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Protest Filed Following MAC Award to Palmetto GBA
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On May 25, 2010, Palmetto GBA was awarded the A/B Medicare Administrative Contractor (MAC) contract for Jurisdiction 11 and Home Health and Hospice MAC Jurisdiction C.
The Medicare Part A and Part B MAC for Jurisdiction 11 is comprised of North Carolina, South Carolina, Virginia and West Virginia. It also includes Home Health and Hospice MAC Jurisdiction C, which covers Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Texas.
On June 1, 2010, the Centers for Medicare & Medicaid Services (CMS) notified Palmetto GBA that the U.S. Government Accountability Office (GAO) had received a protest of the CMS award to Palmetto GBA.
This has resulted in a Stop-Work Order in accordance with Federal Acquisition Regulations. Palmetto GBA has been directed to immediately stop all work in support of the contract. This Stop-Work Order is effective until the final resolution of the protest. Palmetto GBA anticipates a decision from the GAO on or about September 8, 2010.
The "stop work" means that Palmetto GBA won't do anything regarding the J11 contract but will continue to do "business as usual". This should have no effect on physician reimbursement.
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Chart Auditing Class to be Offered Again in July
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The WVSMA, in partnership with Practice Management Institute, will offer a one day Chart Auditing for Physician Services class on Saturday, July 10th, 2010. The Chart Auditing class which was held in May was such a success that we are offering it again. This class is appropriate for physicians, coding and billing professionals, compliance officers and practice administrators. Participants will gain excellent comprehension in the following areas:
Adapting a systematic approach to cross-checking records
Improving communication with physicians and staff about chart documentation
Ensuring that appropriate levels of service are billed
Verifying appropriate levels of history, exam, and medical decision-making
Properly evaluating the nature of the presenting problem
Billing consultations versus other E/M services
Learning a step-by-step process to implement an internal audit program
The Chart Auditing class will take place at St. Francis Hospital in Charleston, West Virginia, on Saturday, July 10th, from 9:00 – 4:00 PM. All attendees must bring current editions of the CPT and ICD-9-CM Volumes 1 and 2 to the class.
Tuition for the class is $249. WVSMA physicians and staff, along with members of the Inaugural CMOM class, may attend for $199. The class size is limited so please register today by contacting Karie Sharp at the WVSMA (304) 925-0342, ext. 12, or karie@wvsma.com.
The WVSMA is proud to be the exclusive West Virginia partner for Practice Management Institute classes. PMI is one of three accrediting agencies that are recognized by the Centers for Medicare and Medicaid (CMS).
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House Passes Short-Term SGR Relief
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On Friday, May 28, 2010 the House passed an amended version of H.R. 4213, the “American Jobs and Closing Tax Loopholes Act of 2010,” which includes provisions to suspend Medicare physician payment cuts produced by the sustainable growth rate (SGR) formula for 19 months. In lieu of the 21 percent cut originally scheduled for 2010, the House-passed proposal would implement a 2.2 percent payment update for the remainder of this year, and a 1 percent payment update for 2011. In 2012, the SGR formula will resume, with an estimated 33 percent payment cut taking effect that year.
The SGR provisions were voted on separately from the rest of the legislation, passing on a bipartisan vote of 245 to 171.
Because the Senate adjourned for the week-long Memorial Day Recess, it will not vote on the legislation until after it returns on June 7. This represents the third time in 2010 that Congress has missed a deadline, causing a Medicare payment cut to take effect. As was previously the case, the Centers for Medicare & Medicaid Services has instructed its carriers to hold Medicare claims for services provided on or after June 1 for 10 business days, until June 14, which should provide sufficient time for Congress to stop implementation of the cut retroactively.
Physicians are encouraged to contact Congress to explain how its mismanagement of the Medicare program is wreaking havoc on their practices. They may use the AMA grassroots hotline (1-800-833-6354).
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Red Flags Rule Delayed Again
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The Federal Trade Commission (FTC) announced on May 28, 2010, that they are delaying the compliance deadline for the red flags rule until December 31, 2010.
For the past two years, the AMA has made the case to the FTC that physicians are not creditors like banks and lenders; therefore, the red flags rule should not apply to them.
Last week, the AMA filed a lawsuit asking a federal court to prevent the FTC from extending the red flags rule to physicians. The latest extension to the compliance date is a promising sign that the AMA lawsuit has caught the attention of the FTC.
Last November, a federal court blocked the rule from being applied to attorneys after the FTC was found to be extending its regulatory power beyond that authorized by Congress. The AMA hopes that this latest extension will be long enough for the FTC to take a good, hard look at the Red Flag Rule and exclude physicians from this regulation.
As always, the WVSMA will keep you informed of compliance issues relating to the Red Flag Rules.
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United Health Care Meeting
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The WVSMA has scheduled a meeting with Dr. Edward Kosa, one of United Health Care’s National Medical Directors, on Friday morning, July 16th, 2010 at the WVSMA office. Dr. Kosa is interested in meeting with West Virginia physicians to discuss any issues or concerns with United Health Care’s policies. If you would like to attend this meeting, please RSVP to Barbara Good (Barbara@wvsma.com) or via phone (304) 925-0342, ext. 11. If there is sufficient interest, we will schedule an additional meeting on the evening prior (Thursday, July 15th).
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CMS Distributes 2008 PQRI Payment Adjustments
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As a result of AMA advocacy, the Centers for Medicare & Medicaid Services (CMS) created an inquiry process for physicians who believe mistakes were made in calculating their payments under the Physician Quality Reporting Initiative (PQRI). For 2008, CMS received a number of inquiries that identified apparent discrepancies between the estimated physician payment schedule allowed charges reported in the CMS feedback reports and the physician’s own records. Following a careful review, CMS identified inaccuracies in its calculations of total estimated allowed charges that were used to determine the 2008 incentive payments. These inaccuracies involved eligible professionals who submitted claims for reconsideration or claims for which Medicare was a secondary payer, and affected a large portion of program participants who satisfactorily reported in 2008. CMS is in the process of distributing the additional payment adjustments. For more information about these adjustments, please visit http://www.cms.gov/PQRI/downloads/PQRI_2008. |
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6-Month Reporting Period for PQRI Begins July 1, 2010
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It is not too late to start participating in the 2010 PQRI program and potentially qualify for incentive payments. The new six-month reporting period begins on July 1 and extends through December 31, 2010. Eligible professionals who satisfactorily report PQRI measures for the 6-month reporting period will become eligible to receive a PQRI incentive payment equal to 2.0 percent of their total Medicare Part B allowed charges for services performed during that time. |
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AMA News
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The American Medical Association (AMA) has released its “Health Insurer Code of Conduct Principles,” calling on all U.S. health insurance companies to adopt consistent corporate practices that will bring transparency and accountability to the multibillion-dollar health insurance industry.
The Health Insurer Code of Conduct Principles were created as a result of the New York Delegation’s Resolution 823 presented at the 2008 AMA Interim Meeting, “Health Insurance Code of Conduct,” that was unanimously adopted by the AMA House of Delegates. This resolution directed the AMA to:
develop a Health Insurer Code of Conduct that sets forth clear and concise principles for health insurers to follow when setting and administering medical care and payment policies;
seek concurrence among health insurers in complying with the Health Insurer Code of Conduct; and
develop a mechanism to monitor compliance with this Health Insurer Code of Conduct.
More than 200 AMA Delegates participated in a survey of the draft Health Insurer Code of Conduct Principles at the 2009 AMA Interim Meeting and overwhelmingly supported the principles. Additionally, numerous Federation organizations have co-signed the letter that was sent to the major national health insurers, the Blue Cross Blue Shield Association and America’s Health Insurance Plans, asking them to pledge their commitment to the Health Insurer Code of Conduct Principles.
A copy of the letter is now posted at www.ama-assn.org/go/codeofconduct under “Help promote and enforce the AMA Code of Conduct”.
Physicians can visit www.ama-assn.org/go/codeofconduct to access a helpful resource toolkit that empowers physicians and their advocates to monitor health insurer compliance with the Health Insurer Code of Conduct Principles. The toolkit includes information on:
Relevant provisions of federal health reform legislation.
Relevant state managed care laws available through the AMA’s National Managed Care Contract.
Model legislative bills available through the AMA’s Advocacy Resource Center.
Health insurer fines, financial information and CEO compensation for the largest national health insurers.
Details on national legal settlements against health insurers.
Filing an online complaint through the AMA Click and Complain Health Insurer Complaint Form.
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WVHIN Update
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(This information submitted by the WVHIN)
The West Virginia Health Information Network (WVHIN) received a Federal award from the Office of the National Coordinator in February 2010 to establish West Virginia’s Health Information Exchange (HIE). The Federal funding will be used by the WVHIN to build a secure electronic health information system for the exchange of patient data among physicians, hospitals, diagnostic laboratories, other care providers, and other stakeholders. Currently, critically important patient data is often fragmented and residing in silos that do not communicate with each other. The WVHIN’s HIE will connect providers and others electronically to enable clinical information and administrative data to be shared between organizations.
The WVHIN has added new team members to its staff, and is currently going through the final stages of an extensive review process to select a technology partner. The WVHIN has worked with a broad group of stakeholders to develop and review Request For Proposal (RFP) criteria. Over 100 vendor organizations attended a bidder’s conference for instructions to submit proposals in response to the RFP. Eleven proposals were scored for their ability to meet all of the technical, privacy and security, and implementation support requirements. Five finalists will provide live demonstrations of their product and services at the Charleston Civic Center in June 2010. The WVHIN is engaging many providers in the selection process, and is actively seeking provider responses regarding the most needed HIE functionality for achieving meaningful use and enabling better coordination of care. Additionally, the WVHIN and is coordinating with multiple organizations and associations to shape the exchange.
The next steps for the WVHIN will be standing up exchange services with its new technology partner, and increasing its statewide name recognition and presence. WVHIN will work simultaneously to establish the Health Information Exchange while focusing in on the first region of the state to pilot services. WVHIN will focus on increasing participation across the state until statewide implementation is achieved.
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Department of Veterans Affairs News
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(This information submitted by Veterans Administration)
The Department of Veterans Affairs includes Veterans Health Administration (VHA), Veterans Benefits Administration (VBA) and National Cemetery Administration (NCA). The Regional Office in Huntington, West Virginia, administers to Veterans and their families VBA benefits to include Compensation and Pension, Vocational Rehabilitation & Employment Services and also education benefits by way of an Education Liaison housed at the Huntington office.
As an advocate for Veterans, VBA’s Huntington Regional Office seeks to find new ways to provide information to Veterans about benefits available to them and also provide such information to third parties in an effort to ensure awareness and opportunity for the existing benefits.
By reaching out to the State medical community, VBA’s Huntington Regional Office seeks to provide information about disabilities which may entitle Veterans to benefits and also generally explain the types of benefits available and also the process by which claims are developed on behalf of Veterans.
The private medical community plays an important role in how quickly VBA can process a Veteran’s claim. VBA is required to seek out medical evidence in support of a Veteran’s claim and will do so based upon any information a Veteran can provide. VBA’s process mandates that medical evidence be requested if a Veteran references it. VBA Form 21-4142 is provided as a release of information signed by the Veteran. VBA cannot pay for copies of medical records in support of Veteran claims. Pre-paid envelopes are provided with the medical records request in an effort to expedite the receipt of records at the Huntington Regional Office.
Compensation is a monthly monetary benefit available to Veterans who demonstrate a diagnosed disability and can connect that disability to their military service. For example, if a Veteran entered military service with no sign of any hearing problems but then left military service and demonstrated hearing loss or otherwise has service treatment records showing some trauma to the ear, it is possible VBA can “service-connect” hearing loss for the Veteran thereby potentially entitling the Veteran to a monthly monetary benefit, healthcare for the disability, and more.
Pension is a monetary benefit available to Veterans who served in a recognized wartime period who meet a certain level of disability and income requirements. For this benefit, a Veteran’s disability may not be at all related to military service.
VBA recognizes certain conditions as “presumptive” to a Veteran’s military service. For example, a presumption of service connection for AL amyloidosis based on exposure to herbicides used in the Republic of Vietnam during the Vietnam era was established effective May 7, 2009 (Federal Register 74 FR 21258).
On October 13, 2009, Secretary Shinseki announced that hairy cell and other B-cell leukemias, Parkinson’s disease, and ischemic heart disease will be added to the list of diseases presumptively associated with exposure to certain herbicide agents. Although the public announcement has been made, the amendment to 38 CFR 3.309(e) is not yet effective; however, Veterans can file claims now and they will be adjudicated when the regulation is finalized.
The Agent Orange Act of 1991 established a procedure for adding diseases to the list of disabilities presumptively associated with herbicide exposure. The procedure requires the Secretary of the Department of Veterans Affairs to consider reports received from the National Academy of Sciences’ Institute of Medicine (IOM) and all other sound medical and scientific information and analysis on the health effects of herbicide exposure before making a decision on presumptive service connection. Previously, under this guidance, VBA acknowledged Diabetes as a presumptive condition as well.
As a medical professional, if you are treating a patient and note any of the disabilities mentioned in this article, ask your patient, "Are you a Veteran? Have you filed a claim for benefits?”. Moreover, if you know your patient is a Veteran, simply remind them they may be entitled to benefits. Veterans should call 1-800-827-1000 for more information about benefits or to file a claim. To file a claim online, Veterans may refer to vabenefits.vba.va.gov/vonapp.
Please join us in advocating for our Nation’s heroes
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June 04, 2010
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