Fall 2011 newsletter

CHART AUDIT BY WCH

ISSUE 17 FALL 2011

3047 Avenue U, Brooklyn NY 11224 / Phone: 718 934-6714 / Fax: 718 504-6072 / [email protected] / www.wchsb.com

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

MEDICARE REVALIDATION –WCH OFFERS HELP

Version 5010 changes

Welcome to Fall Newsletter!Welcome to Fall Newsletter!DEAR DOCTOR’S AND OFFICE MANAGER’S, WELCOME TO

WCH TIMES FALL NEWSLETTER EDITION!

We have changed our look for the new season and we hope that you will like the design. Enjoy this issue and we are looking forward to your feedback.

DEAR DOCTOR’S AND OFFICE MANAGER’S, WELCOME TO WCH TIMES FALL NEWSLETTER EDITION!

We have changed our look for the new season and we hope that you will like the design. Enjoy this issue and we are looking forward to your feedback.

Inside this Issue:

WCH Corner .............................................................. 3-55 Tips for medical practices when creating and maintaining websites: ..................................................................... 6CIGNA has entered into an expanded relationship with medsolutions, Inc. (MSI) .............................................. 7CMS: chiropractors ineligible to order and refer ......... 7Effective july 21, 2011, several claim edits will be implemented in the emedny front end .............................................. 8Fidelis care is pleased to announce the relocation of its operations center and offices in western New York, as of August 15, 2011 .................................................. 8CIGNA: when to file a claim .................................... 9-10National Government Services announces new medical director for jurisdiction ............................................................ 11-12Revalidation of provider enrollment information ...... 13The medicare payment advisory commission in its june report to congress recommended tighter reviews of spending on diagnostic imaging, among other advice ......................................................................... 14Medicaid expands coverage for screening, brief intervention, and referral to treatment (SBIRT) ..................................... 15Limitation on rehabilitation visits ......................... 16-19Iphone can diagnose stroke quickly, accurately ......... 20Questions & answers ............................................ 21-22Feedback .................................................................... 23

September 16, 2011

URGENT MEDICARE UPDATE Dear Doctors and Office Managers! In the next few weeks, Medicare will be sending out Enrollment Revalidation Requests to existing Providers and Suppliers. Providers will be responsible for updating their enrollment file within 60 days of the date of the letter. Revalidation will be possible by 2 methods: online through PECOS or by submitting a CMS 855 paper application. As you are aware, this year Medicare has established an enrollment fee of $ 505.00. This fee as applicable only to Suppliers, not Individual Practitioners or Groups. All Suppliers will be receiving revalidation requests as well, and when fulfilled, they should be accompanied by the receipt of $505.00 ( payment can be made at www.pay.gov ). Medicare expects all providers to complete their Enrollment Revalidation by March 23, 2013. However, all providers must respond within 60 days of the date of the letter they received from Medicare. WCH Service Bureau can gladly help any Provider or Supplier to complete their Revalidation with Medicare. WCH revalidation fee is $160.00. For those Providers, that are receiving Medicare payments by paper checks, this would be an opportunity to upgrade to electronic payments. We urge you to take this matter seriously and respond to the letters that you are receiving. Delay or neglect of this letter will result in your Medicare billing privileges being de-activated. Please contact WCH to start the process of revalidation by calling 718-934-6714 ext 1201, 1211 or 1102 or I can be also reached directly by email at [email protected].

WCH CORNER

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What's ahead in the healthcare reimbursement for our clients – insurance

contracting and patient's benefits will determine the claims payments more

than ever before. Many insurance companies are forcing many providers,

especially specialist rendering services to credential with their networks. In

the upcoming months many changes are being implemented for the

upcoming year. Below are important points that WCH would like our clients to

be aware about.

Insurances Fee Schedules Changes:

Healthcare providers are receiving freshly prepared contracts with new fee

schedules, requesting confirmation of the established changes in the fee

schedule. Particularly, Medicaid HMO's (Fidelis, Metro Plus, and Americhoice

-community plan) are lowering their fee schedule due to CMS/Medicaid

recent requirements. WCH is here to help with your contracts and application

completion. Please feel free to turn to our billing and credentialing

department for help.

Therapy services:

Physical, Occupational and Speech Therapy services are undergoing major

changes starting Fall 2011. Reimbursement, patient's benefits and contracting

changes are greatly going to impact the therapy services for many medical

clinics. This issue includes many of the changes taking place in Medicaid and

with Medicaid HMO plans. We urge that the front desk receptionist will be

more careful with obtaining authorizations for the therapy services and

provide this information to WCH billing department. Additionally, we

recommend informing the patient of the changes in therapy benefits and

availability of services after the authorized visits will lapse. WCH account

representative will continue providing your practice with updates about the

therapy changes.

WCH's Online Provider Credentialing Application Our Simplified approach, “Fill out once—Use always and everywhere”

With our clients' time consuming and busy schedules in mind, WCH has developed and implemented a smooth and efficient way to initiate the credentialing process—An online provider Credentialing Application. Simply log onto our website at , and follow these three easy steps to access the application:

Select the SERVICES option at the top of the page, Select Provider Credentialing, and lastly Select Credentialing Application at the middle of the page. After you have

done this, complete the application with the required information.

Completing the online application is easy and convenient, and saves you the hassle of travelling to our offices when you can easily provide us with all your information online from the comfort of your home or office. Visit our website today, and access the simplest application there is!

www.WCHSB.com

— — —

WCH Toll Free Phone: 888-WCHExperts

Fax: 718-504-6072

Our Website:

TIME MANAGEMENTPROGRAMMLet WCH's Time management software work for you!

www.wchsb.com

http://wchsb.com/management.asp

WCH CORNER

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Fax: 718-504-6072

Our Website:www.wchsb.com

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http://twitter.com/#!/wchsb

http://www.facebook.com/pages/WCH-Service-Bureau-INC/184161778305225

VISIT OUR NEW SITES:

http://credentialingsite.com/http://insuranceenrollment.net/http://medicalbilling.wchsb.com/


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5 TIPS FOR MEDICAL PRACTICES WHEN CREATINGAND MAINTAINING WEBSITES:

Mike Cuesta, marketing director at CareCloud, a Web-based medical practice management software firm in Miami, offered some tips for medical practices when it comes to creating and maintaining websites.

1. Patient registration and forms. Ensure patients can make appointments, register and access important forms no matter where they are. Cuesta says practices can use a patient portal or provide a PDF version of the registration form on their website. Putting the registration form under “new patient” or “welcome” on one's site will allow patients to find it easily, he adds.

2. Timely news and updates. Make sure to display recent blog, news and other alerts or updates to make sure the website looks fresh and timely. This helps patients feel comfortable that their doctor is engaged with the community and current issues. It also makes the practice look “fresher, bigger and more sophisticated,” says Cuesta. Practices will also be “rewarded' by Google, he says, if they show they are constantly updating, the site and “will rank higher than other practices."

3. Accessible contact information. Display contact information clearly on every page. Cuesta recommends putting it in the top right corner. Also, make sure it shows up on local search results, and include the address on the footer of each page.

4. Patient education resources. Patients are relying more and more on the Internet for medical information and news, which can often lead to confusion and inaccurate diagnoses. Cuesta says medical practices should provide patients with their own content, links and resources to help with research while ensuring it's aligned with their treatment plans.

5. Services and insurance. List all services and insurance companies your that are accepted, says Cuesta. Practices should keep this open-ended, he adds, so that if the patient's insurer is not listed, he or she can call for options. “The financial responsibility is moving more toward the patient. The end goal is to educate on them on what their financial options are,” he said. For example, some practices are now taking cash, he said.

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Fax: 718-504-6072

Our Website:

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

www.wchsb.com


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CIGNA HAS ENTERED INTO AN EXPANDED RELATIONSHIP WITH MEDSOLUTIONS, INC. (MSI)

Beginning july 1, 2011 Cigna has entered into an expanded relationship with MedSolutions, Inc. (MSI), who will now provide exclusive radiology benefit and Network management services for cigna.

Health care professionals who are affected by this change will receive a letter explaining this new relationship. As an exclusive provider of radiology benefit and network management services, MedSolutions, Inc. (MSI) will be responsible for processing appeals related to any of their utilization management decisions.

After the market transition to MSI, appeals should be submitted to: MedSolutions, 730 Cool Springs Boulevard, Suite 800, Franklin, Tennessee 37067 If a committee or external review is offered due to state regulations or account requirements, the initial denial letter will provide instructions for submitting the appeal to CIGNAMedSolutions will provide the following services on behalf of CIGNA:— Radiology facility credentialing — A utilization program featuring Predictive Radiology Intelligence— Network management services— Reimbursement of low-technology radiology services provided within the MedSolutions network — Nuclear cardiology imaging management

http://www.cigna.com/customer_care/healthcare_professional/newsletters/JulyNetworkNews/06_MedSolutionsUtil_0711.html

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CMS: CHIROPRACTORS INELIGIBLE TO ORDER AND REFER

The Centers for Medicare & Medicaid Services (CMS) recently discovered that several of its communications incorrectly included chiropractors in the list of health care professionals who may order and refer, and is in the process of revising those documents, including change requests (CRs).

Contrary to what CMS may have said in recent announcements and materials, chiropractors are ineligible to order and refer items or services to Medicare beneficiaries.In accordance with sections 1877(a)(1) and (5)(A) and 1861(r)(5) of the Social Security Act, and 42 CFR 410.21(b)(1) and (2), Medicare Part B pays only for a chiropractor's manual manipulation of the spine to correct a subluxation; all other diagnostic and therapeutic services furnished or ordered by a chiropractor are not covered.


Fax: 718-504-6072

Our Website:

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.

www.wchsb.com

http://www.cigna.com/customer_care/healthcare_professional/newsletters/JulyNetworkNews/06_MedSolutionsUtil_0711.html


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EFFECTIVE JULY 21, 2011, SEVERAL CLAIM EDITS WILL BE IMPLEMENTED IN THE EMEDNY FRONT END

These edits will be performed prior to claim adjudication, and will provide much faster turnaround for notification of these error conditions.

Claims rejected by the front end process will not be reported in the Remittance Advice. Front end error conditions will be returned in outbound responses to claim submissions: 277CA for 5010 submissions and U277 for 4010. Claims that have passed all “pre-adjudication” edits and do not have errors indicated will be reported on a future remittance advice.

A list of pre-adjudication edits and associated claim status codes is posted on in the eMedNY HIPAA Support section. Click on “5010

Crosswalks” or Click here for the list:

Please note: there are differences on the list based on whether you've submitted claims with version 4010 or version 5010, so be careful to reference the proper column on the right side of the chart.

As of July 21, ePaces will only send version 5010 to eMedNY. ePaces users will be provided with the 5010 pre-adjudication edit responses.

www.emedny.org

http://www.emedny.org/HIPAA/5010/transactions/crosswalks/eMedNY%20Pre-Adjudication%20Crosswalk%20(837%20Health%20Care%20Claims).pdf

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FIDELIS CARE IS PLEASED TO ANNOUNCE THE RELOCATION OF ITS OPERATIONS CENTER AND OFFICES IN WESTERN NEW YORK, AS OF AUGUST 15, 2011.

The new address is:Fidelis Care New York480 CrossPoint ParkwayGetzville, New York 14068

Administrative Appeals should be sent to this address. Please refer to Section 12 of the Fidelis Care Provider Manual for additional information.

Please update your records accordingly. All phones numbers remain unchanged.


Fax: 718-504-6072

Our Website:

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

www.wchsb.com

http://www.emedny.org

http://www.emedny.org/HIPAA/5010/transactions/crosswalks/eMedNY%20Pre-Adjudication%20Crosswalk%20(837%20Health%20Care%20Claims).pdf


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CIGNA: WHEN TO FILE A CLAIMFiling a claim as soon as possible is the best way to get the payment, but if you cannot, here's what you need to know:

I. TIMELY FILING LIMITS— participating provider claims must be submitted within 90 days from the date of service;— non-participating provider or member claims – one year from the date of service; — if services are rendered on consecutive days, such as for a hospital confinement, the limit will be counted from the last date of service.

II. EXCEPTIONS TO TIMELY FILING LIMITS— subject to applicable law; — provider agreement specifically allows for additional time; — coordination of benefits: The filing limit is applied based on the primary carrier's processing date stated on the explanation of benefit (EOB). — Medicare (CIGNA HealthCare for Seniors): In accordance with Medicare processing rules, non-participating providers have from 15-27 months to file a new claim. Medicare members' claims must be filed no later than the end of the calendar year following the year in which the services were provided. However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year.— Medicare: The filing limit is applied based on the primary carrier's processing date stated on the explanation of benefit (EOB). — Medicare Secondary Payer (MSP): A three-year (3) filing limitation applies. — Medicaid: A two-year (2) filing limitation applies.

— Resubmission of a claim in response to a request for information by CIGNA HealthCare. If a resubmission is not a CIGNA HealthCare request, and is not being submitted as an appeal, the filing limit will apply.

Extenuating circumstances:CIGNA HealthCare may request appropriate evidence of extraordinary circumstances that resulted in the delayed submission.

III. APPEALS FOR TIMELY FILINGYou can always denied claim if you feel an appeal is warranted. Remember: Your contract with CIGNA HealthCare prohibits member balance billing if claims are denied because they were not submitted within the timeframe outlined above.

Effective August 1, 2011 CIGNA has adopted a common time frame for submitting claims:Except where state law requires a longer time frame, the claim filing limit was changed from 180 days to 90 days for participating health care professionals. Certain states have regulatory requirements that supersede the CIGNA time frames, and health care professionals in these states will have a claim filing limit that meets state requirements. Refer to the Implementation Schedule for state-specific effective dates and claim filing limits.

appeal

http://www.cigna.com/health/provider/medical/procedural/claim_processing/when_to_file.html#Exceptions%20to%20timely%20filing%20limits

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Fax: 718-504-6072

Our Website:

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

www.wchsb.com

http://www.cigna.com/health/provider/medical/procedural/claim_appeals/index.html

http://www.cigna.com/health/provider/medical/procedural/claim_processing/when_to_file.html


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When CIGNA is the primary payer, claims must be submitted within 90 days of the date of service, and when it is secondary – within 90 days of the receipt by the health care professional of the Explanation of Payment from the primary payer. Only participating health care professionals who receive a notification and amendment to their agreement from us, or who are newly contracted with CIGNA, are affected by this change on August 1 and November 1. There will be additional phases in 2012, and affected health care professionals will be notified in advance of any changes.

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Implementation Schedule

Type of Health Care Professional

Effective Date States

Participating, directly contracted health care professionals (notified by letter in May 2011)

August 1, 2011 AK, AR, AZ, CO, CT, DE, IL, IN, KS, LA, ME, MI, MO, NH, NY,* OH, OK, RI, SC, TX,** UT, VT, WI, WV

Participating, directly contracted health care professionals (will be notified by letter in August 2011)

November 1, 2011 CA, GA, KY, MA, MS, NV, PA, TN,* WA

*NY and TN will have a 120-day claim filing limit. **TX will have a 95-day claim filing limit.


Fax: 718-504-6072

Our Website:


www.wchsb.com


http://www.cigna.com/customer_care/healthcare_professional/newsletters/JulyNetworkNews/03_ClaimFile_0711.html

http://www.cigna.com/customer_care/healthcare_professional/newsletters/JulyNetworkNews/03_ClaimFile_0711.html

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NATIONAL GOVERNMENT SERVICES ANNOUNCES NEW MEDICAL DIRECTOR FOR JURISDICTION 13

National Government Services welcomed Dr. Janet I. Lawrence as the new Medical Director for the Jurisdiction 13 (J13) A/B Medicare Administrative Contract (MAC). Dr. Lawrence replaces Dr. Paul Deutsch, who has moved to an alternate role within the company.

As J13 Medical Director, Dr. Lawrence will be responsible for interpreting existing policies and developing new policies based on changes in the healthcare or medical arena. Previously, she served as National Accounts Medical Director at WellPoint, as well as Deputy Surgeon for Mobilization, 81st Regional Support Command, Birmingham, Alabama. Dr. Lawrence has also served as a physician in inpatient, outpatient, home health and hospice, and clinic settings, and Medical Director for a home health and hospice organization as well as a consultant for Qualis Health, a medical review agency. She received her MD from the Michigan State University College of Human Medicine and completed an Internal Medicine Residency at the Medical College of Georgia. She is a Fellow of the American College of Physicians and a Colonel in the US Army Reserves. Dr. Lawrence has served on a number of medical committees for organizations and hospitals, is a Red Cross Disaster Relief Physician Volunteer, and volunteers with a number of civic and community organizations.

http://www.ngsmedicareconvention.com/

Jurisdiction 13 MAC NewsAn Important Message for National Government Services Providers Who Receive Paper Remittance and Paper Checks

To find out how your facility can save on staff time, streamline your claim payment postings, and receive your Medicare payments sooner than a paper check, read this message in its entirety!

We have a very exciting and important message for all providers who are still receiving paper remittance advices and paper checks. There is good news: you can receive your remittance advice and Medicare checks electronically!

This message is to make you aware of electronic funds transfer (EFT) and electronic remittance advice (ERA). EFT is a means of receiving your Medicare payment electronically. ERA is the notice of payment and will explain the reimbursement decisions made on your processed claims.

There are many advantages to receiving electronic remittance advice and checks. Most importantly, you will receive your Medicare funds much faster! There is no danger of having a check/remittance advice lost or stolen and claims postings will go faster saving precious staff time. We are encouraging all providers who are currently not receiving either EFT or ERA to do so now. Below are reasons and features why all providers should be doing this.


Fax: 718-504-6072

Our Website:


www.wchsb.com

Please forward and share this message with the appropriate staff that can get

the facility started on receiving either EFT or ERA or both..

Attention Some important reasons why providers should receive EFT include:

— Electronically deposited funds are available in your account the day after

Medicare transmits an EFT to the bank;

— EFT will usually be available to you one week sooner than paper funds;

— Checks have the potential to be misrouted or misplaced; not the case with

EFT!

— Eliminates the need to keep track of paper checks; and

— Reduces staff time and the expense of entering manual check information.

Some valuable features that attract providers to the ERA option:

— Access to all claims screen — Access to single claim screen — Access to bill type summary screen — Access to provider payment screen — Free software such as PC Print available to create a view-only ERA display — Data and data efficiencies not available in a paper remittance advice — Faster communication and payment — Quicker account reconciliation via electronic posting — Efficient and accurate payment posting issues.

Come join the thousands of providers who are already receiving ERA and EFT and take advantage of this wonderful opportunity to save your facilities time and money!

http://www.ngsmedicare.com/wps/portal/ngsmedicare/welcome

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Fax: 718-504-6072

Our Website:

WCH-Whatever


www.wchsb.com


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REVALIDATION OF PROVIDER ENROLLMENTINFORMATION

All providers and suppliers enrolled with Medicare prior to March 25, 2011, must revalidate their enrollment information after receiving notification from their Medicare Administrative Contractors (MAC). When you receive notification from your MAC to revalidate, you must:

— update your enrollment through Internet-based PECOS or complete the CMS-855; — sign the certification statement on the application; — and if applicable, pay your fee thru pay.gov.

Also, please be sure to mail your supporting documents and certification statement to your MAC.

http://www.cms.gov/MLNMattersArticles/downloads/SE1126.pdfhttp://www.palmettogba.com/palmetto/providers.nsf/ls/J1B~8KJH6L5080?opendocu

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Fax: 718-504-6072

Our Website:


www.wchsb.com


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THE MEDICARE PAYMENT ADVISORY COMMISSIONIN ITS JUNE REPORT TO CONGRESS RECOMMENDEDTIGHTER REVIEWS OF SPENDING ON DIAGNOSTICIMAGING, AMONG OTHER ADVICE.

MedPAC recommended that:

— Congress reduces the professional component for multiple diagnostic imaging services when interpreted by the same physician for the same patient session.

— Congress reduces the physician work component of diagnostic imaging services ordered and performed by the same physician.

— Congress establishes a prior authorization program for very frequent users of advanced diagnostic imaging services.

— The Health and Human Services secretary accelerate ongoing efforts to bundle certain physician Medicare payments.

— Congress provides Medicare funding to physicians, hospitals and other health professionals so they can contract directly with quality improvement organizations.

Source: "June 2011 Report to the Congress: Medicare and the Health Care Delivery System," Medicare Payment Advisory Commission, June

www.medpac.gov/documents/jun11_entirereport.pdf

http://www.ama-assn.org/amednews/2011/06/27/gvl10627.htm

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Fax: 718-504-6072

Our Website:


www.wchsb.com

http://www.medpac.gov/documents/jun11_entirereport.pdf

http://www.ama-assn.org/amednews/2011/06/27/gvl10627.htm


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MEDICAID EXPANDS COVERAGE FOR SCREENING,BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT)

Medicaid currently covers SBIRT services for all Medicaid beneficiaries who are 10 years of age and older in hospital outpatient and emergency departments and free-standing diagnostic and treatment centers (D&TCs), including School-Based Health Centers (SBHCs).

Under the authority of amendments passed as part of the 2011 Executive Budget, coverage will be extended to SBIRT services provided by office-based primary care practitioners effective September 1, 2011. Reimbursement in other clinic settings, including clinics licensed or operated by the Office of Mental Health (OMH) or the Office of Alcoholism and Substance Abuse Services (OASAS) will be available once Ambulatory Payment Groups (APGs) have been fully implemented in these settings.

Based on implementation of this model nationally, of 459,599 patients screened, 22.7% screened positive for a spectrum of use (risky/problematic, abuse/addiction). Of those who screened positive, 15.9% were recommended for a brief intervention, with a smaller percentage recommended for brief treatment (3.2%) or referral to specialty treatment (3.7%).

SCREENING: The screening tools identify substance use/abuse risk and the appropriate level of intervention for indicated individuals. Providers must explain the screening results to the patient and, if the patient has screened positive, the provider must be prepared to deliver or obtain on-site brief intervention services for the patient within the same visit.

OASAS has a list of evidence-based screening tools available online at:

Upon prior approval from OASAS, providers may choose tools that are not included on the list as long as they meet specified criteria and the tool is simple enough to be administered by a wide range of health care professionals. Requests for review of alternate screening tools may be emailed to:

http://www.oasas.ny.gov/AdMed/sbirt/index.cfm.

[email protected].

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Fax: 718-504-6072

Our Website:


www.wchsb.com



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LIMITATION ON REHABILITATION VISITS

Medicaid Redesign Team Proposal #34 (MRT #34)

Effective October 1, 2011, physical therapy, occupational therapy, and speech

therapy will be limited to 20 visits each per twelve-month benefit year as

defined below. This benefit limit applies to rehabilitation visits

in private practitioners’ offices, certified hospital out-patient departments,

and diagnostic and treatment centers (free-standing clinics). The rehabilitation

limit applies to Medicaid fee-for-service (FFS), Medicaid managed care

(MMC), and Family Health Plus (FHPlus) enrollees.

Exemptions

Enrollees, settings, and/or circumstances that are not subject to the 20-visit

limitation are considered Exempt. Enrollees, settings, and/or circumstances

that are subject to the 20-visit limitation are considered Not Exempt. Review

the Enrollees, Settings, and Circumstances chart for details.

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Effective October 1, 2011Medicaid FFS Enrollees: For Medicaid FFS enrollees, the twelve-month benefit

year begins on April 1st of each year and runs through March 31st of the

following year. On October 1, 2011, Medicaid FFS enrollees who have received

20 or more visits of physical therapy, occupational therapy, or speech therapy

between April 1, 2011 and September 30, 2011, will not be entitled to have

Medicaid reimburse additional visits for that therapy type until April 1, 2012.


Fax: 718-504-6072

Our Website:


www.wchsb.com


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Medicaid Managed Care and Family Health Plus Enrollees: For Medicaid

managed care and Family Health Plus (FHPlus) enrollees, the twelve-month

benefit year is a calendar year, beginning January 1st of each year and running

through December 31st of the same year. For calendar year 2011, Medicaid

managed care and FHPlus plans may choose to count therapy visits between

April 1 and September 30 toward the 20 visit limit, or they may choose to

begin counting visits as of October 1, 2011. In either case, plans may not

begin limiting visits until October 1, 2011.

Example: An enrollee received 26 physical therapy visits and 9 speech therapy

visits between April 1, 2011 and September 30, 2011.

Medicaid FFS Enrollees: The Medicaid FFS enrollee has exceeded the 20-visit

limitation on physical therapy visits for the current benefit year. Therefore,

Medicaid will not reimburse for any more physical therapy visits until April 1,

2012. However, the enrollee has 11 more Medicaid-reimbursable speech

therapy visits and 20 occupational therapy visits available through March 31,

2012. A new benefit year begins April 1, 2012.

Medicaid Managed Care and Family Health Plus Enrollees: Medicaid managed

care and FHPlus providers should contact the enrollee’s health plan to obtain

approval/authorization for rehabilitation visits. A new benefit year begins

January 1, 2012.

Claims will not be denied retroactively for Medicaid FFS, Medicaid managed

care or Family Health Plus enrollees who have received more than 20 visits

between April 1, 2011 and September 30, 2011.

Billing and Claiming Guidance

Visits in Excess of the 20-visit Limitation: The 20-visit limitation on physical

therapy, occupational therapy, and speech therapy is a benefit limit. There is

no means or opportunity to request an approval or an authorization that will

allow for additional visits to be reimbursed by Medicaid or a health plan.

Prior to treatment, it is the provider’s responsibility to determine if the

recipient has previously used any or all of their allotted visits while under the

care of another provider of the same therapy type. In calculating the 20-visit

limitation, all providers for each therapy type are combined. If the recipient

has Medicaid feefor-service, providers should ask the recipient about any

previous visits of the same therapy type. If the recipient is enrolled in a

managed care or Family Health Plus health plan, providers should contact the

health plan for approval as is currently done.

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Fax: 718-504-6072

Our Website:

WCH-Whatever


www.wchsb.com


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If more than 20 visits in a benefit year are required, the recipient may elect to

pay privately. Providers should discuss payment arrangements with recipients,

and may ask them to sign a written agreement. It is important this be

discussed prior to the 21st visit, and it is suggested that the provider maintain

the patient's signed payment arrangement in the patient record.

Modifiers: Modifiers apply to clinics and private practitioners billing FFS.

Because some Current Procedure Terminology (CPT) codes used when claiming

for rehabilitation services can be used by more than one discipline, modifiers

must be included on the claims. Each therapy type has a unique modifier.

Modifiers will facilitate correct counting for each therapy type. Physical

therapy, occupational therapy, and speech therapy claims submitted by clinics

and private practitioners that do not contain a modifier will be denied.

Modifiers for each therapy type are:

Medicaid Audit Program Launched:

Two years after starting the Medicare Recovery Audit Program, the

Department of Health and Human Services has launched a similar program to

crack down on Medicaid waste, fraud and abuse.

HHS published a final rule for the Medicaid Recovery Audit Program this week.

Created under the healthcare reform legislation, the program is designed to

help states identify and recover improper Medicaid payments. As in the

ongoing Medicare effort, independent auditors will be paid a contingency fee

out of any improper payments they recover.

HHS is projecting that the Medicaid audits of provider organizations could save

as much as $2.1 billion over the next five years, of which $900 million will be

returned to the states. The Medicare audit effort is on a pace to grow from

recovering roughly $75 million in 2010 to nearly $670 million in 2011.


Fax: 718-504-6072

Our Website:


www.wchsb.com

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The auditors review claims after payments have been made using automated

review processes and detailed reviews of medical records and other

documentation.

The healthcare reform legislation, known as the Affordable Care Act, provided

an additional $350 million over 10 years to ramp up anti-fraud efforts,

including scrutiny of claims before they've been paid, investments in data

analytics and funding for law enforcement agents and others to fight fraud.

Since June 30, the Centers for Medicare & Medicaid Services has been using

predictive modeling technology in an effort to prevent fraudulent payments.

http://www.ofr.gov/OFRUpload/OFRData/2011-23695_PI.pdf

WE REMIND AND ENCOURAGE YOU TO LET A WCH PROFESSIONAL CHART AUDITOR REVIEW YOUR CHARTS

Doctors, nurses, therapists etc tend to focus more on their patients and their medical care, as it should be, rather than the “business of medicine”. As a result their charts are often neglected as not sufficient time is spent on accurate coding/billing, which is why WCH Service Bureau has been dedicating our resources to minimize this avoidable occurrences that not only saves our clients money, but time and energy.

But how can a Chart Audit save you money as well as time and energy? Easy! By allowing WCH's experienced and efficient Certified Professional Coder review a small sample of your charts we can effortlessly detect any incorrect coding and billing errors and suggest more effective ways to organize your charts and submit claims. Addressing these areas as soon as possible means that your medical practice won't be forced to pay Medicare or any other insurance company a huge amount of cash due to simple billing and coding errors that could have been avoided. The benefits? A worry free-stress free system where your staff can focus more on patient care, and your time will be spent taking care of the more important matters instead of constantly re-doing or fixing coding errors.

So why wait for Medicare, Medicaid or other insurances to audit your charts? Let WCH get to them first, and we'll secure an organized chart system, accurate billing & coding and higher reimbursements on claims. Call WCH today, you won't be disappointed.


Fax: 718-504-6072

Our Website:


www.wchsb.com

http://www.wchsb.com


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IPHONE CAN DIAGNOSE STROKE QUICKLY, ACCURATELY

Doctors can make a stroke diagnosis using an iPhone application with the same accuracy as if they use a medical computer workstation, according to new research from the University of Calgary's Faculty of Medicine.

Researchers say this technology can be particularly useful in rural medical settings. This allows for real-time access to specialists such as neurologists, regardless of where the physicians and patients are located.

Neuro-radiologists in this study designed by Dr. Mayank Goyal looked at 120 recent consecutive noncontrast computed tomography (NCCT) brain scans and 70 computed tomography angiogram (CTA) head scans that were obtained from the Calgary Stroke Program database. Scans were read by two neuro-radiologists, on a medical diagnostic workstation and on an iPhone.

"This iPhone app allows for advanced visualization and is 94- 100 percent accurate...”, - says Mitchell who is from the University of Calgary's Faculty of Medicine.

"In a medical emergency, medical imaging plays a critical role in diagnosis and treatment, time is critical in acute stroke care, every minute counts.”

Another strength of this platform was its ability to handle massive imaging datasets of over 700 images seamlessly over the iPhone.

In April 2010, the application – Resolution MD – was approved by Health Canada so Canadian doctors can now legally make a primary diagnosis using the device.

The images can be viewed on an iPhone, iPad, Android smartphone or web-browser.

Calgary Scientific has licensed the application to many medical imaging companies and over 50,000 hospitals around the world will have access to it in the next 24 months as it's installed in their networks.

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http://www.healthcareitnews.com/news/iphone-can-diagnose-stroke-quickly-accurately


Fax: 718-504-6072

Our Website:


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WC

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1. Q: We are a physical therapy and occupational therapy clinic.

We work with the Home Care agency and currently we have a request for an occupational therapist to render services in the patient's home. However, our occupational therapist is not contracted with the insurance that the patient has. By the practice standards, I would like to find out if a physical therapist is allowed to bill for the services performed by an occupational therapist. Both therapists are partners in the clinic and both share the same case load and management of patient care. The PT will co-sign the works performed by the OT. Since the scope of practice and CPT codes are similar, I raise a question, if this type of billing is permitted by the licensure board. A: The professions of OT and PT are separate and distinct and should remain so. What you are proposing is illegal. Your agency, the OT and the PT would all be in jeopardy of losing their professional licenses.

2. Q: When IDTF Provider sees the patients they usually first see PCP doctor

and then go for testing. The PCP gets the co-pay from the patient; IDTF performs the test on the same date. So should the patient pay another set of co-pay to the IDTF? A: IDTF Provider as well as any other one should check patient eligibility: there is certain co-pay amount for certain types of services. Yes, if patient saw 2 doctors on the same day, and 2 separate claims were filed; co-pay will be applied twice. So, Provider should check the eligibility beforehand and collect co-pays prior to rendering the services.

3. Q: What is the due date for certification from PT to DPT?

A: There isn't an actual date, however, the transition from PT to DPT is a goal and part of the American Physical Therapy Association's (APTA) official vision statement for the betterment and future of the profession of physical therapy, healthcare and its patients. The following link provides more details:

While most entry level accredited educational institutions have adjusted their curriculums in this direction, seasoned professionals are encouraged to continue their pursuit and obligation in the “…continual acquisition of knowledge, skills, and abilities to advance the science of physical therapy and its role in the delivery of health care.”

http://www.apta.org/Vision2020/

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Better Life Medical Supplies Inc – Accredited by BOC. They specializes in all kinds of DME supplies, oxygen equipment, orthotics and prosthetics, mastectomy, diabetic, incontinence products.


Fax: 718-504-6072

Our Website:


www.wchsb.com

http://www.apta.org/Vision2020/

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QUESTIONS & ANSWERS

4. Q: What is the process of this certification, for example should any special

courses be graduated, etc. ?A: To obtain a subsequent degree as a Doctor of Physical Therapy (DPT), PT professionals should contact the educational institution of their choice that offers enrollment in this program. The educational institution will consult with the PT professional on the balance due requirements to obtain this higher learning degree.

5. Q: Clients ask what might happen to them if they lose treatment records of

patients:A: - For HIPAA compliant offices, any records maintained electronically must be backed up. But what about records maintained only on paper that are lost, stolen or destroyed by fire or water damage? And for small non-HIPAA compliant offices that maintain computer records, what about some kind of computer catastrophe?

If the loss of records is due to negligence on the part of the practitioner (e.g., leaving them in an unlocked car), and the lack of them results in some type of harm to a patient, then malpractice liability is possible. But the confluence of those two factors is unusual.

More usual is a lack of records when a practitioner is defending against allegations of malpractice or misconduct by a patient, or when records must be produced for a patient access request, subpoena or insurance audit. Because maintenance of records is legally mandatory, the lack of them can be used as evidence against healthcare practitioners in malpractice or misconduct proceedings under the "missing evidence rule" unless counter-evidence is produced that justifiably explains their absence.

"Acts of God" such as floods or fires are such justification as is criminal victimization, but the practitioner would be expected to produce corroborative documentary evidence such as insurance claims for the water or fire damage, a police report for theft, or a repair bill for a computer that has crashed. Perhaps the most common cause of missing paper records that I hear, that they were lost in a move, usually requires an affidavit (sworn statement) of the practitioner as support to try to avoid negative consequences. In a reimbursement challenge by an insurance company, secondary evidence of services rendered such as appointment books and affidavits of patients may also be necessary.

Potential liability for lost records

http://www.brucehillowe.com/main.asp?id=17


Fax: 718-504-6072

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FEEDBACK

Align yourself and your business with people and services that you can count on. Below, please provide any feedback that you think might help us and in turn help you, and our businesses.

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Fall 2011 newsletter

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