WCH bulletin March 2012

March 2012 VOLUME 3 ISSUE 3

WCH Bulletin

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

WCH Bulletin

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

WCH IS

5010

Compliant

Welcome to our Spring Edition!

Build Your Website!turn page 4

ICD - 10Are you ready?turn page 7

WCH Contest! We need your vote!

turn page 3

Welcome to our Spring Edition!

INSIDE THIS ISSUE:WCH BUZZ

HEALTHCARE UPDATES

WCH contest we need your vote!

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STATES UPDATES......................................................................................................12

QUESTIONS AND ANSWERS ........................................................................................14

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TECHNICAL TASK FOR WEB-SITE DEVELOPMENT................................................................................16

FEEDBACK......................................................................................................................................16

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Your Practice Online. We can help you get there.

WCH upcoming Online Store at Amazon.com..................

WCH Preparation for ICD 10...................................................................................

Medicare Revalidation for IDTF Providers - We can help.

Outpatient Cardiology Diagnostic Imaging Services Update.

Affordable Care Act Demonstration to Expand Access to Emergency Psychiatric Care.

Aetna requires preauthorization for sleep testing effective 03.01.12 (HMO and advantage plans)

Comparing ICD-9 and ICD-10......................................... .

NEW SECTION – SPECIALTY UPDATES..............................................................................................

NEW SECTION –

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CONTACT US

3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Fax: (718) 504-6072 www.wchsb.com

WCH BULLETIN VOLUME 3 ISSUE 2Page 3

WCH contest! We need your vote!

WCH is happy to share with you about a unique contest that is taken place in WCH company, between our staff. The

purpose of this contest is to create virtual website assistant. The virtual assistant will become a WCH team player, who will introduce our website and its contents to the visitors, navigate

through website, provide professional, administrative, technical assistance and help connect our clients with WCH

staff directly from the website. WCH contest began on February 20th and concluded on March 26th, 2012. All

submitted work will be uploaded to WCH portal and the link to the work will be emailed to all WCH clients.

Here is where we need your help- we need you to choose the best work and the winner of this contest will be granted a prize

of $1000. WCH is planning to email the link for voting after April 27th.

We are exited about the results of this contest.



Your Practice Online. We can help you get there.

Providers which are not grabbing this idea are going to be left behind in this competitive healthcare business! By having a practice website you will attract many patients and this will lead to higher reimbursements for your medical practice.

We understand that you are busy, therefore we want to help you with this process. Our designer team is ready to help you. All we need is 15 minutes of your time to complete an easy questionnaire which will help our designers to create your website.

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 patients wish they could view more information about their doctors online.

A website is a perfect way to connect you and your patients. We can help you create a simple, visually attractive, and easily accessed site for your practice!

You will be able to add data including your location and contact information, the services you offer, which insurance plans you accept, and any other medical data related to your practice.

We can even incorporate using the services, so that your patients can schedule appointments through your website.

We don't work with templates and each website is unique and individualized to your needs practice type / specialty. Additionally we can help your new website to be ranked higher on different search engines like Yahoo, MSN and Google. The details of this service will be offered

after the creation of the website. Your Website can be also linked with facebook, twitter and you-tube.

WCH is able to work with any size practice or budget.

If you are ready to start please turn to page 18, complete the form and fax or email:

http://www.zocdoc.com/

[email protected] Olesya Petrenko Marketing Manager.

Technical Task forwebsite development

mailto:[email protected]


WCH upcoming Online Store at Amazon.com


Several months ago we have started selling our software product time management on Amazon. This product received a good attention from buyers and we have decided to developed online store on Amazon. We are in process of adding several new products which will include: superbills by specialty, office templates, and variety of other medical documents, and possibly more products we invite you to visit our Amazon store:

Feel free to contact us about our store

Olesya Petrenko Marketing Manager.

http://www.amazon.com/gp/product/B005AKPJA6

[email protected]

WCH Preparation for ICD - 10 WCH preparing for ICD - 10 transition.Our agenda for the next 18 months is to prepare for comfortable transition from ICD - 9 to ICD - 10 formats. Our billing department has implemented education plan that will guide the learning process of each individual in the department as well as cover upcoming changes on the technical site. ICD - 10 will impact every position in the healthcare business. Therefore we are ready started the internal preparation for this big project. Twice a month WCH billing department host seminars dedicated to ICD - 10. We are first beginning introducing with the terminology of ICD - 10 requirements. Secondly, we will begin to the conversion of most common codes used by our clients from ICD - 9 format into ICD - 10. The future ahead is interesting, but it will take time to adjust to the new coding methods. We will continue with each issue to provide you with details of our training process. We also recommend for every provider to visit to obtain the link to the guide for ICD - 10 implementation for small and medium practices. Additionally, we are asking you to turn to your professional boards and to seek training schedule of implementation of ICD - 10, more than ever professional border organizations are offering ICD - 10 training.

Making the transition to ICD-10 is not optional!You can begin to compare ICD - 9 and ICD - 10 please to turn page 9.

www.cms.gov/ICD10/

http://amazon.com

mailto:[email protected]



Medicare Revalidation for IDTF Providers - We Can Help. All IDTF providers (sleep labs, portable imaging and fixed) who are enrolled in the Medicare program prior to March 25, 2011, are required to revalidate their enrollment under new risk screening criteria required by the Affordable Care Act (section 6401a). IDTF’s enrolled on or after March 25th, 2011 have already been subject to this screening, and they don’t need to revalidate at this time.In order to reduce time hassle of revalidation and to avoid any payments holds, WCH credentialing department can take care of the revalidation headache in one shot. Our team works with providers in all states, therefore if you are going through the revalidation process and you are not receiving payments from Medicare, call us today. There are different methods of handling your revalidation, we are experienced and knowledgeable in this area, don’t waste any more time. Please feel free to contact our Credentialing Department specialists at (718) 934-6714 x1102 or via email: .GeorgeO@wchsb

We added two new sections

in Bulletin for your reading

pleasure:

Specia lty Updates and

States updates,

they can be found in

each issue, starting with Marchbulletin!

HEALTHCARE UPDATES

Outpatient Cardiology Diagnostic Imaging Services Update. Effective for dates of service on or after March 6, 2012, Empire BC/BS of NY will require its participating providers to obtain prior authorization from AIM for stress echocardiography (SE), transesophageal echocardiography (TEE), and resting transthoracic echocardiography (TTE). As stated above, this prior authorization requirement is applicable only for those members whose benefits currently require prior authorization for high‐tech diagnostic imaging services. Please contact AIM as outlined below to obtain prior authorization before rendering echocardiography diagnostic imaging services.



Please note: As a participating provider, the failure to obtain prior authorization for SE, TEE, and TTE services on or after March 6, 2012, for those benefit plans that currently require prior authorization for high‐tech diagnostic imaging services will result in a denial of payment under your provider contract. Similar to other high‐tech diagnostic imaging services, Empire members cannot be balance billed if payment is denied based upon your failure to obtain prior authorization for SE, TEE, and TTE diagnostic imaging services.

Prior authorization for SE, TEE and TTE diagnostic imaging services will not be required for the following members:

Members who currently require prior authorization for Magnetic Resonance Imaging (MRI orMRA) only.Out‐of‐area members who do not currently require prior authorization

Medicare Supplement MembersFederal Employee Plan MembersNational account self‐funded group members

Some local ASO group members may not impose these percent requirements. Further information will be posted on our webpage

Hospital‐only plan members

Source Empire BlueCross BlueShield

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empireblue.com

Affordable Care Act Demonstration to Expand Access to Emergency Psychiatric Care. New demonstration program to help States to improve the quality of care for patients with psychiatric emergency. The Centers for Medicare & Medicaid Services (CMS) on 13 March has announced that 11 States and the District of Columbia will participate in the Medicaid Emergency Psychiatric Demonstration, established under the Affordable Care Act to test whether Medicaid beneficiaries who are experiencing a psychiatric emergency get more immediate, appropriate care when institutions for mental diseases (IMDs) receive Medicaid reimbursement. This demonstration will provide up to $75 million in federal Medicaid matching funds over three years to 11 States—Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, and West Virginia— and the District of Columbia, to enable private psychiatric hospitals, IMDs, to receive Medicaid reimbursement for emergency care provided to Medicaid enrollees aged 21 to 64 who have an acute need for treatment.

Source CMS Media Relations Group

Aetna requires preauthorization for sleep testing effective 03.01.12 (HMO and advantage plans)

Aetna has announced that Polysomnography (attended sleep studies) requires preauthorization effective March 1,2012. Preauthorization must be obtained prior to rendering services in order to



receive payment from Aetna.Preauthorization is currently required for Aetna HMO-based and Medicare Advantage benefits plans. Effective March 1,2012, preauthorization will be required for PSG for Aetna members enrolled in all our commercial and Medicare Advantage benefits plans, excluding Traditional Choice plans. The following codes will require preauthorization:

• 95805 • 95808 • 95811• 95807 • 95810

Please note code 95808 was inadvertently left off the December 2011 Aetna OfficeLink Updates™.Home sleep tests (HSTs) will not require preauthorization.Source Aetna

Health reform law ends lifetime limits for 105 million Americans.HHS Secretary Sebelius released a new report on Mon Mar 5 on how the health reform law has eliminated lifetime limits on coverage for more than 105 million Americans. Before health reform, many Americans with serious illnesses such as cancer risked hitting the lifetime limit on the dollar amount their insurance companies would cover for their healthcare benefits. While some plans provided coverage without dollar limits on lifetime benefits, 105 million Americans were previously in health plans that had lifetime limits. HHS estimates that 70 million people in large employer plans, 25 million people in small employer plans, and 10 million people with individually-purchased health insurance had lifetime limits on their health benefits prior to the passage of the Affordable Care Act. This includes 39.5 million women and 28 million children; 11.8 million Latinos and 10.4 million African Americans.Source U.S. Department of Health and Human Services

Medicare Physician Quality Reporting System (PQRS) Medicare's Physician Quality Reporting System (PQRS), previously known as the Physician Quality Reporting Initiative (PQRI), provides a financial incentive to physicians who volunteer to report on best-practice quality measures for the Medicare patients they treat.

If participants successfully meet the criteria of the Physician Quality Reporting System and report all applicable measures for 2012, they receive a bonus of 0.5 percent of total allowed Medicare Part B CMS charges for that reporting period. Don't loose chance this is additional way that can increase practice revenue, bonus payment for doctors and other eligible professionals.Source The American Physical Therapy Association (APTA)

Providers who not par with PQRI will be subject to 2015 PENALTY of %1.5 of all allowed charges!!!



Beginning in 2015, EPs who do not satisfactorily report under the Physician Quality Reporting System will be subject to a payment adjustment equal to 1.5 percent of their Medicare PFS allowed charges. The payment adjustment increases to 2.0 percent in 2016 and beyond.

Novitas Solutions Website Changes.As announced March 1, 2012, Highmark Medicare Services is changing its name to Novitas Solutions. Effective March 10, 2012, Novitas Solutions will begin migrating the current Highmark Medicare Services website to new Novitas Solutions website. The new Novitas Solutions website URL will be www.novitas-solutions.com

Comparing ICD-9 and ICD-10There are several structural differences between ICD-9-CM codes and ICD-10 codes. This Table illustrates the difference between ICD-9-CM and ICD-10-CM

Table: Diagnosis Code Comparison

CHARACTERISTIC IDC-9-CM (VOLS. 1&2) IDC-10-CM

Field length 3-5 characters 3-7 characters

Available codes Approximately 13,000 codes Approximately 68,000 codes

Code composition (numeric or alpha)

Digit 1= alpha or numeric Digits 2-5= numeric

Digit 1= alpha or numeric Digit 2= numeric Digits 3-7= alpha or numeric

Available space for new codes

Limited Flexible

Overall detail embedded within codes

Ambiguous Very specific ( Allows description of comorbidities, manifestations,etiology/causation, complications, detailed anatomical location, sequelae, degree of functional impairment, biologic and chemical agents, phase/stage, lymph node involvement, lateralization and locaization, procedure or implant related, age related, or join involvement)

Laterality Does not identify right versus left

Often identifies right versus left

Sample code 813.15 Open fracture of head of radius

S52123C, Displaced fracture of head of unspecified radius, initial encounter for open fracture type IIIA, IIIB, or IIIC



Overall Comparisons of ICD-9 to ICD-10 Many issues today with the ICD-9 diagnosis and procedure code sets are resolved in ICD-10. A primary concern today with ICD-9 is the lack of specificity of the information conveyed in the codes. For example, if a patient is seen for treatment of a burn on the right arm, the ICD-9 diagnosis code does not distinguish that the burn is on the right arm. If the patient is seen a few weeks later for another burn on the left arm, the same ICD-9 diagnosis code would be reported. Additional documentation would likely be required for a claim for the treatment to explain that the burn treated at this time is a different burn from the one that was treated previously. In the ICD-10 diagnosis code set, characters in the code identify right versus left, initial encounter versus subsequent encounter, and other clinical information. Another issue with ICD-9 is that some chapters are full and impede the ability to add new codes. In some cases, new codes have been assigned to different chapters making it difficult to locate all available codes. ICD-10 codes have increased character length, which greatly expands the number of codes that are available for use. With more available codes, it is less likely that chapters will run out of codes in the future. Other issues that are addressed in ICD-10 include the use of full code titles and appropriately reflecting advances in medical knowledge and technology. More detailed information and examples are provided below to demonstrate the differences between the ICD-9 and ICD-10 code sets.Diagnosis Codes The following table provides a comparison of the features of the ICD-9 and ICD-10 diagnosis code sets.

Table– Comparisons of the Diagnosis Code Sets

ICD-9 ICD-10

3-5 characters in length 3-7 characters in length

Approximately 13,000 codes Approximately 68,000 available codes

First digit may be alpha (E or V) or numeric; digits 2-5 are numeric

Digit 1 is alpha; digits 2 and 3 are numeric; digits 4-7 are alpha or numeric

Limited space for adding new codes Flexible for adding new codes

Lacks detail Very specific

Lacks laterality Has laterality (i.e., codes identifying right vs. left)

In the ICD-10 diagnosis code set, the alpha characters are not case sensitive. The following examples show a comparison of the formats of the ICD-9 and ICD-10 diagnosis codes. You can see the use of alpha characters and longer codes in ICD-10.

Source American Medical Association

http://www.ama-assn.org/ama1/pub/upload/mm/399/icd10-icd9-differences-fact-sheet.pdf


Pharmacy: How do state Medicaid programs reimburse for outpatient drugs?States currently reimburse pharmacies for covered outpatient drugs under their Medicaid programs based on drugs’ estimated acquisition

cost (EAC)—a cost estimate derived from published compendia pricing. In a February 2 Federal Register notice, the Centers for Medicare & Medicaid Services proposed that the EAC be replaced with a new pricing measure called the “actual acquisition cost” (AAC)—the actual prices paid by pharmacy providers to acquire drug products marketed or sold by manufacturers. The proposed rule is open to public comment until April 2, 2012.

Cardiology : Medicare guidelines state that we cannot bill conscious sedation in addition to the heart cath codes. If, during the procedure, a patient receives Nitroglycerin, Integrilin, etc. through an IV push or IV drip, can this be separately billed?

The drugs you listed are used during coronary interventional procedures and not for sedation. If you are asking whether the drugs can be billed, the answer is yes, but their administration is considered inherent to the interventional procedure and not separately billable.

Radiology : We've been assigning unlisted code 76497 for a CT cystogram. Is that correct?No, a computed tomography (CT) cystogram is a protocol that can vary from practice to practice but is, usually, a CT pelvis and possibly also a CT

abdomen. Your doctor should dictate exactly what was performed, and your code choice would then be clear. See the Q & A in the January/February 2007 ACR Radiology Coding Source for more information.

Source Panacea http://panaceahealthsolutions.com


Specialty Updates


Alabama.Important Notice Regarding the 4010 Shutdown. Beginning March 31, 2012, Alabama Medicaid will complete updates to discontinue support of X12 4010, NCPDP interactive 5.1, and NCPDP batch 1.1

transactions. The final financial cycle, where both 4010 and 5010 835 transactions will be produced, occurs March 16, 2012. Beginning April 6, 2012, only 5010 versions of the 835 transaction will be produced.

Alabama pushes health reforms Alabama is a deep red, Deep South state with a health policy that is taking on a decidedly blue tinge these days.Last week alone, Republican Gov. Robert Bentley issued an executive order to move forward on an Alabama health insurance exchange and lashed out at the state’s Republican-controlled Legislature for attempting to scale back his proposed $247 million increase in Medicaid funding by a mere $7 million.

AlaskaHow much does Medicaid cost in Alaska?The total state and federal cost of Medicaid in Alaska in 2010 was $1.2 billion, or $9,011 per beneficiary. Children were $5,723 per beneficiary, while coverage for

each adult was $13,324. Each enrolled senior cost $22,964. The state pays roughly 43 percent of Medicaid costs, while the federal government covers 57 percent. Medicaid represents 8 percent of the state general fund budget in Alaska, about half the average cost in other states. Absent federal health reform or other significant changes currently under discussion in Congress, total Medicaid spending in Alaska is projected to increase steadily in the next 20 years, to approximately $4.5 billion in 2030. The state’s share of that spending will increase about 8 percent annually – to nearly $2 billion in 2030.


STATES UPDATES


ArizonaSebelius Clears the Way for Arizona to Shed Adults From Medicaid. The Obama administration gave a green light to Arizona’s plan to remove about 250,000 adults from its Medicaid rolls, instructing the state that it could circumvent

a requirement in the new health care law that prohibits reductions in eligibility.Last year, Arizona made other significant cuts to its Medicaid program by eliminating coverage of a number of services not mandated by federal law, including some organ transplants.

Arkansas.Good news for Arkansas residents: despite of the fact that about 17.5% of its residents lack Health Insurance coverage, this percentage is likely to decrease this year, thanks to the great efforts of the Arkansas Department of Health. Although

most employers have been reducing their Health Benefits lately within the state (in 2008, about 4.1 of every 10 employers offered Health benefits to their employees), alternate plans have become available for residents to ensure Health Insurance coverage.

CaliforniaAnthem Blue Cross Will Reduce Planned Premium Rate IncreasesResponding to pressure from state officials, Anthem Blue Cross has agreed to lower planned premium rate increases for almost 600,000 policyholders in California, the

Los Angeles Times reports.Insurers in California are required to submit proposed rate increases for review. However, state officials do not have the authority to reject rate hikes they deem excessive. Patient advocates and lawmakers continue to rally support for a proposed ballot measure that would give California's insurance department the authority to approve or reject rate increases (California Healthline, 2/23).

Internet recourse


QUESTIONS AND ANSWERS1. Q: How do commercial insurances reimburse consultation codes? What is the trend?

A: You know that Medicare has recently stopped reimbursing the consultation services and some commercial medical insurance like GHI, Emblem Health follow Medicare policy. But still some medical insurances still reimburses the consultation services (i.e. CPT codes 99241 – 99245). Generally Medicare HMO plans of commercial insurances consistently stopped releasing payment for consultation services as well. let’s take a look through some of policies of insurances what still pays for consultations.

1. Oxford - reimburses for one consultation service for one provider for the one patient no more than once every 6 months. That means that the code (99241-99245) what is billed more than once within a six-month period with the same diagnosis, for the same Member, from the same provider will be denied. Nevertheless it is better when consultation code will be replaced with an established E&M CPT code equal to the same level as billed. But still be acknowledged that usually these codes are reimbursable to specialists. Consultation Codes (99241-99245) are only payable to a single-boarded PCP when billed when billed with diagnosis codes V72.81-V72.84.

2. Blue Cross/Blue Shield - are still reimbursable when Physicians and practitioners that participate in Empire’s Commercial networks when consultation service is provided to commercial plans members. Or they participate in Empire’s Medicare Advantage networks when providing consultation services to MediBlue members. i. e. Empire plan (for New York) will continue to recognize and reimburse for consultation codes for Commercial and Mediblue members. But this insurance won’t cast payments for these services for Medicare Advantage PFFS Physicians & Practitioners. Also Non-Participating Physicians & Practitioners in Blue cross/Blue shield Medicare Advantage network(s) when consulting to a Blue Cross/Blue Shield Medicare Advantage member. i.e. Physicians and practitioners not participating in Blue Cross/Blue Shield’s Medicare Advantage networks should follow the CMS guidelines when billing Empire.

3. Humana - will follow CMS policy just for Medicare products, i.e. it will be reimbursed when these services when they are provided to Commercial member of Humana.

4. United Health Care - commercial plans Still reimburses for Consultation provided by physician, But Medicare plans from United healthcare (SecureHorizons® AARP®, Medicare Complete® Evercare®, AmeriChoice Medicare Advantage®), don’t reimburse for consultation services to their members.

5. Aetna - reimburses the consultations for in-network physicians with Medicare Advantage and




commercial plans. These codes will be denied if claims submitted by non-par providers

2. Q: Can office visit and hospital inpatient visit be billed for a patient on the same date by primary care physician? A: In this case it is better to bill one of the following codes 99221 - 99223 (Initial hospital care, per day, for the evaluation and management of a patient.) because according to the CPT manual, when the patient is admitted to the hospital, as an inpatient (21 place of service), in the course of encounter in another site of service (e.g. physician’s office 11 place of service) all evaluation & management services provided by primary care physician in conjunction with that admission are considered as a part of the initial hospital care when it is performed on the same date of service as the admission of a patient. And the level of service should support the included services related to the admission provided by physician in the other sites of service (11 place of service) as well as in the inpatient setting (21 place of service). Please be advised, according to the Medicare policy contractor both initial and subsequent care are "per diem" services and may be reported only once per day by the same physician or physicians of the same specialty from the same group practice. And if a patient receives observation services who is admitted to hospital, inpatient status on the same date the primary care physician should report only the initial hospital care with AI modifier (Modifier -AI – Principal Physician of Record)

3. Q: What is the rule for the Skilled nursing FA patients and how billing is performed? Why Medicare does not cover services for Skilled nursing FA patients in out-patients settings?

A: Congress then enacted the Balanced Budget Act of 1997 (BBA), Public Law 105-33, Section 4432(b), and it contains a Consolidated Billing (CB) requirement for SNFs. Under the CB requirement, an SNF itself must submit all Medicare claims for the services that its residents receive (except for specifically excluded services listed below).Excluded ServicesThere are a number of services that are excluded from SNF CB. These services are outside the PPS bundle, and they remain separately billable to Part B when furnished to an SNF resident by an outside supplier. However, bills for these excluded services, when furnished to SNF residents, must contain the SNF's Medicare provider number. Services that are categorically excluded from SNF CB are the following:• Physicians' services furnished to SNF residents. These services are not subject to CB and, thus, are still billed separately to the Part B carrier.• Many physician services include both a professional and a technical component, and the technical component is subject to CB. The technical component of physician services must be

Sagirov BulatQuality Assurance


billed to and reimbursed by the SNF.• Section 1888(e)(2)(A)(ii) of the Social Security Act specifies that physical, occupational, and speech-language therapy services are subject to CB, regardless of whether they are furnished by (or under the supervision of) a physician or other health care professional.• Physician assistants working under a physician's supervision;• Nurse practitioners and clinical nurse specialists working in collaboration with a physician;• Certified nurse-midwives;• Qualified psychologists;• Certified registered nurse anesthetists;• Services described in Section 1861(s)(2)(F) of the Social Security Act (i.e., Part B coverage of home dialysis supplies and equipment, self-care home dialysis support services, and institutional dialysis services and supplies);• Services described in Section 1861(s)(2)(O) of the Social Security Act, i.e., Part B coverage of Epoetin Alfa (EPO, trade name Epogen) for certain dialysis patients. Note: Darbepoetin Alfa (DPA, trade name Aranesp) is now excluded on the same basis as EPO;• Hospice care related to a resident's terminal condition;• An ambulance trip that conveys a beneficiary to the SNF for the initial admission, or from the SNF following a final discharge.



Elizaveta BannovaBilling Department Supervisor,

CMRS

WCH Service Bureau, INC

3047 Avenue U, Brooklyn NY 11229

Phones: (718) 934-6714, (718) 934-6728, 888-WCHEXPERTS

Fax: (718) 504-6072




Technical Task for web-site development.


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Address:

Phones:

E-mail:

Contact Person:

Comments:

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q Online Store

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WCH bulletin March 2012