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Mid-Winter Conference and Physician Practice Management Conference Update
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The WVSMA’s recently held Physician Practice provided great information and payor updates for attendees. Some of the payor information provided is included in this edition of the Wesgram Online. Also included is information from Medicare, the announcement of the Spring 2011 CMOM class and a special honor that has been awarded to the West Virginia Medical Journal. |
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2011 Certified Medical Office Manager (CMOM) Class Scheduled
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The 2011 CMOM class is scheduled for March. The CMOM certification, which is offered through an exclusive partnership with Practice Management Institute, is one of only three national certifications recognized by CMS.
The four day class will be held on Thursday, March 24, and Friday, March 25, then again on Thursday, March 31 and Friday, April 1, 2011, from 9:00 -4:00 PM at St. Francis Hospital in Charleston, West Virginia. Participants must attend all 4 days of the course.
The Embassy Suites Hotel is offering a reduced rate for participants in the class. Additional information is available on the WVSMA website. The class size will be limited so register early in order to avoid missing out on this great opportunity.
Registration for the CMOM class may be done via the WVSMA website, www.wvsma.com or by calling Karie Sharp at (304) 925-0342, ext. 12.
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2011 Electronic Prescribing (eRx) Incentive Program Update
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(Information furnished by CMS)
In November, the Centers for Medicare & Medicaid Services announced that beginning in 2012, eligible professionals who are not successful electronic prescribers may be subject to a payment adjustment. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.
The payment adjustment in 2012, with regard to all of the eligible professionals’ Part B-covered professional services, will result in the eligible professional or group practice receiving 99% of the Physician Fee Schedule (PFS) amount that would otherwise apply to such services. In 2013, the eligible professional will receive 98.5% of their covered Part B-eligible charges if they aren’t a successful electronic prescriber. In 2014, the penalty for not being a successful electronic prescriber is 2% resulting in eligible professionals receiving 98% of their covered Part B charges.
For purposes of determining which eligible professionals or group practices are subject to the payment adjustment in 2012, CMS will analyze claims data from January 1, 2011- June 30, 2011 to determine if the eligible professional has submitted at least 10 electronic prescriptions during the first six months of calendar year 2011. Group practices reporting as a GPRO I or GPRO II in 2011 must report all of their required electronic prescribing events in the first six months of 2011 to avoid the payment adjustment in 2012.
Please see the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources.
If an eligible professional or selected group practice wishes to request an exemption to the eRx Incentive Program and the payment adjustment, there are two “hardship codes” that can be reported via claims should one of the following situations apply:
G8642 - The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act.
G8643 - The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act
G8644—The eligible professional practices may indicate that they do not have prescribing privileges. Reporting this G code will prevent the practitioner from being subjected to a payment adjustment in 2012.
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The West Virginia Medical Journal Wins Gold Prize In Its Category
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Bethesda, MD--The West Virginia Medical Journal has been honored with the gold award in Scholarly/Technical/Scientific Journal – Organization budget up to $1 million” in Association TRENDS 2010 All-Media Contest. It was one of more than 470 entries in the association publications contest.
“We are so pleased to be in the winners circle this year. We would like to thank the volunteer members of the Publications Committee who lend their time to complete peer-reviews of all scientific manuscripts, the West Virginia medical schools, and our advertisers and members for their support,” said Angie Lanham, Managing Editor.
Since 1906, the West Virginia State Medical Association (WVSMA) has published the state’s only peer-reviewed journal, the West Virginia Medical Journal, which offers a variety of scientific and special articles of interest to physicians. The Journal also publishes West Virginia medical school news, practice management updates, the Bureau for Public Health news, guest editorials and news of the West Virginia Medical Insurance Agency. The Journal highlights legislative news on the local and national levels and publishes a yearly CME special issue.
The TRENDS All-Media Contest is an annual competition held exclusively for associations, recognizing the most creative and effective communication vehicles developed in the industry over the prior year. The 2010 competition included more than 470 entries in 27 categories of association communications.
Association TRENDS is the national newspaper for association executives and suppliers, spotlighting the latest news, information and trends in association management for the professional staff of international, national, state, regional and local voluntary organizations.
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Blue Cross Blue Shield Update
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As of January 17, 2011, Mountain State became Highmark Blue Cross Blue Shield West Virginia (“Highmark West Virginia”). The plan emphasizes that only the name has changed; the company’s commitment to service for physicians remains the same. Members will continue to carry their Mountain State Blue Cross Blue Shield identification cards for an undefined period of time but will gradually be transitioned to new ID cards bearing the new company name and logo.
Any questions about the change should be addressed to your External Provider Relations Representative.
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Carelink Health Plans (Coventry)
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Carelink has announced that HEDIS measurements and reporting is now available for select Coventry Medicaid plans via Directprovider.com. As of Monday, December 20, 2010, Coventry implemented access for HEDIS (Health Effectiveness Data and Information Set) for Carelink Medicaid. HEDIS data rates are statistical representations of a provider’s or member’s compliance or non-compliance with certain prescribed care measures.
Physicians may access the HEDIS information on the Directprovider.com website through the eligibility function or by clicking “HEDIS REPORTS” in the left navigation. For additional information, contact your Coventry Medicaid Provider Relations Representative.
Also, the 2011 Preauthorization list for Carelink is available on the website. Several changes have been made to the 2011 list. Please check the website or contact Customer Service for the most current list.
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UnitedHealthcare Update
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WVSMA staff and several physician offices recently met with Dr. Ed Kosa, Medical Director for UnitedHealthcare, to discuss the plan’s new initiatives. UnitedHealthcare’s Premium Designation Program and Cardiology Notification Program were two of the new programs discussed. Additional information on both programs may be obtained on their website, www.UnitedHealthcareOnline.com.
The plan has approximately 96,000 members in West Virginia at this time. This number includes their fully insured business, their national accounts and their Medicare Advantage plan.
The UnitedHealthcare Provider Administrative Guide is now available. On December 27, 2010, postcards were mailed to 392,127 physicians, health care professionals, facility and ancillary providers notifying them of the release of the 2011 UnitedHealthcare Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide.
The new 2011 UnitedHealthcare Provider Administrative Guide will be effective April 1, 2011 for all participating physicians, health care professionals, facilities and ancillary providers. For those newly participating on or after January 1, 2011, the Guide becomes effective immediately.
To view the 2011 administrative guide, please visit the UnitedHealthcare Administrative Guides page at the website, www.UnitedHealthcareonline.com.
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The Health Plan of the Upper Ohio Valley
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The Health Plan of the Upper Ohio Valley is continuing its statewide expansion throughout 2011. Their commercial lines of business include HMO, PPO and POS, while the Government programs include PEIA, Medicare Advantage Plans and Mountain Health Trust/Mountain Health Choice Medicaid.
The Health Plan is totally electronic, with claims, vouchers and electronic funds tranfers. Claims are to be filed within 180 days.
The plan’s secure provider website, www.healthplans.org, has a provider tab where all information is available by a simple “click”. Members have a separate secure log on where they may access copays, coverage, and obtain other information.
The Health Plan’s new preauthorization notification requirements are now available. Reauthorizations may be done online or via phone.
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Palmetto GBA News
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Waiver of Coinsurance and Deductible for Preventive Services, Section 4104 of The Affordable Care Act, Removal of Barriers to Preventive Services in Medicare
Change Request (CR) 7012, from which this article is taken, implements the changes in Section 4104 of The Affordable Care Act. The CR announces that (effective for dates of service on or after January 1, 2011) Medicare will provide 100 percent payment for the initial preventive physical examination (IPPE) and the annual wellness visit (AWV). It also provides 100 percent payment for preventive services that are identified with a grade of A or B by the United States Preventive Services Task Force (USPSTF) for any indication or population, and are appropriate for the individual.
Essentially this means Medicare will waive any coinsurance or copayments for the services mentioned above.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8BYMHN4633?opendocument
Claims Rejected Incorrectly
Palmetto GBA has incorrectly rejected some claims with valid CPT and HCPCS codes. The affected claims were submitted to Palmetto GBA on December 17, 20 and 21, 2010. The claims were erroneously rejected with remark code
Credentialing Changes: Submit Updated Information Timely
Credentialing Changes
When there is a change in your practice or facility that affects your credentialing information on file with Palmetto GBA, it is important that you submit updated information. Use this checklist to ensure that your changes are submitted on time.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8D2TPR1776?opendocument
Primary Care Incentive Eligibility Tool
For primary care services furnished on or after January 1, 2011 and before January 1, 2016, a 10 percent incentive payment will be provided to primary care practitioners. CMS has provided Palmetto GBA with a list of the National Provider Identifiers (NPIs) of the primary care practitioners eligible to receive the incentive payments. Use the Primary Care Incentive Eligibility tool to find out if you are eligible to participate in the Primary Care Incentive Program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8CLLZQ2172?opendocument
Timely Claims Filing Requirement: Important Information
Effective immediately, the Centers for Medicare & Medicaid Services (CMS) would like to remind Medicare fee-for-service physicians, providers and suppliers, who are submitting claims to Medicare for payment, all claims for services furnished on or after January 1, 2010, must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service or Medicare will deny them. This is a result of the Patient Protection and Affordable Care Act (PPACA).
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8C5UT62660?opendocument
Registration Now Open for Medicare and Medicaid Electronic Health Record
(EHR) Incentive Program
The Centers for Medicare & Medicaid Services (CMS) encourages eligible professionals, eligible hospitals and critical access hospitals to register for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as possible. You can register before you have a certified EHR. Register even if you do not have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS).
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8CTGUS3370?opendocument
Billing Question Addressed:
If a patient presents to the office for an injection or venipuncture, would it be acceptable to submit an office or other outpatient visit CPT code?
If the only service provided was an injection or venipuncture, Palmetto GBA will not reimburse CPT code 99211 unless another unrelated service is provided and the requirements for CPT code xxxxx have been met. Example:
The patient presents to office for routine blood work; however, he/she started on a new medication for hypertension and the provider requested him/her follow-up with the ancillary staff for a blood pressure check and response to medication.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~86FJWQ6122?opendocument
Medicare Medical Records: Signature Requirements, Acceptable and Unacceptable Practices
The Centers for Medicare & Medicaid (CMS) guidelines mandate the presence of signatures for 'medical review' purposes. However, records pertaining to any procedures billed to Medicare are potentially subject to review by not only Palmetto GBA, but other CMS contractors. Because of this, we are alerting you to the importance of these signature requirements and if changes are needed, we suggest you take immediate action.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~84HSY38833?opendocument
Get Ready for Version 5010
In January, the health care industry will have less than a year left to prepare for the Version 5010 transaction set change on January 1, 2012. To assist with compliance, the Centers for Medicare & Medicaid Services (CMS) is supporting an education effort, Get Ready 5010, that will kick off with a series of free Webinars scheduled from January 11 through 13, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8CMKB31537?opendocument
Medicare Remit Easy Print (MREP) Enhancement
The MREP software is made available to Medicare providers who may want to use the software to print their electronic remittance advice records without having to purchase software on their own. Effective July 1, 2011, the software is being modified to be compatible with Microsoft Windows 7
(32 or 64 bit), Vista (32 or 64 bit), and XP (32 or 64 bit) operating systems. If you wanted to use the MREP software, but have not done so because it was not compatible with your computer’s operating system, this enhancement may make MREP a viable option for you.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8CMGEM0248?opendocument
Revisions to Claims Processing Instructions for Services Rendered in Place of Service Home
Effective for claims processed on or after January 1, 2011, claims submitted on the CMS-1500 claim form with place of service ‘home’ (12) must include the address and 5-digit ZIP code (or the 9-digit code when
required) of the location where the service was provided. Claims that are submitted without the required information will be ‘returned as unprocessable’ and must be corrected and resubmitted as new claims. These instructions do not apply to electronic claims submitted to Palmetto GBA in the ANSI 4010A1 format.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~87YM4G7110?opendocument
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January 31, 2011
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