The WVSMA’s recent Physician Practice Conference, held in conjunction with the Mid-Winter Conference, provided an exciting day of education for attendees.  Physicians, administrators and other office personnel received the latest updates about the CPT coding changes for the New Year, as well as utilization and reimbursement updates that payors have made for 2010.  During the morning session, attendees learned effective strategies for improving their medical practices from Practice Management expert Rose Moore and Protocol Consultant Pam Harvit.  In addition,  Dr. James Lee, of Connolly Consulting, the RAC (Recovery Audit Contractor) for Region C, provided guidance as to the status of the RAC’s activities in West Virginia. 

During the afternoon payor workshop, Patsy Hardy, Secretary of the Department of Health and Human Resources, and Nancy Atkins, Commissioner of the Bureau for Medical Services, joined the attendees and gave an overview of changes at Medicaid.   Management and representatives from many payors participated in the afternoon session.

The conference received high marks from all who attended.   Attendees commented about the diverse program and how there truly was “something for every medical practice”. 

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In response to requests by physicians and office managers, the WVSMA is excited to announce that we will be offering a Certified Medical Office Manager course in April 2010!

The WVSMA, in partnership with the Practice Management Institute, will offer the four-day Certified Medical Office Manager (CMOM) class, which will teach experienced staff proven strategies to lead the medical practice to increased productivity and efficiency.

In today’s healthcare environment, more physicians are seeking certified professionals capable of understanding the newest business and regulatory issues.  Becoming a Certified Medical Office Manager is more than just a title; it demonstrates that a manager has additional skills and knowledge to better guard the practice against risks, increase the practice’s revenue, and most importantly lead the practice to the ultimate goal—that of providing better healthcare for the patients. 

Angie Linville, Office Manager for a large West Virginia medical practice, traveled out of state to take the course and became a Certified Medical Office Manager several years ago.  She has nothing but praise for the course and the certification.  “My CMOM certification has enabled me to perform much more efficiently than ever. The continuous education I receive keeps me up to date on all aspects of practice management,” states Angie.

The inaugural CMOM course will take place in Charleston for two days during two different weeks in order to minimize office downtime.  Participants will be able to “try out” their newly learned skills during the week in between classes.  The course is scheduled for Friday, April 16 and Saturday, April 17 from 9:00 AM – 4:00 PM, and then again on Friday, April 23 and Saturday, April 24.  The certification exam will be given on April 24.   Participants must attend all four sessions.  

The tuition for the class is $799.00, which includes program manuals, workbooks, and the exam.  WVSMA physicians and staff may attend for $699.00.  The clinical faculty for the first class will be Practice Management Specialist Rose Moore.

The class size will be limited and is filling up quickly, so please contact Barbara Good (Barbara@wvsma.com) or Karie Sharp (Karie@wvsma.com) as soon as possible to express your interest in the course.  

The WVSMA is proud to be the exclusive West Virginia partner for the CMOM certification.   We anticipate offering additional classes, as well as other certifications, in the not so distant future.
 

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Congress has been unable to resolve the Medicare sustainable growth rate (SGR) crisis during the two-month extension that prevented a 21% cut from taking effect on January 1, 2010.   SGR extension that was stripped from the Senate jobs bill that passed earlier this week.  Today, February 26, 2010, the Senate failed to repeal the Medicare physician payment formula that will cause a drastic 21 percent payment cut to physicians who care for Medicare and TRICARE patients. On Monday, March 1, 2010, the 21 percent cut goes into effect, forcing physicians to consider the difficult decision to limit the number of Medicare and TRICARE patients they see in order to keep their practice doors open. 
 
CMS has instructed its contactors to hold claims containing services paid under the Medicare Physician Fee Schedule for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward.  This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. 

The WVSMA will keep you updated as to any changes that may occur with the Medicare fee schedule.

In the meantime, the American Medical Association is looking for help in identifying physicians who are willing to share their personal stories about how the Medicare cuts will impact their practice and how their offices plan to handle the cuts. In addition, if your practice has already made changes because of the uncertainty in the system, the AMA would like to hear about the changes you’ve made.
 
The AMA will share the stories with Members of Congress and the press to highlight the impact on real physicians and the seniors and military families they care for.

The information needed, as well as the AMA contact person, is listed below:
 
NAME:
SPECIALTY:
CITY, STATE:
EMAIL:
PHONE NUMBER:
YOUR STORY:
 
Please send your information directly to:

Katherine M. Hatwell
AMA Media Relations
202-789-7419
katherine.hatwell@ama-assn.org
 

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In other Medicare news, physicians have until March 17 to change their Medicare “participating” or “non-participating” status; it is unclear whether that deadline will be extended in response to upcoming Congressional action.  Additional information regarding changing your participation status may be found on the WVSMA’s website, www.wvsma.com.

The Calendar Year (CY) 2010 anesthesia conversion factor (CF), released on December 23, 2009, is being corrected to reflect the CY 2010 anesthesia fee schedule practice expense changes for West Virginia. Also, the malpractice relative value units (RVUs) for the CY 2010 West Virginia Medicare Physician Fee Schedule are being corrected for 52 codes.  For more information, go to
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7ZULF82485?opendocument

There are times when a provider will receive a primary payment from another insurance company after Medicare has paid as primary. When this happens, it is assumed that Medicare should be the secondary payer. If you receive two primary payments, you should refund Medicare’s payment in full.   Additional information may be found at:
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7RJJVE5300?opendocument

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Aetna is in the process of expanding their product offerings to include Medicare in 2011.   The plan will offer a Medicare Advantage PPO plan in select counties in West Virginia and would like physicians to join this new network.  Aetna hopes that physicians will find this network option an exciting opportunity to deliver care to Aetna Medicare members in West Virginia.

West Virginia physicians were recently sent the new Aetna Medicare amendment.  In order to participate in Aetna’s Medicare network, physicians need to sign and return both copies of the amendment to Elaine.

Aetna
Attention:  Elaine Rader 
P.O. Box 593  
Hurricane, WV 25526
(304) 562-0824.

If you already participate in Aetna’s Medicare plans, your compensation for providing covered services to enrollees in the Aetna Medicare Advantage PPO and network-based Private Fee For Services plan will be the same.  

Inclusion in the Medicare provider network is voluntary but to participate, you do need to sign both copies of the amendment that Aetna provided to your office. 

If you have questions about the new Medicare amendment, please contact Aetna network representative, Elaine Rader.

Aetna also is still accepting consult codes for your consults.   Before making a change in this policy, they will give a 90 day written notice.

Finally, you may recently have received a letter from Aetna advising you that they are updating their fee schedule.   This is the standard letter that they send each year, updating to the current year’s Medicare fee schedule.  Any change does not take effect until April 15, 2010.  If you have questions about the fee schedule or want access to those fees before they take effect, you may contact Aetna’s Provider Service Center (800-624-0756).  

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Mountain State Blue Cross Blue Shield is beginning to go green.  The plan’s newsletter is now only available online as of February 1, 2010.   In addition, effective January 1, 2010, Mountain State began requiring all inpatient and outpatient facility claims to be submitted electronically.  The phase II date, which has not been announced yet, will be concentrating on requiring other provider types to submit electronic claims only.

Mountain State has found that a typical solo physician practice could save over $42K annually by implementing EDI.  Electronic claims tend to be cleaner and result in faster payments and physicians are able to receive electronic payments through Electronic Fund Transfer (EFT) Direct Deposit. 

NaviNet is a free electronic solution for both UB and 1500 claims.  Navinet can accommodate primary, secondary and tertiary claims as well as local, FEP, BlueCard and HHIC/Freedom Blue claims for providers using UB or 1500 forms. 

If you’re not submitting claims to Mountain State electronically and would like to do so, you may contact EDI for assistance (1-888-222-5950).  
 

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The Centers for Medicare and Medicaid (CMS) has mandated that all contracted and delegated providers who render benefits or services for Medicare Part D programs must meet annual fraud, waste and abuse training requirements beginning in 2009. 

Several payors are providing Fraud, Waste and Abuse (FWA) Training on their websites.   The training is reciprocal between plans; meaning that if your office does the training from one payor’s website, it may be submitted to the other payors.

The Health Plan of the Upper Ohio Valley has a power point presentation available on its website, www.healthplan.org.     Your staff may view the power point and then fax the FWA training attestation form back to The Health Plan.  If you have completed training via another insurer or source, you simply indicate that on the FWA attestation form and return it.

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Effective January 1, 2010, Medicare no longer recognizes the CPT consultation codes; instead, physicians must submit a valid code that best describes the level of service rendered.  Physicians must now bill an appropriate E/M code based on the complexity of the visit and where the visit occurs, whether it be in the outpatient setting (office, outpatient hospital, emergency room or observation) or inpatient (hospital or nursing facility). 

The HCPCS Modifier A1 is now used to identify the “Principal Physician of Record”, that is, the physician who oversees the patient’s care from all other specialty physicians who may be furnishing care.   This code may only be used on the initial visit. 

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As of March 1st, 2010, Coventry and Brickstreet will be partnering for their Worker’s Compensation bill reviews.   As of that date, Brickstreet will begin to utilize the Coventry network in West Virginia and Coventry will begin to perform the bill review for Brickstreet.

Your EOR/EOBs will continue to be produced by Brickstreet, as well as the medical invoice destination.   The clinical staff and adjusters will be the same, as will the payer of claims.

For additional questions regarding the new partnership, you may contact Customer Service at 1-800-937-6824 or WcClientServices@cvty.com.
 

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UniCare has announced a new CPT coding available for smoking cessation.   The following codes may be used:

99406: Smoking and tobacco use cessation counseling visit; intermediate
 (greater than three minutes, up to 10 minutes)

99407: Smoking and tobacco use cessation counseling visit; intensive
 (greater than 10 minutes)

UniCare's HEDIS (Healthcare Effective Data and Information Set) data collection process began in January.  UniCare will soon be contacting providers to establish key contacts.

The annual study is conducted from February to May and requires that medical records be examined and reports completed by field nurses, either by onsite visits, faxes and/or mail.

HEDIS measures include preventive health services for adults and children.  Physician responsibilities include providing access and availability of medical record data.   Once the information is obtained, it is compiled and compared year over year to identify opportunities for improvement.
 
 

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Molina Healthcare, Inc. recently purchased the Health Information Management (HIM) business of Unisys Corp.  This includes the West Virginia company and its employees.  Unisys has agreed to provide certain transitional and technology support services to Molina Healthcare for up to one year.   

The Unisys’ health information management unit provides solutions to state governments for Medicaid administration. It currently has contracts with Idaho, Louisiana, Maine, New Jersey and West Virginia and provides drug rebate administrative services to the Florida Medicaid program. 

The sale should remain transparent to physicians and other medical providers who participate in the WV Medicaid program.

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• • Physician Practice Conference Scores High Praise
• • WVSMA to Offer CMOM Class
• • Medicare Fee Schedule Cut Still Set to Occur
• • More Medicare News
• • Aetna Update
• • Blue Cross Blue Shield Update
• • Fraud, Waste and Abuse Training---Is Your Practice Doing It?
• • Consultation Coding Change for 2010
• • Carelink Update
• • Cigna Update
• • UniCare Update
• • Unisys Update