Welcome to the December Wesgram. This edition contains important information on 2018 coding changes, as well as an opportunity for you to view a free limited time webinar on MIPS. Also included is information from a recent webinar on Workplace Violence that includes recommendations for your practice. As always, you'll find news from Palmetto GBA and other payers.
The WVSMA staff wishes you a blessed holiday season and a wonderful New Year!
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Important News Regarding the 2018 Coding Update Courses!
The 2018 Coding Update courses have been moved to a new location. The classes will be held at St. Francis Hospital, 331 Laidley Street. If you have any questions about the location, please contact
Barbara Good
.
The WVSMA knows that there is a lot of confusion about all the “new” codes for 2018. In order to help you ensure that you are billing and coding correctly, we have scheduled two special classes for January.
On Wednesday, January 24
th
, 2018, we will host 2 training sessions and invite you to register and attend. You may choose either session or stay all day. Three CEUs are available for each class. Register
here
for one or both classes.
8:30 AM – 11:30 AM
2018 Coding and Reimbursement Updat
e --This class covers the most current reimbursement information available specifically for medical office coding and billing professionals, providers, office managers, consultants, and compliance officers.
1:00 PM—4:00 PM
Bridging the Gap--Clinical Documentation and Coding
-- This class will help coders and billers work with providers to assess and gather the information needed in documentation to support appropriate code assignments.
Participants must bring a current ICD-10-CM code set manual to class.
Breaking News Webinar for Solo and Small Group Physician Practices—Free Webinar!
If you are a small practice and unsure of all the upcoming changes with MIPS and MACRA, here is a
complimentary webinar
that you may want to do. It will give you some insight as to participating in MIPS via a virtual group. The webinar is only available until the end of the month, so if you want to take advantage of the free information, do it soon!
Finally, here are some fun ICD-10 codes for the holiday season--
R12 – Heartburn
Y93.23 – Activity, snow, sledding
W00 – Fall due to ice and snow
V80.1 – Injury as occupant of animal-drawn vehicle
X08.8 – Burn by candle
Y93.G – Cooking injury
43.8 – Emotional stress
Y92.59 – Injury at shopping mall
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(information from Palmetto GBA)
MSP Form Update
The 'Medicare Secondary Payer Inquiry Form' has been updated to include a fax number where additional documentation can be sent. This is the preferred method for Palmetto to receive your documentation. If possible, send all information to the fax number instead of via mail services. This will ensure receipt of the information and have it placed immediately into the workflow for quicker processing.
When submitting voluntary refunds, either electronically or by check, be sure to submit separate refunds for Part A services and for Part B services. Do NOT submit together!
Also submit Medicare Secondary Payer (MSP) refunds separate from Non MSP refunds. This will ensure the refunded amounts are processed appropriately and timely.
A CERT decision may be appealed. If the provider disagrees with the CERT's decision, please appeal through eServices (fast, free, and secure) or by submitting the appropriate form. The form can be located under the 'Forms' Link on the Palmetto GBA home page.
Change Request (CR) 9911 modifies the Medicare claims processing systems to help providers more readily identify the Qualified Medicare Beneficiary (QMB) status of each patient and to support a providers ability to follow QMB billing requirements.
Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare A/B claims.
Pulse oximetry is not considered a vital sign. However, pulse oximetry is listed as a CPT code 9xxxx series. If a physician reviews and/or orders a pulse oximetry, credit will be applied to the complexity of data portion of medical decision making.
Change Request (CR) 10152 eliminates the requirement to use the GT modifier (via interactiveaudio and video telecommunications systems) on professional claims for telehealth services. Use of the telehealth Place of Service (POS) Code 02 certifies that the service meets the telehealth requirements.
This article was revised to indicate that on December 8, 2017, CMS will suspend modifications to the Provider Remittance Advice and the Medicare Summary Notice for QMB claims made on October 2, 2017. The article was also revised to show the HETS QMB release was implemented in November 2017. Finally, the article was changed to clarify that QMBs cannot elect to pay Medicare cost-sharing but may need to pay a small Medicaid copay in certain circumstances. All other information remains the same.
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MACRA Update
:
f you are currrently participating in MACRA, whether for the entire year (2017) or if you have just begun, you'll need to send in your performance data by March 3. You can also begin participating in an Advanced APM.
Remember---to participate in the 2017 MACRA program, physicians only need to report on “one patient. one measure, in order to receive no penalty requirement or 2018.
The first payment adjustments based on performance go into effect on J
anuary 1, 2019.
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Payer News
Important Molina Medicaid Update
Effective January 1, 2018, Molina will begin screening new Managed Care Organization (MCO) network providers who must have a participation agreement in effect with the State Medicaid agency, even if they do not plan to participate in the Medicaid Fee For Service program. All currently enrolled MCO providers, by NPI, must be screened by Molina as of December 31, 2017. If you have multiple NPIs, each NPI will need to be screened by Molina. NOTE: Completion of the screening process does not guarantee enrollment with any of the MCOs. Enrollment must be completed with each MCO individually.
UniCare Update
UniCare is currently contacting and contracting physician practices for participation in a new Medicare Advantage network product for calendar year 2019.
If you wish to participate, there is no action needed, as you will automatically have the Medicare product added to your participation contra; however, if you wish to opt out, you’ll need to notify UniCare.
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Other News
Workplace Violence in Healthcare
This is becoming a serious issue in practices as the climate of our country continues to worsen. OSHA states that “violence against healthcare workers accounted for nearly as many injuries as other industries combined, which is 4 times greater than the average U.S. worker.”
OSHA requires that employers maintain an Emergency Action Plan. These plans must be written, stored in the facility, and available to employees for review.
Your practice should have a policy statement regarding workplace violence. It is also strongly suggested that you have a weapons penalty posted.
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Educational Opportunities
2018 CMOM Class Scheduled!
The WVSMA will host the 2018 Certified Medical Office Manager (CMOM) beginning on Thursday/Friday, February 22
nd
and 23
rd
and Thursday/Friday, 1
st
and 2
nd
. Participants should plan to attend all four days and take the national certification exam on Friday, March 2
nd
.
Registration information is available on the WVSMA website,
Click
here
to register for the CMOM Class.
Cli
March 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 are preparing a wide variety of programming to keep you apprised of all that is happening in the healthcare arena. Plan now to attend and watch both association websites for updates!
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