Volume 8 | August 2018
WVSMA Offers 2 courses in September
The West Virginia State Medical Association and the Practice Management Institute are bringing relevant and exciting courses to help improve your skills and bring additional revenue to your practice.

We are offering two courses in September. Each course fee is $199. A convenient course location at our offices in Charleston at 2018 Kanawha Blvd., E has been arranged to enable easy, affordable attendance.

There is a 10 person minimum registration in order to keep the courses on our schedule. Spots are still available for both courses. Don't miss this opportunity. SAVE your SEAT!
How to be the best receptionist
September 28 | 9 am to noon

September 28 | 1 pm to 4pm
Quality Payment Program Performance Feedback Video Demonstration for Group Participants Now Available
View New Quality Payment Program Demo Video on How to Access 2017 MIPS Performance Feedback for Group Participants
If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback are now available for review on the Quality Payment Program website .
If you believe that an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018 at 8:00 pm (EDT).
To help those who participated in MIPS as a group access their 2017 MIPS performance feedback, CMS has posted this new video: How to Access Performance Feedback for Groups .
Additional Videos
Earlier this week, CMS posted four other demonstration videos to help you access your performance feedback for the 2017 MIPS performance year or request a targeted review :
1.  How to Request a Targeted Review - demonstrates how MIPS eligible clinicians or groups can request a targeted review of their 2019 MIPS payment adjustment.
2.  How to Access Performance Feedback for APM Entities - provides an overview of how to access 2017 MIPS performance feedback for Alternative Payment Model (APM) Entities.
3.  How to Access Performance Feedback for Individuals - demonstrates how to access 2017 MIPS performance feedback for a clinician whose performance was scored separately from his or her group.
4.  How to Access Performance Feedback for Voluntary Submitters - provides an overview of how to access 2017 performance feedback data for a clinician who voluntarily submitted data for 2017.
Resources
To learn more about performance feedback and requesting a targeted review, visit qpp.cms.gov and review the following resources:
Advocacy Update

  • AMA urges DOJ to block CVS-Aetna merger
  • CMS releases 2019 Hospital Inpatient Prospective Payment System final rule
  • USP releases revised draft chapter for sterile compounding
  • Trump administration finalizes rule on short-term limited-duration insurance plans
  • AMA urges HHS to withdraw proposed rule on Title X family planning program
  • AMA testifies on MACRA implementation before Energy and Commerce Committee

August 23 Advocacy Update
  • Free CME for physicians registered with DEA in West Virginia 
TOP 10 DENIAL REASON CODES
MODULES
Part A Outpatient Medical Review Top Denial Reason Codes: April - June 2018

We encourage all providers to review this information when filing outpatient claims to prevent denials and to ensure their claims are processed timely. This information affects North Carolina, South Carolina, Virginia, and West Virginia Part A providers. Please review and share this information with your staff.

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Top 10 Inpatient Hospital Medical Review Denials Module

The goal of Palmetto GBA's medical review program is to ensure that payment is only made for services that meet all Medicare coverage, coding and medical necessity requirements. This module reviews the 10 most inpatient hospital common provider errors. Please share with appropriate staff.
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Top 10 Outpatient Medical Review Denials Module

The goal of Palmetto GBA's medical review program is to ensure that payment is only made for services that meet all Medicare coverage, coding and medical necessity requirements. This module reviews the 10 most common outpatient provider errors. Please share with appropriate staff.

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Part A Inpatient Hospital Medical Review Top Denial Reason Codes: April - June 2018

We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. Please review this information and share it with your staff.

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Part A Skilled Nursing Facility Medical Review Top Denial Reason Codes:
April - June 2018

We encourage all providers to review this information when filing SNF claims to prevent denials and to ensure their claims are processed timely.
This information affects North Carolina, South Carolina, Virginia, and West Virginia Part A providers.

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Top 10 Skilled Nursing Facility (SNF) Medical Review Denials Module

The goal of Palmetto GBA's medical review program is to ensure that payment is only made for services that meet all Medicare coverage, coding and medical necessity requirements. This module reviews the 10 most common Skilled Nursing Facility (SNF) provider errors. Please share with appropriate staff.

Vaccine Code Update & Upcoming Webcasts
Quarterly Influenza Virus Vaccine Code Update - January 2019

Change Request (CR) 10871 provides instructions for payment and edits for Medicare's Common Working File (CWF) and Fiscal Intermediary Shared System
(FISS) to include and update new or existing influenza virus vaccine codes.
This update includes one new influenza virus vaccine code. Please make certain your billing staffs are aware of this update.

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Part A Rural Health Clinic (RHC) Services Webcast - September 5, 2018

Please join Palmetto GBA for a Part A Rural Health Clinic (RHC) Services webcast on from 1 p.m. to 2 p.m. ET Wednesday, September 5, 2018. This 60-minute webcast is designed to provide an overview of billing guidelines, preventive services and more! The Part A RHC Services webcast will enable you to utilize this information to positively affect your billing practices and avoid claim errors. Please share this announcement and registration information with your staff.

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Medicare Part A Quarterly Updates Webcast: September 12, 2018

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Jurisdictions J and M Part B Ask the Contractor Teleconference (ACT) September 11, 2018: Tips, Reminders and News to Use

KEPRO BFCC-QIO/PFE Webinar: September 25, 2018


For a claim to be valid under the Medicare Diabetes Prevention Program (MDPP), you must have a separate Medicare enrollment as a MDPP supplier. If you are an approved MDPP supplier and you meet the MDPP supplier requirements and standards (including preliminary or full Centers for Disease Control and Prevention recognition), you can submit claims for HCPCS G-codes for your services. If you do not have a separate Medicare enrollment as a MDPP supplier and you submit a claim for MDPP services, your claim will be rejected.

Counting Units for Therapy
Counting units for therapy services can be complicated; therefore, we are providing guidance. But first, you must understand the difference between timed codes and untimed codes in order to determine how to bill units correctly. This article gives examples that will assist your office in filing these claims.
Influenza And Pneumococcal Vaccines And Administration Reimbursement
These immunizations are paid at 100 percent of the established fee schedule amount. Coinsurance and the annual deductible do not apply.

Jurisdiction M (JM) MACtoberfest Conference:
October 23 - 24, 2018
Join us for the Jurisdiction M (JM) MACtoberfest Conference held on October 23-24, 2018. Sessions will include: New Medicare Card, Comprehensive Error Rate Testing (CERT) Tips, Billing and Clinical Updates, Enrollment Process, Electronic Data Interchange (EDI), Part A Cost Reporting, Medical Review Overview and Targeted Probe & Education (TPE), Making a Home Health Referral for a Medicare Beneficiary, Appealing to Medicare, Disclosing/Returning Medicare Overpayments, eServices, Changes to Evaluation and Management Reporting and the Fee Schedule, and much more.
Please plan to attend.
October Quarterly Updates
October Quarterly Update for 2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule

Change Request (CR) 10881 informs Durable Medical Equipment Medicare Administrative Contractors (DME MACs) about the changes to the DME, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule which is updated on a quarterly basis, when necessary, to implement fee schedule amounts for new codes and correct any fee schedule amounts for existing codes. Make sure that your billing staffs are aware of these changes.

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Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2018 Update

The HCPCS code set is updated on a quarterly basis. Change Request (CR)
10834 informs MACs of the October 2018 addition of one new HCPCS code.
Effective with dates of service on or after July 12, 2018, the Q5108 is payable by Medicare. Note that MACs should hold claims for Q5108 until
CR10834 is implemented.

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Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2018 Update

Change Request (CR) 10898 amends payment files issued to MACs based upon the 2018 Medicare Physician Fee Schedule (MPFS) Final Rule. Make sure your billings staffs are aware of these changes.

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Quarterly Frequently Asked Questions (FAQs): August 2018

The Part B top Frequently Asked Questions (FAQs) are now available. Please take time to review these for answers to your questions.
SAVE THE DATES!
Appalachian Addiction & Prescription Drug Abuse Conference
October 18-20, 2018 at the Embassy Suites, Charleston, WV

WV Pain Care Meetings
Need to get the word out? Have content suggestions? Please contact angie@wvsma.org.