Welcome to the May WESGRAM. This edition contains important updates from CMS, Palmetto and other payers, as well as information from the WVHIN, and  WVRx Card.  You'll also find information about upcoming educational opportunities.
ICD-10 Latest News
Memorial Day is the unofficial start of summer. Here are some fun ICD-10 codes for summer:
 
W21.11XA---Struck by baseball bat, initial encounter
T23.131A---- burn of first degree of multiple right fingers (nail), not including thumb Y93.G2-------activity, grilling and smoking food
L55.0----------Sunburn of first degree
T63.621------ Toxic effect of contact with other jellyfish, accidental (unintentiona)
V93.35------- falling out of your kayak
(information from Palmetto GBA)

Action Needed:

Due to Increased CMS Security Requirements, eServices Portal Users Must Sign Up for Multi-Factor Authentication (MFA) by July 1, 2017 .

Providers who use the eServices Portal must sign up for MFA by July 1, 2017. Instructions on how to register for MFA are also included in the information on the Palmetto GBA website.

Email and Faxed Inquiries

CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their point of contact with their Medicare Administrative Contractors. 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.  

Medicare Basics for Part B Providers Webcast: June 26

On June 26, 2017 at 10 am ET, Palmetto GBA will host a webcast for new Part B providers and billers with a beginner level experience. If you are new to Medicare or have new billing staff, this webcast is for you. This learning tool gives a general overview of the following topics: The four parts of Medicare; Billing provider enrollment requirements; Mandatory claim submission regulations; Completion of the CMS 1500 claim form and Resources for new providers.

Top 10 Medical Review Denials Module

The goal of Palmetto GBA's medical review program is to ensure that payment is only made for services that meet all Medicare coverage, coding and medical necessity requirements. This module reviews the 10 most common provider errors in the first quarter of 2017.  Click here and learn how to avoid these errors! 

 With healthcare costs rising, many of your patients need assistance. The West Virginia Rx Card can help with those prescription costs and is a free program available to all West Virginia residents. There are no eligibility requirements or forms to fill out. Tell your patients to simply take the card into the pharmacy to get savings of up to 75% on prescription medications for their whole family. West Virginia Rx Card is a proud supporter of Children's Miracle Network. A donation will be made to your local CMN hospital each time a prescription is processed through the West Virginia Rx Card. Your patients can find and print their FREE card  here!
MIPS Participation Status Letters

CMS posted a sample letter and the two accompanying resources about MIPS participation status that are currently being sent to clinician offices. The letters are being mailed to the contact person for each TIN. Below please find the sample letter and resources.


NOTE:  Hospital-based clinicians, non-patient facing clinicians, and clinicians in MSSP Track 1 are not included. CMS is in the process of creating an NPI look-up tool that will be posted on the QPP website

NEW: NPI Look-up Tool Available to Check MIPS Participation

All clinicians who bill Medicare can now check to see if they need to submit data and participate in the Merit-based Incentive Payment System in 2017. Simple entry of a National Provider Identifier (NPI) number into the tool that is posted on the QPP website home page will inform the clinician if he or she is included in MIPS at both the individual and group level.
Payor News
 

WV Medicaid Update

MCO Pharmacy Benefits Transitioning to Fee for Service Program

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.


Aetna Better Health Medicaid Provider Workshops

Aetna Better Health of WV will be hosting provider workshops across the State during the month of June on the below dates.   All providers who see Aetna Better Health of WV members are encouraged to attend.  Representatives from multiple departments within Aetna Better Health of WV will be in attendance including Provider Relations, Member Services, Prior Authorization, Case Management, SIU and Appeals.  During the workshop, each area will present topics that will assist providers in verifying benefits, obtaining authorization, billing claims and filing requests for claim reconsideration and appeals.

Beckley, WV  6/1/17    Time: 8 a.m. -12.p.m.
Location: Tamarack Conference Center
Address: 1 Tamarack Park Beckley, WV 25801

Martinsburg, WV  6/5/17    Time: 8 a.m. - 12 p.m.
Location: Holiday Inn
Address: 301 Foxcroft Ave Martinsburg, WV 25401

Huntington, WV   6/7/17    Time: 8 a.m. - 12 p.m.
Location: Big Sandy Superstore Arena
Address: 1 Center Plaza, Huntington, WV 25701

Charleston, W   06/9/17    Time: 8 a.m. - 12 p.m.
Location: Four Points Sheraton
Address: 600 Kanawha Blvd E, Charleston, WV 25301

Wheeling, WV   6/13/17    Time: 8 a.m. - 12 p.m.
Location: Oglebay Resort – Wilson Lodge (Glessner)
Address: 465 Lodge Dr Wheeling, WV 26003

Clarksburg, WV  6/14/17    Time: 8 a.m. - 12 p.m.
Location: Village Square Conference Center
Address: 1489 Milford St Clarksburg, WV 26301

Please RSVP by email to ABH_WV_ProviderRelations@aetna.com or by fax to 866-810-8476 including the office name, number of people planning to attend, and session.

If you have specific topics that you would like to be sure are addressed at the workshop, please include them with your RSVP.

Breakfast will be provided.  Registration opens at 8 a.m. and the presentation will begin promptly at 9 a.m. 


Highmark Update

(information provided by Highmark)

Gateway Health Now Administers West Virginia Family Health (WVFH) Provider Contracting and Provider Relations Functions

West Virginia Family Health (WVFH) has expanded its ongoing partnership with Gateway HealthSM, a leading Medicaid managed care organization. On March 13, 2017, Gateway Health began to administer WVFH's provider contracting and provider relations functions. WVFH's goal is to make this transition as seamless as possible for its provider network.

Having concentrated on developing relationships and working with medical professionals who serve Medicaid recipients, we understand the challenges that you and your staff face in providing care to this population. To further assist you, we're providing you with a list of readily available resources for answering claims, eligibility, and benefit questions, as well as where to locate easily accessible tools and reference materials.

Participating providers can log into navinet.net for the following self-service transactions and tools:

• Claim status inquiry
• Eligibility and benefits inquiry
• Provider Directory

WVFH has many reference materials available online, such as Provider manuals, forms, bulletins, and policies. Simply go to wvfh.com and select Providers to access these materials.

If you need to speak with someone, please call WVFH's Provider Services line at 1-855-412-8001. Staff are available Monday through Friday between 8 a.m. and 5 p.m. They can assist you with claim inquiries, billing issues, member eligibility questions, or policies and procedures.
Other News


Exclusion Screening Update

The Office of Inspector General suggests monthly checks of Federal databases (LEIE & SAM), and the Centers for Medicare & Medicaid Services (CMS) require monthly checks of both Federal and state databases. In addition, provider agreements in some states require certification that no employee, contractor, or vendor is, or has ever been, excluded from any State or Federal database.

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.   

 LEIE’s online searchable database is here

Exclusion screening is at the direction of CMS. The regulation at 42 CFR 455.436 is
part of the new provider screening and enrollment requirements under Section 6401 of
the Affordable Care Act.  This regulation specifies who must have their identity confirmed and be screened for exclusion status, which databases must be checked, and when screening must be performed and/or repeated.

If you have not been screening monthly, you should begin ASAP!   The WVSMA is making it easy for your practice by offering a special arrangement with Exclusion Screenings. LLC.  For a limited time,  WVSMA members may sign up for a three (3) month FREE trial of the Exclusion Screening’s services.  

A Tribute to an Esteemed Colleague
The healthcare arena lost a good friend and a shining star in management when Joshua “Josh” Tuck was killed in a tragic accident on May 8, 2017. Josh was employed by Charleston Area Medical Center as Ambulatory Services Director.  He was active in many organizations, including the West Virginia Medical Group Managers Association.

After completing his CMOM (Certified Medical Office Manager) certification, Josh had expressed an interest in becoming an associate instructor with (PMI) Practice Management Institute.  Under the mentorship of Physician Practice Advocate Barbara Good and PMI Instructor Pam Joslin, Josh assisted with the CMOM class in February, 2017.  His teaching background served him well as he assisted Ms. Joslin with the course.  Josh was looking forward to continuing to teach for PMI when opportunities were available.  

The WVSMA and PMI have joined together to create a scholarship in memory of Josh.  Candidates who register for the next CMOM course will be eligible to win a scholarship in memory of this fine young man whose wonderful life ended all too quickly and tragically.  

RIP Josh.  You will be greatly missed.     
 
Educational Opportunities 
 
  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.

Click here to register for the CMIS class.  Register today so you don’t miss out!