INSIDE THIS ISSUE - WCH · INSIDE THIS ISSUE: 4-10 ... healthcare organizations and generated...
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Transcript of INSIDE THIS ISSUE - WCH · INSIDE THIS ISSUE: 4-10 ... healthcare organizations and generated...
INSIDE THIS ISSUE:
4-10
WCH Buzz
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Healthcare News
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News by Specialty
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Questions &Answers
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Welcome to our Special Summer Edition!
For 13 years WCH Service Bureau has been providing clients with excellent Provider Credentialing services. In efforts to contin-ue and improve WCH Credentialing services the department is undergoing administra-tive and structural changes. The implemen-tation of the changes will result in further improvements to secure that WCH Cre-dentialing department continues to service healthcare providers in all 50 states.
WCH Management and Staff value our cli-ent’s trust and appreciate their patience and understanding while the department is undergoing change. While we work hard to improve our service, we are delighted to share with you this important information:
• The department is currently under con-trol and supervision of Olga Khabinskay, COO. Candidates for the position of a supervisor are being reviewed and con-sidered.
• Multiple new Credentialing specialists have joined our team and are currently undergoing training to ensure quality of service.
• WCH Medical Billing Department is as-sisting with routine Credentialing work. Medical Billing Clients may be contacted by Medical Billing department Account Representatives regarding credential-ing matters such as insurance updates
and credentialing work that has been requested by the client.
• The use of WCH own credentialing soft-ware is being incorporated into the Cre-dentialing work. Shortly, WCH will pro-vide clients with access to the software. The accessibility to the credentialing application will result in elimination of paper processes, save time and increase efficiency.
• The department is accepting new Cre-dentialing work and new clients’ re-quests. Please feel free to contact Olga Khabinskay or Julia Ilisirova for any cre-dentialing work our practice requires.
The mission of our company and quality of the work of the department will not dimin-ish because of the changes we are going through now. We continue to provide our clients with the same outstanding service as we have been for the last 13 years. As new developments become available, we will continue to share the news with you.
Thank you for your continued support and trust in WCH. Please do not hesitate to con-tact us for any questions you may have.
WCH BuzzWCH Buzz
WCH CREDENTIALING DEPARTMENT CHANGES
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WCH Buzz
Medical billing is a complex process of submitting claims to insurance compa-
nies to receive reimbursement for services rendered by the physician and healthcare practitioners. Medical Billers and Providers nationwide face difficulties in establishing best medical billing practices that lead to proper and timely reimbursement for ser-vices to improve practice revenue cycles. With 13 years of Medical Billing experience,
WCH Certified Medical Billing Professionals provide insight to the most crucial practices in medical billing. The following tips estab-lish successful medical billing practices that help submit clean claims that lead to higher reimbursement levels:
TIPS forSUCCESSFUL
MEDICAL BILLING
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WCH BuzzWCH Buzz
It is crucial that appropriate eligi-bility and benefits are verified be-fore rendering services. Incorrect
insurance information and none covered services are the leading cause of denials that can be easily avoided.
It is important to submit claims on appropriate and updated claim forms, CMS1500 and UB04 forms or the electronic equivalents 837P
and 837I. The type of form submitted sig-nificantly effects claims processing. A solid understanding of a practice type is required to receive appropriate reimbursement lev-els and benefit rates by using the appropri-ate forms to file claims.
Claim should be accurately filed in accordance with insurance spe-cific medical policies and state
and federal billing regulation/ guidelines. A biller should have a concrete understand-ing of the HIPPA regulation and compliance policies.
A biller should have a good un-derstanding of all the information that is required to file a claim. It is important to know the provider
type, revenue codes, covered ICD-9 codes and up-to date CPT/HCPCS codes in order to appropriately report services rendered.
Understanding and Utilizing CMS NCCI (National Correct Coding Ini-tiative) Procedure to Procedure
edits and Medically Unlikely Edits (MUEs). It is important to identify Bundled CPT codes when services are rendered by same pro-vider on same date of service. Understand-ing the NCCI helps correctly submit claims with appropriate modifiers to receive ap-propriate reimbursement.
Submitting claims in a timely manner is an important step to ensuring claims payment. Timely
filling limit of claims submission varies by insurance company, and provider status ( in/out of network) with the insurance. It is important to know the guidelines to avoid timely filling denial.
Keeping up to date with the indus-try trends, state and federal legis-lation, insurance policy, updates
and changes helps navigate through the complex process of medical billing and stay informed. It is helpful to sign up to receive bulletins and news letters on a regular ba-sis.
Putting in place quality assurance measures to ensure accuracy of claims submitted protects the
practice and helps avoid future insurance disputes, refunds or audits.
Successful Medical billing is a di-rect link to a healthy revenue cy-cle. In today’s world the difficul-
ties that are imposed on Medical providers and healthcare practitioners by the health-care industry leave no room for mistake in the Medical billing process
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WCH Buzz
Olga Khabinskay has been invited by CodingLeader to speak at a national web confer-ence to present on a popular topic: “Boost Revenue through Successful Credentialing”
Olga’s extensive Knowledge, experience and awards have caught the interest of many healthcare organizations and generated interest in getting Olga’s views and ideas to help healthcare providers. Olga has been asked to speak at a webinar on ______________ among other leading experts on the topic of credentialing to help providers increase revenues by undergoing the appropriate credentialing process. As part of WCH initia-tive to educate providers, Olga will present to help providers improve reimbursement and stay ahead of the fast changing healthcare industry.
DATE: 27.05.2014 TIME: 00:00 am/pm
Boost Revenue through S u c c e s s f u l Credentialing
WELCOME TO WEBINAR
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WCH Buzz
WCH Service Bureau is a company of dedicated hardworking individuals that are here to help with all Medical Prac-tice needs. In WCH we like to think that trust and loyalty is key to our success and costumer satisfactions. We always find ways to impress our cli-ents with new projects, events, news and updates.
In this issue we present to you the Key fac-tors that led to our success in Medical Bill-ing over the years. We are often asked how we set ourselves apart from our competi-tion and how we are different from other billing companies. The answer is simple, we set ourselves apart from the competition by offering MUCH more to our clients than just medical billing.
WCH WINS
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WCH Buzz
3 We are not “billing company”, we are registered as Service Bureau with the Department of Health
3 We work by a set of rules, obligations and process to submit clean claims
3 We follow OMIG, Medicaid and Medic-aid billing guidelines
3 We heavily invest in education of our staff
3 We educate our clients and their staff
3 We provide CEU credits
3 We create monthly newsletters with cur-rent healthcare and industry news
3 We work in a software that was created by WCH Billing and IT team
3 We get asked to speak at events by na-tionally recognized companies
3 We educate residents in hospitals
3 We received multiple awards for excel-lence
3 We fought and won audits, overpayment and negotiation cases for our clients
3 We reimburse our clients internal errors
3 We had the first Certified Professional Biller in Brooklyn out, 1 of 8 total in USA
3 We have certified staff in multiple health-care related fields
3 We protect the license of the medical professional by doing our job right
3 We offer a comprehensive package of products service that are designed to increase our clients operations and in-crease reimbursement
3 We work as an extension to your office, not a third party biller
3 We provide full transparency to what we do and access to our software
3 We are able to customize our service ac-cording to your practice needs
3 We have a large network of healthcare professionals that can help your prac-tice grow and expend
3 We are in business for 13 years and we are not going anywhere
3 We are experienced in all provider spe-cialties
LET US SHARE WITH YOU HOW WE WIN:
After reviewing the long list of WCH benefits, and what WE do for YOU, the question re-ally is can you find any other company that provides the same services to their clients? At WCH WE got the extra step because we understand that in this complex industry you need a strong, knowledgeable and professional business partner by your side. It is important to us that our clients and partners understand what sets us apart from the competition and supports us in further developing our services to help the Healthcare industry.
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WCH Buzz
WCH launched a new website dedicated to its fully certified ambulatory Electronic Medi-cal Record, iSmart EHR. The interactive website features further details and developments about the product. You can now visit www.ismartehr.com to:
• Request a FREE demo and consultation• View screen shots and templates • Explore feature details • Get pricing information • Obtain updates and information about the product • Contact us about iSmart any time
ISMARTEHR.COM IS HERE!
Go on today to see for yourself! Log on to www.ismartehr.com to see the benefits of WCH iSmart EHR.
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Healthcare News
Healthcare News
Effective Aug. 1, 2014 UnitedHealthcare Medicare Advantage Plans will imple-ment the new Medicare Outpatient Therapy Functional Reporting require-ment.
Contracted physical, occupational, and speech therapist claims with dates of ser-vice on or after Aug. 1, 2014, will require Medicare Outpatient Therapy Functional Reporting codes be appended when one or more of the following current proce-dural terminology (CPT) codes are billed: 92521-92524, 92597, 92607,92608, 92610, 92611, 92612, 92614, 92616, 96105, 96125, 97001, 97002, 97003, 97004.
Consistent with Medicare reporting re-
quirements, a therapy evaluation or re-evaluation CPT code as listed above will require the addition of both a functional G-code (HCPCS codes G8978-G8999, G9158 to G9176, or G9186) as well as the appro-priate severity/complexity modifier (CH-CN). Claims submitted with applicable CPT codes that do not contain the appropriate functional G-code and severity/complexity modifier(s) will be rejected.
We encourage you to evaluate your cur-rent billing practices to ensure they align with the documentation in your patients’ medical records. Claims will be rejected if they do not meet editing guidelines and policies.
Source: http://www.unitedhealthcareonline.com
New Outpatient Therapy Functional Reporting Requirement
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Healthcare News
April 22, 2014 – UnitedHealthcare Medi-care plans will align with CMS guidance and implement the new MPPR (multiple procedure payment reduction) for Diag-nostic Cardiovascular and Ophthalmology Services Policy, effective with claims re-ported with dates of service on and after May 1, 2014. The MPPRs apply independently to car-diovascular and ophthalmology services, as well as technical component services, and the technical component of global services. The policy applies to procedures identified with a Multiple Procedure (MP) indicator 6 (diagnostic cardiovascular) and 7 (diagnostic ophthalmology) on the CMS National Physician Fee Schedule. For car-diovascular services, full payment is made for the technical component service with
with the highest payment under the Medi-care Physician Fee Schedule (MPFS). Pay-ment is made at 75 percent for subsequent technical component services provided by the same physician or multiple physicians in the same group practice to the same pa-tient on the same day. For ophthalmology services, full payment is made for the technical component ser-vice with the highest payment under the MPFS. Payment is made at 80 percent for subsequent technical component services provided by the same physician or by mul-tiple physicians in the same group practice to the same patient on the same day. For more information, go to UnitedHealth-care’s reimbursement policy:http://www.unitedhealthcareonline.com
UNITED HEALTHCARE Adopts CMS Cardiovas-cular & Ophthalmology MPPR
For the first time, the government is re-leasing detailed data about medicare pay-ments to doctors, revealing what proce-dures doctors performed and what they were paid. The trove of billing records shows that thousands of physicians made more than $1 million each from Medicare in 2012. Dozens billed for more than $10 million. Billing for a large amount is not necessarily a sign of wrongdoing.
Doctors may be unusually efficient, may perform procedures that require high overhead, or may treat an especially large
number of Medicare patients. Government inspectors, however, have recommended greater scrutiny for high billers.
HOW MUCH MEDICARE PAYS DOCTORS?
Medicare paid doctors $64 billion in 2012. Most of it was for expenses.
Office overhead
43%Doctor compensation
41%Malpractice Premiums
3%Drugs, other costs
13%
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Specialties with large percentages of their Medicare payments going to:
Healthcare News
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Healthcare News
Providers of Long Term Services and Supports (LTSS) Must Verify Medicaid EligibilityProviders of Long Term Services and Sup-ports (LTSS) are required by the New York State Department of Health (NYSDOH) to verify the Medicaid eligibility and man-aged care enrollment status of their pa-tients twice monthly.
LTSS services include: private duty nurs-ing, home health care, personal care, Con-sumer Directed Personal Assistant Servic-es (CDPAS), Adult Day Health Care (ADHC), AIDS ADHC and nursing home stays.LTSS providers are required to:• Check eMedNY or ePACES on the 1st
and 15th of every month to:• Verify Medicaid eligibility.• Determine if the member has coverage
through Medicaid FFS or a Managed Care Plan (MCP).
• If the member has changed MCPs and if so, the name of the new MCP.
• If the member has enrolled in an MCP or changed MCPs:
• Notify the MCP as soon as possible that you are providing LTSS to their new member.
• Share the most recent Physician’s Or-der, member assessment and care plan.
• Obtain the MCP’s authorization to pro-vide services according to the Mem-ber’s existing care plan for a 90-day transition.
Checking Medicaid eligibility and MCP en-rollment, and notifying the MCPs will re-sult in the early identification and seam-less transition of new members in receipt of LTSS.
Source: http://www.emblemhealth.com
This notice is to advise impacted providers that effective May 22, 2014, the 2 percent Across-the-Board Medicaid payment re-duction will be reactivated pending federal Centers for Medicare & Medicaid Services (CMS) approval for removal. The payment reduction will be applied prospectively beginning in Cycle 1919. If you have any questions regarding this notice please contact Mark Shutts at (518) 474-1673.
Source: http://www.emedny.org
2% Across-the-Board Medicaid Payment Reductions
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Do it Right! WCH it!• Medical Billing - WCH it
• Credentialing - WCH it
• EHR - WCH it
• Healthcare Updates - WCH it
• Chart Reviews - WCH it
Healthcare News
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News by Specialty
News by SpecialtyRADIOLOGYEffective August 1 2014, Cigna will process claims that previously were processed by Medsolutions. Prior auth should still be obtained from medsolutions, but claims will be processed by Cigna.Cigna will process radiology claims.Beginning with dates of service August 1, 2014, claims for in-office low-tech radiolo-gy services should be sent directly to Cigna
As a reminder, medsolutions will continue to be responsible for privileging and as-sessment for low-tech services and for precertification of high-tech radiology, nuclear cardiac studies and stress echo. Please continue to submit precert requests at cigna.medsolutionsonline.comPlease see the list of CPT codes
Source: http://www.ama-assn.org
Covered Exams and Descriptions
93880 DUPLEX SCAN OF EXTRACRANIAL ARTERIES93882 F/U OR LIMITED EXTRACRANIAL STUDY93886 DOPPLER, INTRACRANIAL ARTERIES93888 F/U OR LIMITED INTRACRANIAL STUDY93922 DOPPLER U/L EXTREMITY ARTERIES, 1 LEVEL93923 DOPPLER U/L EXTREMITY ARTERIES, MUL Tl LEVEL93924 DOPPLER LOWER EXTREMITY ARTERIES AT REST93925 DUPLEX SCAN, LOWER EXTREMITY ARTERIES93926 F/U OR LIMITED LOWER EXTREMITY STUDY93930 DUPLEX SCAN, UPPER EXTREMITY ARTERIES93931 F/U OR LIMITED UPPER EXTREMITY STUDY93965 DOPPLER EXTREMITY VEINS93970 DUPLEX SCAN, EXTREMITY VEINS93971 F/U OR LIMITED EXTREMITY93975 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW; COMPLETE STUDY93976 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW; LIMITED STUDY93978 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPA GRAFTS; COMPLETE STUDY93979 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPA GRAFTS; UNILATERAL OR LIMITED STUDY93990 DUPLEX SCAN OF HEMODIALYSIS ACCESSG0365 VESSEL MAPPING FOR HEMODIALYSIS ACCESS09966 LOW OSMOLAR CONTRAST MATERIAL
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Beginning August 1, 2014, Horizon BCBSNJ will deny certain services (including Evalu-ation and Management (E&M) services) when performed by the same provider on the same day as another service/procedure even if one of the codes in question is ap-pended with a Modifier 25. Horizon has provided a sample list of com-monly submitted impacted code pairs prior to the implementation of these changes. All code combinations may be reviewed through the McKesson Clear Claim Connec-tionTM, available on NaviNet®, following implementation. Beginning August 1, 2014, Horizon will only recognize Modifier 25 when appropriately billed with a significant, separately identifi-able E&M service performed by the same provider on the same day as another ser-vice/procedure, if the following criteria is met:• The appropriate level of E&M service is
billed.• Modifier 25 is appended to the E&M
service, which is above and beyond the
other service or procedure provided, in-cluding usual preoperative and postop-erative care associated with the proce-dure.
• The reason for the E&M service is clearly documented in the member’s medical record and this documentation supports that the member’s condition required the significantly separate E&M service.
• The services in question have not been specifically identified as part of an im-pacted code pair combination in our claim processing logic that prevent sep-arate reimbursement even if the E&M code is appended with a Modifier 25.
A revised Modifier 25 Reimbursement poli-cy is available online. Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after August 1, 2014.
Source: http://www.ahsrcm.com
E&M Services and Modifier 25 for HorBCBS NJ
News by Specialty
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Meaningful Use Deadline July 1st!
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Cerebral Palsy NY
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Questions and AnswersQuestion:What changes are made to the physi-cians who issue those medical certifi-cates, starting May 2014?
Answer:On April 18, 2012 the Federal Motor Car-rier Safety Administration (“FMCSA”) an-nounced publication of their Final Rule es-tablishing the National Registry of Certified Medical Examiners (“NRCME”) in an effort to unify and enhance medical oversight of commercial drivers and, in doing so, lessen the chances of commercial motor vehicle-related crashes, injuries and fatalities. Ac-cording to the NTSB, crash investigations indicate that improper medical certification of commercial drivers has directly contrib-uted to both fatal and injury crashes. The new rule provides requirements for medi-cal personnel who plan to conduct DOT physicals, requirements for a drivers’ medi-cal certification, and requirements for mo-tor carriers verifying their drivers’ medical status, and goes into effect May 21, 2012. However, there is a two-year implementa-tion period before compliance becomes mandatory and, after May 21, 2014, only registered practitioners will be permitted to issue valid DOT medical certificates. The FMCSA has made it a point to clarify that the purpose of the rule is to monitor medi-cal examiner performance, not driver quali-fication.
The program is managed via web-based access that is accessible to drivers, motor
carriers, medical examiners, enforcement officials, and the general public. However, protected health information will not be accessible. Registration for medical exam-iners who wish to be certified and listed on the registry will be available August 20, 2012. The FMCSA has announced as a goal the certification and registration of 40,000 medical examiners.
Beginning May 21, 2014, all DOT medical examiners will have to be certified and reg-istered with the NRCME and all drivers will have to obtain medical certificates from a certified and registered medical examiner. The examiners are required to consistently and uniformly apply the driver qualification standards in all driver examinations. Ad-ditionally, medical examiners are required to transmit certain information on drivers examined (name, date of birth, driver’s li-cense number and state of issue, date of ex-amination, examination outcome, whether the driver is intrastate only, and the date on which the certification expires) on a month-ly basis. This information is submitted elec-tronically by way of a secure connection to the FMCSA National Registry website.http://nrcme.fmcsa.dothttps://nationalregistry.fmcsa.dot.gov/
Answered by Zukhra Kasimova, CPB
Q&A
WCH Service Bureau, Inc
ICD-10 SAMPLERW27.4XXAContact with a kitchenutensil?
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Question:How long after payment can payors ask for money back?
Answer:Good question, and I’m sorry there is a need to address. For NY - Private Payors have 2 years to “look back” for potential overpay-ments for a reason - lack of medical neces-sity, incorrect coding, duplicative payment - has to be some reason. If the payor is al-leging fraud or abusive billing practices the payor could go back 6 years. Medicare may look back 5 years even where the provider is “without fault”. 42 U.S.C. §1395gg(b).
If you do receive an overpayment request you believe to be the first of many or a re-quest for an amount above several thou-sand dollars, be sure to consider challenging prior to refunding because the request(s) may be the start of a much larger problem - including cash flow disruption. Contact Jen-nifer or Rachel to discuss the request(s) and your options. Listserv members are never charged for a consult.
Answered by Jennifer Kirschenbaum, Esq
Question:I will be legally changing my name soon (and as a result, the name on my license will now reflect my married last name). What is the process if any regarding the insurances I participates with?
Answer:Need to get updates SS card, marriage certificate, update your license and update insurance companies and CAQH.
Answered by Olga Khabinskay, COOWCH Service Bureau, Inc
Q&A
ICD-10 SAMPLERY92-253Injured at an opera?
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WCH Buzz
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