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Wesgram Online
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This edition of the Wesgram Online includes information about the WVSMA’s recent Physician Practice Conference, as well as two new educational offerings for offices, including a new partnership with the West Virginia State Office Managers Association.
You will also find the latest information on important payment issues affecting your practice, important news from payors and reminders about ways you can stay abreast on the latest issues affecting your practice.
As of this writing, the 27.4% reimbursement decrease is still schedule to take effect on March 1, 2012, unless Congress acts to change the flawed SGR formula. This reimbursement decrease will not only affect your Medicare payments; it will also apply to those who have military benefits (TriCare). Information is included as to how you can act now to help prevent the decrease.
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Physician Practice Conference Summary
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The WVSMA’s Physician Practice Conference on Friday, February 3, 2012, was a huge success! Physicians, office managers and staff filled the Marriott ballroom to hear the latest updates on important healthcare issues.
The morning began with a Special Legislative Breakfast, which featured speaker West Virginia Governor Earl Ray Tomblin. Also included on the legislative panel were Senator Jeff Kessler, Senate President; Senator Ron Stollings, Chairman of the Senate Health Committee; Senator Mike Hall, Senate Minority Leader; Delegate Don Perdue, Chairman of the House Health Committee; and Delegate Tim Armstead, House Minority Leader.
Following the breakfast, keynote speaker Rose Moore, Certified Medical Compliance Officer, kept the audience enthralled with her topic, “Compliance is NOT Optional—What Your Practice Must Know!” This important topic was presented in a way that only Rose can do. Attendees raved about Rose’s presentation style and many stayed afterward to request additional information.
The afternoon session was devoted to insurance payors. Medicare spokeswoman Kathy Boehm, Outreach Education Representative for Palmetto GBA, addressed the group and provided much needed information about Medicare’s 2012 updates.
WV Medicaid was well represented by attendees DHHR Secretary Michael Lewis, MD, and James Becker, MD. Dr. Becker gave the 2012 Medicaid updates to the group. He also talked privately with those offices who were having issues with Medicaid.
Ten major payors participated in the “Popcorn with the Payors Panel” afternoon session of the conference. Management and representatives from the payors gave updates on the latest news with their plans. Not only did attendees have time to ask general questions of each payor; they were also able to speak with the payors individually about claims issues.
It was a great day of education for physicians, managers and staff. We hope you’ll plan to join the WVSMA at the next Conference!
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Having Problems With 5010???
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Having Problems with 5010???
January 1, 2012 marked the compliance deadline for use of the new version of the standard electronic Health Insurance Portability and Accountability (HIPAA) transactions.
Version 4010 has been in use since 2003 and the Centers for Medicare and Medicaid Services (CMS) now requires all HIPAA "covered entities", which includes physicians who conduct any of the transactions named in HIPAA electronically (i.e. claims or remittance advice), to begin using Version 5010. This requirement was effective January 1, 2012.
CMS is the federal agency charged with oversight of HIPAA standards. AMA and others advocated to CMS that overall lack of industry readiness should not compromise physician cash flow following the January 1, 2012 compliance date. For this reason, CMS indicated they would not levy any enforcement actions for the first three months of 2012 while HIPAA covered entities continued to work towards compliance. What this means is that the HIPAA 5010 compliance date remains January 1, 2012 and all physicians and other HIPAA covered entities were to make every effort to comply with the use of the new standards, but that CMS will not take any enforcement action during this period. This does not mean that entities were given 3 extra months to prepare, as some clearinghouses and others have told physicians.
The WVSMA continues to hear from physicians who are having payment issues due to 5010 problems with their clearinghouses and/or payors. Below is information that the AMA has provided for physicians.
What you can do if you are experiencing claims processing issues
Since the deadline on January 1, 2012 to convert to the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 transactions, some physicians have been experiencing issues with their claims processing, resulting in lack of payments.
The AMA is aware of issues with claims processing related to the 5010 transition and is addressing these issues directly with the Centers for Medicare and Medicaid Services (CMS). Please inform the AMA and CMS of your issues:
• Report the problems you are having to the AMA.
• Visit www.ama-assn.org/go/clickandcomplain to access complaint forms, including the Centers for Medicare and Medicaid Services complaint form.
• Submit your problem to 5010ffsinfo@cms.hhs.gov for issues you are having with Medicare.
Until these issues are resolved, the following are action items that physician practices can take if they are having issues with their claims and interruptions in their cash flow:
• If using a billing service or clearinghouse, contact the billing service or clearinghouse to understand where the problem is occurring. Is it related to the data you are submitting? Is it due to the payors’ processing of the claims?
• If you identify a problem with your practice management system, contact your vendor to have the problem resolved.
• If you submit your claims directly to the payor, contact the payor to understand where the problem is occurring. Is it related to the data you are submitting? Is it related to problems within their adjudication system?
• Contact a financial institution about establishing a line of credit.
• Consider submitting paper claim forms to those payors that will accept them.
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Don't Let Your Reimbursement Be Cut!!
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(Information supplied by the AMA)
Before a scheduled 27 percent Medicare pay cut was able to take effect on Jan 1 2012, the U.S. House of Representatives reached agreement with the Senate on a two-month extension of important policies.
AMA President Peter W. Carmel, MD, called on Congress to "enact a real and fiscally responsible solution to this sorry cycle of scheduled cuts and short-term patches that compromises access to care for patients and drives up costs for taxpayers. Members of Congress need to use this time to work in a bipartisan manner to provide long-term stability for seniors, military families and the physicians who care for them."
Now is the time for Congress to come together and permanently repeal the flawed Sustainable Growth Rate (SGR) formula. Here’s what physicians should do:
Register your strong concern with your members of Congress that yet another SGR deadline is approaching and Congress has yet to act. Call the AMA grassroots hotline (800) 833-6354 and ask your senators and representatives what specific items they will require to end the annual SGR fiasco.
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WVSMA and WVOMA Partner for Special Education Opportunity!
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The West Virginia State Medical Association (WVSMA) and the West Virginia Officer Managers Association (WVOMA) are partnering to provide an educational opportunity for all WV physician practices.
A special workshop, “Mastering E/M Coding” will be held on Thursday, March 29th, 2012, at St. Francis Hospital in Charleston. Two sessions of the class will be held on that day, with the morning session beginning at 9:00 AM – Noon and the afternoon session being held from 1:00 PM- 4:00 PM. Three CEUs will be available for the class.
OMA members are being provided a 15% discount on their registrations. In addition, other incentives may be available through the OMA. Check with your local chapter for details.
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You Requested It---2012 CMOM Class Scheduled!!
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The WVSMA is pleased to announce that the 2012 CMOM (Certified Medical Office Manager) course is scheduled in Huntington, WV! The four day class is scheduled for Thursday and Friday, April 26/27 and Thursday/Friday, May 3 /4, at St Mary’s Medical Center in Huntington.
In partnership with the Practice Management Institute, the WVSMA will offer the four-day Certified Medical Office Manager (CMOM) class, which will teach experienced staff proven strategies to lead the medical practice to increased productivity and efficiency.
The cost for the class, which includes the program manual, workbooks and certification exam, is $999.00. WVSMA members and Practice Management Institute Certified Professionals receive a 10% discount on the class.
Registration forms will soon be available on the WVSMA’s website, www.wvsma.com, If you have additional questions, you may contact Karie Sharp (304-925-0342, ext 12) or via email (karie@wvsma.com).
The WVSMA is proud to be the exclusive West Virginia partner for the CMOM certification.
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Palmetto GBA News
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Palmetto GBA has announced some upcoming educational opportunities. You may learn more information and/or sign up for these opportunities on the Palmetto GBA website, www.palmettogba.com.
Medicare Made Easy: Basic Billing for Beginners: February 28, 2012
Palmetto GBA Jurisdiction 11 Provider Outreach and Education is holding a Basic Billing Webinar for providers new to the Medicare Program.
This event will be held February 28, 2012, from 10 a.m. to 12 p.m. ET. All specialties are welcome and the information will be very helpful to staff that codes and bills claims. Sign up today on the Palmetto GBA website.
Beyond the Basics: Taking Your Billing to the Next Level: March 6, 2012
Palmetto GBA Jurisdiction 11 Provider Outreach and Education is holding a Webinar for Beyond the Basics: An Intermediate Medicare Billing Course. This event will be held March 6, 2012 from 10 a.m. to 12 p.m. ET.
All specialties are welcome and the information will be very helpful to staff that codes and bills claims.
Small Provider Training: Beckley, West Virginia, March 20, 2012
Join Palmetto GBA in Beckley, WV, on March 20, 2012, to learn more about new and existing Medicare Part B initiatives, reimbursement changes and other resources available to assist smaller practices. The session will be followed by an interactive question and answer session. All specialties are welcome.
Medical Review Progressive Corrective Action (PCA) Process
Once it is determined that a medical review of a service is necessary, a random claim sample is obtained. Palmetto GBA then contacts the providers of these services for additional documentation and providers have 30 days to respond. If you are notified that a medical review will be performed on claims you submitted to Medicare, please respond to these Additional Documentation Request (ADR) letters promptly.
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UnitedHealthcare Meeting Set
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UnitedHealthcare’s Medical Director, Edward Koza, MD, will be at the WVSMA office for an informational meeting on Thursday, February 16th, at 1:00 PM. Dr. Koza, along with UnitedHealthcare’s Provider Relations Director Deb Carter, 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.
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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.
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!
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Tamper Resistant Prescription Pad/Paper Update
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Beginning October 1, 2008, all written prescriptions for Medicaid recipients were required to be written on mandated tamper resistant prescription pads/paper in order to be eligible for reimbursement. This action was required by section 7002(b) of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, which was signed into law on May 25, 2007.
As a reminder, this includes prescriptions which are printed from EHR systems. Prescription paper for these scripts must be on tamper resistant paper.
In order to encourage our state’s success with the tamper resistant prescription program, the WVSMA provided a free six (6) month supply of the new tamper resistant prescription pads./paper for physicians at no charge. This service was provided by a grant from the Purdue Pharma Asset Forfeiture Funds. You are still able to order discounted prescription pads/paper from Standard Register through the WVSMA’s website.
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Practice Management Institute Announces 2012 National Conference for Medical Professionals
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The conference will be held on June 13-15, 2012, at the Crowne Plaza Riverwalk in San Antonio, Texas. Registration is now open for this great conference!
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 education with nationally acclaimed speakers. If you are interested in attending, 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 (barbara@wvsma.com).
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Medicare Beneficiary Signature Requirements
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(information supplied by Medicare)
Medicare requires the signature of the beneficiary, or that of his or her representative, for both the purpose of accepting assignment and submitting a claim to Medicare. If the beneficiary is unable to sign because of death or a mental or physical condition, the following individuals may sign the claim on behalf of the beneficiary:
• The beneficiary’s legal guardian
• A relative or other person who receives social security or governmental benefits on behalf of the beneficiary
• A relative or other person who arranges for the beneficiary’s treatment or exercises other responsibility for his or her affairs
• A representative of an agency or institution that did not furnish the services for which payment is claimed but furnished other care,services or assistance to the beneficiary
• A representative of the provider or of the non-participating hospital claiming payment for services it has furnished if the provider or non-participating hospital is unable to have the claim signed by any of the authorized individuals (see the four bullets above) after making reasonable efforts to locate and obtain one of these signatures
• A representative of the ambulance provider or supplier who is present during an emergency and/or nonemergency transport. In this circumstance, ambulance suppliers may submit a claim to Medicare if the following documentation is obtained and maintained for at least four years from the from the date of service:
A contemporaneous statement, which is signed by an ambulance employee present during the trip to the receiving facility that includes:
the date and time of the transport
why the beneficiary was physically or mentally incapable of signing
no legally authorized person was available or willing to sign the claim on behalf of the beneficiary; and
the name and location of the facility that received the beneficiary
AND
Signed statement from the receiving facility indicating that:
the name of the beneficiary; and
the date and time the beneficiary was received
OR
one of the following secondary forms of verification from the receiving facility:
the signed patient care/trip report
the hospital registration/admission sheet
the patient's medical record
the hospital log
other internal hospital records
A provider/supplier (or his employee) cannot request payment for services furnished except under circumstances fully documented to show that the beneficiary is unable to sign and that there is no other person to sign.
Medicare does not require that the signature to authorize claim submission be obtained at the time of transport for the purpose of accepting assignment of Medicare payment for ambulance benefits. When a provider/supplier is unable to obtain the signature of the beneficiary, or that of his or her representative, at the time of transport, may obtain this signature any time prior to submitting the claim to Medicare for payment.
If the beneficiary/representative refuses to authorize the submission of a claim, including a refusal to furnish an authorizing signatures, then the ambulance provider/supplier may not bill Medicare, but may bill the beneficiary (or his/her estate) for the full charge of the ambulance items and services furnished.
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February 13, 2012
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