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Welcome to the 2012 Wesgram Online!
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This edition of the Wesgram Online contains information about upcoming educational events, as well as important payor updates. Also included are new features—a Practice Pointer and a Coding Tip. If you have questions about items in the Wesgram, please feel free to contact Barbara Good (Barbara@wvsma.com). |
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It's Not Too Late to Register!
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Join the WVSMA on Friday, February 3, 2012, for the Annual Business Meeting/Physician Practice Conference. We guarantee that you will leave the conference with additional knowledge and resources to help ensure your practice is the best that it can be!
The schedule for the day includes keynote speaker Rose Moore, Certified Medical Compliance Officer, whose topic, “Compliance is NOT Optional—What Your Practice Must Know!” will be one you can’t afford and won't want to miss!
Another featured speaker will be Kathy Boehm, Outreach Education Representative for Palmetto GBA. Not only will Kathy address the group; she will also be available throughout the day to answer your questions and address your issues.
Ten major payors, including West Virginia Medicaid, will be participating in the afternoon session of the conference. Management and representatives from the payors will give updates on the latest news with their plans. Attendees will have the opportunity to speak with them and obtain the most recent updates. You’ll also be able to seek guidance about specific issues. You won’t want to miss this wonderful opportunity to have individual conversations with so many payors in one location!
In addition to these sessions, attendees will have the opportunity to network with other medical professionals. In addition, six (6) CEUs are available for PMI certified attendees.
To register for the conference, visit the WVSMA’s website, www.wvsma.com for a registration form. If you have additional questions, please contact Karie Sharp. (304) 925-0342, ext. 12 or via email (karie@wvsma.com).
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Medicare Reimbursement Update
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Many physician offices have had questions regarding the reimbursement variations in the Medicare payments they have received during January 2012. The following information may help better explain the payments.
As a review, due to the last minute action by Congress in December 2011, the scheduled 27.4% pay cut was delayed for the first two months of 2012. This means that an update of zero percent is effective for claims with dates of service January 1, 2012, through February 29, 2012. This action became effective when President Obama signed the Temporary Payroll Tax Cut Continuation Act of 2011. Section 301 of the Temporary Payroll Tax Cut Continuation Act of 2011 (TPTCCA) prevented the 27.4% payment cut for physicians on a temporary basis.
Due to this change, CMS told contractors (Palmetto GBA for West Virginia physicians) to hold claims for 10 business days. Any claims that were processed for 2012 dates of service were processed with the new 2012 fee schedule which was based on the new legislations. Because CMS had to keep the budget neutral, in some cases, the conversion factor and Relative Value Units (RVUs) have been adjusted. These adjustments may make it appear as though physicians were paid under the wrong fee schedule.
Palmetto GBA had the new 2012 fee schedule loaded into their pricing system well before the 10 business days were up so the claims should have been processed under the correct fee schedule. If you have a specific example where you think you may have received the wrong amount, you may either verify it through the fee schedule link on the Palmetto GBA page or call the provider contact center.
Additionally, providers who were not successful e-prescribers (10 instances within the first 6 months of 2011) will have the negative 1% payment adjustment applied to their 2012 dates of services. This may be affecting the payment that practices are receiving.
Remember that the current fee schedule is just a temporary “fix” unless Congress acts to make it permanent. The “fix” is scheduled to end on February 29, 2012. If you receive information and requests from the WVSMA to contact your legislators, please do so and let your voice be heard!
For more information about the fee schedule, you may view the Palmetto GBA website, www.palmettogba.com.
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Palmetto GBA Updates
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2012 Annual Participation Enrollment Program Extension
The Centers for Medicare & Medicaid Services (CMS) is extending the 2012 Annual Participation Enrollment Program. The participation enrollment period will now end February 14, 2012, instead of December 31, 2011.
The effective date for any participation status change during the extension remains January 1, 2012, and will be in force for the entire year. Contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are post-marked on or before February 14, 2012.
2012 Electronic Prescribing (eRx) Payment Adjustment: Assessment and Application
Eligible professionals who met the eRx payment adjustment inclusion criteria, but who failed to meet the reporting requirements in 2011, may receive the 2012 eRx payment adjustment starting January 1, 2012. The 2012 eRx payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice participating in eRx GPRO receiving 99 percent (one percent less) of their Medicare Part B Physician Fee Schedule (PFS) amount that would otherwise apply to such services.
HIPAA 5010 Update
CMS recently announced that it would not initiate enforcement action with respect to any HIPAA covered entity that is non-compliant with ASC X12 Version 5010, NCPDP, NCPDP D.0 and 3.0 standards until 90 days after the upcoming January 1, 2012 compliance date. Although compliance will not be enforced for Version 5010 until April 1, 2012, it is important to continue to take the necessary steps to complete your transition to Version 5010 as soon as possible.
Notice of New Interest Rate for Medicare Overpayments and Underpayments:
The Department of the Treasury has notified the Department of Health and Human Services that the private consumer rate has been changed to 10.5 percent effective January 19, 2012, for Medicare overpayments and underpayments.
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2012 Medicare/Coding Update
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The WVSMA’s recent 2012 Coding and Medicare Update Course, held in Beckley, Charleston, Huntington and Morgantown, received high praise from attendees. Comments included “excellent class and I learned so much’, “very good and very informative course”, “content was very well presented and the information will be implemented in our practice”, and “I would definitely recommend this course!”
Instructor Rhonda Granja received accolades for her ability to keep the class focused on the important changes facing medical practices today. The course was all encompassing with respect to the three key areas of reimbursement-CPT, ICD-9, and Medicare.
Every specialty that had code changes was included in the class curriculum. CEUs were available for both PMI certified professionals and AAPC certifications.
Planning has already begun for 2013 Medicare and Coding Updates to be given in the fall of 2012. Watch for details in the summer of 2012 and plan to attend this excellent course!
The WVSMA and Practice Management Institute (PMI) are partnering to ensure that you are fully aware of all the coding changes so that you may code and bill correctly in order to receive the maximum amount of reimbursement for your services.
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UniCare News
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UniCare reminds physicians that UniCare claim submissions need to include a "W" prefix in front of the existing UniCare member ID. It is important to ask your patients for their new ID card so you can update your patient records.
UniCare will be participating in the WVSMA’s Payor Workshop on Friday, February 3, 2012.
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UnitedHealthcare News
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UnitedHealthcare’s Medical Director, Edward Koza, MD, will be at the WVSMA for an informational meeting on Thursday, February 16th, at 1:00 PM. Dr. Koza will discuss the plan’s changes and update attendees on new initiatives. Physicians and office staff are welcome to attend this meeting. Please let the WVSMA know if you are interested in attending.
UnitedHealthcare’s Provider Relations will be attending and speaking at the WVSMA’s Physician Practice Management Conference on Friday, February 3, 2012.
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New AMA Toolkit Available for Guidance on Self-Referral Regulations
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The American Medical Association (AMA) now has a new toolkit available for guidance on self-referral regulations.
Navigating self-referral regulations can be challenging. Sometimes referred to as the "Stark Law," the purpose of the regulations is to restrict financial considerations from influencing certain physician referral decisions. But the law itself can be confusing for anyone who isn't a legal expert. Meanwhile, unintentional violations can lead to serious penalties ranging from payment denials and refunds to large monetary fines.
Prepare your practice to comply with self-referral regulations by taking advantage of the AMA's new "Stark Law Rules of the Road" toolkit. The toolkit can help you identify which self-referrals are permissible and which referral patterns and business relationships you should avoid.
An easy-to-use interactive tool walks you through six simple questions to determine how the Stark Law might apply to you. The tool also defines key terms and explains a number of exceptions to the law that permit certain self-referrals.
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Practice Pointer
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Do you have I-9 forms on file for all your employees? All employees hired after November 6, 1986 and working in the United States must complete form I-9. The purpose of the form is to document that each new employee (both citizen and non citizen) hired after that date is authorized to work in the United States.
There is no filing fee associated for completing form I-9. The form must be retained by the employer as part of the employee’s personnel record. It must be made available for inspection by the U.S. Government officials upon request. While submission of the information required in this form is voluntary, an individual may not begin employment unless this form is completed. Employers are subject to civil or criminal penalties if they do not comply with the Immigration Reform and Control Act of 1986.
The I-9 form may be obtained by downloading it from the US Citizenship and Immigration Services website at www.uscis.gov/forms.
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Coding Tip
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In grade school you learned to include “how, when, where, what and why” in your writing. When coding a physician service, you should think the same way and include the “4 Ws” in your documentation. All documentation should include answers to the following questions:
Who did you see?
Where did you see them?
What did you do?
Why did you do it?
By including the proper documentation and coding for the above questions, you will ensure that you are billing properly for your services.
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PMI Announces the 2012 National Conference for Medical Office Professionals
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The Practice Management Institute (PMI) 2012 conference will be held on June 13-15, 2012, at the Crowne Plaza Riverwalk in San Antonio, Texas. Registration is now open and you may save $200 off your registration when you sign-up before January 31!
This much-anticipated annual learning event is open to anyone seeking advanced training in coding, reimbursement, and office management skills for the medical practice. Attendees are comprised primarily of physician staff members – medical office managers, coding and billing professionals from across the United States. Thirty sessions will be offered, presented by 9 speakers and organized into three learning tracks.
Attendees receive a conference manual and tote bag, access to all general and breakout sessions, breakfast each morning, networking luncheons on June 13-15, and continuing education units (CEUs). Exhibitors will be on hand to share product information and door prizes with participants.
Last year, CMOMs Karen Lavery (Morgantown), Jamie Ray (South Charleston) and Barbara Good (WVSMA) attended the conference. It was an exciting time of fast-paced sessions with nationally acclaimed speakers. We plan to attend again this year! If you are interested in joining us, please let Barbara know, so we can make special plans for our West Virginia delegation!
For more information, see the PMI website, www.pmimd.com, or contact Barbara Good.
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West Virginia Medical Group Managers News
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The West Virginia Medical Group Managers will hold their spring conference on Friday, March 9. 2012, at the Charleston Marriott.
The group has also announced the dates for the fall conference, which will be held at Stonewall Jackson Resort on Thursday/Friday, October 18/19, 2012.
Additional information may be obtained by contacting President John Trout (jtrout@greenbrierphysicians.com).
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West Virginia Office Managers Association News
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The West Virginia Office Managers Association (OMA) has kicked off 2012 with chapter meetings across the state. All physician office managers are encouraged to join their local chapters for these excellent educational and networking meetings.
The OMA State Conference is scheduled to be held at Canaan Valley Resort on Thursday/Friday, October 11/12, 2012.
For more information, you may contact President Julie Williams (jwilliams@wvmi.org).
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January 31, 2012
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