| |
News From the American Medical Association (AMA)
|
|
| |
The AMA is advocating for a standard format for payer contracted price/fee schedules to enhance accuracy and transparency in the claims process. Your feedback can help enhance accuracy and transparency in the claims process.
The AMA would like to learn from your knowledge and expertise in the physician practice. Please take a few minutes to provide your feedback on a survey that will help facilitate the development of a standardized format for electronic payer contracted price/fee schedules, which could be uploaded into any practice management system. The AMA is committed to helping physicians take charge of the business side of their practice, and the data collected from the survey will help us in our efforts to help you.
Please visit the following Web page to begin the survey:
http://survey.qualtrics.com/SE/?SID=SV_9KTQUCBSpi5ivHK
The survey will close March 1, 2011. If you have any questions, please contact Gail Ogden at gail.ogden@ama-assn.org or (312) 464-4632.
|
|
|
Top
|
| |
Are You Ready for the Next Generation of Coding?
|
|
| |
October 1, 2013, is the scheduled compliance date for implementation of the ICD-10 codes. The new system, officially known as International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) will enhance accurate payment for services rendered. It is also expected to facilitate evaluation of medical processes and outcomes. The new classification system gives greater detailed information and the ability to expand in order to capture additional advancements in clinical medicine.
The current system, ICD-9, is thirty years old and often doesn’t provide the necessary detail for some patients’ medical conditions or the procedures and services performed on hospitalized patients. The ICD-9 system is said to use outdated and obsolete terminology and can’t accurately describe the diagnoses and inpatient procedures of care delivered in the 21st century.
The ICD-10 codes will replace the ICD-9 diagnosis codes for use in outpatient and inpatient settings and will replace ICD-9 procedure codes for inpatient settings as of October 1, 2013.
The new classification system (ICD-10-CMS/PCS) consists of two parts. The first part, ICD-10-CM, was developed by the Centers for Disease Control and Prevention for use in all United States healthcare treatment settings. Diagnosis coding under this system uses 3-7 alpha and numeric digits and full code titles, but the format is very much like the ICD-9-CM.
The second part of the new system, the ICD-10-PCS, was developed by the Centers for Medicare and Medicaid Services (CMS) for use in the United States for inpatient hospital settings ONLY. The new procedure uses 7 alpha or numeric digits while the current ICD-9-CM coding system uses 3 or 4 numeric digits.
A number of countries are already using the ICD-10 codes, including the United Kingdom, France, Australia, Germany and Canada.
Physician practices need to ensure that their technology will be ready for the October 1, 2013 compliance date. It sounds a lot farther away than it really is! Physicians and staff will need to have training on the new coding.
Organizations across the country, including the WVSMA plan to offer training for physicians and staff as the compliance deadline nears. Stay tuned and watch for upcoming coding workshops!
|
|
|
Top
|
| |
CMOM Course to be Offered Again
|
|
| |
Due to popular request, the WVSMA is offering a Spring CMOM class for our office managers and physicians!
The Spring 2011 CMOM (Certified Medical Office Manager) 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 CMOM Course is an all-inclusive class and participants receive all materials necessary for the training. The Certification Examination is given on the final day of the class.
The CMOM course content includes modules in Financial Management, Managed Care and the Medical Practice, Practice Administration, and Personnel & Time Management in the Medical Practice.
Managers will learn how to initiate policies and protocols that will improve, protect and stabilize the financial security of the practice. They will receive expert guidance on the types of managed care, how to participate more selectively with the managed care plans, and how to be in full compliance with HIPAA and the OIG.
The Practice Administration and Personnel Management Modules will ensure that your practice hires and retains the best employees possible. Managers will also learn the labor laws for personnel so that your practice will be in full compliance.
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.
Register soon for this outstanding class!
|
|
|
Top
|
| |
WVMGMA Conference Scheduled
|
|
| |
The West Virginia Medical Group Management Association (WVMGMA) has planned a Spring Symposium Meeting that promises to be full of great information about issues that affect medical practices daily.
The meeting will be held on Friday, March 11, 2011, at the Marriott Hotel in Charleston. The registration desk will open at 7:30 A.M., with the Symposium starting promptly at 8:30 A.M.
A block of hotel rooms have been reserved with the Marriott at $131.00 per night plus tax. Please call the Marriott directly at 304-345-6500 or 800-228-9290 and tell the reservation clerk that you are with the WV Medical Group Management Association in order to receive this special room rate. Reservations need to be made as soon as possible to receive the group rates.
For additional information, contact WVMGMA President John Trout (jtrout@greenbrierphysicians.com) or Barbara Good (Barbara@wvsma.com).
|
|
|
Top
|
| |
OMA Meetings Scheduled
|
|
| |
The Charleston Office Managers Association will meet on Thursday, March 10, 2011, at 11:15 at the WVU Building at CAMC Memorial Hospital, 3110 MacCorkle Avenue, SE. Lunch will be provided for the meeting. The program will include updates from Palmetto GBA and Molina Healthcare. The lunch is free for OMA members and $20.00 for non-members.
This is a great time to learn about all the payor updates, as well as network with other physician office managers. To register, please contact Connie Frazier (eyeconnie@gmail.com).
The Huntington Chapter of the OMA will meet on Wednesday, April 13, for a luncheon meeting and insurance seminar. The group will meet in the Heart Center at St. Mary’s Hospital. Contact Pam Shafer (pamela.shafer@camc.org) for reservations and additional information.
|
|
|
Top
|
| |
AAPC Meeting Scheduled
|
|
| |
The Charleston Chapter of the American Association of Professional Coders (AAPC) will meet on Tuesday, March 22, at 8:30 A.M. at the WVU Building at CAMC Memorial. The program on "Physician Advocacy” will be given by WVSMA’s Amy Tolliver and Barbara Good |
|
|
Top
|
| |
CMS News
|
|
| |
Reprocessing Claims Affected by the Affordable Care Act and 2010 Medicare Physician Fee Schedule Changes
On March 23, 2010, President Obama signed into law the Affordable Care Act. Various provisions of the new law were effective April 1, 2010, or earlier and, therefore, were implemented some time after their effective date. In addition, corrections to the 2010 Medicare Physician Fee Schedule (MPFS) were implemented at the same time as the Affordable Care Act revisions to the MPFS, with an effective date retroactive to January 1, 2010.
Due to the retroactive effective dates of these provisions and the MPFS corrections, a large volume of Medicare fee-for-service claims have been, or will be, reprocessed. Given this large workload, the Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure that new claims coming into the Medicare program are processed timely and accurately, even as the retroactive adjustments are being made. CMS has begun to reprocess these claims during the last several weeks. They expect that this reprocessing effort will take some time and will vary depending upon the claim-type, the volume and each individual Medicare claims administration contractor. (The West Virginia contractor is Palmetto GBA).
In the majority of cases, physician practices will not have to request adjustments because claims Palmetto GBA will automatically reprocess your claims. You should not resubmit claims because they will be denied as duplicate claims and slow the retroactive adjustment process. However, any claim that contains services with submitted charges lower than the revised 2010 fee schedule amount (MPFS and ambulance fee schedule) cannot be automatically reprocessed at the higher rates. In such cases, you will need to request a manual reopening/adjustment from Palmetto GBA. While there is normally a one-year time limit for physicians and other providers and suppliers to request the reopening of claims, these circumstances should fall under the 'good cause' criteria described in the Claims Processing Manual, Publication 100-04, Chapter 34, Section 10.11 (PDF, 147 KB). CMS is, therefore, extending the time period to request adjustment of these claims, as necessary.
Medicare claims administration contactors will follow the normal process for handling any applicable underpayments or overpayments that occur while reprocessing your claims. Underpayments will be included in your next regularly scheduled remittance after the adjustment. Overpayments resulting from institutional provider (e.g., hospitals, inpatient rehabilitation facilities, etc.) claim adjustments will be offset immediately, regardless of the amount, unless there are insufficient funds to make the offset. When these overpayments cannot be offset, the amounts will accumulate until a $25 threshold is reached. At that time, a demand letter will be sent to the institutional provider. When a claim adjustment for a non-institutional provider (e.g., physician, other practitioner, supplier, etc.) results in an overpayment, the Medicare contractor will send a request for repayment. If this overpayment is less than $10, your contractor will not request repayment until the total amount owed accrues to at least $10. See the Financial Management Manual, Publication 100-06, Chapter 4, Section 70.16 or Section 90.2 (PDF, 1.18 MB) for more information.
The CMS wants to remind physicians, practitioners, suppliers and other providers impacted by the retroactive increases in payment rates for claims affected by the Affordable Care Act and 2010 MPFS changes, of the Office of Inspector General policy (PDF, 193 KB) related to waiving beneficiary cost-sharing amounts attributable to retroactive increases in payment rates resulting from the operation of new Federal statutes or regulations.
Registering for the Medicare and Medicaid EHR Incentive Programs
As of this date, there is no method available for a third-party to register multiple eligible professionals (EPs) for the Medicare and Medicaid EHR Incentive Programs. Beginning in May, CMS plans to implement functionality that will allow an Eligible Providers to designate a third-party to register and attest on his or her behalf. CMS plans to release detailed information about that process when it is available.
Physicians should be aware that, currently, Eligible Providers (EP) are NOT permitted to allow a practice manager or any other person to register in their place. Sharing your National Plan and Provider Enumeration System (NPPES) user ID and password with third-parties can place the physician’s information at risk. Until CMS implements new functionality in May, each EP should register himself or herself separately for the Medicare and Medicaid EHR Incentive Programs.
Registration for the Medicaid program – Eligible professionals must select between the Medicare and Medicaid EHR Incentive Programs. If you register for the Medicaid EHR Incentive Program, when you select “Medicaid” on the registration screen, you will be asked to select a state from the drop-down menu. Only states with launched programs (i.e. states that are prepared to confirm your eligibility and make payments) are listed in that drop-down menu. Each month, CMS will add new states as they launch programs. If you have questions about when your state will launch, visit Medicaid State Information. You may also contact your State Medicaid Agency for more information about the program; visit State EHR Incentive Program Launch Dates and HIT Websites for the Medicaid EHR Incentive Program links for each State Medicaid Agency.
At this time there is no specific time that West Virginia is set to launch the program.
For more information about the Medicare & Medicaid EHR Incentive Programs and to register, visit http://www.CMS.gov/EHRIncentivePrograms.
CMS Staff to Conduct Follow-up Calls for CERT Program
The Centers for Medicare & Medicaid Services (CMS) will be conducting follow-up calls to providers related to the Comprehensive Error Rate Testing (CERT) program. CMS staff may contact you to obtain all necessary medical record documentation for claims reviewed under the CERT program.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8EBMXL7277?opendocument
|
|
|
Top
|
| |
Palmetto GBA News
|
|
| |
New HCPCS Code for Influenza
CMS has released instructions to update seasonal influenza codes. Although Healthcare Common Procedure Coding System Codes (HCPCS) became effective for dates of service on or after October 1, 2010, the Medicare claims processing systems didn’t recognize the codes until January 1, 2011. Medicare systems were unable to process roster claims until February 7, 2011, but physicians should have been able to submit a roster bill as of that date.
Physicians who submitted influenza vaccine claims with CPT code 90658 after January 1, 2011, will receive a rejection and must submit a new claim with the correct HCPCS codes.
Auto Denial of Claims Submitted With a GZ HCPCS Modifier
Medicare contractors that process both institutional and professional claims have discretion to automatically deny claims billed with the GZ HCPCS modifier. The GZ HCPCS modifier indicates that an Advance Beneficiary Notice (ABN) was not issued to the beneficiary and signifies that the provider expects denial due to a lack of medical necessity based on an informed knowledge of Medicare policy. Medicare contractors will automatically deny claim line(s) items submitted with a GZ HCPCS modifier, effective for dates of service on or after July 1, 2011.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8DVPE58261?opendocument
|
|
|
Top
|
| |
United Healthcare Update
|
|
| |
United Healthcare Announces New Coordination of Benefits (COB) Policy
Effective December 1, 2010 UnitedHealthcare has switched to a “pay and pursue” coordination of benefits (COB) model for commercial claims processed with a billed amount of $10,000.00 or less.
What this means is that claims less than $10,000 in billed charges will be processed and released for reimbursement regardless of pending coordination of benefits inquiries. The “pay and pursue” model supports UnitedHealthcare’s efforts to improve the provider service process.
UnitedHealthcare says that the plan is committed to improving the provider relationship and welcomes the feedback they received this year related to COB issues.
|
|
|
Top
|
| |
Alzheimer's Association West Virginia Chapter Kickoff Event
|
|
| |
The WV Chapter of the Alzheimer’s Association will present a kickoff event for the Chapter’s conference, Confronting Challenges, Exploring Solutions, with speaker Christopher Colenda MD, MPH. The free seminar will begin on Monday, March 14 at 7:30 PM, with Dr. Colenda’s speech titled, “Three Decades in the Trenches: Mystery of the Mind”.
Christopher Colenda, M.D, M.P.H. is currently Chancellor of WVU Health Sciences and has been honored for his work in geriatric psychiatry. Prior to coming to West Virginia, he served as the Jean and Thomas McMullin Dean of the College of Medicine of Texas A&M Health Science Center and Vice President for Clinical Affairs.
To attend this special event, please RSVP to JT at jt.hunter@alz.org or by calling (304) 343-2717 by March 7, 2011.
|
|
|
Top
|
| |
Kids' Chance of West Virginia, Inc. Announces Event
|
|
| |
Kids’ Chance of West Virginia, Inc. wishes to announce its Kids’ Chance Annual Golf Tournament on Friday, April 29, 2011 at Little Creek Golf Course in South Charleston, WV. This is a great opportunity to enjoy a fine day of golf and help raise money for an important cause.
Kids’ Chance is a nonprofit scholarship fund which grants educational scholarships to the sons and daughters of West Virginians who suffer catastrophic or fatal workplace injuries or illnesses. Scholarships can be used to continue or further education at the secondary, post-secondary, career or professional levels. Thus far, scholarship recipients have attended schools ranging from vocational programs to Harvard University and the majority of the recipients have remained in West Virginia. This is an ongoing program designed to help West Virginia’s kids for the years to come.
The Kids’ Chance Annual Golf Tournament is a major fund raiser for the organization. All proceeds go to Kids’ Chance of West Virginia, Inc. for scholarships. Entry fee is $90.00 per golfer for green fees and cart, and lunch is provided. In addition to participating in the tournament, we welcome tee sponsorship and provision of door prizes. Please contact Robert Stultz at 304-269-1311 to obtain further information and an entry form.
|
|
|
Top
|
|
February 25, 2011
|
