KPMA Conference

May 11th, 2011

Members of our staff, Terry and Brooke, will be attending the KPMA (Kentucky Podiatric Medical Association) Annual Scientific Meeting May 20-22 at Embassy Suites in Lexington, KY. Please stop by our booth to say “hello”, and register to win a door prize! We welcome the opportunity to meet you, and learn more about your practice needs.

KMGMA Conference

May 11th, 2011

Members of our staff, Amy and Megan, are excited to be attending the upcoming KMGMA Spring Conference in Louisville, KY on May 19th and 20th!  The theme this year will be, “secrets to running a thriving and healthy practice”. Accurate credentialing is certainly a piece of that puzzle. Please stop by our booth to see us, and register to win a door prize! We would love to make your acquaintance and learn more about your practice.

J15 Implementation-Cigna Government Services

April 27th, 2011

As you are probably aware, Cigna Government Services (CGS) will take over Medicare Part B administration for the states of KY & OH effective 04/30/11. As they have recently communicated, the first step in this process was for all current Medicare Part B providers to submit a new group Medicare 588 “Electronic Funds Transfer” form to CGS prior to the 04/30/11 cut-off date. Recently, more information has been released about the change-over process and how providers will be affected moving forward. I hope you find the following dates and information to be helpful:

 

  • If  you have questions related to J15, your EFT status, etc. inquires may be e-mailed to j15implementation@cigna.com.
  • If you currently receive paper checks from Medicare, you do not have to submit an EFT enrollment form to CGS. You will continue receiving paper checks after 04-30.
  • If CGS has not been able to verify your EFT enrollment accurately against the records Medicare currently has on file for your practice, Medicare Part B payments will be held until this information is verified/updated!
  • Temporarily the current contractor will speed up the payment process for all claims currently processed, approved and on the payment floor. These claims will be paid out prior to 04/29/2011. The outgoing contractor, National Government Services, will transfer all pending and in-process operations to CGS after 04/30, including but not limited to claims, appeals, and enrollments.
  • There will be a few “dark days”, 04/30, 05/1 and 05/2 while NGS and CGS complete the conversion process. During this time payments, remittances, IVR, PPTN, the provider contact center, etc. will not be available. After 05/3 providers may call CGS for any questions at (877) 819-7109.
  • Beginning Friday, 04/29/11, providers must change the contractor number from “00600” to “15102” on all claim forms.  
  • News was released recently that Blue Cross Blue Shield of South Carolina bought CGS at the end of March. However, CGS is a wholly-owned subsidiary of Cigna, and BCBS of SC bought the entire CGS unit from Cigna. Therefore, there will be no need to fill out another EFT form in the future. The acquisition only affects things on the back-end for now, and providers should see no changes in administration on the front end.   

 

New Administrator of Medicare Part B Services

February 18th, 2011

Many providers have recently received information regarding Cigna Government Services taking over administration of Medicare Part B services in the states of Kentucky and Ohio.  As noted in a recent e-mail from Cigna Government Services regarding Jurisdiction J15:

 “Part B providers who currently bill National Government Services (NGS) and are currently enrolled with NGS to receive payments electronically must submit a revised CMS-588 EFT Authorization Agreement to CIGNA Government Services immediately upon receipt of notification. Request letters for Kentucky Part B providers were mailed the week of January 24, 2011….. timely completion of the EFT agreement will ensure continued receipt of electronic Medicare payments following the completed transition of claims processing and payment operations to CIGNA Government Services. It is imperative that Kentucky Part B providers complete an EFT Authorization Agreement and return it to CIGNA Government Services no later than March 18, 2011.”

Other transitions (i.e.: claims resolution, payment processing, etc.) will take place in the coming months. For a full list of dates and deadlines, please visit the Cigna Government Services website at: www.cignagovermentservices.com.

Medicare Reimbursements for Primary Care Physicians

February 18th, 2011

Good news for primary care physicians! Even though there have been Medicare provider reimbursement cuts, Medicare has included a 10% bonus opportunity for certain primary care services rendered between 2011 – 2015 in the new fee schedule.  Physicians who are considered “Primary Care” providers, (internal medicine, family practice, pediatrics and geriatrics), whose Medicare reimbursements make up 60% of their total reimbursements, will receive a 10% bonus at the end of each quarter. These bonuses will be paid out for the following CPT codes: 99201- 99215, 99304-99340, and 99341-99350. To see if you qualify for 2011 reimbursement, please check the Kentucky Medicare contractor’s website at http://www.cignagovernmentservices.com/

The Change From ARNP To APRN

January 5th, 2011

After many years of studying and developing an APRN model for the state of Kentucky, the Kentucky Board of Nursing has implemented the first steps in bringing Kentucky more in line with the national model, which is endorsed by more than 40 regulatory, professional and accrediting agencies.  The reason for the changes is facilitate consistency in education, licensure and certification of the APRN role. By adopting this model the goal is to ensure public safety and improve access to safe, quality APRN care.

Beginning January 10, 2011 the legal name for an “Advanced Registered Nurse Practitioner” (ARNP) will change to “Advanced Practice Registered Nurse”, (APRN). In addition, the license number will change to a 7-digit number. The number will start with a three (3) followed by the number of zeroes (0) that brings the license number to 7 digits. Also, the letters at the end of the number will longer be used.  For example, if an APRN’s number is currently 1234P, it will now be 3001234.

All APRN’s will be instructed to start using the new number and

title effective January 10th. This information can be validated via the Kentucky Board of Nursing website at www.kbn.ky.gov. In the future, there will be further implementation of the APRN model…which will include participation by employers, educators and practicing APRN’s. However, the only changes initially will be those mentioned above. To view the entire national APRN Model Consensus document go to:  https://www.ncsbn.org/7 23 08 Conensue APRN Final.pdf

The Benefits of Outsourcing Provider Credentialing

December 21st, 2010

With many practices preparing for the impending 5010 changes, as well as having to invest thousands of dollars into a new EHR system, Practice Administrators are looking at various way to be more efficient and economical. In doing so, outsourcing credentialing may provide at least one easy way to achieve this. Gone are the days of filling out simple applications here and there, and your provider is “set” and ready to see patients. In today’s ever changing healthcare field, credentialing has become much more complex and time-consuming.

Much of successful provider credentialing or re-credentialing, is tracking and consistent follow-up. With medical office staff being stretched very thin anyway, it is difficult to find time to take care of this very crucial step.  Not to mention, for many practices credentialing is often not a “part-time” assignment anymore…it demands the full attention of trained staff that knows when and where to submit information to ensure that proper provider reimbursement begins or continues. In addition, when you consider that the average income of a trained Credentialing Specialist is $30,000 annually plus benefits, not to mention additional exposure to employee liability issues… it makes perfect sense to outsource credentialing to professionals who specialize in this niche.  Often, practices who chose to go this route find that their credentialing gets completed better, faster and cheaper than keeping this as an in-house task.

In the future, as quality standards for each practice are scrutinized more than ever before regarding EHR reimbursement and 5010 compliance, the last thing a practice wants is to have happen are providers incorrectly credentialed, or not credentialed at all with critical private payers in their area. Accurate credentialing the first time means maximum and timely reimbursement for services rendered.  These are all things to consider while putting together a plan and budget for the upcoming year!

EHR Incentives and Meaningful Use

December 21st, 2010

With the federal government now offering financial incentives for providers to purchase electronic health record systems, many practices have been exploring options with various software vendors. However, one concern voiced by many providers is that regulations on what type of EHR’s qualify for the subsidies has not been finalized. There are many questions around what is considered “meaningful use”…. which you will have to show in order to claim the funds. 

The good news is that in the interim, rules and proposed regulations are not likely to significantly change when they’re finalized in spring 2011.  It has already been established that in order to receive the federal incentives in 2011 you will need to have an EHR that meets the requirements for security, interoperability and privacy, as well as show that the EHR has been used “meaningfully”.

The basic way to qualify for government incentive funds are as follows:

1.)    Participate with Medicaid and/or Medicare. (If you participate with both, you must choose to participate in either incentive program…but not both.)

2.)    Participation in the programs ends 2015…after this time physician’s who don’t have EHR’s will actually receive penalties, and see reductions in their Medicare payments.

3.)    Each professional provider in the practice may qualify for bonus payments individually.

4.)    Use electronic prescribing

5.)    Use a system that has the ability to electronically exchange health information to improve the quality of care patients receive

6.)    Submit information about clinical and quality measures

7.)    Show “meaningful use”.

According to director of the Office of National Coordinator for Health Information Technology (ONC), the way to show “meaningful use” is through 15 requirements (with an 10 additional criteria, of which providers must meet at least 5). They are as follows:

REQUIREMENTS:

  1. Record personal patient information
  2. Chart any changes in vital signs or test results
  3. Maintain active problem
  4. Maintain current medication
  5. Maintain any allergy information
  6. Record if patient smokes
  7. Provide patients electronic copies of their medical records
  8. Provider patients an overview of their clinical information
  9. Prescribe and transmit prescriptions electronically
  10. Order medication via “provider order entry”
  11. Implement checks and balances for any drug allergy and other prescription contraindications
  12. Implement and track compliance of a clinical decision support rule
  13. Assure privacy and security of patient data
  14. Have capacity to exchange clinical  information with providers and patient-approved facilities
  15. Report all ambulatory quality measure to the state or Medicare.

 

TEN ADDITIONAL CRITERIA (MEET AT LEAST 5):

1.)    Drug formulary checks

2.)    Structured data to incorporate lab test results

3.)    All patients with particular medical conditions must be listed for at least one condition

4.)    Provide educational information to patients specific to their diagnosis

5.)    Reconcile medications

6.)    Provide patient summaries of transactions of care

7.)    Ability to provide data to public health agencies

8.)    Ability to provide data regarding patient immunizations

9.)    Provide patients with follow-up care instructions and preventative care measures

10.) Provide patients with timely electronic access to their health records.

The main things to keep in mind when shopping for an EHR are to really research the functionality of the product, and ensure the vendor meets or exceeds correct meaningful use criteria. For more information regarding meaningful use and reimbursement criteria, visit the CMS website under “Notice of Proposed Rulemaking on the HER Incentive Programs”.

CMS announces partial code set freeze prior to ICD-10 implementation:

October 27th, 2010

With all of the changes surrounding the changeover from ICD-9 to ICD-10 coding, there is a bit of good news on the Medicare implementation front. The Centers for Medicare & Medicaid Services (CMS) recently announced  a partial freeze on coding updates for ICD-9-CM, ICD-10-CM and ICD-10-PCS codes prior to implementing ICD-10 on Oct. 1, 2013. This is how Medicare will implement the freeze:

1.    The last regular annual update to both ICD-9 and ICD-10 code sets will occur on Oct. 1, 2011

2.    On Limited updates to the ICD-9- CM and ICD- 10 code sets to capture new technology and new diseases will occur on Oct. 1, 2012

3.    No updates to ICD-9 -CM will occur on Oct. 1, 2013, as the system will no longer be a HIPAA standard

4.    Regular updates to ICD-10 will being on Oct. 1, 2014

The ICD-9 Coordination & Maintenance Committee will meet twice per year during this freeze. If there is a need to develop a new diagnosis or procedure code, in order to capture new technology or disease, the public will be allowed to comment and send requests during this time. If requests don’t meet specific criteria, they will be considered for implementation in ICD-10 on or after October 1, 2014.

For practices who are members of MGMA, and are interested in learning more about how to transition their practice to ICD-10 / Version 1510 HIPPA electronic transactions,  MGMA will offer a webinar on November 18, 2010. For more information about this upcoming training event please copy and paste the following link: https://www.mgma.com/Store/ProductDetails.aspx?id=39752&kc=Wac

 

ICD-10 Updates

September 21st, 2010

Changes to the current ICD-9 coding system are quickly upon us! Effective October 1, 2013 ALL providers must bill with the new Medicare ICD-10 coding system. The new codes provide greater detail, and are longer than the current ICD-9 codes and contain both alpha and numeric characters. There will be no delays or grace periods after the 10/01/13 effective date!  While the task of conversion may seem like a daunting one, there are many tools and resources available to help in this transition period. Medicare has developed GEMs (General Equivalence Mappings) to assist in the process of converting data from ICD-9-CM to ICD-10.

For more information about GEMs visit the CMS website at http://www.cms.gov/ICD10and click on “ICD-10-CM” or “ICD-10-PCS” to find the most recent GEMs.  In addition to GEMs, other valuable resources are available on the website as well such as updates, timelines, implementation planning, reports and summaries from CMS meetings, and more! Also, visit http://www.cms.gov/ICD10/06_MedicareFeeForServiceProviderResources.asp#TopOfPage for additional Fee-for-Service provider resources.  Although integration testing has already begun, Medicare will be ready to support test-to-test production effective January 1, 2011. After the 5010 implementation concludes on January 1, 2012, all providers must be able to submit and receive compliant HIPAA version 2010 electronic transactions. To ensure your practice is prepared, make sure to contact your system vendor and make sure that your license includes regulation updates, that their upgrades will include acknowledgement transactions 277CA & 999, and that the upgrade will include a “readable” error report from these transactions.