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CMOM Class Update
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The inaugural CMOM (Certified Medical Office Manager) class is off to a great start! Thirty-three (33) attendees just completed the first weekend of the course and will finish the course this coming weekend. The material has been presented in an exciting format with much “hands on” experience. Attendees have raved about the course thus far.
With the interest in this class and the waiting list that we have, the WVSMA plans to host another class soon, most likely early in the fall. We are also planning a chart auditing course. Watch the Wesgram for details so that your office staff doesn’t miss out on the chance for a great educational experience!
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21% Medicare Reimbursement Temporarily Halted Again
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On April 15, 2010, President Obama signed into law the "Continuing Extension Act of 2010." This law extends through May 31, 2010, the zero percent update to the Medicare Physician Fee Schedule (MPFS) that was in effect for claims with dates of service January 1, 2010 through March 31, 2010. The law is retroactive to April 1, 2010. Effective April 16, 2010, claims with dates of service April 1 and later, which were being held by Medicare contractors, are being released for processing and payment.
Practices should keep in mind that the statutory payment floors still apply; therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).
The AMA is continuing to work closely with House and Senate leadership offices and with White House officials on a long-term solution to the sustainable growth rate formula.
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Medicare Medical Records Signature Requirements
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CMS guidelines mandate the presence of signatures specifically for all 'medical review' purposes, including modifiers, etc. Records pertaining to any procedures billed to Medicare are potentially subject to review by Medicare contractors (Palmetto GBA for WV.) Physicians should be aware of the importance of these signature requirements and if changes are needed, they should take immediate action.
Effective 3/31/10, stamped signatures were no longer acceptable for medical review purposes. Although Medicare does not require orders for clinical diagnostic tests to be signed, if the orders are not signed, there must be signed documentation (via electronic or handwritten signature) by the treating physician that he/she intended to order the clinical diagnostic test being performed.
If Palmetto GBA reviews records and finds that signature requirements are not met, they will request a signature attestation or signature log. Physicians then will have 20 days to respond to such a request.
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Recovery Audit Contractor (RAC) Update
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CMS has announced a series of nationwide educational conference calls regarding the Recovery Audit Contractors, entitled RAC 101. They will be presented by CMS staff. The content on each call will not change drastically. The RAC operational process will be discussed and there will be a question and answer session held at the end of the call. The information presented will not be much different from other RAC 101 sessions that were held in the past in conjunction with the hospital and/or medical associations. These calls offer another opportunity for physicians who may have missed the earlier presentations to hear the RAC 101 session and to ask any questions they may have regarding the RAC process. Registration is not required for the calls.
Listed below are the dates of the RAC 101 calls:
April 28, 2010 1:00pm - 2:30pm EST: Nationwide RAC 101 Call 1-877-251-0301, meeting ID: 66532244
May 4, 2010 1:00pm - 2:30pm EST: Nationwide RAC 101 Call for Home Health and Hospice Providers 1-877-251-0301, meeting ID: 66524952
May 5, 2010 1:00pm - 2:30pm EST: Nationwide RAC 101 Call for DMEPOS, 1-877-251-0301, meeting ID: 66527260
May 12, 2010 1:00pm - 2:30pm EST: Nationwide RAC 101 Call for Physicians 1-877-251-0301, meeting ID: 66529242
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Aetna News
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Aetna has announced that it is suspending its marketing as well as enrollment of new members in its Medicare Advantage plans. This comes as a result of federal government sanctions relating to compliance with requirements involving Medicare prescription drug plans. The suspension affects Aetna's Medicare Advantage and prescription drug plans. The sanctions do not affect current enrollees and come after the March 31st end of the open enrollment period for Medicare Advantage plans.
As of September 2010, Aetna will no longer be printing and mailing copies of their newsletter, entitled Aetna OfficeLink Update (OLU). Beginning on that date, the newsletter will be available only electronically, either by email or through the public website, www.aetna.com.
If you have been getting OLU through the mail, you will need to make sure that Aetna has your email address. Practices may sign up for electronic delivery at https://aetna.providerpreference.com. If you previously gave Aetna your email address but are still getting the paper version, please check your information at the above website and verify that they have your correct email address. If you have been getting OLU by email, you will keep receiving the newsletter as you currently do.
OLU has been available by email since 2006. Currently, more than 60% of all provider offices that participate with Aetna get the newsletter this way. The electronic version arrives in an HTML format, so physicians may click on and view individual articles of interest. You also get access to the newsletter faster because you don’t have to wait for copies to be printed and mailed.
Offices who have not provided Aetna with their email addresses will receive notification through the mail that the issue is available on the Aetna website, www.aetna.com. Offices without email or internet access will be able to obtain a printed version of the newsletter upon request.
Effective April, 1, 2010, Aetna requires preauthorization for outpatient dialysis treatments (CPT codes 90935, 90935, and 90999). This requirement applies to members in the Aetna commercial and Medicare plans. Preauthorization for outpatient dialysis treatments will be required every 6 months.
Effective May 1, 2010, Aetna will change the rate for physicians assisting at surgery. Physicians were previously notified of this change in February, 2010. The rate will change from 20% of the negotiated rate or recognized charge to 16% of the negotiated rate or recognized charge. Multiple eligible assistant surgery codes will reimburse at 16% for the primary procedure, 8% for the second procedure and 4 % for each additional procedure.
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Mountain State Blue Cross Blue Shield
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Effective January 1, 2011, Mountain State Blue Cross Blue Shield will launch a radiology management program that is designed to improve quality and appropriateness of non-emergency imaging services delivered to their members.
National Imaging Associates, Inc. (NIA) will begin providing utilization management services for non-emergent, high-tech outpatient radiology services for Mountain State members enrolled in Mountain State health plans. NIA is NCQA and URAC accredited and offers participating providers a program that supports standard protocols and offers the expertise of peer physicians.
Future communications will be sent out providing more specific information and details regarding the radiology program. Educational seminars introducing this new program will be offered later in the year. In the meantime if you have any questions, please contact your Mountain State External Provider Relations Representative.
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UnitedHealthcare News
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UnitedHealthcare will soon publish a new reimbursement policy that will address appropriate coding and documentation for Observation Care Evaluation and Management services billed on a 1500 Health Insurance Claim Form (a.k.a CMS-1500) or its electronic equivalent or its successor form. This policy does not apply to claims billed on a UB-04 form. The new policy is scheduled for publication on July 1, 2010.
Observation care CPT® codes 99217-99220 as quoted from the CPT manual are used to report evaluation and management services provided to new or established patients designated or admitted as “observation status” in a hospital. The policy will reinforce the correct coding guidelines as published by the American Medical Association Current Procedural Terminology manual in addition to CMS guidelines.
Pursuant to the UnitedHealthcare “Global Days" policy, the global surgical fee includes payment for hospital observation services (99217-99220, 99234-99236) unless the criteria for modifiers 24, 25, 57 are met. Physicians should refer to the UnitedHealthcare "Global Days" policy for guidelines on reporting services during a global period.
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April 21, 2010
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