March 2011 | In this Issue.
Annual Third Party/Practice Management Seminar - Registration is OPEN Oregon Health Plan Pharmacy Announcement eRx Incentive Program Reminder - Avoiding the Adjustment Medicare Carrier Advisory Committee Update Excerpts From The Noridian Hot Topic Q & A Session What's the Buzz on the OOPA ON-Line Member Forum? Annual Third Party/Practice Management Seminar - May 6 & 7, 2011
Check your mailbox, e-mail and the OOPA web site www.oregonoptometry.org for registration materials for the 2011 Third Party Practice Management Meeting, May 6th and 7th! This year's lineup includes great topics from national y renowned speakers Doctors Laurie Sorrenson and Chuck Brownlow and favorite practice management speaker Mary Schmidt. This year we wil be adding a special breakout session for new coding professionals with Elizabeth Cottle, coding and bil ing expert - but sign up early, room in the breakout class is limited! Friday afternoon wil offer the American Heart Association Health Care Provider CPR Complete Recertification Course - NEW 2010 Standards. You must pre-register for this course, additional registration fee applies.
Also note - new location this year: the Embassy Suites at the Portland Airport - newer, nicer and better parking! Easy access to the Max line for those who want to venture to local shopping like Ikea and Cascade Station. Thank You to Our Generous Sponsors PCLI, VSP, Ciba Vision, Alcon, OSO, Optovue, Hoya, VisionSource, OHSU and AOA Oregon Health Plan Pharmacy Announcement Preferred Drug List (PDL) Revised March 1, 2011 Drug Products Removed
Effective March 1 2011, the Division of Medical Assistance Programs (DMAP) wil remove certain drug products from the Preferred Drug List. Any drug being removed that a client is currently taking wil be exempt from Prior Authorization requirements for 90 days. Of interest to optometrists is the removal of Alphagan P from the preferred list. eRx Incentive Program Reminder - Avoiding the Adjustment
In November, CMS announced that, beginning in calendar year 2012, eligible professionals who are not successful electronicprescribers based on claims submitted between January 1, 2011 - June 30, 2011, may be subject to a payment adjustment ontheir Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare
Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether ornot the eligible professional is planning to participate in the eRx Incentive Program. Read the complete update
Medicare Carrier Advisory Committee Update: CMS: As the process for determining the Medicare contractors for multiple areas drags on, CMS has decided that they wil reorganize the Medicare jurisdictions yet again, decreasing the number from 15 to 10. Oregon is currently part of Jurisdiction 2 (OR/WA/ID/AK), but our jurisdiction wil now be combined with Jurisdiction 3 (ND/SD/MT/WY/AZ/UT) to create Jurisdiction F (now al jurisdictions wil have letter designations). Noridian is the current contractor for both jurisdictions, so the medical director is inclined to believe they wil be awarded the next 5 year contract, as avoiding the changeover costs to another contractor would be a huge cost savings for CMS. Hopeful y a decision wil be made by the end of March, although protests/appeals could stil delay the process. Oregon Medicaid: Continued under funding is a problem for the Oregon Health Plan, so services wil be further decreased (the "line" wil be moved to exclude about 40 more conditions/treatments on the prioritized list). Reimbursement levels wil also likely decrease. This is dependent on the legislature and OHP managed care plans. Noridian: Improved search tool for Physician Fee Schedule: Click here for the PDF PQRI is becoming PQRS (no longer wil be considered an "incentive" program, as it wil be mandated starting in the near future): Physicians Quality Reporting System.
Physician's original signatures are required on al orders for lab tests and on printouts of results, plus written notes regardingaction taken in chart - except with electronic records. EXCERPTS FROM THE NORIDIAN HOT TOPIC QUESTION AND ANSWERS SESSION: MODIFIERS: What would be the scenarios for using the modifier GU versus the modifier GX? Is one for reporting purposes only? Would these replace the modifier GA? Answer: Modifier GU is defined as “Waiver of liability statement issued as required by payer policy, routine notice.” Modifier GX is “the notice of liability issued, voluntary under policy.” Providers may use modifier GX to provide notice of liability regarding services excluded from Medicare coverage by statute. It is appropriate to use when you know the service is considered non-covered by Medicare. When the service is noncovered, the office does not have to provide an ABN to a patient for signing, hence “voluntary.” It is, however, a good idea to inform the patient that they are financial y responsible. CODING: From the last October teleconference on Signature Requirements, I understood the electronic record could say “Electronical y reviewed and approved by” (Physician and title). I am getting requests for signature attestation. Is this no longer correct? Answer: An electronic signature should be accompanied by a statement such as “electronical y signed by” or “verified/reviewed by” fol owed by the providers name and credentials. In addition, authentication of the signing provider must be clearly defined in records. It may be necessary in some instances to provide a signature attestation form. The form for the states of AK, OR, and WA is located at: https://www.noridianmedicare.com/pmedb/claims/cert/docs/signature_attestation_statement.pdf INCENTIVE PROGRAMS
How can I get my report for PQRI? Answer: The reports are available from the Provider Contact Center (PCC) for smal providers. The PCC can be reached at 1 800 933 0614. Group providers wil utilize Individuals Authorized to Access CMS Computer System (IACS). For assistance with IACS contact the QualityNet Help Desk at 866-288-8912; TTY 877-715-6222 or email [email protected]
We only have two Ophthalmologists and two Optometrists. I cal ed and they told me the doctor has to sign up first. We have been using PQRI measures. Answer: The IACS system has security standards that must be set up in order to get the reports released. Smal providers are no longer required to obtain reports through the IACS system and you may contact the PCC at 800-933-0614.
I have been told that to qualify for eRx incentive, claims must be received on paper? Is this statement correct? Answer: No, they just have to be submitted by claim based reporting and cannot be submitted via registry or Electronic Health Records (EHR).
Please define what a unique event is for E-prescribing (eRx). Please define percentage of measurement if it pertains to submitting a prescription at the time of an office visit or if it measures al refil s prescribed by the provider. Answer: A unique prescribing event happens when one or more prescriptions are transmitted via the eRx system during the office visit. A refil could be counted as a unique event if handled during a different office visit. Prescriptions submitted that were not part of an office visit do not qualify.
Our providers are general surgeons. We have an eRx system; however, they prescribe many narcotic prescriptions that currently cannot be sent electronical y. They must be handwritten. How do we prevent being penalized for not being able to utilize the system? Answer: If your providers ONLY prescribe narcotics and would not qualify for the 10% threshold requirements they would not be considered an eligible EP for eRx.
Did I understand that if we didn’t do the incentive program for Electronic Health Record (EHR) there would be a penalty? Answer: Penalties for EHR start in 2015. EPs are required to register to participate in this incentive program. For complete information about EHR see CMS web page: http://www.cms.gov/EHRIncentivePrograms
We submitted the G8447 for PQRI measure #124 for EHR for dates of service in 2010. When can we expect payment for that incentive? Answer: Incentive payments go out the second half of the fol owing year.
Do we need to be set up specifical y with eRx or is this simply referring to electronic prescribing? We are currently sending scripts electronical y and reporting the G code. Answer: EP’s are not required to register for electronic prescribing. For complete information regarding the incentive and specific requirements review CMS website at: http://www.cms.gov/ERXincentive/.
Do we need to register to start reporting PQRI? Answer: No, EPs are not required to register. Review the measures on the CMS website at http://www.cms.gov/PQRI . The CMS website has great documentation and explanations on how PQRI works and how to get started. GENERAL INFORMATION Who can I contact with a question about the Medicare Part B Electronic Funds Transfer (EFT) form? I’m not sure if we need to submit a new one if nothing has changed. Answer: NAS Provider Enrol ment can be contacted at 888-608-8816. EFT deposits your Medicare payments directly into your bank account. CMS requires that al providers that are enrol ing in Medicare Part B, revalidating, or making any changes to their file, must use EFT. To sign up, you must fil out an Authorization Agreement for Electronic Funds Transfer at http://www.cms.gov/cmsforms/downloads/CMS588.pdf . Complete the form and have it signed and dated by the provider or authorized/delegated official (for groups or organizations). The signature must be original (cannot be a copy or stamped signature)
Regarding claim filing deadlines, what do we do when another insurance takes back their payment stating the patient was noteligible and that they should have been secondary and it is now past timely filing for Medicare? Do we have any recourse? Answer: Normal filing guidelines would stil be fol owed; however, you have one year from the date of service. If NAS doeshave a claim in the system that was paid incorrectly, it can be adjusted one year from the paid date.
Can you tel us what NAS uses for E&M guidelines for their reviews? Answer: Medical professionals can use either the 1995or the 1997 guidelines. Remember E&M reviews are based on medical necessity, not the number of systems/organsreviewed. The 1995 guidelines are located at http://www.cms.gov/MLNProducts/Downloads/1995dg.pdf and the 1997guidelines are located http://www.cms.gov/MLNProducts/Downloads/MASTER1.pdf . Useful links: ICD 10 updates from Noridian: https://www.noridianmedicare.com/p-medb/news/docs/icd10_update.html%3f ICD 10 updates from CMS: http://www.cms.gov/ICD10 What's the Buzz on the OOPA On-Line Member Forum? Current topics include.Member Forum; Ethics, OHP Changes, DMV Mandatory Submissions. Staff (only) Forum; Insurance bil ing and coding. Are you missing out on the current topics and concerns of your fel ow OOPA Members? If you require assistance to log on, please contact the OOPA Office.
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What others like and admire about Rachel Her ‘model-looks’: she is a stunner! wicked sense of humour Her ability to make friends and connect with people Her taste in men, music and DVD’s! Her long eye lashes and expressive eyes She is a funky babe! Important To Rachel Contact with her family, especially her mum and sister Lindsay. Listening to pop
Available online at www.sciencedirect.comChemical Physics Letters 447 (2007) 316–319He intercalated C60 solid under high pressureDepartment of Materials Science and Engineering, Graduate School of Engineering, Nagoya Institute of Technology, Gokiso-cho,Received 26 July 2007; in ﬁnal form 19 September 2007In situ synchrotron X-ray diﬀraction measurement of solid C60 under high pressu