WCH BULLETIN June 2012 VOLUME 3 ISSUE 5
Interview with New Credentialing Department Manager WCH PANTHERS RACE FOR CURE 2012
WCH Contest Winner Announced!
WCH and CITIBANK Complimentary dinner CHART AUDIT
WCH Service Bureau is a proud member of the following professional organizations:
INSIDE THIS ISSUE: WCH BUZZ 4 Interview with New Credentialing Department Manager
HEALTHCARE UPDATES 15 Senate Passes "New Jobs-New York" Job Creation Plan
6 WCH Contest Winner!
15 Medical claims error rate drops to 9.5%: AMA
8 WCH and CITIBANK Complimentary dinner 9 WCH PANTHERS - RACE FOR CURE 2012 10 WCH needs your feedback about your account representative performance
16 92980 May Become Obsolete in 2013. Learn The Possible Revisions For Cardiology Practice 16 CMS To Do Away With The 12Month Claim 'Lookback' Period 16 Say Goodbye to Fee-For-Service Reimbursement?
10 WCH Go Green Initiative 11 WCH offers free website for clients, don't miss a chance
17 Radiology Notification/Prior Authorization Program expansion to New York, New Jersey and Connecticut Effective August 13, 2012
12 Auditing Services CREDENTIALING NEWS 12 Major Improvements to the Internet-Based PECOS System
17 Medicare Advantage Cardiology Prior Authorization Program Effective October1, 2012 17 ICD-10 Forums
13 WCH became a proud member RAMARussian American Medical Association 14 We changed our Fax Number 14 Time Management Program
18 NEWS BY SPECIALTY 19 STATES UPDATES 20 QUESTIONS AND ANSWERS 22 FEEDBACK
WCH BUZZ Interview with New Credentialing Department Manager WCH is proud to announce that George Osipyants has been promoted as a Manager of the Credentialing Department effective as of July 1st, 2012. We are confident that with Mr. Osipyants experience in credentialing arena and well established relationship with insurances vendors will streamline all credentialing processes and hopefully relive George Osipyants, our clients from their enrollment headaches. Credentialing Department Manager
e wanted our readers to learn more about Mr. Osipyants, so we have prepared a brief interview that will provide outline of the George Osipyants growth in the Credentialing Department and give you inside look into his personal achievements. Hello, George. What do you attribute your success in the Credentialing Department? - It has been a long and tough road, but with help of the company management, good team work and achieved positive results I was able to obtain necessary knowledge's to reach the new position. I am grateful to have the new title and I am proud to take the next step with my team. What qualities do you think you possess that will make you a good leader for your team? - It's not that easy to specify my qualities; you are asking me about good ones, aren't you? I believe I have enough experience, knowledge's and
individual approach to my co-workers. I have always been a team player and I strongly understand the importance of delivering our clients timely and needed results. During my work in the credentialing department as an account representative and then supervisor, I have learned to deal with problems in the healthcare industry and my experience taught me how to look at clients credentialing from all aspects: reimbursement, marketingâ€Śetc. Please, briefly describe your career history and your special traits and abilities. - Briefly - I came, I saw, I conquered... Just joking, of course. It is still a long way to say "I won here", I just made a good start. I am at WCH for almost a year and a half, you'd better believe it - everything just begins.
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Concerning traits and abilities, I can tell there is nothing special or unique about my success was done – I just did my job by standards and requirements and I was devoted to my job. You'll will see how fast you can get the results if you follow directions, belief and dream a little. What, according to you, has been your greatest achievement in professional life? - I am sure that the greatest achievements are not yet made. I have plenty of time for them; the whole life is before me. Can't say it for sure... But, as I think, I was able to build confidence in the company management and with hard work; I received the recognition to become Manager of the Credentialing Department How do you motivate people under you? How you motivate yourself? - For my part, I support the colleague’s ideas, try to make them feel like they are able to change the things in our department. Nothing more powerfully promotes the efficiency of work than awareness of own importance. When people are happy and can have a little fun at work and meanwhile their job is done and results achieved the, I don’t see any problem with this at all. When my team comes to work, I want their everyday mood to be positive and I want them to feel good when they come to work every day. This is the best motivation techniques that I live by - Treat people as you would want to be treated. What are your short-term goals? Long-term? - Short-term goals: arrange the work in our department so that our clients would always be satisfied with the results, department staff is glad to come and work every day. So it is now, but you know... There's no limit to perfection. Long-term goals: they follow from the short-term goals when people work with their full hearts and clients enjoy working with our company, quantity of satisfied and new clients will increase. Accordingly, we let our company grow. That is what we are here for.
What are your strengths? - Self-confidence, optimism - it always helps me. Describe yourself in five words. - Young, Zealous, Cheerful, Responsive and Responsible. And If you're asked to describe yourself in just 1 word, what would it be? Ambitious What are your hobbies and activities? - Laziness is my drawback (I'm learning to defeat it. Lately, I have discovered the benefits of running, it is really super activity, I have more energy, more motivation and more charisma. Also I am a sport fan (supporting Chelsea Football Club and tennis player Maria Sharapova). Where do you see yourself in the next five to ten years in your personal life? - I hope that in the next 5 years, I will have my own private summer house somewhere in Florida or California with view of the ocean and enjoying every second of this life from Friday to Sunday.
Please contact our Credentialing Manager George Osipyants at (718) 934-6714 x1102 or via email: georgeo@wchsb.
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Congratulations to all Participants
The Winner is Announced! Well, the time is finally here. It is time to announce the winner of the WCH Contest! The competition was fierce, and it was great to see such amazing, interesting, exciting designs of potential virtual assistant. We really appreciate all hard work, and hope that the winners personage will help WCH visitors to navigate faster on our website and promote WCH products. The competition was really intense. Well done! Majors thanks to Judges (New York Psychiatric Service & Irina, Dr. Ellen Vitievsky & Anatoliy and Dr. Anna Potash) who spent a lot of individual time on each design. The entire management team of WCH is grateful to all of the participants and their ideas. Great job everybody!
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Winner and Participants
1. Ilya Mirolyubov
9. Ivan Bulatov
2. Helen Kim
10. Ilana Kozak
3. Kamila Abdullaeva
12. Karina Lebedeva
4. Nias Adamov
13. Bulat Sagirov
5. Tatyana Kantor
14. Adeya Salikhova
6. Albert Khamidulin
15. Slava Kudrov
7. Vadim Zemlyanoi
16. Polina Firsova
8. Valeriya Aksenova
17. Julia Saraeva
Prize Winner of $1000 WCH Times | 7
DEAR CLIENTS, WE WANT TO INVITE YOU TO A SPECIAL FREE DINNER, SPONSORED BY CITIBANK.
WCH PANTHERS - RACE FOR CURE 2012
WCH in Pink is pleased to support the work of Susan G. Komenâ„˘. WCH Company has been active in the fight against breast cancer since 2009. We hope that you will join us. Welcome Warriors! In today's society everyone knows someone who has been touched by breast cancer. Whether it's a friend or relative, someone in your circle has battled this devastating disease. We found a way to be an active part of the fight against breast cancer: the Susan G. Komen Greater NYC Race for the Cure. Susan G. Komen is the global leader of the breast cancer movement. As the world's largest grassroots network of breast cancer survivors and activists, its mission is to save lives, empower people, ensure quality care for all and energize science to find the cures. Each year over 1.5 million people take part in more than 140 Race for the Cure events around the world. We will be joined by other corporations, volunteers, survivors and people that have desire to help on September 9th in Central Park. We were honored and privileged to take part of such an extraordinary event that not only benefited the foundation by helping them reach the goal of $6 million, but also to promote awareness of local breast cancer screening,
education and outreach programs. How can you help? You can support WCH by making a donation to the Greater NYC Affiliate of Susan G. Komen for the Cure. If you wish to support our team WCH Panthers and The Susan Komen Foundation please visit our website http://wchsb.com click icon donate today on Donation banner and make the donation. WCH set goal to reach $1,000 with help of our clients and our dedicated staff we are getting closer to the goal. You may also call our General Manager Olga Khabinskay with the amount you will be pledging and can send the donation. We must have all donations in to Komen Greater NYC not later than October 31, 2012. Additionally, you can join us at the event as a Race participant or volunteer for the event. You are welcome to join us on this day and be part of WCH Panthers team! For participation and for any other questions related to this event, please contact Maka Kiria email: firstname.lastname@example.org
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WCH needs your feedback about your account representative performance Several weeks ago WCH has emailed our clients a request to participate in our survey. The main mission of this survey to find out your opinion about performance of your account representative. Your feedback are very important to us as, we are constantly working towards improving our standards and quality of services we offer both now and in the future. We greatly value your opinion and would appreciate your feedback to our email. If you did not receive a survey and want to evaluate your account representative, please email – Oleseya email@example.com to obtain link to the survey. We greatly appreciate your participation!
WCH Go Green Initiative
ur world is constantly changing before our eyes. Technology has created advancements that we could never have imagined 20 years ago. But with many of the advancements have come negative changes to our environment like pollution and global warming that affect the way we live our lives. WCH continues systemic changes that we hope will have a larger ripple effect throughout all of society and especially in our client's offices. WCH has initiated Go Green inside our office, one of the first things that we did is go away from use of paper and other unnecessary paper products during the daily routine. Copy paper, envelopes, claim forms, reports, endless manila folders: all of these represent a real cost in office and greater cost to the environment. With the increasing use of wireless Internet, computerized software we are converting our records and communications to an electronic format, which is greatly helping us from financial aspect as well as office organization. Did you know that 95% of our claims, remittances, and invoice payments are currently electronic? We have even converted from standard fax system to E-Fax. We are sending more information by email rather than mail than ever before. Through the use of our Time
Management Program we become paper free and more organized with our payroll and task reminders. We recommend that our clients follow us on this initiative, you can start with simple things first: Upgrade to E-Fax Set up for electronic funds transfer (EFT) for your insurance payments · Set your staff's payroll for direct deposit · Communicate with everyone via email · Stop printing or copying- purchasing scanner is priority for every office · Use Gmail or Hotmail on your mobile device for reminders · Accept our invitation to receive your Electronic remittances by email · ·
WCH will continue to update about our internal Go Green processes every issue. If you need a more personal assistance with the process, please contact us for help.
Think Green and Go Paperless! WCH Times | 10
WCH offers free website for clients, don't miss a chance Free Websites for Doctors. For clients that do not have a website, we are offering to create one to three page website with information about your practice.
You may ask Why you need to create a website? Because 97% of your potential patients use online to find their doctors, laboratories and imaging centers.
Three reasons to start building your free website with WCH
1 2 3
Choose a template and add content.
Create, edit and publish your new website in about few days.
Enjoy your website, domain name and hosting free for an entire year.
All additional website optimization services can be discussed at separate fee. We're making it easy to get your business online. Contact Us TODAY to Get Started. Already we have happy clients who have and enjoy their websites, do not miss your chance to have personal website. Here are some of our happy clients and their testimonials.
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Auditing Services Auditing services, we care about your charts. It may seem simple, but with today's everchanging medical codes, guidelines, and regulations the task of properly putting together your medical charts requires more time and experience than ever before. Selecting the appropriate codes and level of care requirements can be challenging. With the implementation of Medicare and other payer audit projects, these problems, if not addressed, could cost medical professionals excessive charge-backs and penalties. We have an experience and Certification! Let us help you today! Benefits of auditing your charts with WCH: Ÿ Get your records evaluated by AAPC staff Certified Professional
Coders, and Medical Auditors Ÿ Ensure that your charts are error free Ÿ Prevent losing money to prepayment or post payment reviews Ÿ Stay focused on your patient's health, while we take care of your charts
Don't risk losing money, take advantage of our 15 % DISCOUNT till September, 2012 for chart auditing services.
CREDENTIALING NEWS Major Improvements to the InternetBased PECOS System Over the last year, Centers for Medicare & Medicaid Services (CMS) has listened to your feedback about Internet-based Provider Enrollment Chain & Ownership System (PECOS) and made improvements to increase access to more information. Following upgrades are now available: Access to More Information The layouts of the Internet-based PECOS homepage and log in screen have been redesigned. The homepage updates provide an easier way for users to register for a PECOS
account and update personal information. It also features additional helpful links to allow access to multiple tools and reference information. The helpful links include PECOS enrollment tutorials, the Ordering and Referring List, and the Revalidation Notice Sent List. Users will also now be able to see if their revalidation application has been received and processed by the Medicare Administrative Contractor (MAC). In addition to a “Revalidation Notice Sent” date, a “Revalidation Received” date and a “Revalidation Complete” date will be displayed on the My Enrollments page. The “Revalidation Notice Sent” date and the “Revalidation Received” date will display on the WCH Times | 12
My Enrollment page for 120 days. The â€œRevalidation Completeâ€? date will display on the My Enrollments page indefinitely. (At this time, the quickest way to see if a revalidation letter was mailed to you is to check the Revalidation Notice Sent List link on the PECOS homepage. Later this year, a faster process will be used to update this information on the My Enrollments page.) A reassignment report is now available for all organizations and individuals that are accepting reassignments. The option to view this report is only available if the enrollment has current reassignments. The reassignment report is accessible via the Application Questionnaire page and displays the following columns: Provider Name, National Provider identifier (NPI), Current Enrollment Status, Enrollment State, Revalidation Notice Sent Date, and Revalidation Status.
The report displays up to 50 records on the report screen. For reassignment reports containing more than 50 records, the authorized user will be prompted to download the report into an excel spreadsheet by clicking the Generate Report button at the bottom of the screen. WCH credentialing department is well trained to handle your enrollment through PECOS. Don't hesitate to call us with your questions. Office Phone: (646) 807-3419 Fax: (347) 464-0740
Dora Mirkhasilova Credentialing Specialist
WCH became a proud member RAMA-
Russian American Medical Association
On June 1st WCH became a RAMA member. Russian American Medical Association was founded and incorporated in 2002. It was created to facilitate and enable Russian American physicians and other health care professionals to excel in patient care, teaching and research, and to pursue their aspirations in professional, humanitarian and community affairs. More than a hundred new members have joined the organization in 2012 representing 35 specialties across the professional medical spectrum. RAMA is not a political organization. The main office of RAMA is located in Cleveland (Ohio) and has regional offices in several U.S. states. RAMA holds annual conference in conjunction with associations, as RADA (Russian Amerisan Dental Assosiation) and RASA (Russian Academic Science Association). RAMA - the largest association of Russian-speaking professionals in health care industry outside of Russia. In association More than 500 members of the U.S., Canada, Russia and other countries of the former Soviet Union and Europe. The Association maintains contact with more than five thousands of Russianspeaking professionals in the healthcare and other related medical professionals and business people. If you are interested to join Rama, please contact Olga Osipoff the marketing director and tell her that you are WCH client Olga Osipoff RAMA Executive Director, Tel: 440 321-2311, Email: firstname.lastname@example.org
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We changed our Fax Number Please send your faxes to the new number: 347-371-9968
Time Management Program Feeling overwhelmed? Can't keep track of your employees' time schedules? Let WCH's Time management soft-ware work for you! Time Management Software is very important for small business companies, who are performing many different jobs during the day. Our Time Management Program will help you understand the real value of your time, increase your productivity and stay tune and collected. The skills we explain below will help you become highly effective, by showing you how to identify and focus on the activities that give you the greatest returns. Investing in these time management activities will actually save you time, helping you work smarter, not harder. What's more, these same techniques help you beat work overload - a key source of stress. Here are the skills you'll achieve while you're using our Time Management Program: Ÿ Activity Logs – Know where your time goes. Ÿ Prioritization - Taking control of your time. Ÿ Beating Procrastination – Manage your time. Get it all done. Ÿ Action Programs – Becoming exceptionally well organized. Ÿ Effective Scheduling – Bringing your workload under control. Ÿ New Year's Resolutions – Planning for a year of achievement. The program can be purchase through WCH website, from our Amazon Store http://www.amazon.com/s/ref=bl_sr_software?_encoding=UTF8&node=229534&fieldbrandtextbin=WCH%20Service%20Bureau and of course by calling us at 718-934-6714 x 1202. WCH Times | 14
HEALTHCARE UPDATES Senate Passes "New Jobs-New York" Job Creation Plan Comprehensive plan will help create thousands of new private sector jobs. Highlights of the 2012 New Jobs-NY Job Creation Plan are as follows: Ÿ Reducing the Job-Killing Tax Burden on New York Manufacturers: The plan would spur creation of thousands of manufacturing jobs by dramatically reducing taxes on manufacturers over a three-year period ($495 million in tax relief). Ÿ 20% Tax Cut for Small Businesses: This tax cut will save nearly 200,000 small businesses $49 million. Ÿ 10% Tax Credit for Small Businesses: This tax credit will save 800,000 small businesses $80 million. Ÿ Major Energy Tax Cut: The legislation accelerates the phase-out of the 500% energy tax hike previously approved by Senate Democrats. Ÿ New Incentives for Each New Job Created: The bill includes new job-creating incentives that would give businesses a tax credit of up to $5,000 for each new job they create; up to an $8,000 credit if the new job goes to someone on unemployment; and up to a $10,000 credit if a business hires a returning military veteran.
Medical claims error rate drops to 9.5%: AMA Cumulative error rates for paid medical claims among seven major private health insurers dropped to 9.5% in 2012 from 19.3% in 2011, according to an American Medical Association survey of physician practices. The AMA, which took credit for the decrease in a news release, estimated that the reduction saved $8 billion by cutting administrative costs related to fixing errors and that reducing the error rate to zero would have saved an additional $7 billion. Also, according to the survey, private insurers improved medical claim response times by 17% from 2008 to 2012. But the AMA survey indicates that medical services requiring prior authorization from commercial health insurers were reported on 4.7% of claims—a 23% increase from the
previous year's survey. The findings from the 2012 National Health Insurer Report Card are based on a random sampling of roughly 1.1 million electronic claims for about 1.9 million services that were submitted in February and March to Aetna, Anthem Blue Cross and Blue Shield, Cigna Corp., Health Care Service Corp., Humana, Regence, United HealthCare and Medicare, though Medicare wasn't included in the improvement results above, according to the AMA. Claims were accumulated from more than 380 physician practices in 79 medical specialties providing care in 39 states, according to the AMA. Source: AMA
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92980 May Become Obsolete in 2013. Learn The Possible Revisions For Cardiology Practice What's new for cardiology? Cardiology specialty will be heavily impacted with code changes for 2013. Remember: The changes are tentative, and final CPT® 2013 codes would only be finalized by the fall of 2012. CPT® may delete: 92980-92981, Transcatheter placement of an intracoronary stent(s) … 92982 and 92984, Percutaneous transluminal coronary balloon angioplasty … 92995-92996, Percutaneous transluminal coronary atherectomy … Source: AMA
CMS To Do Away With The 12-Month Claim 'Lookback' Period
Say Goodbye to Fee-For-Service Reimbursement?
Typically you only have to produce records that are up to a year old when a Part B MAC contacts your practice asking to see medical records. But this time limit, however, will be done away with by the end of this month, when MACs will have more flexibility in asking for older documentation. Currently, if a MAC asks to see your records related to claims that are under review, the MAC can collect documentation “related to the beneficiary's condition before and after a service, but shall not request documentation dating from more than 12 months prior to the date of service unless an exception exists,” according to Section 18.104.22.168 of the Medicare Program Integrity Manual. However, the CMS issued Transmittal 422, which will eliminate the 12-month lookback period. This will go into effect on June 26 and no replacement period has been suggested. This means that records can be requested indefinitely from the date of service, although it's not completely clear in the document whether any deadline will be introduced to replace the previous 12-month limit.
On June 5, 2012, the Centers for Medicare & Medicaid Services (CMS) announced a new data and information initiative that CMS reports “will be a key tool in the agency's evolution from a fee-forservice based payer to a value-based purchaser of care.” CMS reports that with timely, relevant data, CMS will be able to better define and reward high quality, low cost care. The initiative includes the creation of a new CMS oversight group known as the Office of Information Products and Data Analytics (OIPDA). The goal of OIPDA is to make data management and information sharing a core function of CMS. OIPDA will assume responsibility for many current CMS data functions, including, but not limited to, the Chronic Condition Warehouse, the Medicare Current Beneficiary Survey, the Medicaid Analytic Extract, and the Research Data Assistance Center. Healthcare providers will have to keep detailed and careful documentation in support of their clinical decisions and actions. OIPDA will be focused on the information providers create through their requests for payment.
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Radiology Notification/Prior Authorization Program expansion to New York, New Jersey and Connecticut Effective August 13, 2012 The UnitedHealthcare Commercial Radiology Notification Program and Medicare Advantage Radiology Prior Authorization Program are expanding to the following states effective for dates of service on or after Aug. 13, 2012: The UnitedHealthcare Commercial Radiology Notification Program is expanding to include: Ÿ Connecticut Ÿ New York The existing New Jersey Commercial Radiology Notification Program is being enhanced to align with the national UnitedHealthcare Commercial Radiology Notification Program. The following states remain out of scope for the Commercial Radiology Notification Program: Alaska, Idaho, Minnesota, Montana, North Dakota, Nebraska, Oregon, Rhode Island, South Dakota, Washington, and Wyoming. The UnitedHealthcare Medicare Advantage Radiology Prior Authorization Program is expanding to include: Ÿ New Jersey The following states remain out of scope for the Medicare Advantage Radiology Prior Authorization Program: Idaho, Nebraska, Oregon, and Washington. Visit UnitedHealthcareOnline.com > Clinician Resources > Radiology > Radiology Notification & Authorization > Reference Materials for more details about the Commercial Radiology Notification and Medicare Advantage Radiology Prior Authorization programs.
Medicare Advantage Cardiology Prior Authorization Program Effective October1, 2012 Effective Oct. 1, 2012, UnitedHealthcare's Cardiology Notification Program for Medicare Advantage benefit plans is changing from a notification program to a prior authorization program. This change is consistent with other UnitedHealthcare programs and prevailing industrywide standards. Over the coming year, additional UnitedHealthcare programs will ultimately be aligned to verify that services are medically necessary. Beginning Oct. 1, 2012 UnitedHealthcare will require that you obtain prior authorization for the following procedures prior to rendering them to UnitedHealthcare's Medicare Advantage members: Ÿ Echocardiogram Ÿ Stress Echo Ÿ Diagnostic catheterizations Ÿ Electrophysiology implants Ÿ When prior authorization is required based on site of service: Cardiac Procedure: Outpatient Office Inpatient Diagnostic Catheterization Required Required Not required Electrophysiology Implants Required Required Required Echocardiogram
Required Required Not required
Required Required Not required
Note: Prior authorization is not required for services that are rendered in an emergency room, observation unit or urgent care facility. Prior authorization is only required in the inpatient setting prior to rendering Electrophysiology Implant services.
ICD-10 Forums forum dedicated for your ICD-10 conversations. It is located at www.icd10forums.com. There are threads on ICD-10-CM, ICD-10-PCS, implementation, mapping, 5010, the timeline and a general discussion as well. Now there is a new
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NEWS BY SPECIALTY Podiatrist Question: We billed a motion analysis with dynamic plantar measurements (96001) and the doctor's interpretation and report of the results (96004) to Blue Cross Blue Shield. The carrier denied the claim. We performed the test here at our facility, and the doctor reviewed and interpreted the results. Are we billing the codes incorrectly? Should we append a modifier to 96001? Answer: No, you are not billing the codes incorrectly. The problem is that Blue Cross Blue Shield considers gait analysis an “investigational procedure” and does not provide coverage for the service. Several other carriers have specific policies in place that state gait analysis is investigational and therefore not covered.
Cardiology Question: Must one session of CPT code 93798 (physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring [per session]) be a minimum of 60 minutes if only one session is provided that day? Answer: No, according to the Medicare Claims Processing Manual, Chapter 32, section 140.2.1, the duration of treatment must be at least 31 minutes. Two sessions of cardiac rehabilitation services may only be reported for the same day if the duration of treatment is at least 91 minutes. In other words, the first session would account for 60 minutes and the second session would account for at least 31 minutes if two sessions are reported. If several shorter periods of cardiac rehabilitation services are furnished on a given day, the minutes of service during those periods must be added together for reporting in one-hour session increments.
Question: If a patient has an aberrant artery with a separate ostium and the physician selected each one individually (for example, separate ostium for the LAD and a separate ostium for the circumflex), can we charge procedure code 93563 in addition to 93458 (LHC)? Answer: No, you would not code for the 93563 in addition to 93458. The instructions at the beginning of the heart cath section say, “Anomalous coronary arteries, patent foramen ovale, mitral valve prolapse, and bicuspid aortic valve are to be reported with 93451–93464, 93566–93568.”
Radiology Question: Can a quantity of two be billed for the Sestamibi — one dose at rest and one dose at stress? The Medicare MUE [medically unlikely edit] is 3, so that's no help. Answer: Yes, you may code Sestamibi twice if you administer it twice, once for the rest study and once for the stress study. If no SPECT is performed, you also should assign CPT code 78452—myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection. If SPECT is not done, the code is 78454. Since Sestamibi (A9500) is "per study dose," and you are performing two studies, you may assign A9500 x 2. There may be only one CPT code, but it encompasses multiple studies
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STATES UPDATES Most California docs' EHRs wouldn't meet meaningful use A majority of physicians in California use electronic health records, but only 30% use an EHR system that has the functionality to achieve the CMS' meaningfuluse requirements. The study was conducted in 2011 by UCSF and the California Medical Board for the California HealthCare Foundation and the California Department of Health Care Services. Researchers found that 61% of the physicians surveyed had an EHR system that allowed them to record clinical notes electronically. However, only 45% of those surveyed had a system with the ability to generate routine reports of quality indicators. Source: modernphysician
Aetna, Inova collaborating on new health plan Inova Health System and Aetna announced they will partner to create a jointly owned health plan serving northern Virginia called Innovation Health Plans. Terms of the 50/50 partnership were not disclosed. The new insurer is expected to officially begin Jan. 1 and will seek to promote clinical integration in the northern Virginia region, according to a news release. The plan will offer commercial plans and Medicare Advantage HMO and PPO plans.
Alaska Medicaid agency to pay $1.7 million in HIPAA settlement Alaska's state Medicaid agency has agreed to pay HHS $1.7 million to settle possible violations of the security-rule provisions of the Health Insurance Portability and Accountability Act of 1996 and take actions to guard the electronic protected health information of the state's Medicaid beneficiaries.
Cigna has announced new accountable care initiatives in several states. In California, the agreement with the Palo Alto Medical Foundation, an affiliate of Sutter Health, will include as many as 21,000 patients. Cigna's agreement with New West Physicians in Denver will cover about 7,800 patients, according to a news release from the Bloomfield. In Texas, the insurer reached an agreement with St. Luke's Health System Clinically Integrated Providers and Renaissance Physician Organization for an initiative that will cover 44,000 individuals. And in Vermont, Cigna's accountable care organization with Fletcher Allen Health Care and Central Vermont Medical Center will cover 10,500 patients. The agreements pay providers for care coordination and offer payfor-performance incentives, according to news releases on the deals. Incentive payments are based on reaching quality and cost-saving targets.
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QUESTIONS AND ANSWERS Question: t Does WCH have a compliance plan?
Answer: t WCH has a fully developed and effective compliance plan consistent with CMS, by the U.S. Department of Health Services. Our plan is based on “Professional requirements for service bureau per Title 18 – Department of Health Rules and Regulations” (Section 504.9 – Service bureaus). Our compliance plan has been fully developed by WCH management team and is being stringently followed by all departments. If your practice is currently using a billing company we highly recommend reviewing their compliance plan. Those companies working without a compliance plan leave an open door for problems that might impact your practice's operations.
Question: t Can I or any of my office staff access billing, claim, or patient information from my own computer?
Answer: t Yes. WCH offers the use of our individual PMBOS program for your personal computer, in which, all of your practice's information including billing, claim, and patient information can be viewed; along with abilities such as creating an appointment schedule, and accessing helpful information for instance insurance's phone numbers and address lists. Please contact us, if you are not yet using our program.
Question: t Who can perform an Annual Wellness Visit?
Answer: t Medicare Part B covers the Annual Wellness Visit (AWV) if it is furnished by a: Ÿ Physician (doctor of medicine or osteopathy) Ÿ Physician assistant
Ÿ Nurse practitioner Ÿ Clinical nurse specialist Ÿ Medical professional (including a health
educator, a registered dietitian, nutrition professional or other licensed practitioner) or a team of such medical professionals working under the direct supervision of a physician (doctor of medicine or osteopathy)
Question: t When is a beneficiary eligible for the Initial Preventive Physical Exam?
Answer: t Medicare provides coverage of the Initial Preventive Physical Exam (IPPE) for all beneficiaries who receive the IPPE within the first 12 months after the effective date of their first Medicare Part B coverage period. This is a one-time benefit per Medicare Part B enrollee. Additional information regarding Medicare coverage of the IPPE is available in the CMS MLN Quick Reference Information: The ABCs of Providing the Initial Preventive Physical Exam chart.
Question: t When is a beneficiary eligible for the Annual Wellness Visit?
Answer: t Medicare provides coverage of an Annual Wellness Visit (AWV) for a beneficiary who is no longer within 12 months after the effective date of his or her first Medicare Part B coverage period and who has not received either an Initial Preventive Physical Exam (IPPE) or an AWV within the past 12 months. Medicare pays for only one first AWV per beneficiary per lifetime, and pays for one subsequent AWV per year thereafter. Additional information regarding Medicare coverage of the AWV is available in the CMS MLN Quick Reference Information: The ABCs of Providing the Annual Wellness Visit chart. WCH Times | 20
FEEDBACK Your feedback is very important to us! In our continued dedication to improve, we want your feedback, opinions, ideas, news and comments. Please send us your feedback today. Let us know what you want to see in upcoming issues or changes to the format that you would like to see. __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ Name_________________________________ E-Mail_________________________________
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