicians with the opportunity to learn about all the company’s recent updates. An important announcement that may affect some practices is that the Mountain State BCBS newsletters will be online only as of January 1, 2010.
Also, physician offices are reminded of Mountain State’s timely filing policy and appeal limits. Physicians have 365 days (one year) to file a claim and 365 days from the date of the primary EOB to file a secondary claim. Physicians have 180 days to file an appeal.
There is a new COB (Coordination of Benefits) questionnaire form online. Physician practices are urged to use this form in order to expedite claim payments for COB claims.
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Top 10 Reasons to Provide Your Email Address to the WVSMA
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Here are the Top 10 reasons to provide your email address to the WVSMA--
10. Give your fax machine a rest.
9. Impress the kids with your use of e-mail.
8. Save trees and "go green:'
7. Increase your personal comfort with technology.
6. Get information in a quick-read, timesaving format.
5. Share news with staff just by clicking Forward.
4. Help the WVSMA maximize your dues dollars.
3. Know what your colleagues know at the same time they know it.
2. Protect your patients with access to immediate updates from the CDC and other healthcare bulletins.
AND the TOP reason to ensure the WVSMA has your e-mail address:
1. Learn news of importance to physicians as soon it is available.
To make sure you, like your colleagues, are getting e-mail news and bulletins of importance to West Virginia physicians, send an e-mail message to mona@wvsma.com. If your e-mail has changed -or whenever it changes -make sure you send your new address to the WVSMA.
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WVSMA 2010 Invoices
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The WVSMA will begin invoicing for 2010 during early October. Your membership, participation, and financial support in the state’s largest physician advocacy organization are a valuable investment for your medical practice. The WVSMA is dedicated to advocating on behalf of physicians and their patients.
Thank you for your support of the WVSMA!
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September 23, 2009
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