Editor’s note
WCH Insights/April 2022
INSIGHTS APRIL 2022
insurance updates at a glance Horizon BC BS NJ Modifiers CQ/CO reimbursement policy to be implemented Change Healthcare’s review of medical injectable drugs to end Reminder: Horizon NJ Health is the payor of last resort
helping ukraine The progress of our donation 🇺🇦 campaign feature story Improving your front desk communication experience: a three-step approach
Medicare COVID-19: New codes for Moderna vaccine booster doses The CMS now covers a take-home supply of nasal Naloxone Inpatient psychiatric facilities: the fiscal year 2023 proposed rule — submit comments by May 31 CMS expands coverage of lung cancer screening with low dose computed tomography Medicare fee-for-service claims and the sequestration payment adjustment changes Advanced practice registered nurses, anesthesiologist assistants, & physician assistants — revised
Medicaid of New York New York State Medicaid professional pathology policy
business corner How to secure a stable revenue flow for your practice in 2022 meet wch Elena Pak СCredentialing Specialist
Pharmacy and medical billing guidance for SPRAVATO® (esketamine) Medicaid coverage of split evaluation and management services
FidelisCare New York Authorization status will transition to a selfservice function Updates To The Medicare Remittance Advice
Your Questions Answered: Get your CEU Credit Contact Us
How to bill unattended at-home sleep studies?
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WCH Insights/ФApril 2022 Editor’s note
WCH Insights/April 2022
table of contents If you are a healthcare provider from New Jersey, please click here to discover the most important insurance updates from The Garden State
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Editor’s note
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Helping Ukraine - the progress of our donation campaign
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Insurance updates at a glance
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Important insurance updates (full report)
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Your guide to new payment policies
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Feature story
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Business Corner
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WCH Accomplishments
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Meet WCH
10. Lifestyle - top travel destinations in 2022 11. Your questions answered
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Editor’s note
WCH Insights/April 2022
“Every accomplishment starts with a decision to try” Arthur Schopenhauer
In
business, every major success is preceded by a series of thoughts, hesitations, planning, and failures. This is especially relevant if you run a private medical practice. As a healthcare provider, not only do you have to focus on generating revenue and covering opportunistic costs, but you also must reflect on whether your actions will bring the least possible harm and the best possible good. An ever-changing healthcare industry is full of intricate and redundant laws, rules, and customs that prevent medical professionals from flawless reimbursement. At WCH Service Bureau, we care about the financial well-being of your practice. One of the main objectives of WCH Insights has constantly been raising awareness on issues that can decrease your practice revenue. In this edition, I have decided to take a reversed approach and instead focus on the things that can help your business prosper by maximizing its revenue. For this reason, I am dedicating this April edition to all the strategies, tips, and lifehacks that can help you improve your practice workflow and earn more money as a result. However, life should never be only about work! To sustain an efficient work capacity, each of us should combine it with a decent vacation, fun, and loving what we do. I am pleased to introduce a new section of our magazine called “Lifestyle”. There, I am going to do my best to share the best ways of spending leisure time and reducing stress for medical professionals. Because this is a pilot project, I am extremely looking forward to getting your feedback on it. My email is at the bottom of this page. Last but not least, our medical supplies donation campaign is still up and running. In April, WCH Service Bureau did its best to spread the word about our initiative all over the country and motivate organizations to help the people of Ukraine. We are eternally grateful to everyone who participated in this community initiative. Your contribution saves lives. To discover a full progress report of our campaign for this month, please read a dedicated section of this edition.
One of the main objectives of WCH Service Bureau, since we launched our operations in 2001, has been providing an all-inclusive package of services to healthcare providers to fulfill any needs they may have. We have always strived to be a unique practice management solution that would not just submit claims to insurances and sign enrolment contracts but would also be the primary source of guidance into the sphere of healthcare reimbursement. It was in this spirit that we decided to create & run a digital magazine in 2006, which would include information on all the critical insurance updates and governmental regulations and provide unique guidance on how to maximize the revenue of our clients. The idea was to keep our clients informed on all the issues that may directly or indirectly affect their practice revenue. What has initially been a seasonal single-page bulletin with a simple list of insurance updates has emerged into an elaborate digital magazine, delivered to you each 5th day of the month. We would like to inform you that effective December 2021, you can get a Continuing Education Unit (CEU) credit for reading WCH Insights. Please contact us via contact@ wchsb.com to get your credit and an applicable certificate. Thank you for reading!
Yours faithfully, Arslan Suleymanov Author and editor-in-chief of WCH Insights.
Our editor-in-chief, Arslan Suleymanov, can be contacted via email: arslans@wchsb.com
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Meet WCH
WCH Insights/ФApril 2022 Insights/January WCH Insights/April2022 2022
helping ukraine The progress of our donation campaign
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Helping Ukraine
WCH Insights/April 2022
Shortly after the outbreak of the war in Ukraine, WCH Service Bureau has organized a donation campaign to collect medical supplies and send them to the Ukrainian people. We are astonished by the commitment and continuous contribution of our clients and partners. To date, over 50 organizations have demonstrated their support of our mission by donating life-saving supplies, medications, and funds that have already been delivered to hospitals in Kyiv. With medications having already reached the hospitals of Kyiv this April, our initiative was also supported and shared by the media. Please keep reading to stay in the loop with the progress of our donation campaign.
War is never about conquest. All military conflicts always cause suffering, grief, and thousands of deaths that could have been prevented. Days and even years after a conflict, these three things haunt the people who once went through it. With the major portion of Russian forces retreating from the north of Ukraine, this country is still in the middle of the conflict. Thousands of people have died since early March all over the country. While the military atrocities continue in Southern and Eastern Ukraine, many innocent people, including children, get hit or die of missile strikes and booby traps planted by the aggressor. It is now or never that the people of Ukraine need help of the entire world. More medical supplies are needed to save the lives of those affected by the conflict. It is for this reason that WCH Service Bureau continues the donation campaign we organized in March. Since we first shared our story in the previous edition of WCH Insights, many more organizations have brought medications and medical equipment to our office for shipment. To date, over 400 life-saving items have been donated by our friends, clients, and partners. Together, we have managed to collect the supplies worth $350,000 in total. This would have been impossible without the contribution of our respectful partner – Integra Partners IPA, that has helped us to collect the supplies worth $140,000 together with its contracted DME suppliers. WCH Service Bureau has already shipped 6 packages of donated supplies to Ukraine. A major part of the donation has already been handed out to the hospitals of Kyiv, and is currently distributed to the Ukrainian people.
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Helping Ukraine
WCH Insights/April 2022
These shipments are possible thanks to a significant self-sacrificing contribution of our shipping partners: Velox International and Nova Poshta, working tirelessly and delivering the supplies to Ukraine through Poland free of charge. We keep track of all donations. Please feel free to access a regularly updated list of items here.
Our contribution WCH Service Bureau is proud that our initiative is spreading across communities. On April 22, we shared our progress with the global audience on the News 12 Brooklyn TV channel. Speaking from a warehouse in Coney Island with piles of boxes behind her shoulders, Olga Khabinskay, our Director of Operations, has urged people not to stop humanitarian efforts toward Ukraine. Please watch this video for more details. We hope that our example will motivate other organizations to step up and help the Ukrainian people. WCH is extremely thankful to everyone who has participated in this donation campaign and/or shared the news about its progress. Your commitment proves that responsibility, compassion, and kindness know no borders nor governments.
How can YOU help the Ukrainian people Dear partners, Your help is truly invaluable. However, it is never enough. Please help us to save more lives! You are saving lives in the United States, now is the perfect time to help the people of Ukraine. Just a single donation may save a life of a Ukrainian child. Look at these photographs. These people need your help. Ignorance leads to tragedy. Now is the time to act! WCH Service Bureau is currently looking for at least 500 GEN 7 certified combat application tourniquets that can stop bleeding of arms and legs. In addition, if you are willing to help us with our ongoing initiative, please check out the flyer on the next page for a full list of products needed for the Ukrainian people.
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Helping Ukraine
WCH Insights/April 2022
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Editor’s note
WCH Insights/April 2022 WCH Insights/April 2022
insurance updates at a glance
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Insurance updates at a glance
Horizon BC BS NJ Modifiers CQ/CO reimbursement policy to be implemented Horizon BC BS NJ will change how it considers and reimburses certain professional claims based on our new reimbursement policy Modifiers CQ/ CO. Please read a full report on this new reimbursement policy in the “Insurance Updates” section.
Change Healthcare’s review of medical injectable drugs to end Change Healthcare (CHC)’s medical drug review initiative previously announced has ended. Please keep reading to know how this affects the requests you receive from CHC for medical records!
Reminder: Horizon NJ Health is the payor of last resort Services rendered to Horizon NJ Health members who also have other health insurance plans should first be reviewed against those other plans before sending a claim to Horizon NJ Health. To know how to successfully submit such a claim, please continue reading!
Medicare COVID-19: New codes for Moderna vaccine booster doses The FDA amended the Moderna COVID-19 vaccine emergency use authorization (PDF), including new packaging for vaccine boosters (blue cap), and CMS has issued new codes for the vaccine booster and administration. Please keep reading to find out the codes and their descriptors!
The CMS now covers a take-home supply of nasal Naloxone
WCH Insights/April 2022
Inpatient psychiatric facilities: the fiscal year 2023 proposed rule — submit comments by May 31 The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare payment policies and rates for the inpatient psychiatric facility prospective payment system (IPF PPS) for the fiscal year (FY) 2023. Please keep reading to know how this affects your practice and how to submit your comments!
CMS expands coverage of lung cancer screening with low dose computed tomography CMS announced a national coverage determination that expands coverage for lung cancer screening with low dose computed tomography (LDCT) to improve health outcomes for people with lung cancer. To know the implication of this expanded coverage, please continue reading!
Medicare fee-for-service claims and the sequestration payment adjustment changes The suspension on the sequestration put in place by the Protecting Medicare and American Farmers from Sequester Cuts Act due to the PHE is gradually being lifted. Please keep reading to know the adjustments and their effective dates!
Advanced practice registered nurses, anesthesiologist assistants, & physician assistants — revised In this revised policy, nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants (PAs) can certify Medicare patient home health benefits eligibility and oversee patient care plans. To know more about the requirements, please keep reading!
Medicaid of New York New York State Medicaid professional pathology policy New York State (NYS) Medicaid fee-forservice (FFS) and Medicaid Managed Care (MMC) plans will reimburse participating laboratories and facilities for a consultation on pathology specimens as outlined in this policy. Please keep reading to know the effective dates and the affected CPT codes!
Pharmacy and medical billing guidance for SPRAVATO® (esketamine) Billing guidance will be implemented for SPRAVATO® (esketamine) for New York State (NYS) Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC) plans, including Mainstream MMC Plans, Human Immunodeficiency Virus (HIV) Special Needs Plans (HIV-SNPs), and Health and Recovery Plans (HARPs). Please keep reading to know how it affects drugs procured by a medical provider and drugs dispensed by a REMS-certified specialty pharmacy, as well as the claims billing requirements!
Medicaid coverage of split evaluation and management services Providers may bill the appropriate E/M procedure code(s) that represent the time observing and monitoring the member post administration. To gain more information about the applicable codes, please read along!
Medicare now covers HCPCS Code G1028 (Take-home supply of nasal Naloxone; 2-pack of 8mg per 0.1 mL nasal spray) in accordance with the Medicare Opioid Treatment Program. To know how to list the code, please keep reading!
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Insurance updates at a glance
WCH Insights/April 2022
FidelisCare New York
EmblemHealth
Authorization status will transition to a self-service function
Preauthorization list update
All Fidelis Care providers inquiring about an authorization status will need to use the Authorization Search function on Fidelis Care’s Provider Portal, Provider Access Online. The Authorization Search function helps your staff to quickly get the real-time status of an authorization and submit any additional documentation if needed. Please keep reading to learn how you can use this function!
Updates To The Medicare Remittance Advice
Emblemhealth no longer requires preauthorization for certain speech therapy services. Also, capsulorrhaphy services do not require preauthorization for non-City of New York members. Please read along to find the effective dates!
New York State Insurance Fund (Workers’ Compensation) Change to authorization request process NYSIF will no longer accept prior authorization requests (PAR) directly from providers. All PARs must be submitted through the Workers’ Compensation Board’s OnBoard portal, which will automatically route the request to the appropriate claim administrator for review. To know the effective date and how it affects your practice, please continue reading!
Fidelis Care will be aligning with the new CMS guidance on reinstating sequestration in 2022 and, as a result, will be making a change to the Medicare Remittance Advice (RA). Please read along to know the effective dates and the planned adjustments!
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