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| Welcome to the Wesgram Online! Welcome to the October Wesgram. This edition contains important information from CMS, Palmetto GBA and other payors. You'll also find the most recent information about ICD-10, payor updates and upcoming educational opportunities for physicians and staff. |
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How to Handle ICD-10 Issues
Congratulations on surviving the transition to ICD-10! Although it may temporarily cause a Z56.3 (stressful work schedule), all should work hard to avoid Z56.4 (discord with boss and workmates) or Z56.5 (uncongenial work environment).
Now that ICD-10 is here to stay, physicians need to be prepared for handling any claims processing issues that result from using the new code set.
In July, the Centers for Medicare & Medicaid Services (CMS) announced that the AMA secured flexibilities for physicians to make the transition to ICD-10 less disruptive. One of those provisions was for CMS to establish a communication center to monitor issues and an ICD-10 ombudsman devoted to triaging physician issues.
CMS said the communication center, headquartered in Baltimore, began operation at the end of September. William Rogers, MD, an emergency physician who heads CMS' Physician Regulatory Issues Team, is the ombudsman.
It's important that you know help is available if you have problems with ICD-10. Your first line for help for claims questions is the Medicare Administrative Contractor, Palmetto GBA. They'll offer their regular customer service support and respond quickly.
You can email the ICD-10 Coordination Center; and receive a response to most questions. Physicians who experience claims processing issues should email their complaint to the CMS
ombudsman at ICD10_Ombudsman@cms.hhs.gov.
Important Update for ICD-10 Billing!
Now that practices must bill using two code sets (ICD-9 for services prior to October 1, 2015, and ICD-10 for services post October 1), it is critical that you identify the ICD in the
indicator field, which is in the
top right corner of item 21.
You must enter either:
9 - to indicate the ICD-9 CM diagnosis code set
0 - to indicate the ICD-10 CM diagnosis code set
Enter the indicator as a single digit between the vertical, dotted lines. Failure to complete this field or incorrectly completing this field will result in claim rejection.
When the October 1, 2014 ICD-10 implementation date was delayed, Palmetto GBA began auto populating the ICD Indicator field with a '9' on claims submitted without an indicator. Shortly before the implementation of ICD-10 on October 1, 2015, Palmetto GBA will stop auto populating the field so providers should begin submitting the correct indicator now.
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(information from Palmetto GBA)
Palmetto GBA Contractor Advisory Committee to Meet
The Palmetto GBA CAC will meet on
Tuesday evening, October 20, 2015, at 6:00 PM. The meeting will be held at :
Holiday Inn & Suites
400 Second Ave
Charleston, WV 25303
If you are a member of this committee, Palmetto requests that you attend or send your alternate.
Coming Soon! Jurisdiction M Medicare to Implement Automated Calls to Providers with Eligible Overpayments
Jurisdiction M Medicare will soon begin making automated calls to providers in an effort to increase timely responses to eligible outstanding overpayments.
An automated courtesy call will be made when the debt remains open and ages to 67 days old. This call will be a reminder to any provider who has not responded either with payment in full, by submitting an appeal, or by submitting a request for an extended repayment schedule, to a first demand letter.
These calls will provide basic information about the pending overpayment, including the date of the first demand letter and the outstanding balance.
To avoid further collection action, providers can submit payment electronically using Online Provider Services on the Palmetto GBA website, submit a check to the address listed on the demand letter, submit a request for an extended repayment schedule, or file an appeal in accordance with the rights provided to you in the demand letter.
Medicare Secondary Payer (MSP) Rejections for Paper Claims - Block 11
Effective for claims processed on and after October 1, 2015, Palmetto GBA will reject MSP paper claims if Block 11 of the CMS-1500 form is not completed. Completion of Block 11 is necessary to determine the correct coordination of benefits for your claims.
Voluntary Refunds Job Aid
A voluntary refund should be returned to Medicare anytime an overpayment has been identified by the provider. Overpayments are Medicare funds that a provider, physician/supplier or beneficiary has received in excess of amounts due and payable by Medicare. Once a determination of overpayment has been made, the amount is a debt owed to the United States Government.
When you identify an overpayment, please send a check to Medicare for that amount using the
Part B Voluntary Refund Overpayment Form found on the forms section of the Palmetto GBA website.
If submitting your refund via check, please be sure to fill out the Voluntary Refund form completely, and then submit the form with a check made payable to Palmetto GBA or Medicare to the address listed on the bottom of the form. Once received in their office and processed, you will receive a corrected Medicare Remittance Advice.
If you are refunding an overpayment for multiple claims, you may attach a listing of the individual claim details so that you do not have to complete a new form for each claim.
Online Provider Services (OPS) Passwords
Are you ready to set up your OPS account? Once you have been assigned your user ID, you will need to choose your own password. As a reminder, OPS passwords are case sensitive and:
- Must be at least eight characters long
- Must contain an uppercase letter
- Must contain a lowercase letter
- Must have at least one of these special characters (@, #, or $)
- Must contain numbers (0-9) and letters (A-Z, a-z)
- Must start with a letter
- No leading portion of first or last names may occur
- Must contain at least four changed characters from the previous password
- Must be changed every 60 days
- Cannot contain spaces
- Cannot use same password as the last 13 passwords
- Online Provider Services (OPS): How Often is Patient Eligibility Updated?
As a provider, do you wonder how often eligibility information is updated in HETS? The Online Provider Services (OPS) application is required to use CMS' HETS 270/271 system for all eligibility inquiries. Although OPS pulls data from HETS in real time, the data available in the HETS 270/271 system is only updated at certain times. CMS currently pulls the updated data Tuesday through Saturday during the hours of 6 p.m. and 8 p.m. This data is then uploaded into HETS during the hours of 9 p.m. to 6 a.m. As soon as updated data is available in the HETS 270/271 system, providers will be able to view it in OPS.
E/M Tips:
Type of Data/Old Records or History From Others
Relevant findings from the review of old records and/or the receipt of additional history from the family, caretaker or other source to supplement that obtained from the patient should be documented. If there is no relevant information beyond that already obtained, that fact should be documented. A notation of 'Old records reviewed' or 'Additional history obtained from family' without elaboration is insufficient.
Cloning
Each document must be specific to the beneficiary and date of service rendered. Cloning of documentation will be considered misrepresentation of the medical necessity requirement for coverage of services.
Separate Elements of the History
The chief complaint (CC), review of systems (ROS) and past, family and social history (PFSH) may be listed as separate elements of history or they may be included in the description of the history of present illness.
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CMS Releases Final Rules for Meaningful Use
The Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) has released final rules that simplify requirements and add new flexibilities for providers to make electronic health information available. It also helps health care providers and consumers be able to readily, safely, and securely exchange that information.
According to CMS, the final rule for 2015 Edition Health IT Certification Criteria (2015 Edition) and final rule with comment period for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs will help continue to move the health care industry away from a paper-based system.
According to the HHS announcement, the rule eases the reporting burdens, simplifies requirements, adds flexibility, supports interoperability and improves outcomes. The rule also continues the transition to a new payment system that basically moves physicians from the MU (Meaningful Use) program in to a new merit based incentive program (MIPS). The new payment methodology is based on MACRA (the Medicare Access and Chip Reauthorization Act). Providers and state Medicaid agencies will now have until
Jan. 1, 2018, to comply and prepare for the next set of system improvements
The rules
do not delay Stage 3 of Meaningful Use. Highlights of this latest announcement include:
- Stage 3 will now be optional in 2017
- Stage 3 will have eight objectives; more than 60 percent require interoperability; public health reporting will have flexibility options
- APIs will be required
- Cybersecurity requirements have been strengthened
- The reporting period for 2015 will be only 90 days for all providers, for new providers in 2016 and 2017 and for any provider moving to Stage 3 of the program in 2017
Physicians have expressed concerns that the rule has come too late for them to report in 2015; however, Patrick Conway M.D., acting principal deputy administrator and chief medical officer at the Centers for Medicare & Medicaid Services, has reminded practices that the deadlines could be extended and that they may apply for hardship exemptions.
For more information, please see the CMS press release and fact sheets on the
CMS website.
In other news affecting your practice, CMS has announced that physician practices who are facing a Medicare pay cut in 2016 for unsatisfactory reporting of clinical quality data have only until
November 9 to request an informal review if they believe they have been treated unfairly. If you've not reviewed your PQRS feedback report, you may find information on the
CMS website. Requests for the informal review must be made online.
The penalty, based on performance in the Physician Quality Reporting System (PQRS) in 2014, will reduce fee-for-service payments next year by 2%.
Physicians who met PQRS reporting requirements last year are receiving a 0.5% bonus this fall. If you have not met the requirement, you will continue to receive the 2% "negative payment adjustment" until 2019, when all payments are scheduled to shift to the new merit based incentive payment system (MIPS).
More information about the PQRS program is available on the
CMS website.
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UnitedHealthcare Update
Patients who are UnitedHealthcare Commercial members can pay for out-of-pocket medical expenses using the plan's website,
myuhc.com. By registering with InstaMed for Member Payments, physicians can receive these payments deposited directly into their designated bank account and integrate them with their practice management system. Integration capabilities exist with more than 60 practice management systems to help simplify payment posting.
UnitedHealthcare has contracted with InstaMed, an integrated health care clearinghouse and payments network, to process and distribute these payments to physicians. If you'd like a demonstration to learn how Member Payments can benefit your practice, please contact InstaMed at memberpayments@instamed.com or 866-945-7990.
Important News Regarding Medicaid Authorizations!
(information from APS Healthcare and BMS)
In order to better serve Medicaid members and to provide more efficient service to you as a Medicaid provider, please be aware:
Effective Thursday, OCTOBER 1, 2015, APS Healthcare began performing
ALL Utilization Management functions associated with both Medical and Long Term Care Prior Authorizations, including Clinical Operations, which had previously been performed by a subcontractor.
Please take the time to review the attached forms and begin utilizing them effective IMMEDIATELY.
Please note that fax numbers have changed and any request or correspondence faxed to WVMI on or after October 1, 2015 will not be processed.
Click
here for the new phone and fax numbers.
BMS Announces their Fall Medicaid Provider Workshops
Below are the dates and locations for the fall Medicaid trainings. Additional information will be coming soon.
Monday, October 19: Beckley-Tamarack
Tuesday, October 20:
Huntington-Big Sandy Arena
Wednesday, October 21
: South Charleston-Holiday
Inn and Suites
Monday, October 26:
Martinsburg-Holiday Inn
Tuesday, October 27:
Wheeling-Olgebay Resort
Wednesday, October 28:
Morgantown-Lakeview
Resort
Thursday, October 29
: Flatwoods-Days Inn
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OMA Schedules October Conference
The State Office Managers Conference is scheduled for
Thursday/Friday, October 15/16, at the Pullman Plaza in Huntington, WV. More information may be found on their website,
www.stateoma.com.
Certified Medical Coder Course Begins Soon!
The West Virginia State Medical Association (WVSMA), in partnership with Practice Management Institute (PMI) is holding a Certified Medical Coder (CMC) class of 2015 in Charleston, West Virginia.
The 5 week CMC class will begin on
Friday, October 23, and continue through Friday, November 20, at the WVSMA in Charleston, WV. The 5 day course will include Medical Terminology, ICD-10 Coding, HCPCS/CPT Procedural Coding, Ancillary Services and Advanced Coding.
Please register as soon as possible in order to ensure a place in this class. You may register
here.
WVSMA MidWinter Physician Practice Conference
The WVSMA's Physician Practice Conference will be held on
Friday, January 22, 2016, at the Embassy Suites in Charleston, WV. Scheduled speakers for the conference include the Incredible
Motivational Speaker/Mentalist Keith Matheny; Incomparable Healthcare Consultant Rose Moore, and Palmetto GBA's Always Informative Shannon Chase, as well as management and representatives from all major insurance carriers. As always, there will be great networking and great door prizes.
You won't want to miss this event! Mark your calendar and watch for registration information!
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(OUTPATIENT EXAMS - NO TREATMENT)
Tri-State Occupational Medicine, Inc. (TSOM) is looking for physicians to join their group to perform disability evaluations in their WV offices. Part-time and possible full-time opportunities. No treatment is recommended or performed. No call, no weekends and no emergencies. Physicians working for us have various backgrounds and training. Training and all administrative needs including scheduling, transcription, assisting, and billing are provided. Some travel is required. Must have a current WV medical license. TSOM has an excellent reputation for providing Consultative Evaluations for numerous state disability offices.
Contact: Susan Gladys 866-929-8766 / 866-712-5202 (fax) / susang@tsom.com.
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| Wesgram Online Copyright ©2015, West Virginia State Medical Association WESGRAM is solely intended for members of the West Virginia State Medical Association (WVSMA) and PMI certified professionals.To join WVSMA, go to our website. |
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