WCH BULLETIN

Interview with

New

Credentialing

Department

Manager

WCH

Contest

Winner

Announced!

WCH and CITIBANK

Complimentary dinner

Free

Websites

CHART AUDIT

DISCOUNT

15%

June 2012

VOLUME 3

ISSUE 5

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

WCH PANTHERS -

RACE FOR CURE 2012

WCH BUZZ HEALTHCARE UPDATES

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CREDENTIALING NEWS

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18 NEWS BY SPECIALTY

19 STATES UPDATES

20 QUESTIONS AND ANSWERS

14 22 FEEDBACK

14

Interview with New Credentialing

Department Manager

WCH Contest Winner! Medical claims error rate drops to

9.5%: AMA

WCH and CITIBANK

Complimentary dinner

WCH PANTHERS - RACE FOR CURE

2012

WCH Go Green Initiative

Radiology Notification/Prior

Authorization Program expansion to

New York, New Jersey and Connecticut

Effective August 13, 2012

Auditing Services

Medicare Advantage Cardiology

Prior Authorization Program Effective

October1, 2012

Senate Passes "New Jobs-New York"

Job Creation Plan

92980 May Become Obsolete in

2013. Learn The Possible Revisions For

Cardiology Practice

CMS To Do Away With The 12-

WCH needs your feedback about Month Claim 'Lookback' Period

your account representative

performance Say Goodbye to Fee-For-Service

Reimbursement?

WCH offers free website for clients,

don't miss a chance

Major Improvements to the

Internet-Based PECOS System

ICD-10 Forums

WCH became a proud member

RAMA-

Russian American Medical Association

We changed our Fax Number

Time Management Program

INSIDE THIS ISSUE:

WCH Times | 4

Interview with

New Credentialing

Department Manager

WCH is proud to announce that George Osipyants has been

promoted as a Manager of the Credentialing Department st

effective as of July 1 , 2012. We are confident that with

Mr. Osipyants experience in credentialing arena and well

established relationship with insurances vendors will

streamline all credentialing processes and hopefully relive

our clients from their enrollment headaches.

W

Hello, George. What do you attribute your

success in the Credentialing Department?

Please, briefly describe your career history and

your special traits and abilities.

What qualities do you think you possess that will

make you a good leader for your team?

e wanted our readers to learn more individual approach to my co-workers. I have

about Mr. Osipyants, so we have always been a team player and I strongly

prepared a brief interview that will understand the importance of delivering our

provide outline of the George Osipyants growth in clients timely and needed results. During my work

the Credentialing Department and give you inside in the credentialing department as an account

look into his personal achievements. representative and then supervisor, I have learned

to deal with problems in the healthcare industry

and my experience taught me how to look at

clients credentialing from all aspects:

- It has been a long and tough road, but with help reimbursement, marketingetc.

of the company management, good team work

and achieved positive results I was able to obtain

necessary knowledge's to reach the new position.

I am grateful to have the new title and I am proud - Briefly - I came, I saw, I conquered... Just joking,

to take the next step with my team. of course. It is still a long way to say "I won here",

I just made a good start. I am at WCH for almost a

year and a half, you'd better believe it - everything

just begins.

- It's not that easy to specify my qualities; you are

asking me about good ones, aren't you? I believe I

have enough experience, knowledge's and

WCH BUZZ

George Osipyants,

Credentialing Department Manager

Concerning traits and abilities, I can tell there is

nothing special or unique about my success was - Self-confidence, optimism - it always helps me.

done I just did my job by standards and

requirements and I was devoted to my job. You'll

will see how fast you can get the results if you - Young, Zealous, Cheerful, Responsive and

follow directions, belief and dream a little. Responsible.

And If you're asked to describe yourself in just 1

word, what would it be?

Ambitious

- I am sure that the greatest achievements are not

yet made. I have plenty of time for them; the - Laziness is my drawback (I'm learning to defeat

whole life is before me. Can't say it for sure... But, it. Lately, I have discovered the benefits of

as I think, I was able to build confidence in the running, it is really super activity, I have more

company management and with hard work; I energy, more motivation and more charisma. Also

received the recognition to become Manager of I am a sport fan (supporting Chelsea Football Club

the Credentialing Departmentand tennis player Maria Sharapova).

- For my part, I support the colleagues ideas, try - I hope that in the next 5 years, I will have my

to make them feel like they are able to change the own private summer house somewhere in Florida

things in our department. Nothing more or California with view of the ocean and enjoying

powerfully promotes the efficiency of work than every second of this life from Friday to Sunday.

awareness of own importance. When people are

happy and can have a little fun at work and

meanwhile their job is done and results achieved

the, I dont see any problem with this at all. When

my team comes to work, I want their everyday

mood to be positive and I want them to feel good

when they come to work every day. This is the

best motivation techniques that I live by - Treat

people as you would want to be treated.

- Short-term goals: arrange the work in our

department so that our clients would always be

satisfied with the results, department staff is glad

to come and work every day. So it is now, but you

know... There's no limit to perfection. Long-term

goals: they follow from the short-term goals -

when people work with their full hearts and

clients enjoy working with our company, quantity

of satisfied and new clients will increase.

Accordingly, we let our company grow. That is

what we are here for.

What are your strengths?

Describe yourself in five words.

What, according to you, has been your greatest

achievement in professional life?

What are your hobbies and activities?

How do you motivate people under you? How Where do you see yourself in the next five to ten

you motivate yourself?years in your personal life?

What are your short-term goals? Long-term?

Please contact our

Credentialing Manager

George Osipyants

at (718) 934-6714 x1102 or

via email: . georgeo@wchsb

WCH Times | 5

The Winner is Announced!

Well, the time is finally here. It is time to announce the

winner of the WCH Contest!

The competition was fierce, and it was great to see

such amazing, interesting, exciting designs of potential

virtual assistant.

We really appreciate all hard work, and hope that the

winners personage will help WCH visitors to navigate

faster on our website and promote WCH products.

The competition was really intense. Well done!

Majors thanks to Judges (New York Psychiatric

Service & Irina, Dr. Ellen Vitievsky & Anatoliy and

Dr. Anna Potash) who spent a lot of individual time on

each design.

The entire management team of WCH is grateful to all

of the participants and their ideas.

Great job everybody!

WCH Times | 6

Congratulations

to all

Participants

Contest 2012

1. 9. Ivan Bulatov

2. Helen Kim 10. Ilana Kozak

3. Kamila Abdullaeva 12. Karina Lebedeva

4. Nias Adamov 13. Bulat Sagirov

5. Tatyana Kantor 14. Adeya Salikhova

6. Albert Khamidulin 15. Slava Kudrov

7. Vadim Zemlyanoi 16. Polina Firsova

8. Valeriya Aksenova 17. Julia Saraeva

Ilya Mirolyubov

Meet ourWinner and

Participants

Prize 1000Winner of $

WCH Times | 7

DEAR CLIENTS, WE WANT TO INVITE YOU TO A

SPECIAL FREE DINNER, SPONSORED BY CITIBANK.

education and outreach programs. WCH in Pink is pleased to support the

work of Susan G. Komen.

You can support WCH by making a donation to WCH Company has been active in the fight

the Greater NYC Affiliate of Susan G. Komen for against breast cancer since 2009.

the Cure. If you wish to support our team WCH We hope that you will join us. Welcome

Panthers and The Susan Komen Foundation Warriors!

please visit our website click

icon donate today on Donation banner and make In today's society everyone knows someone

the donation. WCH set goal to reach with who has been touched by breast cancer.

help of our clients and our dedicated staff we are Whether it's a friend or relative, someone in your

getting closer to the goal. circle has battled this devastating disease. We

You may also call our General Manager Olga found a way to be an active part of the fight

Khabinskay with the amount you will be pledging against breast cancer: the Susan G. Komen

and can send the donation. We must have all Greater NYC Race for the Cure.

donations in to Komen Greater NYC not later than Susan G. Komen is the global leader of the breast

October 31, 2012. cancer movement. As the world's largest

grassroots network of breast cancer survivors and

Additionally, you can join us at the event as a activists, its mission is to save lives, empower

Race participant or volunteer for the event. people, ensure quality care for all and energize

science to find the cures.

Each year over people take part in

For participation and for any other questions more than 140 Race for the Cure events around

related to this event, please contact Maka Kiria the world. We will be joined by other

email: corporations, volunteers, survivors and people

that have desire to help on September 9th in

Central Park.

We were honored and privileged to take part of

such an extraordinary event that not only

benefited the foundation by helping them reach

the goal of , but also to promote

awareness of local breast cancer screening,

$1,000

1.5 million

$6 million

How can you help?

You are welcome to join us on this day and be

part of WCH Panthers team!

http://wchsb.com

makak@wchsb.com

WCH PANTHERS - RACE FOR CURE 2012

WCH Times | 9

Several weeks ago WCH has emailed our clients a

request to participate in our survey. The main mission of

this survey to find out your opinion about performance of

your account representative. Your feedback are very

important to us as, we are constantly working towards

improving our standards and quality of services we offer

both now and in the future. We greatly value your

opinion and would appreciate your feedback to our

email. If you did not receive a survey and want to

evaluate your account representative, please email

Oleseya to obtain link to the survey.

We greatly appreciate your participation!

olesyap@wchsb.com

WCH Go Green Initiative

OWe recommend that our clients follow us on this

initiative, you can start with simple things first:

Go Green

Go Green95%

Think Green and Go Paperless!

ur world is constantly changing before Management Program we become paper free

our eyes. Technology has created and more organized with our payroll and task

advancements that we could never have reminders.

imagined 20 years ago. But with many of the

advancements have come negative changes to

our environment like pollution and global

warming that affect the way we live our lives.

WCH continues systemic changes that Upgrade to E-Fax

we hope will have a larger ripple effect Set up for electronic funds transfer

throughout all of society and especially (EFT) for your insurance payments

in our client's offices. Set your staff's payroll for direct

WCH has initiated inside our deposit office, one of the first things that we

Communicate with everyone via did is go away from use of paper and

email other unnecessary paper products

Stop printing or copying- purchasing during the daily routine. Copy paper,

scanner is priority for every officeenvelopes, claim forms, reports, endless manila

Use Gmail or Hotmail on your mobile folders: all of these represent a real cost in office

device for reminders and greater cost to the environment. With the

Accept our invitation to receive your increasing use of wireless Internet, computerized

Electronic remittances by emailsoftware we are converting our records and

communications to an electronic format, which is

greatly helping us from financial aspect as well as WCH will continue to update about our internal office organization.

processes every issue. If you need a Did you know that of our claims,

more personal assistance with the process, remittances, and invoice payments are currently

please contact us for help.electronic? We have even converted from

standard fax system to E-Fax. We are sending

more information by email rather than mail than

ever before. Through the use of our Time

WCH needs your feedback about your account representative performance

WCH Times | 10

WCH offers free website for clients, don't miss a chance

Free Websites for Doctors.

97%

For clients that do not have a website, we are offering to create one to three page website with

information about your practice.

You may ask Why you need to create a website?

Because of your potential patients use online to find their doctors, laboratories and imaging centers.

Three reasons to start building your free website with WCH

1It's easy

Choose a template

and add content. 2It's fast

Create, edit and

publish your

new website

in about few days. 3It's free

Enjoy your website,

domain name and

hosting free for

an entire year.

All additional website optimization services can be discussed at separate fee.

We're making it easy to get your business online. Contact Us TODAY to Get Started.

Already we have happy clients who have and enjoy their websites, do not miss your chance to have

personal website. Here are some of our happy clients and their testimonials.

WCH Times | 11

Auditing Services

Auditing services, we care about your

charts.

It may seem simple, but with today's ever-

changing medical codes, guidelines, and

regulations the task of properly putting

together your medical charts requires more

time and experience than ever before.

Selecting the appropriate codes and level of

care requirements can be challenging. With

the implementation of Medicare and other

payer audit projects, these problems, if not

addressed,

Benefits of auditing your charts with WCH:

Get your records evaluated by AAPC staff Certified Professional

Coders, and Medical Auditors

Ensure that your charts are error free

Prevent losing money to prepayment or post payment reviews

Stay focused on your patient's health, while we take care of your

charts

could cost medical professionals excessive charge-backs and penalties. We have an

experience and Certification! Let us help you today!

Don't risk losing money,

take advantage of

our

till September, 2012 for chart

auditing services

15 % DISCOUNT

.

CREDENTIALING NEWSaccount and update personal information. It also Major Improvements to the Internet-features additional helpful links to allow access to Based PECOS Systemmultiple tools and reference information. The

helpful links include PECOS enrollment tutorials, Over the last year, Centers for Medicare &

the Ordering and Referring List, and the Medicaid Services (CMS) has listened to your

Revalidation Notice Sent List.feedback about Internet-based Provider

Users will also now be able to see if their Enrollment Chain & Ownership System (PECOS)

revalidation application has been received and and made improvements to increase access to

processed by the Medicare Administrative more information. Following upgrades are now

Contractor (MAC). In addition to a Revalidation available:

Notice Sent date, a Revalidation Received date Access to More Information

and a Revalidation Complete date will be The layouts of the Internet-based PECOS

displayed on the My Enrollments page. The homepage and log in screen have been

Revalidation Notice Sent date and the redesigned. The homepage updates provide an

Revalidation Received date will display on theeasier way for users to register for a PECOS

WCH Times | 12

My Enrollment page for 120 days. The The report displays up to 50 records on the

Revalidation Complete date will display on the report screen. For reassignment reports

My Enrollments page indefinitely. (At this time, containing more than 50 records, the authorized

the quickest way to see if a revalidation letter was user will be prompted to download the report

mailed to you is to check the Revalidation Notice into an excel spreadsheet by clicking the

Sent List link on the PECOS homepage. Later this Generate Report button at the bottom of the

year, a faster process will be used to update this screen.

information on the My Enrollments page.) WCH credentialing department is well trained to

A reassignment report is now available for all handle your enrollment through PECOS. Don't

organizations and individuals that are accepting hesitate to call us with your questions.

reassignments. The option to view this report is Office Phone: (646) 807-3419

Fax: (347) 464-0740only available if the enrollment has current

reassignments. The reassignment report is

accessible via the Application Questionnaire page

and displays the following columns:

Provider Name,

National Provider identifier (NPI),

Current Enrollment Status,

Enrollment State,

Revalidation Notice Sent Date, and Revalidation

Status.

Dora Mirkhasilova

Credentialing Specialist

st

On June 1 WCH became a RAMA member. Russian American Medical Association was founded and

incorporated in 2002. It was created to facilitate and enable Russian American physicians and other health

care professionals to excel in patient care, teaching and research, and to pursue their aspirations in

professional, humanitarian and community affairs. More than a hundred new members have joined the

organization in 2012 representing 35 specialties across the professional medical spectrum. RAMA is not a

political organization. The main office of RAMA is located in Cleveland (Ohio) and has regional offices in

several U.S. states. RAMA holds annual conference in conjunction with associations, as RADA (Russian

Amerisan Dental Assosiation) and RASA (Russian Academic Science Association).

RAMA - the largest association of Russian-speaking professionals in health care industry outside of Russia.

In association More than 500 members of the U.S., Canada, Russia and other countries of the former

Soviet Union and Europe. The Association maintains contact with more than five thousands of Russian-

speaking professionals in the healthcare and other related medical professionals and business people.

If you are interested to join Rama, please contact Olga Osipoff the marketing director and tell her that you

are WCH client Olga Osipoff RAMA Executive Director, Tel: 440 321-2311, Email: olga.osipoff@gmail.com

WCH became a proud member RAMA- Russian American Medical Association

WCH Times | 13

We changed our Fax Number

Please send your faxes to the

new number: 347-371-9968

Time Management Program

Feeling overwhelmed?

Can't keep track of your employees' time

schedules?

Let WCH's Time management soft-ware work for

you!

Time Management Software is very important for

small business companies, who are performing many

different jobs during the day. Our Time Management

Program will help you understand the real value of

your time, increase your productivity and stay tune

and collected. The skills we explain below will help

you become highly effective, by showing you how to

identify and focus on the activities that give you the

greatest returns. Investing in these time

management activities will actually save you time, helping you work smarter, not harder. What's more,

these same techniques help you beat work overload - a key source of stress.

Here are the skills you'll achieve while you're using our Time Management Program:

The program can be purchase through WCH website, from our Amazon Store

and of course by calling us at 718-934-6714 x 1202.

Activity Logs Know where your time goes.

Prioritization - Taking control of your time.

Beating Procrastination Manage your time. Get it all done.

Action Programs Becoming exceptionally well organized.

Effective Scheduling Bringing your workload under control.

New Year's Resolutions Planning for a year of achievement.

http://www.amazon.com/s/ref=bl_sr_software?_encoding=UTF8&node=229534&field-

brandtextbin=WCH%20Service%20Bureau

WCH Times | 14

HEALTHCARE UPDATES

Senate Passes "New Jobs-New York" Job Creation Plan

Comprehensive plan will help create thousands of new

private sector jobs.

Highlights of the 2012 New Jobs-NY Job Creation Plan

are as follows:

Reducing the Job-Killing Tax Burden on New York

Manufacturers: The plan would spur creation of

thousands of manufacturing jobs by dramatically

reducing taxes on manufacturers over a three-year

period ($495 million in tax relief).

Tax Cut for Small Businesses: This tax cut will save nearly 200,000 small businesses $49 million.

Tax Credit for Small Businesses: This tax credit will save 800,000 small businesses $80 million.

Major Energy Tax Cut: The legislation accelerates the phase-out of the energy tax hike previously

approved by Senate Democrats.

New Incentives for Each New Job Created: The bill includes new job-creating incentives that would give

businesses a tax credit of up to $5,000 for each new job they create; up to an $8,000 credit if the new

job goes to someone on unemployment; and up to a $10,000 credit if a business hires a returning

military veteran.

20%

10%

500%

previous year's survey. The findings from the Medical claims error rate drops to 2012 National Health Insurer Report Card are : AMAbased on a random sampling of roughly 1.1

million electronic claims for about 1.9 million Cumulative error rates for paid medical claims

services that were submitted in February and among seven major private health insurers

March to Aetna, Anthem Blue Cross and Blue dropped to in 2012 from in 2011,

Shield, Cigna Corp., Health Care Service Corp., according to an American Medical Association

Humana, Regence, United HealthCare and survey of physician practices. The AMA, which

Medicare, though Medicare wasn't included in took credit for the decrease in a news release,

the improvement results above, according to the estimated that the reduction saved $8 billion by

AMA. Claims were accumulated from more than cutting administrative costs related to fixing

380 physician practices in 79 medical specialties errors and that reducing the error rate to zero

providing care in 39 states, according to the AMA.would have saved an additional $7 billion. Also,

Source: AMAaccording to the survey, private insurers improved

medical claim response times by from 2008

to 2012. But the AMA survey indicates that

medical services requiring prior authorization

from commercial health insurers were reported

on of claimsa increase from the

9.5%

9.5% 19.3%

17%

4.7% 23%

WCH Times | 15

92980 May Become Obsolete in 2013. Learn The Possible Revisions For

Cardiology Practice

Cardiology specialty will be heavily impacted with code changes for 2013.

CPT may delete:

92980-92981, Transcatheter placement of an intracoronary stent(s)

92982 and 92984, Percutaneous transluminal coronary balloon angioplasty

92995-92996, Percutaneous transluminal coronary atherectomy

Source: AMA

What's new for cardiology?

Remember: The changes are tentative, and final CPT 2013 codes would only be finalized by the fall

of 2012.

CMS To Do Away With The 12-Month

Claim 'Lookback' Period

Typically you only have to produce records that

are up to a year old when a Part B MAC contacts

your practice asking to see medical records. But

this time limit, however, will be done away with by

the end of this month, when MACs will have more

flexibility in asking for older documentation.

Currently, if a MAC asks to see your records related

to claims that are under review, the MAC can

collect documentation related to the beneficiary's

condition before and after a service, but shall not

request documentation dating from more than 12

months prior to the date of service unless an

exception exists, according to Section 3.2.3.4 of

the Medicare Program Integrity Manual.

However, the CMS issued Transmittal 422, which

will eliminate the . This

will go into effect on June 26 and no replacement

period has been suggested. This means that

records can be requested indefinitely from the date

of service, although it's not completely clear in the

document whether any deadline will be introduced

to replace the previous

Source: CMS

12-month lookback period

12-month limit.

Say Goodbye to Fee-For-Service

Reimbursement?

On June 5, 2012, the Centers for Medicare &

Medicaid Services (CMS) announced a new data

and information initiative that CMS reports will be

a key tool in the agency's evolution from a fee-for-

service based payer to a value-based purchaser of

care. CMS reports that with timely, relevant data,

CMS will be able to better define and reward high

quality, low cost care. The initiative includes the

creation of a new CMS oversight group known as

the Office of Information Products and Data

Analytics (OIPDA). The goal of OIPDA is to make

data management and information sharing a core

function of CMS. OIPDA will assume responsibility

for many current CMS data functions, including, but

not limited to, the Chronic Condition Warehouse,

the Medicare Current Beneficiary Survey, the

Medicaid Analytic Extract, and the Research Data

Assistance Center. Healthcare providers will have to

keep detailed and careful documentation in support

of their clinical decisions and actions. OIPDA will be

focused on the information providers create

through their requests for payment.

WCH Times | 16

Radiology Notification/Prior

Authorization Program expansion to

New York, New Jersey and

Connecticut Effective August 13,

2012

The UnitedHealthcare Commercial Radiology

Notification Program and Medicare Advantage

Radiology Prior Authorization Program are

expanding to the following states effective for

dates of service on or after Aug. 13, 2012:

The UnitedHealthcare Commercial Radiology

Notification Program is expanding to include:

Connecticut

New York

The existing New Jersey Commercial Radiology

Notification Program is being enhanced to align

with the national UnitedHealthcare Commercial

Radiology Notification Program.

The following states remain out of scope for the

Commercial Radiology Notification Program:

Alaska, Idaho, Minnesota, Montana, North

Dakota, Nebraska, Oregon, Rhode Island, South

Dakota, Washington, and Wyoming.

The UnitedHealthcare Medicare Advantage

Radiology Prior Authorization Program is

expanding to include:

New Jersey

The following states remain out of scope for the

Medicare Advantage Radiology Prior

Authorization Program: Idaho, Nebraska,

Oregon, and Washington.

Visit UnitedHealthcareOnline.com > Clinician

Resources > Radiology > Radiology Notification

& Authorization > Reference Materials for

more details about the Commercial Radiology

Notification and Medicare Advantage Radiology

Prior Authorization programs.

Medicare Advantage Cardiology Prior

Authorization Program Effective

October1, 2012

Effective Oct. 1, 2012, UnitedHealthcare's

Cardiology Notification Program for Medicare

Advantage benefit plans is changing from a

notification program to a prior authorization

program. This change is consistent with other

UnitedHealthcare programs and prevailing industry-

wide standards. Over the coming year, additional

UnitedHealthcare programs will ultimately be

aligned to verify that services are medically

necessary.

Beginning Oct. 1, 2012 UnitedHealthcare will require

that you obtain prior authorization for the following

procedures prior to rendering them to

UnitedHealthcare's Medicare Advantage members:

Echocardiogram

Stress Echo

Diagnostic catheterizations

Electrophysiology implants

When prior authorization is required based on

site of service:

Diagnostic Catheterization Required Required Not required

Electrophysiology Implants Required Required Required

Echocardiogram Required Required Not required

Stress Echo Required Required Not required

Note: Prior authorization is not required for services

that are rendered in an emergency room,

observation unit or urgent care facility. Prior

authorization is only required in the inpatient

setting prior to rendering Electrophysiology

Implant services.

Cardiac Procedure: Outpatient Office Inpatient

ICD-10 Forums

Now there is a new forum dedicated for your ICD-10

conversations. It is located at .

There are threads on ICD-10-CM, ICD-10-PCS,

implementation, mapping, 5010, the timeline and a general

discussion as well.

www.icd10forums.com

WCH Times | 17

Podiatrist

We billed a motion analysis If a patient has an aberrant artery with a

with dynamic plantar measurements separate ostium and the physician selected each

(96001) and the doctor's interpretation one individually (for example, separate ostium for

and report of the results (96004) to Blue Cross Blue the LAD and a separate ostium for the circumflex),

Shield. The carrier denied the claim. We performed can we charge procedure code 93563 in addition to

the test here at our facility, and the doctor 93458 (LHC)?

reviewed and interpreted the results. Are we billing

the codes incorrectly? Should we append a No, you would not code for the 93563 in

modifier to 96001? addition to 93458. The instructions at the

beginning of the heart cath section say,

No, you are not billing the codes Anomalous coronary arteries, patent foramen

incorrectly. The problem is that Blue Cross Blue ovale, mitral valve prolapse, and bicuspid aortic

Shield considers gait analysis an investigational valve are to be reported with 9345193464,

procedure and does not provide coverage for the 9356693568.

service. Several other carriers have specific policies

in place that state gait analysis is investigational

and therefore not covered. Can a quantity of two be billed

for the Sestamibi one dose at rest and

one dose at stress? The Medicare MUE [medically

Must one session of CPT code unlikely edit] is 3, so that's no help.

93798 (physician services for outpatient

cardiac rehabilitation; with continuous Yes, you may code Sestamibi twice if you

ECG monitoring [per session]) be a minimum of 60 administer it twice, once for the rest study and

minutes if only one session is provided that day? once for the stress study. If no SPECT is performed,

you also should assign CPT code

No, according to the Medicare Claims 78452myocardial perfusion imaging,

Processing Manual, Chapter 32, section 140.2.1, tomographic (SPECT) (including attenuation

the duration of treatment must be at least 31 correction, qualitative or quantitative wall motion,

minutes. Two sessions of cardiac rehabilitation ejection fraction by first pass or gated technique,

services may only be reported for the same day if additional quantification, when performed);

the duration of treatment is at least 91 minutes. In multiple studies, at rest and/or stress (exercise or

other words, the first session would account for 60 pharmacologic) and/or redistribution and/or rest

minutes and the second session would account for reinjection. If SPECT is not done, the code is 78454.

at least 31 minutes if two sessions are reported. If Since Sestamibi (A9500) is "per study dose," and

several shorter periods of cardiac rehabilitation you are performing two studies, you may assign

services are furnished on a given day, the minutes A9500 x 2. There may be only one CPT code, but it

of service during those periods must be added encompasses multiple studies

together for reporting in one-hour session

increments.

Question: Question:

Question:

Question:

Answer:

Answer:

Answer:

Answer:

Radiology

Cardiology

NEWS BY SPECIALTY

WCH Times | 18

Most California docs' EHRs Alaska Medicaid agency to

wouldn't meet meaningful use pay $1.7 million in HIPAA

A majority of physicians in settlementCalifornia use electronic health Alaska's state Medicaid agency

records, but only use an EHR system that has has agreed to pay HHS $1.7 million to settle

the functionality to achieve the CMS' meaningful- possible violations of the security-rule provisions of

use requirements. The study was conducted in the Health Insurance Portability and Accountability

2011 by UCSF and the California Medical Board for Act of 1996 and take actions to guard the

the California HealthCare Foundation and the electronic protected health information of the

California Department of Health Care Services. state's Medicaid beneficiaries.

Researchers found that 61% of the physicians

surveyed had an EHR system that allowed them to Cigna has announced new accountable care record clinical notes electronically. However, only initiatives in several states.

of those surveyed had a system with the In California, the agreement with the Palo Alto

ability to generate routine reports of quality Medical Foundation, an affiliate of Sutter Health,

indicators. will include as many as 21,000 patients. Cigna's

Source: modernphysician agreement with New West Physicians in Denver

will cover about 7,800 patients, according to a

news release from the Bloomfield. In Texas, the

Aetna, Inova collaborating on insurer reached an agreement with St. Luke's

Health System Clinically Integrated Providers and new health plan

Renaissance Physician Organization for an initiative Inova Health System and Aetna announced they

that will cover 44,000 individuals. And in Vermont, will partner to create a jointly owned health plan

Cigna's accountable care organization with Fletcher serving northern Virginia called Innovation Health

Allen Health Care and Central Vermont Medical Plans. Terms of the 50/50 partnership were not

Center will cover 10,500 patients. The agreements disclosed. The new insurer is expected to officially

pay providers for care coordination and offer pay-begin Jan. 1 and will seek to promote clinical

for-performance incentives, according to news integration in the northern Virginia region,

releases on the deals. Incentive payments are according to a news release. The plan will offer

based on reaching quality and cost-saving targets.commercial plans and Medicare Advantage HMO

and PPO plans.

30%

45%

STATES UPDATES

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Nurse practitioner

Clinical nurse specialist Does WCH have a compliance plan?

Medical professional (including a health

educator, a registered dietitian, nutrition WCH has a fully developed and effective professional or other licensed practitioner) or a compliance plan consistent with CMS, by the U.S. team of such medical professionals working Department of Health Services. Our plan is based under the direct supervision of a physician on Professional requirements for service bureau (doctor of medicine or osteopathy) per Title 18 Department of Health Rules and

Regulations (Section 504.9 Service bureaus).

Our compliance plan has been fully developed by

When is a beneficiary eligible for the Initial WCH management team and is being stringently

Preventive Physical Exam? followed by all departments. If your practice is

currently using a billing company we highly

recommend reviewing their compliance plan. Medicare provides coverage of the Initial

Those companies working without a compliance Preventive Physical Exam (IPPE) for all beneficiaries

plan leave an open door for problems that might who receive the IPPE within the first 12 months

impact your practice's operations. after the effective date of their first Medicare Part

B coverage period. This is a one-time benefit per

Medicare Part B enrollee. Additional information

Can I or any of my office staff access billing, regarding Medicare coverage of the IPPE is

claim, or patient information from my own available in the CMS MLN Quick Reference

computer? Information: The ABCs of Providing the Initial

Preventive Physical Exam chart.

Yes. WCH offers the use of our individual

PMBOS program for your personal computer, in

which, all of your practice's information including When is a beneficiary eligible for the Annual

billing, claim, and patient information can be Wellness Visit?

viewed; along with abilities such as creating an

appointment schedule, and accessing helpful Medicare provides coverage of an Annual

information for instance insurance's phone Wellness Visit (AWV) for a beneficiary who is no

numbers and address lists. Please contact us, if you longer within 12 months after the effective date of

are not yet using our program. his or her first Medicare Part B coverage period

and who has not received either an Initial

Preventive Physical Exam (IPPE) or an AWV within

the past 12 months. Medicare pays for only one

Who can perform an Annual Wellness Visit? first AWV per beneficiary per lifetime, and pays for

one subsequent AWV per year thereafter.

Additional information regarding Medicare Medicare Part B covers the Annual Wellness

coverage of the AWV is available in the CMS MLNVisit (AWV) if it is furnished by a:

Physician (doctor of medicine or osteopathy)

Physician assistant

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Quick Reference Information: The ABCs of

Providing the Annual Wellness Visit chart.

QUESTIONS AND ANSWERS

WCH Times | 20

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