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CMS Fee Schedule to Change on June 1, 2010
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When President Obama signed H.R. 4851, the Continuing Extension Act of 2010, into law, reinstating Medicare physician payments to where they were on March 31, the 21.3% fee schedule cut was again postponed until May 31, 2010. This most recent extension of 2009 payment rates continues through the end of May. Unless another extension occurs, the new fee schedule is scheduled to begin on June 1, 2010.
The WVSMA will continue to monitor the fee schedule and keep physicians advised.
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Red Flags Rule Effective Date is Rapidly Approaching!
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The Federal Trade Commission (FTC) has scheduled compliance of the Red Flags Rule to begin June 1, 2010. The rule was originally scheduled to go into effect on November 1, 2008 but received three extensions for the actual compliance date. The FTC delayed the compliance date to June 1, 2010 following previous compliance dates of May 1, 2009, August 1, 2009 and November 1, 2009. The delays have largely been due to continued advocacy of physician organizations who continue to object to the applicability of this Rule to health care providers and professionals.
As a means of review, the Red Flags Rule is an anti-fraud regulation, requiring “creditors” and “financial institutions” with covered accounts to implement programs to identify, detect, and respond to the warning signs, or “red flags,” that could indicate identity theft. The financial regulatory agencies, including the FTC, developed the Rule, which was mandated by the Fair and Accurate Credit Transactions Act of 2003 (FACTA). FACTA’s definition of “creditor” includes any entity that regularly extends or renews credit – or arranges for others to do so – and includes all entities that regularly permit deferred payments for goods or services.
The Red Flags Rule require that physicians and other organizations have “reasonable policies and procedures in place” to identify, detect and respond to identity theft “red flags”. The definition of “reasonable” will depend on the practice’s specific circumstances or experience with medical identity theft as well as the degree of risk for identity theft in your practice. These policies and procedures should complement your practice’s existing HIPAA privacy and security policies and procedures that describe the administrative, technical and physical safeguards that your practice has in place to ensure the protection of the patient’s PHI (protected health information).
Since most physician offices are considered “low risk” by the FTC, one of the policies for your office should be to obtain a photo ID upon check-in. You should train your employees about identity theft and have a policy in place for preventing such theft. A downloadable and customizable template is available on the AMA website, http://www.ama-assn.org/ama1/pub/upload/mm/368/red-flags-rule-policy.pdf.
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Save the Date for the Next CMOM Class!
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The Inaugural CMOM class was a great success! Thirty-three ambitious office administrators attended the 4 day inaugural class and sat for the exam. The exams are currently being scored and the attendees should receive word within a month regarding their certification.
Due to the high demand for the class, the WVSMA has scheduled an additional class which will be offered again in Charleston in September. As before, the class will be held on four days over the course of two weekends. The dates for the class are Friday/Saturday, September 10/11 and Friday/Saturday, September 17/18.
More details will be coming soon. If you’re interested in the class, please contact Barbara Good (Barbara@wvsma.com) or Karie Sharp (Karie@wvsma.com) to ensure that you receive priority reservations.
The WVSMA is proud to be the exclusive West Virginia partner with the Practice Management Institute. PMI is one of only three entities whose certification is recognized by Medicare.
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The Fight is On! Med-Mal Caps Challenge Heads to WV Supreme Court
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The WVSMA has been expecting this for several years now since the passage of our comprehensive medical liability reform legislation (HB 2122) in 2003. A case challenging the non-economic damages cap was accepted to be heard by the WV Supreme Court of Appeals. Justice Ketchum was the one dissenting vote. Justice McHugh recused himself because he is on the Board of Trustees of Thomas Hospital, and Chief Justice Davis replaced him with Circuit Judge Ronald Wilson. The briefing and oral argument schedule is yet to be set.
On April 15, the WV Supreme Court voted 4-1 to accept the petition for appeal in McDonald v. City Hospital, Inc. The case involves a Medical Professional Liability Act (MPLA) jury verdict for the plaintiffs, awarding $1,129,000 to the plaintiff and $500,000 to his wife for loss of consortium, splitting liability between the doctor (70%) and the hospital (30%). The award to the plaintiff included $1M in non-economic damages for past and future pain and suffering. On post trial motion, Circuit Judge Silver reduced the award to $500,000, applying the MPLA cap per WV Code § 55-7B-8b which caps non-economic damages at $250,000 or $500,000 if there is death or substantial permanent injury. Judge Silver’s ruling meant the wife's award was reduced to “0” and the plaintiff’s to $500,000. The plaintiffs challenged the constitutionality at the circuit court level and pursued the issue on appeal.
The WVSMA is taking this challenge very seriously and will be gearing up to engage in this battle to support the position that the non-economic damages caps are constitutional and an appropriate exercise of legislative power. The non-economic damages "caps" are a critical piece of the 2003 legislation, and maintaining them is essential to the state's ability to attract and maintain new doctors.
Now is the time for physicians to stand together. When you receive information or a call to action from the WVSMA or your specialty society, please be prepared to respond and let your voice be heard!
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UnitedHealth Settlement Information
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The American Medical Association is offering physicians help in claiming damages from the UnitedHealth settlement. There is more than $350 million available to physicians and patients.
The American Medical Association has launched a new online resource that will help thousands of physicians file claims in the record-breaking settlement reached in the AMA legal victory against UnitedHealth Group, which is the nation’s largest health insurer. More than $350 million is available to help compensate physicians and their patients for 15 years of artificially low payments for out-of-network services.
“The AMA is offering its support to physicians who are now receiving mailings containing details and claim forms regarding the historic UnitedHealth settlement,” said AMA President J. James Rohack, M.D. “The new AMA guide provides physicians with step-by-step assistance in determining eligibility, assembling documentation and filing a claim under the terms of the settlement.”
During the last decade, the AMA worked diligently with the Medical Society of the State of New York, the Missouri State Medical Association, the courts and regulators to expose and prohibit a price-fixing scheme used by UnitedHealth and other health insurers to underpay physicians and patients for out-of-network care.
Evidence of UnitedHealth’s improper business practices gathered in the course of the AMA-led litigation was brought to the attention of New York Attorney General Andrew Cuomo, who confirmed the abuses with his own investigation. Under legal pressure from Attorney General Cuomo, UnitedHealth and several major insurers agreed to meaningful reforms that promise to help keep the system for determining out-of-network reimbursements free from further corporate manipulation.
The UnitedHealth settlement is governed by a series of court-imposed deadlines that physicians must follow. The current settlement deadlines include the following key dates:
July 27 – Deadline for filing objections to the settlement or for opting out of the settlement.
September 13 – Date for the final settlement hearing to consider any filed objections.
October 5 – Deadline for filing a claim to share in the settlement fund.
In addition to the information available in the new settlement guide, the AMA offers members personal assistance from the AMA’s Practice Management Center if they have questions about the settlement or filing a claim form. AMA members interested in retaining a claims submission service can obtain a discounted rate offered by the Managed Care Advisory Group.
“The AMA’s continued fight in the name of fairness shows yet again that when doctors enlist the help of organized medicine, the best outcome for patients and doctors can be achieved,” said Dr. Rohack.
For more information on the effectiveness of organized medicine’s advocacy in the courts, including continued efforts to reform the improper business practices of insurers, please visit the Litigation Center of the AMA and State Medical Societies.
Court-required notices are now finally being sent to physicians across the country regarding their options under the terms of the historic UnitedHealth settlement. To help physicians file claims in the $350 million settlement, the AMA today launched a new online guide that provides physicians with step-by-step assistance in determining eligibility, assembling documentation and filing a claim.
The AMA launched a new online resource at www.ama-assn.org/go/ucrsettlement that will help thousands of physicians file claims in the record-breaking settlement reached in the AMA legal victory against UnitedHealth Group-the nation's largest health insurer. More than $350 million is available to compensate physicians and their patients for 15 years of artificially low payments for out-of-network services.
The Settlement Claims Administrator began mailing the Settlement Notice and claim forms to physicians on Friday, April 16. Physicians should keep an eye out for their claim forms-the claim form sent to them will contain important information that can help with filing the claim.
In addition to the information available in the AMA's new online resource, AMA members can get personal assistance from the AMA's Practice Management Center. If members have questions about the settlement or how to file a claim form they can call (800) 621-8335. AMA members interested in retaining a claims submission service can obtain a discounted rate offered by the Managed Care Advisory Group.
The deadline for filing a claim to share in the settlement fund is October 5, 2010.
(This information was furnished by the AMA)
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Time to Renew Your West Virginia Medical License!
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Medical Doctors whose last names begin with the letters A through L are required to renew for the years 2010 - 2012. For the years 2010 - 2012, the Board of Medicine will not be mailing a paper renewal application to all the medical doctors who are renewing their licenses. Beginning May 13, 2010, licensees who meet the criteria for online renewal may go to the Board’s website, www.wvbom.wv.gov, and follow the online renewal directions.
The criteria are as follows:
1. Physician currently holds an ACTIVE medical license;
2. Physician currently holds an INACTIVE medical license and will renew in an INACTIVE status;
3. Physician has obtained the required continuing medical education;
4. Physician has answered “no” to all questions (see “Renewal FAQ’s” currently on the Board’s website);
5. Physician will pay via credit/debit card.
If a licensee is unable to use the online renewal service, he or she will need to request a paper renewal application to complete and return to the Board offices. The online application or paper application must be completed and submitted BEFORE Wednesday, June 30, 2010, at 4:30 p.m.
As in the past, please remember that WV Medicaid requires that a copy of your renewed licensed be sent to Medicaid. You may send a copy of your license to:
Unisys
Provider Enrollment Unit
PO Box 625
Charleston, WV 25322-0625
You may also fax a copy to Unisys at 304-348-3380.
A request form for a paper renewal application is available on the Board of Medicine website, www.wvbom.wv.gov, under the “FORMS” section
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CIGNA Update
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CIGNA reminds physicians that inquiries regarding Medicare claims are handled by a specific Medicare unit. The phone number for this dedicated CIGNA Medicare unit is 1-800-577-9410. |
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Humana Update
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Humana reminds physicians that the West Virginia Public Employees Insurance (PEIA) retirees health plan begins a new year on July 1, 2010. At that time, the PEIA members’ out-of-pocket maximum balance will be reset to zero. The out-of –pocket costs will begin applying to the new plan year maximum.
Also, as of July 1, 2010, PEIA Humana members will be responsible for a $25.00 annual deductible. Once the annual $25.00 deductible has been satisfied, the members will only be responsible for their copayments or coinsurance.
For more information on the Humana Medicare Advantage Regional Preferred Provider Organization (RPPO) plan or member benefits, please contact Humana customer service at 1-800-783-4599. You may also find information at the Humana website, www.Humana.com.
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Mountain State Blue Cross Blue Shield NIA Update
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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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CMS 2010 ICD-10/5010 National Provider Call
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The Centers for Medicare & Medicaid Services (CMS) will host a national provider conference call on ‘ICD-10 Implementation in a 5010 Environment’ on Tuesday, June 15, 2010 from 12 p.m. to 2 p.m. EDT. The target audience for this call includes: medical coders, physician office staff and provider billing staff, health records staff, vendors, educators, system maintainers and all Medicare fee-for-service (FFS) providers. Registration information for this national provider conference call will be announced soon, so hold the June 15th date now for this informative provider conference call. |
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UnitedHealth to Fill Temporary Gap in Health Coverage Facing 2010 College Graduates
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UnitedHealthcare will extend the health coverage that graduating college students currently have under their parents’ plans until the new health reform provision requiring dependent coverage up to age 26 is fully implemented.
As part of the Patient Protection and Affordable Care Act, young adults will be able to stay on their parents’ employer-offered or individual family health plans up until age 26. However, this extension does not begin to take effect for employer-sponsored plans until September 23, 2010.
UnitedHealthcare is acting to eliminate this coverage gap that some graduating students may face when losing their parents’ UnitedHealthcare health plan coverage upon graduation, and will work with its employer customers to implement the extension.
This extension of coverage applies to college students who currently are covered under their parents’ fully-insured health plan offered through UnitedHealthcare. Individual family health plans through UnitedHealthcare’s Golden Rule business already allow all dependents to stay on the plan until age 26 and enrollees do not need to take any action
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Unisys Update
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Unisys has scheduled regional training sessions for providers. Invitations are being sent to providers statewide. If you do not receive your invitation and information, you may contact the Unisys Provider Relations Department at 1-888-483-0793. Please note that some locations will have one session while others have two scheduled session. Registration for each session will begin at 8:15AM (morning sessions) and 1:00 PM (afternoon sessions). The following sessions have been scheduled:
Monday, June 7, 2010 Martinsburg--- Holiday Inn
Morning Session 9:00 AM –Noon
Tuesday, June 8, 2010 Morgantown--- Lakeview Golf Resort and Spa
Morning Session 9:00 – Noon Afternoon Session 1:30- 4:30
Wednesday, June 9, 2010 Flatwoods---Flatwoods Conference Center
Morning Session 9:00-Noon Afternoon Session 1:30- 4:30
Thursday, June 10, 2010 Huntington---Big Sandy Arena
Morning Session 9:00 – Noon
Friday, June 14, 2010 Beckley---Tamarack
Morning Session 9:00 –Noon Afternoon Session 1:30-4:30
Tuesday, June 15, 2010 Wheeling---Wheeling Park
Afternoon Session 1:30- 4:30
Wednesday, June 16, 2010 Mineral Wells/Parkersburg Holiday Inn
Morning Session 9:00-Noon
Thursday, June 17, 2010 Charleston---Civic Center
Morning Session 9:00-Noon Afternoon Session 1:30 – 4:30
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Practice Pointer
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Do you have I-9 forms on file for all your employees? All employees hired after November 6, 1986 and working in the United States must complete form I-9. The purpose of the form is to document that each new employee (both citizen and noncitizen) hired after that date is authorized to work in the United States.
There is no filing fee associated for completing form I-9. The form must be retained by the employer as part of the employee’s personnel record. It must be made available for inspection by the U.S. Government officials upon request. While submission of the information required in this form is voluntary, an individual may not begin employment unless this form is completed. Employers are subject to civil or criminal penalties if they do not comply with the Immigration Reform and Control Act of 1986.
The I-9 form may be obtained by downloading it from the US Citizenship and Immigration Services website at www.uscis.gov/forms.
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Farewell to an Outstanding Colleague
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Many of you know that Tim Allman, Community Education Administrator for Palmetto GBA OH/WV Medicare Part B, will be leaving Palmetto GBA as of Friday, May 28th. Tim has accepted an opportunity with another company where he will expand his knowledge in the healthcare arena.
Tim has been an incredibly valuable source of information and education for medical practices throughout West Virginia. His knowledge and commitment to Medicare education as well as to his customers, has made him a very credible source of information. His personality has endeared him to physicians and staff alike. He will be great missed by all of us!
I know I speak for many when I say that we wish Tim the best of luck in his new endeavor but will miss him greatly. Good luck, Tim!
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OMA News
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The WV State Office Managers Association (OMA) recently held a day long education workshop entitled Attitude and its Impact in the Workplace. Attendees learned many different strategies for dealing with attitudes, both their personal attitudes and those of the people in their offices.
The Statewide OMA conference is scheduled for Thursday and Friday, October 14th and 15th at the Pullman Plaza in Huntington, WV. For information as to how you may become a member of the OMA or of a local chapter, you may contact Barbara Good (Barbara@wvsma.com).
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May 19, 2010
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