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ISSUE 18 WINTER 2012

1 1 0 2 r e t n i W r u o o t e m S o c E l e M I W T H C W f o n o Editi

WCH Service Bureau is a proud member of the following professional organizations:

3047 Avenue U, Brooklyn NY 11224 / Phone: 718 934-6714 / Fax: 718 504-6072 / wch@wchsb.com / www.wchsb.com


WCH Service Bureau, Inc. would like to take this time to wish you and your family a happy holiday season. It gives us great gratitude and pleasure to express to you our season's greetings and best wishes for the upcoming year. Thank you for giving us the opportunity for having your trust in our services. May your holiday season and the New Year be filled with much joy, happiness and success. We look forward to working with you in the coming year and hope our business relationship continues for many years to come. We, from WCH, would like to consolidate in wishing you health, comfort, and a prosperous holiday season and a happy New Year!


Inside this Issue: WCH BUZZ WCH IS AN OMIG COMPLIANT....................................................................................4 MEDICAL OFFICE STRUCTURE.............................................................................................................5-7 ALLERGY TESTING.............................................................................................................7 CIVIL SURGEON..........................................................................................................8 PHYSICIAN MARKETING........................................................................................9-10 S T. J U D E C H I L D R E N ' S R E S E A R C H H O S P I TA L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 CARD SWIPE TECHNOLOGY........................................................................................................12 HOW INCIDENT VISITS WORK?.......................................................................................13-14 PATIENT SURVEY..............................................................................................................15-16

HEALTHCARE NEWS UNIVERSAL HEALTHCARE................................................................................................................17 5010 ENFORCEMENT DELAY SET................................................................................................................18 NATIONAL GOVERNMENT SERVICES CONDUCTING ....................................................................................................................19 OIG TELLS CONGRESS OVER $5 BILLION RECOVERED.................................................................................19 QUESTIONS & ANSWERS...................................................................................................................20-21 FEEDBACK......................................................................................................................22


WCH BUZZ WCH is an OMIG Compliant Page 4

WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

TIME MANAGEMENT PROGRAM Let WCH's Time management software work for you! http://wchsb.com/manage ment.asp

As you are aware, office of Medicaid, inspector general (OMIG) requested that those that claim, order or receive payments for services or supplies directly or indirectly, or submit claims for as a minimum of $500,000 a year must have in place a compliance program. This requirement has been in place since 2009. WCH has been in compliance with OMIG since the beginning. You may question the reason for WCH having compliance in place, well since we are submitting claims on behalf of Medicaid providers and we are a registered service bureau with the department of health in the state of New York, we are obligated to follow all state requirements similar to a licensed medical professional complies with these rules. WCH's compliance plan includes the following: · Code of ethics · Written policies and procedures of staff members · A listed procedure on a day to day basis · Individual responsibilities of their role · Compliance officer's duties · Details of training and education of each department · Responsibilities for governing board, management and employee communication compliance · Disciplinary policies and their outcomes · A system of control of supervisor and managers of departments · Assistant of client inventory and all billing processes · Measure risk of all errors · Established billing manual · All HIPAA regulations OMIG requires that all providers must submit their compliance manual by the 31 of December every year online. WCH received a certification for having the compliance submitted on time every year. Certification acceptance is kept by the General Manager, Olga Khabinskay. Should you have any questions or concerns regarding the compliance program, please feel free to contact General Manager, Olga Khabinskay at (718) 934-6714 ext. 1201 or via email olgak@wchsb.com. We can help your practice to set up a compliance program today!


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Medical Office Structure How physicians choose to organize and operate their practices can have a significant effect on cost containment. Changes in the practice of medicine brought on by managed care have created an impact on the WCH Toll Free Phone: organizational structure of the physician practice. The demand for 888-WCHExperts Fax: greater information on the amount and quality care has put pressure on 718-504-6072 the cost side of the equation. Making the decision to participate or not to Our Website: participate in a health plan requires the ability to gather data on your www.wchsb.com practice's costs. Deciding to offer new services or add new diagnostic tests and procedures, again, requires the data for proper analysis. The right organization can help provide this information in a cost- effective way. The ability to operate a practice in a cost- effective manner is greatly determined by the availability of qualified individuals and effectiveness with which they are used. It is necessary to keep the number of PHYSICIAN employees to a minimum because of the cost in retaining them. At the MARKETING same time, this seems counter to the need to have enough qualified help. Physician marketing How you meet these needs will have an effect on how you organize your attracts new Patients,Grows,Revenues practice. and promotes your Solo versus Group Practice brand! The decision to practice in a group setting or on your own has many

http://physicianmarketing.us/

considerations. It is clear that the number of physicians choosing to practice in a solo setting is declining. Between 1991 and 1995, the number of physicians in solo practice declined by 22%, from a total of 34.1% in 1991 to 26.5% in 1995. At least part of the reason for this trend is the need for physicians to practice more efficiently than solo practices. Such efficiency is determined not only by practice costs but also by physician productivity.


Staff Costs

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WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

WCH Credentialing Department specializes in — IDTF (Mobile) — Sleep Centers — Multispecialty group enrollment — Labs — Group/Facility — Contracting — Fee Schedule negotiation

Demands on practices to provide more data to third- party payers along with increased administrative duties have put pressure on practices to add more administrative personnel. In addition to quantity, the quality of staff required has been elevated. Dealing with complex regulations for billing and managed care operational requirements has forced practices to hire a level of employee. The cost of staff has been a big factor in the lower efficiency of solo practices. The ability to share new staff with multiple physicians does not exist. Hiring a part time staff with specific skills such as managed care billing and collections is more difficult than hiring a full time staff. In addition, it is cost prohibitive to hire qualified practice managers in a solo practice. Group practices are able to hire specialists in various areas because of the practice's larger revenue base. The cost of well trained practice manager is within the financial ability of the larger group practice. Well trained and experienced practice managers, whether they are called office managers, practice administrators, or chief operating officers, can have a significant impact on practice costs. The implementation of the various strategies requires an individual with good training and understanding in operations of a medical practice. Such an individual is compensated at a higher level than are most general office workers. However, such a person should be able to save he practice an amount far in excess of his or her salary and benefit costs. Still, it is hard to justify such a highly paid position in a solo practice. Clearly, staff costs can be held to a more reasonable level in a group practice and become more reasonable as the group increases in size.

Forming a Group Practice There are two ways to approach the formation of a group practice. If you are currently in a solo practice, you can recruit new physicians to join your practice, thus forming a group. The alternative is to merge your solo practice into an existing group practice. While the two methods require different legal steps and documents, the end result is the same. Before you form or join a group, it is important to clearly define the reasons you have for taking this step. Those reasons can help you identify your goals and give you the basis for a business plan necessary to achieve success. In addition, if one of your purposes in forming or joining a group practice is to help reduce or contain costs, you should make a list of areas in which you hope to achieve the cost savings. Once you have identified the areas of potential cost savings, you must carefully analyze each to determine how you plan to reduce costs. Too often practices think they will realize savings before they restructure, only to find out later that the changes actually led to increased costs.

Personnel Questions As one of the greatest areas of cost for a practice is in personnel, staffing is the logical place to start an analysis. Generally it is wise to divide the personnel into clinical and administrative to begin this analysis. Questions to be asked and answered include: - Can you share staff with an additional practitioner? - Which staff will have to be added to the new group practice? - Can an existing staff be let go? Be realistic in your analysis and include your practice administrator in the process. Also, remember to add the other costs of personnel into your calculations, such as an employee taxes and benefits.


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General Overhead

Variable Costs

Another area to analyze is the effect on general overhead in the formation of the group. Will more office space be needed? How much does new equipment will have to be purchased? What will the effect be on utilities and insurance? Carefully make these calculations.

Finally, consider the effect the group formation will have on the variable cost of this practice, such as office supplies, medical supplies, and other supplies. It is also important to factor in any potential savings you may receive by being able to order larger quantities of those supplies.

ALLERGY TESTING What is Allergy testing?

WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

WCH-Whatever your credentialing or billing needs, we can help you. Don't get lost trying to do it on your own; let the professionals help.

Allergy testing measures a person reaction to specific allergens, such as tree pollen, pet dander, foods, medications or molds. A "positive" allergy test means that a person has a specific allergic antibody to the substance tested. This often means that the person is allergic to the substance, meaning that the person will experience symptoms when exposed to the allergen. However, a positive allergy test does not necessarily mean that the person is indeed allergic to the substance. A person may have a positive allergy test to dog dander, for example, but experience no symptoms with exposure to dogs. In addition, a person may have multiple positive food allergy tests, but be able to eat these foods without any bad reactions. Therefore, an allergist is needed to perform and interpret allergy tests based on the person's symptoms. What is the reimbursement for Allergy testing by Medicare Fee per unit: CPT

Fee

95004 95010 95012 95015 95024 95027 95028

8.19 22.31 26.51 17.09 9.49 6.02 16.09

CPT 95044 95052 95056 95060 95065 95070 95071 95075

Fee 7.84 9.14 52.13 36.49 31.28 48.65 65.15 74.79

What benefits it bring to the patient? Many, many people have allergies to different things throughout the United States. Some don't recognize it because of feeling no symptoms and others feel the worst of it all. The benefit it brings to a patient when diagnosed with allergies and understands the symptoms will help treat the condition of allergies you may have. Studies showing the effectiveness of immunotherapy show about 8 out of 10 allergy patients benefit from immunotherapy. Immunotherapy significantly reduce patients' symptoms, hyperactivity and medication requirements. It is important to test patients for allergies due to seasonal change and body changes, etc. WCH can help to set up allergy testing in your practice, if you have any further questions or concerns regarding to allergy testing please free to give Olga Khabinskay, General Manager of WCH Service Bureau, at (718) 934-6714 ext. 1201. Thank You.


Civil Surgeon WCHSB Credentialing Department is happy to help our clients to obtain Civil Surgeon Designation. Page 8

Who is Civil Surgeon? A Civil surgeon is a doctor, selected by the United States Citizenship and Immigration Services (USCIS) to conduct medical examinations of aliens in the United States who are applying for adjustment of status to permanent residence, or who are required by the USCIS to have a Medical Examination (Form I-693). A physician without designated civil surgeon privileges cannot conduct Medical Examinations or complete any medical forms related to USCIS. What documentation WCH needs to start the process? Those Doctors that are interested in being registered as a Designated Civil Surgeon should submit the following documentation to WCH: · A copy of a current medical license; · A current resume that shows 4 years of professional experience, not including a residency program; · Proof of U.S. Citizenship or lawful status in the United States; · Two signature cards (WCH will provide this form).

WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

WCH specializes in enrollment of: — IDTF — DME — Pharmacies — Multi-Specialty Groups — Laboratories — Solo Groups and Physician Groups — Civil Surgeonsv — Individual contracts (all specialties) — Transportation Companies — EIA — Home Health Agency

What will WCH do? WCH will prepare a detailed letter to the District Director in the provider's service location area requesting consideration for a physician to become Designated Civil Surgeon. Our credentialing specialist will attach all above requested documents and submit it for process to the District Director. WCH will monitor on a monthly basis the process of the request and provide the client with feedback of the ongoing status. Please keep in mind that decision of the District Director can take up to six months. Registration in USCIS as a Civil Surgeon may give your practice an additional income for performing Civil Surgeon Services. Your name and the location of your practice will be listed on the www.uscis.gov and it will be available to the public. Those patients that will be in need of this service will be able to find the Doctor by the last name on the website. If you are interested in becoming Civil Surgeon, feel free to contact our Credentialing Department specialist Dora Mirkhasilova at (718) 9346714 x 1102 or via e-mail: doram@wchsb.com

Contact us and we can do it for you!


Physician Marketing

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Dear, providers and office administrators. WCH Service Bureau, Inc is glad to introduce our new service “Physician Marketing”. Marketing is the art of persuasion, and in today's highly competitive environment, it's more essential than ever. When properly executed, a marketing plan can be a smart investment. WCH will help your practice to build strong brand within community, by establishing your brand you will be able to: · Attract new patients, increase your profits · Maximized practice visibility · You will have better informed and educated patients and overall improve your bottom line

Our service includes: Design : Online marketing: logo and slogan, registration on the top search engines, business card , Facebook, Twitter, YouTube -company corporate letters (letterhead), profile setup, incl. site integration and tri-fold or bi-fold brochure, blog posts, professional website design advertising postcards , or re-design(domain registration, 100% flyer and custom graphic custom designs, SEO (Search engine WCH Toll Free Phone: design, advertising banners, optimization) friendly, patient education 888-WCHExperts (printed form , electronic video, patient portal integration, Rx refill, Fax: form), Bill pay, appointment request forms), 718-504-6072 presentations, informative and education video, blog Our Website: www.wchsb.com congratulatory letters, posts, advertising in electronic and print cards for patients or anybody journals, analytics site statistics software EXPERIENCE IS A KEY IN else, newsletter and bulletin. setup week/ monthly report, patient's CREDENTIALING statistics. PRACTICE AND WCH WCH knows how to present your practice in a fresh, creative, unique SERVICE BUREAU, INC IS and innovative way. We have an extensive knowledge and experience in THE RIGHT COMPANY the medical community and our “Physician Marketing” will offer your FOR THE JOB. practice better opportunities. If you are interested in our offer and want to include WCH Service Bureau, Inc in your marketing strategy and would like additional information about new project or have specific questions, please contact olesya.wch@gmail.com, skype: wchsb.olesya. Leave us your contact details and the information requested below. We will get back to you within 24 hours, all the data will be kept confidential. Physician marketing attracts new Patients, Grows Revenues and promotes your brand! Don't be afraid to advertise yourself! Best Regards, Olesya Petrenko Marketing Manager WCH Service Bureau, Inc 3047 Avenue U Brooklyn, NY 11229


4 Useful tips why your practice need physician marketing

Page 10

Why should I create a website for my practice? In our present days the internet is one of the most underutilized operational resources and sometimes many patients complain that it's difficult to find information about doctors online. All people wish they could view more information about their doctor online. A website is a perfect way to connect you and your clients. It is a simple, visually attractive, and easily accessed site for your practice. WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

TIME MANAGEMENT PROGRAM Let WCH's Time management software work for you! http://wchsb.com/manage ment.asp

It should help your patients and prospective clients to find important medical information. Share useful data including your location and contact information, the services you offer, which insurance plans you accept, and a list of frequently asked questions. The creation of a business website will allow you to present your practice in its best light. Thanks to your website you'll be able to attract new patients and find possible new business aspects.

I'm part of a multiple Doctor practice. Why do I need my own internet presence? Many multi-doctor groups have own practice website, but WCH recommends that every physician have a unique creative and innovative website to highlight their personal profile and demonstrate they professionalism. Your own, individual website helps you build a personal strong brand. A mutual website is generally concentreited on corporate branding and often limits individual physicians to a short biography and a picture. A personal website allows physicians to share more information about practice goals, therapeutic methods with their patients and share feedback throughout Facebook or Twitter. Why would I need a print advertising? A print advertising gives you the wide opportunity to correspond directly with your patients. Flyer, newsletter, bulletin and advertising postcards are a wonderful way for physicians to attract new patients and establish relationship for a long period. A professionally designed and high-quality practice brochure is much more than "information", it must represent the quality and ideals of your practice. The print advertising will provide your patients with insight on up to date health news, promote practice procedures and seasonal reminders. I use the internet but I certainly don't know how to establish or have the time to maintain a website, Facebook account or Twitter. Can you help me? Yes. It is a pleasure for WCH to do it. You'll have a professional website, Facebook, and Twitter profiles in no time. WCH can help not only to create an effective website but will also make it rank high on search engines. Our talented creative team will help you obtain the results you want. WCH knows how to present your practice in a fresh, creative, unique and innovative way. WCH is able to work with any size practice or budget. Please, leave your contact details. We will contact you. Thank you. Please feel free to contact me olesya.wch@gmail.com , skype:wchsb.olesya. Our Website: http://physicianmarketing.us/


Page 11 Finding cures. Saving Children Today, you can make a difference in the lives of St. Jude's children, how? Easy! St. Jude Children's Research Hospital needs your help in fundraising $3 million dollars within 41 days by January 17, 2012. I'm sure you can see what a great opportunity it is for St. Jude's to raise $3 million in saving lives of sick children. We urge you to help St. Jude's meet this challenge to help raise these funds for children battling leukemia, brain tumors and other deadly diseases.

WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

Your gift could help: 路 Perform 19 autologous lifesaving bone marrow transplants for critically ill children; or 路 Provide more than 2,000 days of IV chemotherapy for children suffering with leukemia; or 路 Give 30 boys and girls with brain tumors complete courses of radiology. If you send a gift of $35 to help these children now, your gift would do the work of $70 in giving the children of St. Jude's the life saving cancer treatments they desperately need. And if you could send a gift of $70, your caring generosity would double and put $140 towards helping St. Jude's children beat their cancers. What's more, you can manage to donate $105; your wonderful contribution would double and be worth $210.

PHYSICIAN MARKETING Physician marketing Simply send St. Jude's your gift of $35 or $70, write that amount on a attracts new Patients,Grows,Revenues check and return it along with whatever size gift you are able to send at this time. and promotes your brand! http://physicianmarketing.us/ You can even donate by making a phone call to 1-(800) 822- 6344 You have the chance to make a real difference. If you can dig deep right now, knowing that every dollar you send will go twice as far in caring for St. Jude's children, I believe they'd be very grateful in being able to see another day. Any amount that you can spare would be a meaningful gift because it will be doubled in caring for St. Jude patients.


CARD SWIPE TECHNOLOGY

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WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

WCH Credentialing Department specializes in — IDTF (Mobile) — Sleep Centers — Multispecialty group enrollment — Labs — Group/Facility — Contracting — Fee Schedule negotiation

Transactions for patient eligibility and benefits just got better! WCH highly recommends using the new card swipe technology in order to explore and/or process a patient's eligibility information and records as well as eliminating manual data entry by swiping patient's insurance card. The new card swipe software provides over 564 payers for real time as well as PCP information, out of pocket stop loss, deductible, co pay information, store demographic data, and active or inactive data plus more. Payer Gateway Plus provides the software and swipe card reader which is designed to reduce time spent in order to be able to verify individual patients and/or multiple patients (batches) to be processed at one time. Fully processing batches and response time in which data to be returned from payer is within 24 hours, however most process within 1 – 2 hours, transaction responses within 3-6 seconds. Responses are viewed colorcoded in order to display if they are active or inactive as a table in which to compare PCP information, coverage status as well as other information and can be customizable to your fulfillment. Sound too good, to be true? Retrieve patient's information that was previously processed for re-verification by name, DOB or account number in your history that has automatically saved up to 2 years and gives you the ability to upload your entire patient population. Schedule multiple appointments that can be exported to Microsoft Excel as well as your work list and save it where ever you'd like. Determine estimate of your patient's payments or patient's payment plan when linked to real- time credit card processing, which is optional, having the patient pay up front before walking out the door and would have to bill awaiting responses. For 300 transactions shared with doctors, providers, etc. costs $45.00 per subscription. For unlimited transactions each provider must pay $65.00 in which to share the amount of transactions. · No long term contract. · No set up fee's. · All new provider account receives a 14 day trial or 300 transactions. The card swipe device provided by Payer Gateway Plus costs $79.00. http://www.payergateway.com/


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Incident to Simply Stated One qualified individual rendering a service that is billed by a different qualified individual. Incident to What? Incident to physician's professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness. What? To qualify for reimbursement, the service must be: · An integral part of the physician's professional service · Commonly provided without change or included in the physician's bill · Commonly furnished in the physician's office or clinic · Limited to situations in which there is direct physician supervision of auxiliary personnel · Without their own benefit category

WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

WCH-Whatever your credentialing or billing needs, we can help you. Don't get lost trying to do it on your own; let the professionals help.

Who? Qualified individuals · Have sufficient training to provide service · When appropriate, are licensed under state law to perform within the scope of practice for their individual disciplines Who Can Render? · Nurse practitioner (NP) · Physician assistant (PA) · Auxiliary staff - E.g., medical assistants, licensed practical or vocational nurses, registered nurses · Other practitioners when their services are provided as auxiliary personnel Who Can Supervise? “Physician” defined as a physician or other practitioner (PA, NP, CNS, CNM, etc.) authorized by the Act to receive payment for services incident to his or her own services. Incident to criteria must be me in all case. Supervision Requirements The supervising physician must be present in the same office suite and immediately available during the encounter when necessary


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Supervision in Group Practices · Not necessarily the physician who performed the initial patient visit · Not necessarily the patient's primary care physician · Not necessarily of the same specialty as the primary physician · Any physician in the same group who is in the clinic or office suite and is immediately available to furnish assistance or direction if needed When? Services may be provided incident to when · The physician has performed an initial service · The patient is an established patients with an established diagnosis · They are part of continuing plan of care in which the physician will be an ongoing and active participant · There is a physician's service to which the rendering provider's services relate · They involve a face-to-face encounter · The physician is physically present in the same office suite to provide supervision

WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

WCH specializes in enrollment of: — IDTF — DME — Pharmacies — Multi-Specialty Groups — Laboratories — Solo Groups and Physician Groups — Civil Surgeonsv — Individual contracts (all specialties) — Transportation Companies — EIA — Home Health Agency

Where? · Typically furnished in the physician's offices · NOT in a hospital setting or skilled nursing facility · If furnished in setting outside the office, such as a home or an institution, there must be direct supervision by the physician · Phone contact with the physician doesn't not constitute direct supervision Incident to: What it isn't Incident to is not · A visit by an established patient for a new problem · Services which have their own coverage requirements and benefit category · Services provided by residents, medical students · The services of scribes How? Documentation Documentation should include · A clearly stated reason for the visit · A means of relating this visit to the initial service and/ or ongoing service provided by the physician · Patient's progress, response to, and changes/ revisions in the plan of care · Date the service was provided · Signature of person providing the service While co signature of the supervising physician is not required, documentation should contain evidence that he or she was actively involved in the care of the patient and was present and available during the visit.


Patient Survey

Page 15

WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

EXPERIENCE IS A KEY IN CREDENTIALING PRACTICE AND WCH SERVICE BUREAU, INC IS THE RIGHT COMPANY FOR THE JOB.

It's the end of the year and you may wonder how your medical practice is satisfying patients. Knowing what your customers truly think is critical to retaining your customers and keeping your profits. By identifying the needs, wants, and expectations of your customers, your business is able to maximize customer satisfaction and retention. Physicians in medical practice should begin slowly either vendor to consultants or simply obtain utilized questionnaires. This approach allows the medical practice more control and if properly conducted could be more cost effective. Most importantly, a well done customer satisfaction survey will arm your company with valuable information needed to ensure your hard-earned customers do not go elsewhere. All information should be treated as confidential. While participation is voluntary, always encourage your patients to fill out the questionnaires and return for better services.


Practice's Name

Patient Survey Questionnaire

Patient: __________________________Today's Date:____/_____/____ (LAST)

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WCH Toll Free Phone: 888-WCHExperts

Fax:

(FIRST)

(MM) (DD)

(YY)

Email: ___________________________________ Please circle the level of satisfaction that best reflects your experience with our center: 1 = very dissatisfied - 5= very satisfied 1 2 3 4 5 How would you rate your overall visit? Did the staff greet you properly?

1

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5

Did you have to wait past your appointment time to be seated?

1

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How was making a call to set an appointment?

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How was the registration process at the front 1 desk?

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Were your financial options explained to you?

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Would you refer your friends and family?

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How are questions answered by our staff?

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Did the preparation for your test/ exam 1 adequately Explained?

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Did the doctor take the time to listen to and understand your concerns?

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Are you comfortable with the level of technology 1 used in the office?

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5

718-504-6072

Our Website: www.wchsb.com

TIME MANAGEMENT PROGRAM Let WCH's Time management software work for you! http://wchsb.com/manage ment.asp

We are always striving to improve our services. Your comments are important to us. How may we serve you better?

________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ____________________________________


UNIVERSAL HEALTHCARE

Page 17

WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website:

Universal Health Care is excited to announce the launch of their new exclusive Private Fee for Service provider network in your county. They are in the final phases of forming their physician network that will serve Medicare Advantage Health Plan Members in your area. Universal Health Care is a physician-owned and physician operated, NCQA - accredited plan and, as such, ensure hassle free healthcare for both of their members. To be included in the provider directory, and maintain continuity of care, we encourage you to join the provider network immediately. Universal Health Care offers many advantages to both you and your patients including: · Reimbursement at 10.2% of the Medicare fee schedule · Prompt claim payment in as few as 10 days · Hassle free Healthcare with no authorizations or physician to physician referrals required · Access to Universal's on- line enrollee eligibility and claims information · Low fixed fee Member co payments · Electronic billing and electronic remittance advice · Part D prescription drug coverage for Members To participate all you need to do is: · Complete and execute both Agreements signature page. · Complete the List of Affiliated Provides Form · Complete Credentialing application for all affiliated providers. · Return Agreements · Retain copies of the contract documents in your files for future reference · Enclose a completed W-9 form to ensure proper reimbursement

www.wchsb.com

AMA Vigorously Opposes 2013 ICD-10 Implementation During the 65th Interim Meeting in New Orleans, the American Medical Association's (AMA's) House of Delegates formally resolved to “vigorously work to stop the implementation of ICD-10 and to reduce its unnecessary and significant burdens on the practice of medicine“. The AMA cited cost as most significant of those burdens. PHYSICIAN The Centers for Medicare and Medicaid Services (CMS) has mandated on MARKETING October 1, 2013 implementation date of the ICD-10 code set for all health Physician marketing care providers. The increased specificity of ICD-10 is expected to improve attracts new the quality of health care data and subsequently improve clinical, Patients,Grows,Revenues financial and administrative outcomes. and promotes your ICD-10 also introduces new complexity into health care, will require brand! providers to document patient encounters to greater detail, and will be http://physicianmarketing.us/ costly to implement. A 2008 study found that a small three-physician practice would need to spend $83,290 to implement ICD-10, while a tenphysician practice would spend $285,195 to make the coding change. The AMA would support a new code set, however, and also resolved to “work with other national and state medical and informatics associations to assess an appropriate replacement for ICD-9”


5010 Enforcement Delay Set

Page 18

WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website: www.wchsb.com

WCH Credentialing Department specializes in — IDTF (Mobile) — Sleep Centers — Multispecialty group enrollment — Labs — Group/Facility — Contracting — Fee Schedule negotiation

The Centers for Medicare and Medicaid services (CMS) Office of Ehealth Standards and Services (OESS) recently announced that its loosening its ASC X12 Version 5010 standards compliance enforcement with a 90-day discretion periods for all Health Insurance Portability and Accountability Act (HIPAA) covered entities. It has come just in time before the compliance January 1, 2012 deadline however, is it enough time to meet the compliance expectations? C M S sta te d i t w i l l i n i t i a te enforcement on office- based physicians, health insurance plans and claims clearing houses starting March 21, 2012. CMS made this decision based on industr y feedback from organizations and their trading partners who aren't ready to finalize system upgrades to 5010 standards. Providers must comply, regardless. That doesn't mean, however, that providers have a delay of implementation. While the payers may not be implementing 5010 January and there will be no penalty, failure to use 5010 means no reimbursement. “CMS has to look seriously about allowing 4010 claims for a considerable length of time.” Tennant said. “We strongly encourage the government to monitor the industry. If things don't improve, they'll have to look seriously about augmenting this decision they made today.” Now is the time to make sure you are ready for the March 31 compliance deadline. CMS advises in the press release “OESS encourages all covered entities to continue working with their trading partners to become compliant with the new HIPAA standards, and to determine their readiness to accept the new standards as of January 1, 2012. While enforcement action will not be taken, OESS will continue to accept complaints associated with compliance with Version 5010, NCPDP D.0 and NCPDP 3.0 transaction standards during the 90 - day period beginning January 1, 2012. If requested by OESS, covered entities that are the subject of complaints must produce evidence of either compliance or a good faith effort to become compliant with the new HIPAA standards during the 90-day period.”


National Government Services Conducting Prepayment Reviews in an Effort to Decrease Error Rates Page 19

During the middle of December, the National Government Services will carry on a process for a prepayment medical review on Connecticut and New York claim types and services that have consistently affected the comprehensive error rate testing Part B (CERT). This is due to Centers for Medicare and Medicaid Service (CMS) to reduce the Medicare claim payment error rate. These actions are an addition to the National Government Services Medical Review strategy and will not target any specific provider or region with the jurisdiction.

Following services that are subject for review: Chiropractic services o CPT/HCPCS code 98941 will be reviewed Physical therapy services billed by specialties other than physical or occupational therapists o CPT/HCPCS code 97110 will be reviewed

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Diagnostic radiology (diagnostic imaging) services o CPT/HCPCS codes 78815 and 72141 will be reviewed

888-WCHExperts

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Claims for the stated services that are listed above will suspend the reason codes referenced. Providers will receive additional requests, requesting documentation to support the service billed. Providers are encouraged to respond with the requested documentation in a timely manner to expedite these claims. When preparing your documentation in response to ADR, refer to Responding to Additional Development Requests on the National Government Services website.

your credentialing or billing needs, we can help you. Don't get OIG Tells Congress over $5 Billion Recovered The OIG reported 723 criminal actions against individuals or entities lost trying to do it on that engaged in crimes against the U.S. Department of Health & Human your own; let the Services (HHS) programs and 382 civil actions, which included false professionals help. claims and unjust- enrichment lawsuits filed in the federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider self – disclosure matters.

Among those programs that have contributed to its success, the OIG gave special mention to the Health Care Fraud Prevention and Enforcement Action Team (HEAT), which coordinates law enforcement operations among federal, state, and local law enforcement entities; prescription drug investigators and reviews. Future priorities for the OIG were identified as a continued focus on reducing improper payments, the public health and welfare of HHS beneficiaries and protection of electronic patient health information.


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Q: Are there any limitation for performing transcranial Doppler, NCV and VNG to a Medicare beneficiary? A. Transcranial doppler, no limitations "Frequency of follow-up studies will be carefully monitored for medical necessity and it is the responsibility of the physician/provider to maintain documentation of medical necessity in the patient’s medical record.

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B. Nerve conduction, no limitation, but "Consistent repeated testing on the same patient, or testing every patient referred for pain, weakness or paresthesia may become evident on review. In such cases, the claim will considered not medically necessary. The NCS-EMG performing provider, in consultation with the referring provider, is responsible for determination of the appropriateness of a study.

718-504-6072

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WCH specializes in enrollment of: — IDTF — DME — Pharmacies — Multi-Specialty Groups — Laboratories — Solo Groups and Physician Groups — Civil Surgeonsv — Individual contracts (all specialties) — Transportation Companies — EIA — Home Health Agency

C.

For VNG Medicare does not even have policy, so there is no limit

Q: What actions should be taken into affect if a breach of information and patient data has been carried out from a medical office by an employee? The HITECH Act requires entities covered under HIPAA to report breaches of medical data privacy. “Large breaches” are those which affect over 500 individuals; “small breaches” affect fewer than 500 individuals. The Office of Civil Rights (OCR) in the US Department of Health and Human Services (HHS) maintains records on reported breaches. Notice to Affected Individuals Physician should send written notification via first class mail to each affected individual (or if deceased, the individual's next of kin) at the last known address, unless the individual has indicated a preference for email. In situations where a physician deems possible imminent misuse of unsecured PHI, the physician may provide other forms of notice, such as by telephone or e-mail, in addition to the written notice. If the breach of unsecured PHI affects 500 or more individuals, then the notice must also be provided to major media outlets serving the relevant State or jurisdiction. The notice to the media must contain the same information as the written notice to individuals, and must similarly be


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provided without unreasonable delay, but in no case later than 60 calendar days after discovery of the breach. HIPAA covered entities (i.e., physicians) are required to notify the affected individuals of any unauthorized acquisition, access, use, or disclosure of unsecured PHI without unreasonable delay but not later than 60 calendar days after discovery. Thus if the physician has compiled all of the necessary information to provide notification of a breach of unsecured PH to affected individual(s) by day 10 (10 days from the day the breach was discovered) but waits until day 60 to send notifications, this would constitute an unreasonable delay. Notice to HHS Additionally, the physician must notify HHS, in the manner specified on the HHS website, contemporaneously with the notice sent to the individuals. The HHS website will have a list that identifies the covered entities involved in a breach in which 500 or more individuals are affected. If less than 500 individuals are affected then the covered entity may maintain a log of the breaches and must submit this log annually to HHS (within 60 days after the end of each calendar year). Also the law contains what written notice must contain and also exceptions to the Breach notification requirements.

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EXPERIENCE IS A KEY IN CREDENTIALING PRACTICE AND WCH SERVICE BUREAU, INC IS THE RIGHT COMPANY FOR THE JOB.


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Winter 2012