Welcome to the June Wesgram. This edition contains important updates from CMS, Palmetto and other payers, as well as information about upcoming educational opportunities.
The final 2018 ICD-10 code update that was posted to the CMS website on June 13 contains 360 new, 142 deleted, and 226 revised diagnosis codes.
The final update includes 322 more code changes than were originally proposed by CMS. The 2018 codes will go into effect
October 1, 2017, so you’ll want to ensure that your practice is ready for the changes. Each practice needs to be sure the billing/coding department is prepared with up to date coding manuals. You should also make sure your EHR systems are ready. The WVSMA will continue to provide updates on the coding changes for your practices.
With the July 4th holiday approaching, the WVSMA is providing you with some entertaining ICD-10 codes. Would you be able to code these events?
W39.XXXA, discharge of firework, initial encounter
W39.XXXD, discharge of firework, subsequent encounter
W39.XXXS, discharge of firework, sequela encounter
H91.90: Unspecified hearing loss
Y93.G2: Activity, grilling and smoking food
X10.2XXA: Contact with fats and cooking oils
97.XXXA: Assault by smoke, fire, and flames
Too much fun in the sun:
L55.0 sunburn, first degree
L55.1 sunburn, second degree
L55.2 sunburn, third degree
W16.512A Jumping or diving into swimming pool, striking water surface, causing other injury, initial encounter
(sounds like a belly flop into a pool!)
V91.07XA: Burn due to water skis on fire
(information from Palmetto GBA)
CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their first point of contact with their Medicare Administrative Contractors (Palmetto GBA). If you submit an unsolicited fax or email inquiry directly to a specific department, your inquiry will be routed to the written correspondence area within the PCC for proper logging, tracking, research and response. An escalation process is used for complex issues. Submitting inquires directly to the PCC will assure CMS compliance and allow for the most timely response.
Signatures, Credentials and Dates: They Are Important
Each entry in the patient's medical record requires the acceptable signature of the person writing the note along with the date. Palmetto GBA also recommends the inclusion of the applicable credentials (e.g. P.A., D.O. or M.D.), especially when the services being billed are only coverable when performed by certain credentialed professionals CMS mandates the presence of signatures for medical review purposes. Signature requirements are applicable to all Medical claims and medical records submitted for medical review purposes.
Stamped Signatures Not Acceptable!
Stamped signatures are not acceptable. Stamped signatures are only permitted in the case of an author with a physical disability who can provide proof to CMS or a CMS contractor of an inability to sign due to a disability.
Medicare requires that services provided/ordered be authenticated by the author. The method used must be a hand written or an electronic signature.
Ancillary staff may only document: Review of systems (ROS), Past, family and social history (PFSH), and Vital signs. These three areas must be reviewed by the physician or non-physician practitioner (NPP) who must write a statement that it is reviewed. They may then correct or add to it.
The chief complaint (CC), review of systems (ROS) and past, family and social history (PFSH) may be listed as separate elements of history or they may be included in the description of the history of present illness.
5 Ways for Healthcare Providers to Get Ready for the New Medicare Cards
Medicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative the Centers for Medicare & Medicaid Services (CMS) will prevent fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of our Medicare beneficiaries.
CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems in use now. Palmetto will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.
CMS is committed to helping providers by giving them the tools they need. They want to make this process as easy as possible for you, your patients, and your staff. Based on feedback from healthcare providers, practice managers and other stakeholders, CMS is developing capabilities where doctors and other healthcare providers will be able to look up the new MBI through a secure tool at the point of service. To make this change easier for you and your business operations, there is a 21-month transition period where all healthcare providers will be able to use either the MBI or the HICN for billing purposes.
Therefore, even though your systems will need to be able to accept the new MBI format by April 2018, you can continue to bill and file healthcare claims using a patient’s HICN during the transition period. Palmetto encourages you to work with your billing vendor to make sure that your system will be updated to reflect these changes as well.
Beginning in April 2018, Medicare patients will come to your office with new cards in hand. Palmetto is committed to giving you information you need to help your office get ready for new Medicare cards and MBIs.
Here are 5 steps you can take today to help your office or healthcare facility get ready:
1. Go to the provider website and sign-up for the weekly MLN Connects® newsletter.
2. Attend Palmetto GBA quarterly calls to get more information.
3. Verify all of your Medicare patients’ addresses. If the addresses you have on file are different than the Medicare address you get on electronic eligibility transactions, ask your patients to contact Social Security and update their Medicare records.
4. Work with Palmetto to help your Medicare patients adjust to their new Medicare card. When available later this fall, you can display helpful information about the new Medicare cards. Hang posters about the change in your offices to help us spread the word.
5. Test your system changes and work with your billing office staff to be sure your office is ready to use the new MBI format.
We’ll keep working closely with you to answer your questions and hear your concerns. To learn more, visit the CMS website
WV Medicaid Update
MCO Pharmacy Benefits Transitioning to Fee for Service Program
As previously printed, as of July 1, 2017, the WV Medicaid Fee for Service Program will provide retail Point of Sale (POS) pharmacy services for all Medicaid MCO patients Prior authorization obtained from the MCOs will be transferred to the Molina system and will be honored for the amount of time through which they were issued by the MCOs.
Medicaid members should experience no disruption in service and can continue to take their prescriptions to the pharmacy of their choice.
Drug services billed with a CPT or HCPCS code (buy-and-bill), administered by a healthcare professional, will continue to be reimbursed by the Medicaid member’s individual MCO.
To obtain a prior authorization after June 30, 2017 for retail pharmacy POS services, please contact the Rational Drug Therapy Program by fax at 800-531-7787 or by phone at 800-847-3859.
WV Medicaid Exclusion Screenings
As a reminder, West Virginia Medicaid is required by CMS to direct physicians to:
Screen employees and contractors for excluded persons to prevent Medicaid payments for items/services furnished or ordered by excluded individuals or entities.
Search the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) monthly to capture new exclusions or reinstatements that occurred since the last search.
If you are not currently screening your employees and need more information, please contact the WVSMA for assistance.
PEIA Claims Information
As a reminder, providers can check the status of a claim online through the HealthSmart provider portal. This is the best way to ensure your payments are correct.
Changes Occurring for Locum Tenens Service Time Frames
Effective August 22, 2017, locum tenens service time frames may not exceed 60 consecutive days for Medicare Advantage or commercial networks. Highmark requires all physicians who provide services to our members to be credentialed and contracted. However,under certain circumstances, Highmark allows for locum tenens arrangements. A locum tenens provider is defined as a practitioner who is covering for
another practitioner when they are absent for reasons of illness, retirement, death, medical leave, vacation, military leave or continuing medical education.
If a regular physician is absent longer than 60 days without returning to work, the locum tenens must be credentialed and enrolled as if he or she were joining your practice as a new physician.
Highmark to Update Laboratory Fees Effective July 1, 2017
Effective July 1, 2017, Highmark Blue Cross Blue Shield West Virginia will adjust the Laboratory Fee Schedule to 85 percent of the current Centers for Medicare & Medicaid Services (CMS) lab fee schedule.
Also, the Highmark West Virginia Medicare Advantage fee schedule will align to the Highmark Pennsylvania Medicare Advantage fee schedule of 70 percent of the Commercial fee schedule.
This change will impact independent clinical laboratory allowances for the Clinical Diagnostic Laboratory Fee Schedule in the West Virginia region.
As always, fee information is available via NaviNet®, and the updated clinical laboratory fees will be viewable on July 1, 2017.
Save the Date! Molina Announces Fall 2017 Workshop Dates
Save These Dates!
WVSMA 2017 Healthcare Summit
The WVSMA Healthcare Summit will be held at The Greenbrier on August 25-27, with 9.5 hours CME available. Plan now to join the WVSMA’s 150th Celebration. Register
WVMGMA Fall Conference
---Thursday/Friday, September 21/22, at Stonewall Jackson Resort
OMA Fall Conference
---Thursday/Friday, October 19/20 at the Flatwoods Days Hotel &
2017 CMIS Class Scheduled!
The WVSMA has scheduled a CMIS (Certified Medical Insurance Specialist) in August. Classes will be held on Thursday/Friday, August 3rd and 4th, and Thursday/Friday, August 10th and 11th at the WVSMA in Charleston.
This certification program explores the current landscape of third party reimbursement. Detailed lecture, course materials and examples will teach participants how to effectively expedite claims, secure timely, correct reimbursement, and protect the financial interest of the practice.
to register for the CMIS class. Register today so you don’t miss out!