Welcome to the February Wesgram. This edition contains important updates from CMS, Palmetto and other payers, as well as information about upcoming educational opportunities.
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Spring is coming! Here are some fun ICD-10 codes for Springtime.
R11.0
Too much corned beef and cabbage on St. Patrick’s Day
T78.05XA
Anaphylactic reaction due to tree nuts and seeds
J30.1
Allergic rhinitis due to pollen
Y93.66
Activity, soccer
F40.218
Fear of the Easter Bunny
W61.33XA
Pecked by a chicken
T63.441A
Toxic effect of bee sting
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(information from Palmetto GBA)
Palmetto GBA will host an informative '
Get to Know KEPRO Your BFCC-QIO'
webcast on
March 14, 2018 at 10 am EST.
KEPRO is the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) for over 30 states, including West Virginia. You will learn more about the services that they offer to Medicare beneficiaries and their families concerning beneficiary complaints, discharge appeals and immediate advocacy.
New Medicare Cards Start Mailing in April 2018
CMS is removing Social Security Numbers from Medicare cards to prevent fraud, fight identity theft, and keep taxpayer dollars safe. The new Medicare cards will be mailed by geographical regions from April 2018 through April 2019.
West Virginia will be among the first states to receive the cards, with the mailing dates scheduled between April -June 2018.
Proper Use of Modifier 59
The Medicare National Correct Coding Initiative (NCCI) includes Procedure-to-Procedure (PTP) edits that define when two Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) codes should
not be
reported together either in all situations or in most situations. For PTP edits that have a Correct Coding Modifier Indicator (CCMI) of “0,” the codes should never be reported together by the same provider for the same beneficiary on the same date of service. If they are reported on the same date of service, the column one code is eligible for payment and the
column two code is denied.
For PTP edits that have a CCMI of “1,” the codes may be reported together only in defined circumstances which are identified on the claim by the use of specific NCCI-associated modifiers.
One function of NCCI PTP edits is to prevent payment for codes that report overlapping services except in those instances where the services are “separate and distinct.” Modifier 59 is an important NCCI-associated modifier that is often used incorrectly.
The CPT Manual defines modifier 59 as follows:
“
Distinct Procedural Service:
Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.
However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.
Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.”
Modifier 59 and other NCCI-associated modifiers
should NOT be used
to bypass a PTP edit unless the proper criteria for use of the modifier are met. Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier that is used.
For more information on the proper use of Modifier 59, click
here
Orders Issued by Text Messages Unacceptable For Medicare
Some providers may use text messaging as a means to expedite patient care and issue instructions or orders to another healthcare provider. For Medicare purposes, an order communicated solely by text messaging
will not be
considered acceptable documentation to support an order.
Another form of the text order (written, verbal order transcribed, electronic, etc.) must also be present in the medical record.
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CMS Releases 2017 Quality Benchmark Changes
On December 19, 2017, the Centers for Medicare & Medicaid Services (CMS) published an updated 2017 quality measure benchmark table for MIPS quality measures. The following ten quality measures had benchmark changes.
You can view the changes
here.
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Payer News
Meet all the of payers at the Physician Practice Conference
Highmark Update
Highmark reminds physicians that they are encouraged to file electronic claims. However, effective Jan. 1, 2018, you must submit a paper replacement claim if your original claim was submitted on paper. In Box 22, enter the correct Frequency code under Resubmission code, and Original Claim Number under Original Ref. No. to indicate you’re submitting a replacement claim.
Molina Medicaid News
Molina has scheduled their 2018 spring workshops.
The West Virginia Bureau for Medical Services (BMS), the West Virginia Children’s Health Insurance Program (WVCHIP) and Molina Medicaid Solutions will be conducting eight workshops throughout the state from April 23rd – May 3, 2018 (see venues and dates below). The agenda items will impact a wide variety of providers and topics. Please take a moment to register for the workshop of your choice. For more information, please visit the Molina Website or email our Provider Field Representatives at
WVProviderFieldRepresentative@MolinaHealthCare.com.
April 23, 2018 - Wheeling – Oglebay Resort
April 24, 2018 - Beckley - Tamarack
April 25, 2018 - Huntington – St. Mary’s Conference Center
April 26, 2018 - Charleston – Holiday Inn & Suites
April 30, 2018 - Martinsburg – Holiday Inn
May 1, 2018 - Morgantown – Waterfront Hotel
May 2, 2018 - Vienna – Grand Pointe Conference Center
May 3, 2018 - Flatwoods – Days Inn
Contact Information: BMS -- 304-558-1700.
PEIA News
PEIA reminds practices that the provider portal of HealthSmart’s website is now in production. Please note the attached overview indicates providers can download an EOB, but this is not available for PEIA since bulk payment is utilized. Click
here
for additional information regarding this new service.
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1014 Bridge Road
Charleston, WV 25314
Jay Goldman, Broker | 304.343.5695
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Goldman Associates, Inc. has played a prominent part in the Charleston-Huntington market and has participated in appraisal or brokerage assignments in nearly all West Virginia counties.
Some of the largest real estate transactions in West Virginia have been conducted through Goldman Associates, Inc. Whether they are downtown Charleston office buildings, corporate headquarters for state firms, or restaurant sites, there is a high degree of skill and ability through these real estate specialists.
Below are some of our current listings in Charleston, WV:
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1223 Washington Street East - For Sale
19,995 sf mixed use building on a corner site directly across from CAMC General Division Campus. High profile location with on‑site parking.
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100 Peyton Way, Charleston - For Sale
14,655 sf multi-tenant medical/ general office condominium building located in the Southridge Center with 60 car parking. Built in 2005. Includes Physical Therapy space on first floor and two tenants occupied suites on the second floor. Excellent condition.
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604 Virginia Street East, Downtown Charleston For Lease
The DiTrapano Law building is steps away from the Kanawha County Courthouse. The entire 4th floor is for lease which contains approximately 3,000 sf of professional offices, conference room, storage and kitchen. There is also extra storage space on the mezzanine. There are individual offices on the 3rd floor available for lease.
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184 Summers Street, Downtown Charleston
For Lease
Approximately 5,500 sf of corporate office space. Includes twelve large offices, conference room, receptionist area, storage/file room and kitchen. Also, individual offices available for lease.
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513 Tennessee Avenue, Charleston - For Sale
Architecturally designed, two-story commercial building with approximately 10,000 sf. In the Elk City District of Charleston. On-site parking.
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608 Tennessee Avenue, Charleston - For Sale
Two story office building with adjacent parking lot for 17 cars. First floor includes seven offices, conference room, kitchen, large open area and storage and the second floor has seven offices and lots of storage/file space. In the Elk City District of Charleston.
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Other News
March Physician Practice Conference
The WVSMA and the WVMGMA will again combine forces this year to host a conference for physicians, management and staff. Mark your calendars now for
Friday, March 23th at the Embassy Suites in Charleston.
The groups have prepared a wide variety of programming to keep you apprised of all that is happening in the healthcare arena.
You’ll hear from outstanding and knowledgeable speakers Rose Moore, Dave Jakielo, Trisha Clark and Wally Suttle. You’ll also have a chance to hear from West Virginia government and commercial insurance payers. This will be a great day of education and networking that
you won’t want to miss!
Plan now to attend!
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Educational Opportunities
Huntington Consortium to Meet
The Huntington Consortium has scheduled the next meeting for Thursday evening, March 8, at the HIMG Regional Medical Center’s Charles “Skip” Turner Memorial Education Center. Hors D’ouevres will begin at 5:00 P.M., with the program beginning at 5:30 P.M.
The speaker for the evening will be Wallace Horne, MD, Vice President of Medical Affairs, Princeton Community Hospital, who will speak on “
Cyber Attacks: What Happens When It Hits You
”.
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