(information from Palmetto GBA)

E/M Comparative Billing Reports: Peer Code Comparison

 

The Evaluation and Management (E/M) Comparative Billing Reports: Peer Code Comparison are complete for South Carolina (SC), North Carolina (NC), Virginia (VA), and West Virginia (WV). The reports are based only on the Part B Extract Summary System (BESS) data between January 1, 2015 - June 30, 2015.

 

Understanding eCheck in eServices

 

eCheck allows providers to submit either solicited or voluntary payments electronically. The electronic payment is treated like an immediate debit card transaction. The amount and necessary bank information from the check is captured and routed using PHT A-Claim Technology to make the payment directly from the provider's financial institution.

 

 

 

E/M Tip: Medical Decision Making - Complexity

 

The levels of evaluation and management (E/M) services recognize four types of medical decision making (straightforward, low complexity, moderate complexity and high complexity). Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option

 

 

E/M Tip: 1995 Examination-Constitutional

 

The measurement of at least three vital signs (sitting or standing blood pressure, supine blood pressure, pulse rate and regularity, respiration, temperature, height and weight) or the patient's general appearance must be documented in order to receive 'credit' for 'constitutional,' under the 1995 'organ systems.'

 

 

E/M Tip: History of Present Illness (HPI) - Multiple Complaints

 

A patient may present with more than one complaint, sign or symptom. They may use the most descriptive under the History of Present Illness (HPI) and additional information may be used under review of systems (ROS).

 

 

Authentication Matters!

 

Medicare requires that services provided/ordered be authenticated by the author. The method used must be a hand written or an electronic signature.

 

Stamped signatures are not acceptable. Stamped signatures are only permitted in the case of an author with a physical disability who can provide proof to CMS or a CMS contractor of an inability to sign due to a disability.

 

Signatures, Credentials and Dates: They Are Important

 

Each entry in the patient's medical record requires the acceptable signature of the person writing the note along with the date. Palmetto GBA also recommends the inclusion of the applicable credentials (e.g. P.A., D.O. or M.D.), especially when the services being billed are only coverable when performed by certain credentialed professionals

 

 

 

 

 

As of January 1, 2016, the West Virginia Children's Health Insurance Program (WVCHIP) is using Molina to process claims.

All WVCHIP providers are required to enroll and provide credentialing. If you have not done so, or if you have submitted incomplete information, BMS is unable to process your claims.

 

There are issues with some provider files which are expected to be resolved in the next 30 days. If you are having difficulty with claims payment, please let BMS know by emailing Jennifer.J.Myers@wv.gov.

 

NOTE: Prior Authorization requests are still to be submitted to HealthSmart.

Although WVCHIP is now a division of the West Virginia Department of Health and Human Resources, it still operates as the same program, with the same benefits and payment rates.

 

WVCHIP is not part of Medicaid or its managed care programs.

Providers can confirm eligibility for a patient without a member card through the provider tab on www.wvmmis.com. Membership may also be verified by the patient, who can print a temporary card through this website. Contact the WVCHIP Helpline at 1-877-982-2447 or Molina at 1-800-479-3310, if assistance is needed.