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WVSMA Completes Second CMOM Class!
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The second CMOM (Certified Medical Office Manager) class was held on two weekends during September. The nineteen attendees who took the class and sat for the certification exam must now wait until late October for their scores. Attendees were unanimous in stating that the course had already been of great benefit to them in their practices.
The WVSMA commends the attendees for their interest in furthering their practice management knowledge. We also commend the physicians who encouraged and supported their managers in the effort to obtain the national CMOM certification.
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CMS Update
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(CMS supplied this information and asked that it be shared with the WVSMA)
CMS Makes Information about Physician Fee Schedule Payment Rates More Accessible
CMS has updated and enhanced the Medicare Physician Fee Schedule Lookup to allow the user to: download search results into a CSV file, modify search criteria without starting over, search on all available types of information at the same time (Pricing Information, Payment Policy Indicators, Relative Value Units and Geographical Practice Cost Index), and sort and view results table columns in ascending or descending order.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~896HMB1802?opendocument
Key Step in National Initiative Toward Adoption of Electronic Health Records (EHRs)
The Certification Commission for Health Information Technology (CCHIT), Chicago, Ill. and the Drummond Group Inc. (DGI), Austin, Texas, were named recently by the Office of the National Coordinator for Health Information Technology (ONC) as the first technology review bodies that have been authorized to test and certify electronic health record (EHR) systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health and Human Services earlier this year.
Announcement of these ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) means that EHR vendors can now begin to have their products certified as meeting criteria to support meaningful use, a key step in the national initiative to encourage adoption and effective use of EHRs by America’s health care providers.
Applications for additional ONC-ATCBs are also under review.
Certification of EHRs is part of a broad initiative undertaken by Congress and President Obama under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009. HITECH created new incentive payment programs to help health providers as they transition from paper-based medical records to EHRs. Incentive payments totaling as much as $27 billion may be made under the program. Individual physicians and other eligible professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid. Hospitals can receive millions.
For the complete press release, go to Initial EHR Certification Bodies Named.
For more information about the ONC certification programs visit http://healthit.hhs.gov/certification .
For information about the Medicare and Medicaid incentive programs, visit www.cms.gov//EHRincentiveprograms .
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CMS Schedules Webinar and "Open Door Forum" Call for WV Providers
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The Philadelphia Regional Office of the Centers for Medicare & Medicaid Services (CMS)will be hosting a webinar and “Open Door Forum call” for health care providers in West Virginia on Wednesday, October 6, 2010 from 4:00 p.m. to 5:30 p.m. The purpose of the webinar/call is to present an overview of the definition of “meaningful use” as well as the Medicare and Medicaid incentive payment programs that are part of the federal HITECH legislation and final rule. Congress enacted the HITECH legislation as a way to provide reimbursement payments to eligible hospitals and health care providers who implement certified electronic health record systems and achieve health improvement outcomes through “meaningful use." Those incentive payments will begin in 2011.
Participating in the webinar/call also will be representatives from West Virginia Regional HIT Extension Center (www.wvrhitec.org) and representatives from the W.Va. Medicaid agency who will be available to answer questions. There will be ample time at the conclusion of the presentations for questions and answers regarding HITECH.
Dial-in instructions and a link to the webinar page are as follows:
Dial-In Number: (866) 742-7165
Conference ID: 11084522
Webinar link: https://webinar.cms.hhs.gov/r44907053/
More information can be found here:
Official web site for the Medicare and Medicaid EHR Incentive Programs:
http://www.cms.gov/EHRIncentivePrograms/
Fact Sheet: Electronic Health Records At-a-Glance (July 13, 2010)
Fact Sheet: Medicare EHR Incentive Program Final Rule Overview (July 16, 2010)
Fact Sheet: Medicaid EHR Incentive Program Final Rule Overview (July 16, 2010)
Provided is a link to additional information about meaningful use: click to read
Information for Eligible Providers:
http://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_081010.pdf
Information for Hospitals:
http://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Hospital_Training_FINAL.pdf
Official Web Site for the W.Va. Regional HIT Extension Center
www.wvrhitec.org
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Medicare Participation Options
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From mid-November through December 31, physicians will have their annual opportunity to review and perhaps change their participation status with the Medicare program. Given the severe Medicare payment disruptions caused this year as Congress established, and then missed, multiple deadlines to stop payment cuts caused by the sustainable growth rate (SGR) formula, the WVSMA is encouraging physicians to prepare for this opportunity and review their options carefully.
To help physicians choose the direction that is right for their practices, the AMA has developed the “Know your options: Medicare participation guide.” This kit contains a detailed explanation of the three available options: participation (PAR), non-participation (non-PAR), and private contracting. It also includes a helpful revenue calculator and various sample materials to help physicians share information with current, new, and prospective patients.
In every year of the last decade, physicians have faced a significant Medicare payment cut. These cuts are a result of a flawed Medicare physician payment formula called the sustainable growth rate (SGR). Several times this year Congress was unable to pass legislation in time to avert cuts. As a result, Medicare carriers stopped processing claims in order to avoid paying them at the reduced rates.
Now, once again, physicians face a 23 percent cut in Medicare payments on Dec. 1, 2010, followed by an additional 6 percent cut on Jan. 1, 2011.
The West Virginia State Medical Association and the American Medical Association (AMA) will work vigorously to prevent these cuts. Physicians need to prepare contingency plans in the event Congress fails to act to avert the looming cuts of nearly 30 percent.
Physicians will have until Dec. 31, 2010, to modify their status with the Medicare program, and will want to carefully weigh their options. To help ensure that physicians are making informed decisions about their contractual relationships with the Medicare program, we are providing the following overview of the various participation options available. The AMA and WVSMA are not advising or recommending any of the three options. The purpose of the AMA’s toolkit is to ensure that physician decisions about Medicare participation are made with complete information about the available options.
The three Medicare options for physicians include:
Sign a Participation Agreement (PAR). By doing this, the physician accepts Medicare’s allowed charge as payment in full for all of their Medicare patients.
Elect Non-Participation Status (non-par). This option permits physicians to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims.
Become a Private Contracting Physician. This means that the physician may bill patients directly and forego any payments from Medicare to their patients or themselves. To become a private contractor, the physician must give 30 days notice before the first day of the quarter the contract takes effect.
Those considering a change in status should first determine that they are not bound by any contractual arrangements with hospitals, health plans or other entities that require them to be PAR physicians. In addition, some states have enacted laws that prohibit physicians from balance billing their patients. Physicians who want to continue their current PAR or non-PAR status do not need to take any action. However, those who want to change their status will need to notify their contractor in a written document that is received or post-marked on or before Dec. 31, 2010.
Those physicians who wish to change their status from PAR to non-PAR or from non-PAR to PAR are required to do so before Dec. 31, 2010, even if Congress fails to act in time to prevent the payment cuts on Dec. 1 and Jan. 1. Unless CMS reopens the enrollment period, this decision is binding throughout the calendar year.
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Palmetto GBA News
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J11 MAC Contract Awarded to Palmetto GBA
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.
On June 1, 2010, the Centers for Medicare & Medicaid Services (CMS) notified Palmetto that the U.S. Government Accountability Office (GAO) had received a protest of CMS' award to Palmetto GBA. The GAO denied the protest on September 9, 2010. Accordingly, Palmetto will be working closely with CMS in the coming days to begin work on implementation of the Jurisdiction 11 workload.
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. Palmetto GBA has one business partner for this contract, National Government Services, a subsidiary of Wellpoint.
Palmetto GBA will continue to share information through the Palmetto GBA Web site and listserv as more details become available regarding how these decisions will affect you, including transition plans and schedules. You may also reference the CMS article “Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC) or from one Durable Medical Equipment (DME) MAC to another DME MAC,” which is available on the CMS Web site (http://www.cms.gov/MLNMattersArticles/downloads/SE1017.pdf).
Medicare Advisory Subscription Form
The Centers for Medicare & Medicaid Services (CMS) is committed to providing excellent service to Medicare providers and patients using the most efficient and cost-effective means. One way to achieve this is to reduce administrative costs associated with printing and mailing paper. As a result, Palmetto GBA no longer automatically mails paper copies of Medicare bulletins to providers. They are produced for Internet access only. If you subscribe to the Medicare Advisory, we will mail a paper copy to you each month. The cost is $100 per fiscal year (October through September). If you are interested in subscribing, please complete a subscription form and mail it to the address indicated.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~7GLVME5656?opendocument
PECOS Dark Days
Due to scheduled maintenance, the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will be unavailable from Wednesday, September 29, 2010, through Sunday, October 3, 2010. Internet-based PECOS allows physicians, non-physician practitioners, providers and other suppliers to enroll or make a change to their existing Medicare enrollment information over the Internet.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~89CLB68565?opendocument
Provider Medicare Voluntary Refunds: Immediate Offset Requests Terminated
As of October 1, 2010, Palmetto GBA will no longer allow providers to request 'immediate offset' as a payment method relating to voluntary/self-disclosed Medicare overpayments. Providers must submit a check made payable to Palmetto GBA or Medicare with the overpayment refund form. If the check payee is addressed differently, the check will be returned to the provider. Overpayment refund forms received without check payment will be processed under established collection procedures mandated by CMS. As an alternative to this, providers may request an immediate offset once an overpayment has been established and a demand letter has been sent to the provider.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~899H6K5776?opendocument
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Federal Tax Credit for Small Employers
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Employee Health Plans
(The following information was provided by WV Medical Insurance Agency Manager, Steve Brown.)
Effective September 23, 2010, small employers with fewer than 25 employees will receive a maximum credit, based upon number of employees, of up to 35% of premiums for up to 2 years if the employer contributes at least 50% of the total premium cost. Businesses do not have to have a tax liability to be eligible. Nonprofits are eligible also. The average salary must be $50,000 or less for the covered employees.
For more information and a formula for determining eligibility for this federal tax credit, please call the West Virginia Medical Insurance Agency at 1-800-257-4747 (or locally 304-925-0342).
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Last Chance to Register for MGMA and OMA Conferences!
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Register Now! It’s not too late to register for these two upcoming conferences.
West Virginia Medical Group Managers Association Conference
The West Virginia Medical Group Managers Association (WVMGMA) will hold their fall conference at Stonewall Jackson Resort in Roanoke, WV, on Wednesday, October 6 and Thursday, October 7, 2010. More details may be found on the WVMGMA’s website, www.wvmgma.com.
Office Managers Association State Conference
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. If you need a brochure, you may contact Rita Hope (rhopecmom@gmail.com) or Barbara Good (Barbara@wvsma.com).
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West Virginia Medicaid News
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DHHR Postpones Planned Medicaid Changes
West Virginia state health officials have announced a delay in the plan to change the way many West Virginia Medicaid recipients receive their mental health benefits. The DHHR had planned to begin transitioning the approximately 55,000 people who receive Supplemental Security Income (SSI), as well as 160,000 recipients who receive cash assistance, into managed care programs for their behavioral health and dental benefits.
The plan, which was to have gone into effect in November (AFDC population) and December (SSI), will now be delayed until January 1, 2011.
The three managed care companies who are contracted to manage these benefits are Carelink, UniCare and The Health Plan of the Upper Ohio Valley.
West Virginia Medicaid Pharmacy Update
(This information provided by Vickie Cunningham, R. PH, Drug Utilization Review Coordinator Bureau for Medical Services)
West Virginia Medicaid has launched their ePrescribing program and an ePrescribing software tool is now available in the MediWeb Portal. Just click on the ePrescribing button in the MediWeb Portal and use your PIN number (assigned when you registered for the MediWeb Portal). This software application can be used for all of your patients, not just those covered by Medicaid. There is no charge for using the software and we hope that, if you do not already ePrescribe, you will take the opportunity to try out the process. Medicaid eligibility data has been downloaded to Surescripts, the national database provider for ePrescribing and our claims processor, Molina, is connected to the Surescripts database and will provide pharmacy history, formulary information and the prescription will be routed to the pharmacy of your patient’s choice. This process can eliminate the need for phone calls from pharmacies regarding prior authorization requests and also eliminates the need to use tamper-proof prescription blanks!! If you are currently ePrescribing for your other patients, you are now able to use your current ePrescribing software to send electronic prescriptions for your West Virginia Medicaid patients.
Virtual classroom have been developed with information about ePrescribing and the current environment for Health Information Technology, including Medicare incentives, privacy and security standards, federal and state laws regarding ePrescribing and practice readiness for HIT. The information can be found at http://www.wvescript.com/training_materials. This address can be copied and pasted in your web browser. Once there, click on Other Providers and two classrooms, Why ePrescribing? and Communications Basics are available to you.
If you need further information or have questions, please call 304-558-7309 or send an e-mail to DHHRMedicaideScripts@wv.gov.
For more information about the WV Medicaid Pharmacy program, you may contact Vickie Cunningham, R. PH, Drug Utilization Review Coordinator Bureau for Medical Services
Phone 304-558-6541 FAX 304-558-1542
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Carelink Update
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Carelink Health Plans has announced that the 2011 Provider Manual will be available on the plans’ website, www.carelinkhealthplans.com on November 1, 2010. Please visit Providers » Document Library. Traditionally, Carelink has provided CDs to the network providers. This year, they are going green and will produce a limited number of CDs to distribute to those providers who do not have internet access. If you would like a CD or a printed copy, please contact your Provider Relations representative. |
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Mountain State Blue Cross Blue Shield Provider Workshops
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Don’t miss out on the Mountain State Blue Cross Blue Shield 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 remainder of 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 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 Health Plan of the Upper Ohio Valley
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The Health Plan has a number of lines of business in West Virginia, including Commercial (HMO, PPO, and POS), Government Programs (PEIA, Medicare Advantage Plans and Mountain Health Trust/Mountain Health Choices Medicaid), and Employer Funded Programs.
The Medicare Advantage Plans include SecureCare HMO and SecureChoice PPO and the Medicaid Plans include the traditional Mountain Health Trust Program, as well as the Re-Design Mountain Health Choices.
At the present time, the Health Plan is the only remaining Managed Care option for PEIA enrollees.
The Health Plan plans a statewide expansion during late 2010 and 2011. For information about the Health Plan, you may contact Network Management Representative Roxanne Loughery (800-588-3911, ext. 6500) or Roxanne@healthplan.org.
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UnitedHealthcare Update
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Time is Running Out for Physicians to File for Settlement Funds
(This information supplied by the AMA)
With the deadline for filing a claim in the $350 million settlement with UnitedHealth Group looming, AMA President Cecil Wilson, M.D. has urged physicians not to wait until the last minute to file a claim.
The record-breaking settlement that resolved the AMA-led court battle with UnitedHealth will help compensate physicians for years of artificially low payments for out-of-network services. Physicians have until October 5 to postmark a settlement claim.
According to Dr. Wilson's blog:
"A key step at this stage in the claims process is asking the settlement claims administrator for a copy of the defendant’s report. This report indicates the covered out-of-network services and supplies provided to patients from Jan. 1, 2002, to May 28, 2010. It’s a starting point for the claims filing process and can save a tremendous amount of time that would otherwise have to be invested in compiling all of the information from scratch. "
Receiving the report may take a number of weeks. That’s why it’s so important for physicians to start now.
The AMA can help physicians get started with its "Step-by-step guide to maximizing your recovery from the UnitedHealth settlement." The AMA guide offers physicians downloadable copies of the required forms along with step-by-step assistance in determining eligibility, assembling documentation and filing a claim. The AMA also offers a comprehensive list of frequently asked questions to help physicians navigate the claims process.
The historic settlement with UnitedHealth resulted from a decade-long fight by the AMA, Medical Society of the State of New York and Missouri State Medical Association to remove the shroud of secrecy from the great black box used to calculate out-of-network payments.
Organized medicine's persistent efforts exposed a fundamental conflict of interest at UnitedHealth, and called into question the entire insurer-controlled system for paying out-of-network medical bills. This discovery produced meaningful insurance industry reforms that promise to benefit every physician and patient by keeping the system for determining out-of-network reimbursements free from further corporate manipulation.
However, assurances of future fair payment do not make up for years of shortchanging physicians. UnitedHealth owes what they should have paid in the first place and physicians should claim their fair share of the settlement now before time runs out.
Pursuant to Court Order, all Class Members have until October 5, 2010 to file their claim form to be eligible to receive monies from the Settlement Fund. When Class Members submit requests for claims data from the Claims Administrator, as described in the Class Notice at pages 4 and 8, or submits the claim information request form on page 15 they will be assigned an Initial Claim Number, which will satisfy the filing deadline. Once Class Members receive the requested claims data, they should submit their claim form directly to the Claims Administrator at the address shown, using the Initial Claim Number for identification purposes.
After the October 5, 2010 deadline, and after all requested claims data has been provided, the Claims Administrator will send a Deficiency Letters to any Class Member who has been assigned an Initial Claim Number but who has not yet submitted a complete and signed claim form, as well as to any Class Member whose submitted claim form is deficient in some manner. The Deficiency Letter will notify the Class Member of what has to be submitted as well as a new due date by which such new information must be supplied. All deficiencies in Class Members’ submissions to the Claims Administrator, including the lack of complete and signed claim forms for those class members assigned an Initial Claim Number, and the absence of all necessary evidence, must be resolved by the due date set out in the Deficiency Letter in order for Class Members to be eligible to receive their Recognized Losses from the Settlement Fund. Please note that the deadline for filing claim forms for those Class Members who did not submit requests for claims data to support their claims remains October 5, 2010.
UnitedHealthcare (UHC) to Reverse a Proposed Guideline That Required CT Report Documentation
UHC has agreed to revise its proposed guideline "Coverage Determination Guideline Rhinoplasty, Septoplasty and Turbinate Resection". The guideline has been revised to eliminate the requirement for CT scanning if patients refuse the scan or physicians believe it is unnecessary. In such cases, UHC will accept detailed clinical documentation that adequately demonstrates chronic and consistent nasal obstruction that is unresponsive to medication.
In addition, the requirement for photographs has been eliminated for all cases except those in which there is a post-traumatic nasal deformity.
UHC’s original guideline, which was to become effective October 1, 2010, would have required physicians to submit not only written documentation, but also a CT scan and 7 “high quality color” photographs prior to providing the service. Further, patient care would have been potentially compromised if the patient were exposed to unnecessary large doses of CT radiation.
Radiology Notification for Rendering Providers for Services Ordered by Non-participating Physicians
For claims with dates of service Sept. 7, 2010, and after, UnitedHealthcare requires rendering providers to submit notification for services ordered by non-participating physicians when no notification is on file, in accordance with the Radiology Notification protocol for commercial benefit plans set forth in the UnitedHealthcare Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide.
If the rendering provider does not provide notification for services ordered by a non-participating physician, the rendering provider’s claim will be denied for failure to provide notification and the member cannot be billed. Furthermore, UnitedHealthcare will uphold on appeal any claims denied for failure to provide notification that are appealed on the basis that the ordering physician is a non-participating provider.
As a reminder, if the ordering physician is a participating provider, the rendering provider should not provide notification to UnitedHealthcare – this is the responsibility of the participating ordering physician.
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Veterans' Benefits Administration Update
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(This information was supplied by Laura A. Finlay, Veteran Service Center Manager
VARO Huntington WV.)
The Veterans Benefits Administration (VBA) of the Department of Veterans Affairs (VA) received notification of final publication of the regulation governing Agent Orange cases. Most recently, 3 new disabilities were added to be recognized as presumptive conditions for Veterans who served in-country Vietnam. The 3 conditions included in the newest Agent Orange regulation are Ischemic Heart Disease, Hairy Cell Leukemia and other B-cell Leukemias, and Parkinson’s Disease. Congress will perform a budgetary review during the next 60 days. During this time, VBA is developing claims for Veterans with an expectation to pay benefits on completed claims by November 1, 2010.
As part of a VBA Innovation Initiative, a working group was formed to develop streamlined Disability Benefits Questionnaires to facilitate the expedited processing of claims for the 3 new presumptive conditions. Formerly known as Worksheets, the Questionnaires are designed for use by both private and VA physicians in connection with applications for VA disability benefits. Each Questionnaire is derived directly from the disability rating criteria contained in the VA Schedule for Rating Disabilities.
The Regional Office in Huntington is 1 of several sites processing Veterans' claims under the new Agent Orange presumptives. The use of Questionnaires completed by private physicians represents one example of VBA's efforts to simplify the claims process for Veterans. Expedited completion and return of these Questionnaires by private physicians will assist greatly in moving Veterans' claims forward for decision.
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September 28, 2010
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