WESGRAM

Welcome to the April Wesgram. This edition contains important information about your medical license renewal, as well as a survey from Practice Management Institute (PMI). You'll also find upcoming educational programs from Palmetto GBA, the WVMGMA and the OMA. As always, we've included the latest information from the payers. Happy Spring!

Latest News

WV Board of Medicine 2017 Renewal Advisory

(information from the WVBOM)

Physicians with last names beginning with the letters M through Z and all Podiatric Physicians take note: your West Virginia medical license or podiatric license will expire on July 1, 2017 unless you renew your license by 4:30pm EDST on Friday, June 30, 2017. Due to legislative enactments, there are some changes to the information you must provide in association with your renewal application. Successful renewal of your West Virginia license will require you to be prepared to meet the new renewal requirements. The renewal fee remains at $400 for the 7/1/2017 to 6/30/2019 renewal period.

The following summary will assist you in preparing to renew your active or inactive license. Please familiarize yourself with the new information and documentation you will need to have available to complete the renewal process. More detailed information is available on the website at https://wvbom.wv.gov under Renewal and Board Rules.

New Requirement for All Physician Renewal Applicants - PICF

All active physician renewal applicants must pay the Patient Injury Compensation Fund’s $125 assessment fee prior to being granted access to the online renewal application. This is a result of new legislation passed in 2016. If you renewed in the inactive license status in July 2015 you will not have to pay the assessment fee at this time, but will be required to pay the fee if you wish to have your license status changed to active prior to July 1, 2020. Payment is made when accessing the renewal application or through a separate portal on the Board’s website home page with the funds being deposited directly to BRIM. The WVBOM is charged with the processing of the fee since it must be paid in order to be eligible for licensure renewal. Once the fee is paid you will have access to the renewal application. If you qualify for one of the five limited exemptions listed on the payment portal, please contact the Board office to confirm your exempt status and have it recorded. This fee may be paid after January 3, 2017, using the PICF portal on the website homepage. If you were initially licensed after July 1, 2016, you have paid the fee for this renewal cycle.

New Requirement for All Renewal Applicants - WVCSMP

A renewal applicant who has prescribed or dispensed Schedule II, III or IV controlled substances pursuant to a West Virginia medical license may not renew his or her West Virginia medical license without verification that he or she has obtained and maintained access to the West Virginia Controlled Substance Monitoring Program (WVCSMP) database. As part of your on-line renewal application, you will be required to enter the complete date, mm/dd/yyyy, that you originally registered to have access to the WVCSMP. The date of original registration listed on your Confirmation of Access to West Virginia Controlled Substance Monitoring Program – CSAPP certificate is the date to be entered on your renewal application. If you are a licensee required to register with the WVCSMP, please obtain this certificate so you may enter the correct date in your application before you access your renewal application. Verification certificates can be obtained at https://www.csapp.wv.gov . To view guidelines provided by the WV Board of Pharmacy to assist you in registering with the WV CSMP and accessing your verification certificate please click here.

Reminder to All Applicants Regarding Process for Providing Digital Documents

Any “yes” responses will require an explanation to be typed in the related text box, which you will be required to answer. “Yes” responses may also require either the uploading of supporting documents or an attestation that you will request documents to be sent from third parties to be submitted to the Board office in support of your application. Your application will not be complete if the required supplemental information or documentation is not provided. Have responses prepared and documentation saved as a pdf file(s) for easy uploading when you renew.

Applications with uploads attached and/or “yes” responses will be pending further review. If your website profile under Licensee search has not updated to the new renewal expiration date of 6/30/2019 within five business days of submission, and if you have not received an explanation e-mail from Board staff, please follow-up with the Board office. Once your license shows the 2019 expiration date you will be able to print your wallet card from the website home page. Wallet cards are no longer being mailed. Due to the new requirements you are encouraged to renew your license as soon as you are eligible and prior to June 24th to allow ample processing time.

Reminder to All Applicants Regarding CME Attestation

The CME requirements have not changed since 2015. All renewal applicants must attest to the successful completion of all CME requirements. Please make sure you are familiar with your CME obligations. While the CME cycle is from July 1, 2015, to June 30, 2017 you must have completed all CME requirements as of the date you execute the attestation on your renewal application.    Please note the 3 hours of drug diversion training and best practice prescribing of controlled substances through a course which has been approved by the WVBOM is a recurring obligation. Your prior completion of a course in satisfaction of this requirement prior to July 1, 2015 does not satisfy your obligation for this renewal cycle!

You can meet the CME requirements of completing 50 hours of AMA PRA category 1 or its equivalent by completing:

    50 hours of AMA PRA category 1 (with 30 of those hours pertaining to your practice specialty) – may receive up to 20 hours of credit for teaching medical students towards the 50 hours; or

    1 full year of ACGME postgraduate training completed between the dates above; or

    Sit for and pass a certification or recertification examination of one of the ABMS members boards and receive certification or recertification from said board; or

    Current ABMS Board certification and successful involvement in maintenance of certification (MOC) requirements.

    And

    3 hours of drug diversion training and best practice prescribing of controlled substances through a course which has been approved by the WVBOM (click here) and completed July 1, 2015 or later and prior to submitting your on-line renewal application. This requirement may be waived on the application only if you may truthfully attest that you have not prescribed, administered or dispensed any controlled substances WHATSOEVER (in any jurisdiction) during the current CME renewal cycle 7/1/15 to 6/30/17.

PMI News

Practice Management Institute (PMI) offers four nationally recognized certifications---the Certified Medical Office Manager (CMOM), the Certified Medical Coder (CMC), the Certified Medical Insurance Specialist (CMIS), and the Certified Medical Compliance Officer (CMOC).

Our physicians recognize the importance of certified professionals and the WVSMA has offered certification courses each year. Many practices now have PMI certified professionals.

We want to continue to offer the certification courses and are asking for your assistance as we plan this year’s courses. If you are interested in the CMOM, CMC, or CMIS course, please respond to Barbara Good with the certification you wish to obtain. That will assist both the WVSMA and PMI as we schedule courses. We want to serve you!

Also, the WVSMA is scheduling re-testing for any who needs to re-test. Please email Barbara Good) if you are interested in re-testing in May.

The WVSMA is the exclusive West Virginia partner for PMI.

(information from Palmetto GBA)

Palmetto GBA, the JM A/B MAC, will present an informative workshop in West Virginia that will provide information related to the most common errors identified through a variety of data analysis and tips to avoid them. Palmetto GBA’s ultimate goal is to have educated and compliant providers who know how to accurately and skillfully apply the information they learn to their documentation and billing practices.

The workshop is intended to keep providers apprised of Medicare guidelines as well as using technology for better results. The recommended participants are administrators, billers, nurses and other healthcare professionals that submit claims to Medicare.

   Registration: 12:30 - 1 p.m. ET
   Time: 1 - 5 p.m. ET
   Date: May 24, 2017

Location: WV University Auditorium at Charleston Area Medical Center (CAMC)
3110 MacCorkle Avenue SE
Charleston, WV 25304

Part B: The workshop is tailored for Medicare providers and their staff that bill Palmetto GBA for Part B claims on the CMS 1500 claim form or electronic equivalent. The Part B session will include:

•   Medicare B Updates
•   Electronic Data Interchange (EDI)
•   Provider Enrollment Revalidations
•   Medical Review Strategy
•   Appeals
•   Toolkit: Eservices, Focus on Feedback and more

This is a FREE event.

Providers are reminded:

• Registration is required
• Handouts will be emailed to each registrant at least three business days prior to the event. Sign in the

day of the event begins no earlier than 30 minutes prior to the event start time.
•   A parking fee may apply (view specific event locations for details)
•   Bringing a light jacket or sweater may help to assure your comfort
•   Palmetto GBA will not provide refreshments

Controlled Substances and Drugs of Abuse Screenings

Physicians and other providers are tasked with addressing legitimate patient therapeutic needs against what may be potential abuse or drug diversion. Prescription opioids are safe and effective when used appropriately to alleviate pain, but no drug is without the potential for side effects, especially above a given dose threshold. It is important to note that when a presumptive test is negative for a patient on a prescribed medication, a definitive drug test may be performed. Only one definitive service may be billed per patient per date of services (DOS), regardless of the provider. Medicare will process the first definitive service received per patient, per DOS. All subsequent claims for a definitive service for a given patient on the same DOS will be denied.

Cert Tips

Physician Signatures Missing on Medical Records: CERT Tip

Palmetto GBA continues to see a problem regarding the absence of a physician signature on medical records reviewed by the CERT contractor. Providerss should not add a late signature to the medical record, (beyond the short delay that occurs during the transcription process). Medical records must be signed prior to their submission to CERT.

E/M Tip: Chief Complaint

The extent of the information gathered for the chief complaint (CC) and history component is dependent upon clinical judgment and the nature of the presenting problem. The documentation must clearly reflect the CC.

Action Needed: Due to Increased CMS Security Requirements, eServices Portal Users Must Sign Up for Multi-Factor Authentication (MFA) by July 1, 2017

Providers who use the eServices Portal that they must sign up for MFA by July 1, 2017. Instructions on how to register for MFA may be found on the Palmetto GBA website.

MY DRUG IS NOT COVERED. NOW WHAT?

With the rising cost of healthcare today, families are in need of assistance. The West Virginia Rx Card can help with those prescription costs and is a free program available to all West Virginia residents. No eligibility requirements or forms to fill out, simply take the card into the pharmacy to receive savings of up to 75% on prescription medications for the whole family. West Virginia Rx Card is a proud supporter of Children’s Miracle Network. A donation will be made to your local CMN hospital each time a prescription is processed through the West Virginia Rx Card. Go to www.westvirginiarxcard.com and print your free card today.

Payor News

UniCare Update
(information provided by UniCare)

ATTENTION PROVIDERS:

Your Network Education Representative should not be your first point of contact for billing/claims issues and cannot accept inquiries that have not gone through the following escalation process: Claims and billing inquiries must be handled in our Provider Services Call Center at 1-800-782-0095, select provider, then follow the prompts. In the event the Call Center Representative does not sufficiently address your issue, please request that you be escalated to a Manager. (Remember to please get the name of the person(s) with whom you spoke with and the inquiry number.) Thank You for following this protocol.

UnitedHealthcare Update

Starting in April 2017, the Network Bulletin will be sent from the following email address:

networkbulletin@providernews.uhc.com

If you currently receive the online Network Bulletin from UnitedHealthcare, you’ll need to add this email address to your contacts to help ensure that you continue to receive the bulletin.

Visit our website

Educational Opportunities

WVMGMA Update

WVMGMA members in Huntington have coordinated together to create an email listserv group for the sharing of ideas, workflows, and solutions. Please see the below welcome message that was sent out to initial members. It is currently targeted at business office type functions but it is anticipated that further topics will grow out of continued interest. We would like to offer participation state-wide. Instructions to join are below, as well as the email to use when you have questions. When you email that address, your question will go out to all members to allow for responses and conversation. Please remember that this is utilizing unsecure email so no PHI should be shared. We hope you will find this a beneficial resource as members come together to help each other overcome obstacles.

This is a good way to connect with other local providers regarding issues they may be running into, whether it’s a coding or billing issue, or an issue with the payers themselves. Someone in the group may have had the same issue and have an answer that could help another member out. We may also find that we are having the same issues with a payer and approaching them together for a fix may hold more weight than us going at it individually! So please don’t hesitate to post or respond to someone’s post! The submission email is hhccwv@googlegroups.com, or you can just reply to an email on that subject.

If you know someone who may benefit from participating in the group please invite them to join. The more we have participating, the more beneficial this could be to us. Just have them send a request to join to hhccwv@gmail.com and we will get them added.

WVMGMA Regional Meetings

The West Virginia Medical Group Management Association will be holding Regional meetings during May. The dates and locations are as follows: Tuesday, May 16—Parkersburg

Wednesday, May 17--Teays Valley

Friday, May 19—Beckley

Wednesday, May 24---Morgantown

For additional information, please visit www.wvmgma.com.

OMA Educational Day

The West Virginia OMA has scheduled an Educational Day on Friday, May 19, 2017, from 8:00 AM-4:00 PM, at the Days Inn Conference Center in Flatwoods, WV.

Topics and speakers will include “Improving Patient Experience and Outcomes through Staff Engagement” by Susan Oran, Certified Seminar Leader; CEO Susan Oran Associates; “MACRA/MIPS” by Dr. Mark Stephens, and “MedKoder-Topic E/M Common Questions” Speaker-Tricia Lewis, CPC, CPMA.

CEUs will be available. Register Online at www.stateoma.com

Free for 2017 Registered Members /$25.00 for Non Members

Mail registration check to: PO Box 1672, Huntington, WV 25717