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Welcome to the Wesgram. This edition contains important information regarding the new law for charging for health care records, as well as information about Medicare's ABN form. You'll also find updates from CMS, Palmetto and other payers.
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Important News----CMIS Class Cancelled
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The CMIS (Certified Medical Insurance Specialist) Charleston class that was scheduled to begin on August 3, 2017, has been cancelled. The course is available in webinar format. If you are interested in additional information about a webinar course, click
here.
The WVSMA plans to continue to offer certification classes for office managers and staff.
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(information from Palmetto GBA)
West Virginia Part B Clinicians: Merit-based Incentive Payment System (MIPS) Tips Webcast: July 18
West Virginia Part B providers, Palmetto GBA is pleased to partner with Quality Insights for a free CMS-Funded Quality Payment Program (QPP) and MIPS webcast on July 18, 2017 at 1 p.m., EST. Registration is required and this session is only for WV Part B providers.
Action Needed: Due to Increased CMS Security Requirements, eServices Portal Users Must Sign Up for Multi-Factor Authentication (MFA) by July 1, 2017
This article informs providers who use the eServices Portal that they must sign up for Multi-factor Authentication (MFA) by July 1, 2017. Instructions on how to register for MFA are also included in this article. Effective July 1, 2017, if you have not yet signed up for MFA, your account will automatically be set to MFA with the email address associated with the user ID.
Modernized National Plan and Provider Enumeration System
The Centers for Medicare & Medicaid Services has modernized the National Plan and Provider Enumeration System (NPPES 3.0) that now has unified login for type 1 and type 2 providers which increases security, provides new surrogacy functionality, has a more responsive User Interface (UI) and a streamlined National Provider Identifier (NPI) application process. All NPPES users who obtain and manage NPI account information should be aware of these new and improved features/processes, especially those who support Type 2 providers. NPPES has implemented a more efficient way of accessing type 2 NPI accounts so providers no longer need separate credentials for type 2 accounts and are no longer inclined to share these credentials.
Influenza and Pneumococcal Roster Billing Packet and Forms
Roster billing is a simplified process used by mass immunizers. Palmetto GBA has prepared a packet for health care providers who mass immunize their patients against influenza and pneumonia. The packet contains instructions on how to submit claims using the roster billing method
E/M Weekly Tip: History Component - Interval History
For certain categories of E/M services that include only an interval history, it is not necessary to record information about the PFSH. Those categories are subsequent hospital care and subsequent nursing facility care. In order to receive 'credit' for an interval history the provider must provide an update on the status of the patient from the last encounter. It may be a simple statement like 'no complaint of sob,' 'complains of chest pain” or 'pt. feels better today.' The chief complaint is still required.
E/M Tip: 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.
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CERT Tip---
A Legible Medical Record Matters
Signatures in the medical record must be clearly visible after each entry. Remember, if you can't read it, Palmetto GBA can't read it!
Medicare Does Not Accept Retroactive Orders
Providers may not add late signatures to medical records. Medicare does not accept retroactive orders. In the event a signature is missing, the record cannot be changed.
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With healthcare costs rising, many of your patients need assistance. The West Virginia Rx Card can help with those prescription costs and is a free program available to all West Virginia residents. There are no eligibility requirements or forms to fill out. Tell your patients to simply take the card into the pharmacy to get savings of up to 75% on prescription medications for their 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. Your patients can find and print their FREE card
here!
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MACRA Update
On Wednesday, June 21, CMS released a proposed rule for the 2018 Quality Payment Program. The proposal contains a number of provisions that address concerns raised by the AMA and other physician groups and that will help minimize the number of physicians who face penalties under the program.
The proposed rule (CMS-5522-P) can be downloaded from the Federal Register
here
New ABN Form from CMS
Has your practice implemented the new “Advance Beneficiary Notice of Noncoverage” (ABN), required by the Centers for Medicare and Medicaid Services (CMS)? CMS has said that although the latest version of the form (ABN Form CMS-R-131) does not include any substantive changes, in accordance with Section 504 of the Rehabilitation Act of 1973, the form has been revised to include language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format if needed. The form also now includes an expiration date.
The effective date for providers to use this new ABN form was
June 21, 2017, so if you are not using the new form, you should begin now.
As a reminder, the Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service) beneficiaries in situations where Medicare payment is expected to be denied. Guidelines for mandatory and voluntary use of the ABN are published in the Medicare Claims Processing Manual, Chapter 30, Section 50.
To download the form in English and / or Spanish, click
here.
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Payer News
Highmark Update
Changes Occurring for Locum Tenens Service Time Frames
Effective August 22, 2017, locum tenens service time frames may not exceed 60 consecutive days for Medicare Advantage or commercial networks. Highmark requires all physicians who provide services to our members to be credentialed and contracted. However, under certain circumstances, Highmark allows for locum tenens arrangements. A locum tenens provider is defined as a practitioner who is covering for another practitioner when they are absent for reasons of illness, retirement, death, medical leave, vacation, military leave or continuing medical education.
If a regular physician is absent longer than 60 days without returning to work, the locum tenens must be credentialed and enrolled as if he or she were joining your practice as a new physician.
PEIA Update
All Primary Care copays for PEIA members increased to $20.00 per visit as of July 1, 2017.
iSelectMD Telehealth Benefit
PEIA has rolled out a new benefit for PEIA PPB Plan members. PEIA has chosen iSelectMD as its preferred provider for telehealth services. Telehealth allows you to connect with a physician via phone or video chat when you have a non-
emergent medical condition that needs treatment. Please note that WV law requires that the first visit be done face-to-face via web cam or cell phone video chat.
With just one simple phone call, members are connected to state licensed, board-certified physicians who are ready to resolve non-emergency health issues 24 hours a day for a $40 copay. iSelectMD physicians take the time to listen and consult with you to recommend a treatment plan and, when appropriate, prescribe medication.
iSelectMD physicians treat many non-emergent illnesses, for example:
- Sinus Infections
- Bronchitis
- Cold & Flu
- Ear Infections
- Sore Throat
- Pink Eye
- Gastroenteritis
- Urinary Tract Infections
To access iSelectMD Services: Call 1-877-775-3006 ext. 1 - 24/7. Use access code WV1144.
iSelectMD is available anytime and anywhere. SelectMD encourages patients to have a primary care physician and does not replace their existing primary care physician.
iSelectMD requires a Medical History Disclosure to be completed prior to your first consultation. This may be completed online at
www.iselectmd.com or by calling customer care at 1-877-775-3006
Depending on time of day or call volume, iSelectMD physicians dedicate themselves to return calls within 30 minutes from the time they receive the request.
Prescriptions
iSelectMD physicians reserve the right to write prescriptions when deemed appropriate and do not prescribe DEA controlled substances or certain other drugs that may be harmful due to potential abuse.
To learn more, click
here or call 1-877-775-300
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Other Important News
New Fees for Health Care Records
(information from the WV Board of Medicine)
Legislation that goes into effect July 6 establishes a new fee structure that physicians and other providers may utilize for providing health records to patients or their representatives.
The law resulting from Senate Bill 578 requires providers to produce records within 30 days of receiving a written request. The provider may charge a patient or their personal representative a fee consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
For someone other than the patient or their personal representative, the provider may charge a $20 search and handling fee, a per-page fee of 40 cents for paper copies, and postage (if mailed), plus any applicable taxes.
If requested, records may be furnished in electronic form, upon agreement of both parties; the per-page fee cannot exceed 20 cents.
In no event can the charge exceed $150, inclusive of all fees, except for applicable taxes.
The new law also allows for a $10 fee for certification of copies. If someone requests or agrees to an explanation or summary of the records, the provider can charge a reasonable cost-based fee for labor (plus postage and taxes). If records are stored with a third party, or a third party responds to a records request, the provider, “may charge additionally for the actual charges incurred from the third party.”
The per-page fee for copying may be adjusted on Oct.1 of each year to reflect the consumer price index for medical care services.
QPP Update
(info from Quality Insights)
Need a simple way to jump start your participation in the Medicare Quality Payment Program (QPP)? Quality Insights, which has been offering free support to practices through its Quality Innovation Network since August, 2016, is expanding its assistance through a new Centers for Medicare & Medicaid Services-funded initiative called Quality Payment Program-Small, Underserved and Rural Support (QPP-SURS).
The QPP-SURS team offers technical assistance, education and networking opportunities to all small practices (15 or fewer QPP-eligible clinicians) in Delaware, New Jersey, Pennsylvania and West Virginia. Quality Insights QIN staff will continue to provide QPP assistance to large practices in these states.
Quality Insights’ 360-degree approach combines the latest in self-directed, e-based learning; interactive, online seminars; and social media and e-mail outreach with old-fashioned, personalized attention to help small practices maximize their care quality and improve their Merit-Based Incentive Payment System (MIPS) scores. To get started, clinicians can visit
www.qppsupport.org and sign up to receive all of the benefits of participation. For more information, email Quality Insights at
qpp-surs@qualityinsights.org or call 877.497.5065.
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Educational Opportunities
Save These Dates!
WVSMA 2017 Healthcare Summit
The WVSMA Healthcare Summit will be held at The Greenbrier on August 25-27, with 12.25 hours CME available. Plan now to join the WVSMA’s 150th Celebration. Register
here.
WVMGMA Fall Conference ---Thursday/Friday, September 21/22, at Stonewall Jackson Resort
OMA Fall Conference---Thursday/Friday, October 19/20 at the Flatwoods Days Hotel &
Conference Center
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