If you’ve not registered for the WVSMA’s Healthcare Summit at the Greenbrier on August 27-29, there is still time to do so!   The Summit will feature a variety of topics which are of vital importance to physicians.   The agenda includes sessions on Prescription Fraud and Abuse, the latest updates on Health Information Technology and Health System Reform, as well as appearances by candidates who are running in West Virginia’s Key Congressional District Races.

In addition to the sessions, the West Virginia Medical Foundation will host a gala on Friday, August 27, to honor the inaugural recipients of the Foundation’s prestigious Excellence in Medicine Awards.

For additional information, including registration forms, visit the WVSMA’s website, www.wvsma.com.   The CAMC Health Education and Research Institute has designated this educational activity for a maximum of 7.75 AMA PRA Category 1 credits.  
 

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The WVSMA is excited to announce that we will be offering a second Certified Medical Office Manager Course in September!

Due to the success of the inaugural CMOM class, the WVSMA, in partnership with the Practice Management Institute (PMI), will again offer the four-day Certified Medical Office Manager (CMOM) class.  PMI is one of only three entities whose certification is recognized by Medicare and the WVSMA is proud to be the exclusive West Virginia partner for the CMOM certification.

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.

The 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, September 10 and Saturday, September 11, and then again on Friday, September 17 and Saturday, September 18.  The certification exam will be given on September 18.   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.   Discounted hotel rooms are available at the Embassy Suites.  Additional information will be sent to participants following registration.

The class size will be limited so interested managers should contact
Karie Sharp (Karie@wvsma.com) as soon as possible. 
 

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CMS Protest Notice: Jurisdiction 15 Medicare Administrative Contractor (MAC)

On July 9. 2010, CMS made a decision on the J15 Medicare Administrative Contract (MAC), which includes Medicare Parts A and B for Ohio and Kentucky.  Palmetto GBA had teamed with another contractor to submit a proposal for Ohio and Kentucky.  This proposal was not successful during the rebid process and CMS awarded the J15 MAC to CIGNA.

On July 23, 2010, a protest was filed with the U.S. Government Accountability Office (GAO) regarding CMS' award of the A/B Medicare Administrative Contractor (MAC) contract for Jurisdiction 15 to CIGNA Government Services (CGS).  The GAO is expected to issue its decision regarding the protest on or about October 31, 2010. This means that Palmetto GBA will continue to perform its existing functions in Ohio.

PQRI Update

CMS has announced an alternative process for individual eligible professionals to access physician quality reporting initiative (PQRI) and electronic prescribing (E-Prescribing) feedback reports.

Individual Eligible Professionals requesting reports based on their individual National Provider Identifier (NPI) now have an alternative means of accessing those reports. Physicians and other practitioners who qualify as individual under the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting Initiative (PQRI) and the 2009 E-Prescribing Incentive Program can request feedback reports through their claims processing contractor.  For additional information, please visit the website at
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7WUJP40467?opendocument

DHHS Issues EHR Regulations

The Department of Health and Human Services (HHS) recently issued its long-awaited regulations on electronic health records (EHRs). Under the regulations, the government will reward doctors and hospitals for the "meaningful use" of electronic health records. In many ways, the rule scales back requirements proposed in a draft regulation from the agency, which had been criticized for an all or nothing approach. Standards in the new rule are less demanding and more flexible for physicians and other providers. Doctors will have to meet 15 specific requirements, plus 5 chosen from a list of 10 objectives (rather than the 25 criteria requirement initially proposed), while hospitals will have to meet 14 requirements, plus 5 chosen from a menu of 10 goals.

Similarly, physician will have to transmit 40% of prescriptions electronically to meet the required standards, while under the proposed rule, 75% of prescriptions had to be sent electronically. A doctor can receive up to $44,000 under Medicare and $63,750 under Medicaid toward the purchase of EHR technology. Starting in 2015, hospitals and doctors will be subject to financial penalties under Medicare if they are not using electronic health records. On July 13, HHS published final rules outlining the requirements for what physicians must do in order to be a "meaningful user" of a "certified" EHR.

There are two incentive programs, one for Medicare and one for Medicaid. Congress created different subsidies and parameters for each program. For Medicare, physicians are eligible for up to $44,000 over five years starting in 2011 and incentives are predicated on 75 percent of the physician's Medicare allowed Part B charges.

For Medicaid, the incentives are based upon a physician's patient volume. For most physicians a Medicaid patient volume of at least 30 percent is required; for pediatricians it is 20 percent. Under the Medicaid program, physicians are eligible for up to $63,750 over six years beginning in 2011.

Physicians, practice managers and staff may learn more about Meaningful Use and the Incentive Programs at the 2010 Healthcare Summit which will be held on August 27-29 at The Greenbrier.   The Health Information Technology session will feature several speakers, among them Dr. Barbara Connors, Medical Director for CMS Region III.   Don’t miss this opportunity to learn first hand about the new opportunities for funding and technical assistance with HIT adoptions.

Protect Your Medicare Enrollment Record

 If you are a physician or non-physician practitioner who is enrolled in Medicare, or who is planning to enroll in Medicare, it is important that you protect your Medicare enrollment information from getting into the hands of dishonest and unscrupulous people.  The Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN) has released Medicare Fee-For-Service (FFS) Physicians and Non-Physician Practitioners:  Protecting Your Privacy – Protecting Your Medicare Enrollment Record as the first in a series of fact sheets designed to educate health care providers about important Medicare enrollment information.  This particular fact sheet advises FFS physicians on how to ensure their enrollment records are up-to-date and secure and is available in downloadable format at http://www.cms.gov/MLNProducts/downloads/MedEnrollPrivcy_FactSheet_ICN903765.pdf on the CMS website.
 

Electronic Prescribing (eRx) Incentive Program 2010 Updates

CMS is issuing a special edition article to alert providers that it is not too late to start participating in the eRx Incentive Program to potentially qualify to receive a full-year incentive payment. Eligible professionals may begin reporting eRx at any time throughout the 2010 program year of January 1, 2010, through December 31, 2010, to be incentive eligible.  For 2010, eligible professionals who successfully report the eRx measure will become eligible to receive an eRx incentive equal to 2.0 percent of their total Medicare Part B Physician Fee Schedule (PFS) allowed charges for services performed during the reporting period. Beginning in 2012, eligible professionals who are not successful electronic prescribers will be subject to a PFS payment adjustment or penalty.
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/87HJ2M3433?opendocument

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Many physician practices have expressed concerns and questions regarding future education events following the recent departure of Tim Allman, Community Education Administrator.   The WVSMA has been assured by Palmetto’s Medical Directors and administration that Palmetto will strive to offer the same support that had been provided in the past.  

Until a decision is made regarding the replacement of a Community Education Administrator, it was suggested that questions and concerns about Medicare issues be referred to Palmetto GBA via Physician Advocate Barbara Good, who will contact the appropriate person at Palmetto GBA.   

Palmetto Announces New Online Provider Services

As of June 21, 2010, all providers who have EDI enrollment agreements on file with Palmetto GBA can register for a new online provider service.   There is no charge to use this new service, which will allow practices to access information via internet, including beneficiary eligibility, claim status and remittances, and financial information.

Only one provider administrator per EDI enrollment agreement must register.   The administrator may then grant permission to other users related to that PTAN. 

In order to use the new online service, physicians must have an EDI agreement on file and they must also be submitting claims electronically.   For more information, visit the Palmetto GBA website, www.PalmettoGBA.com/bwv.  

Palmetto Reminder Regarding Timely Filing

Physicians are reminded that due to the Patient Protection and Affordable Care Act (PPACA or ACA) the time limit for filing claims has changed to one year from the date of service.   Claims with dates of service prior to 10/1/2009 must be filed by 12/31/2010.  Claims for the period 10/1/2009 – 12/13/2009 must be filed by 12/31/2010.   Claims for dates of service after 1/1/2010 must be filed within  one year of the date of service.

Small Provider Forum: Beckley, West Virginia

Palmetto GBA is sponsoring a Medicare Part B Update workshop in Beckley, West Virginia, on August 12, 2010, from 1 p.m. to 4 p.m. The workshop is specifically designed for providers with fewer than 10 full time employees.

The session will include Medicare updates and reimbursement changes and be followed by a question and answer session. All small provider specialty offices are welcome!
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/877KLS3814?opendocument

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Tricare recently announced that the contract originally received by Aetna had been terminated and was awarded back to Health Net.   The change came after a review by the Government Accountability Office (GAO) who agreed with Health Net’s protest over alleged improprieties by Aetna during the bidding for the Tricare contract.   

West Virginia is in Tricare’s North region which is covered by Health Net.   More than 3 million Tricare beneficiaries are served by Health Net.  
 

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MSBCBS Goes Paperless!

Mountain State recently announced that they are moving to paperless Explanations of Benefits (EOBs) Statements and Electronic Funds Transfers (EFT). 

Beginning October 1, 2010 and continuing through 2011, Mountain State will require network practitioners to enroll in NaviNet, receive paperless EOB statements and EFT.  These electronic transactions provide enhanced protection of both member and practitioner data and provide physicians with faster reimbursement.

Physicians who enroll in the EFT process will be required to receive a paperless EOB by either accessing NaviNet or by enrolling in the 835 HIPAA format as the means of receiving your EOB or Remittance advice.   Upon enrollment the paper version will no longer be mailed to your office.

The paperless provider EOB and facility remittance can be viewed in NaviNet under the AR Management option. 

Electronic Funds Transfer (EFT) is the process by which Mountain State deposits reimbursement directly into a provider’s bank account.   EFT provides a variety of benefits, including faster availability of payments, enhanced cash flow, and easier record storage.  Your office also saves money by reducing the need to keep paper forms, purchase envelopes and stamps, and invest time and labor on paper billing.

Physicians will be receiving additional information in the upcoming Provider News and other communications.  You may also contact your provider relations representative with specific questions. 

Mountain State Blue Cross Blue Shield Provider Workshops

Mountain State Blue Cross Blue Shield has announced the dates for their 2010 Provider Workshops.   For those unable to attend the workshops, the company plans to offer webinars.  These workshops are an excellent means of obtaining the latest news about the plan.

Here are the locations for the fall conferences.  Each conference will run from 8:00 AM – 12: 45 PM.  More information about the workshops and the webinars, as well as registration forms, is available on Mountain State website, www.msbcbs.com. 

Wednesday, September 15—Wheeling, WV—-Oglebay Park
Wednesday, September 22---Beckley, WV-------Tamarack
Wednesday, September 29---Parkersburg-------Mountain State Corporate Office
Wednesday, October 13-------Morgantown--------Lakeview Resort
Wednesday, October 19-------Charleston----------Holiday Inn Charleston House
 

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The WVSMA recently held a meeting with several officials from United Healthcare Group, including Dr. Edward Koza, Medical Director, Priscilla Butcher-Burnside, Network Contractor, and Rosemarie Watson, Provider Relations Representative.  They provided updates on United Healthcare’s policies and procedures, membership and network in West Virginia.  They also spoke briefly about the United Health Group settlement.  

More than $350 million is available in the UnitedHealth Group settlement fund to compensate physicians and their patients for 15 years of artificially low payments for out-of-network services. This settlement is the result of diligent work by the American Medical Association (AMA), the Medical Society of the State of New York and the Missouri State Medical Association. This settlement is the latest legal action in which the courts and regulators expose and prohibit a price-fixing scheme used by UnitedHealth Group and other health insurers to underpay physicians and patients for out-of-network care.
 
The AMA recommends that you file by October 5. 2010.  As a part of the UCR Settlement, UnitedHealth Group has agreed to make a settlement payment of $350 million, which will be distributed to physicians and patients whose payments for out-of-network services were based on skewed data from the insurer’s UCR database.

The AMA has created resources to aid physicians in filing a claim. Please visit www.ama-assn.org/go/ucrsettlement to access an educational webinar, a comprehensive FAQ list and a step-by-step guide to help maximize recovery of the settlement. Claim forms need to be completed and submitted by October 5, 2010. Don’t miss this opportunity to collect your share of the $350 million.

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The Office Managers Association (OMA) will hold their fall conference at Pullman Plaza in Huntington, WV, on Thursday, October 14 and Friday, October 15, 2010.   Brochures were mailed recently.   If you need a brochure, you may contact Rita Hope (rhope@wvdsl.net) or Barbara Good.

The West Virginia Medical Group Managers Association (MGMA) will hold their fall conference at Stonewall Jackson Resort in Roanoke, WV, on Wednesday, October 6 and Thursday, October 7, 2010. More details, including reservation information, will be coming soon from the WVMGMA.

Both of these conferences feature outstanding speakers and workshops.Physician practices can benefit greatly if their office administrator/manager attends.  For additional information, please contact Barbara Good (Barbara@wvsma.com).  

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• • 2010 Healthcare Summit Rapidly Approaching!
• • Another CMOM Class Available in September!
• • CMS News
• • Palmetto GBA Update
• • HeatlhNet News
• • Mountain State Blue Cross Blue Shield Update
• • United Healthcare Settlement Information
• • Save the Date For These Fall Conferences!
• • Tamper Resistant Prescription Pads and Paper Still Available!