3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com WCH Service Bureau, Inc Is the proud member of the following professional WCH Bulletin June 2011 VOLUME 2 ISSUE 3 WELCOME TO OUR SUMMER EDITION! Dear Readers, We would like for you to enjoy this issue of WCH bulletin, its mainly focuses on the credentialing ser- vices that WCH offers to healthcare providers and suppliers. In addition, we are providing you with most recent updates currently taking place in the insurance industry. WCH wishes you and your family to have a won- derful summer. We are looking forward hearing your adventure stories.
Dear Readers, We would like for you to enjoy this issue of WCH bulletin, its mainly focuses on the credentialing ser-vices that WCH offers to healthcare providers and suppliers. In addition, we are providing you with most recent updates currently taking place in the insurance industry.
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3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
WCH Service Bureau, Inc Is the proud member of the
following professional
WCH Bulletin June 2011 VOLUME 2 ISSUE 3
WELCOME TO OUR SUMMER EDITION!
Dear Readers, We would like for you to enjoy this issue of WCH bulletin, its mainly focuses on the credentialing ser-vices that WCH offers to healthcare providers and suppliers. In addition, we are providing you with most recent updates currently taking place in the insurance industry. WCH wishes you and your family to have a won-derful summer. We are looking forward hearing your adventure stories.
3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
INSIDE THIS ISSUE:
Provider enrollment by WCH.................................................................................................................................3 Our credentialing process.......................................................................................................................................4 Medicare proposes a 50% cut for some imaging fees in 2012............................................................................5-6 Medpac recommended that...................................................................................................................................7 The accompanying chart outlines coding and policy changes.............................................................................8-9 California blue shield pledges $180 million in rebates.........................................................................................10 California hmo rates raised an average of 11% per year from 2000 to 2010.......................................................10 Medicare identified six billing characteristics that may indicate fraud in outpatient therapy services..............11 010 electronic prescribing (erx) incentive program ...........................................................................................12 Revalidation of provider enrollment information................................................................................................13 Reporting of recoupment for overpayment on the remittance advice (ra) with patient control number..........13 Compliance alert.............................................................................................................................................14-15 Medicaid: radiology prior approval......................................................................................................................16 Valueoptions to administer emblem behavioral health services to hip and ghi hmo members..........................17 New radiology claims processor...........................................................................................................................18 Frequently asked by physical therapist clients.....................................................................................................19 Contact information..............................................................................................................................................20
3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
PROVIDER ENROLLMENT by WCH For more than ten years, WCH Service Bureau, Inc. proudly serves a thousand of providers
in New York, New Jersey, Pennsylvania, California, Delaware, Florida and many other
states, providing each client with best credentialing, personal attention, re-credentialing,
chart auditing and billing services.
Our company provides services to fit all your practice’s needs, and we can find any solu-
tions that will satisfy your practice. The quality of our services are designed to increase
your practice revenue and ensure that
the accuracy of your medical data to be
parallel to the guidelines and require-
ments of the healthcare industry.
We know and understand the creden-
tialing process rules and regulations of
different insurance organizations and
their unique provider credentialing re-
quirements. Moreover, also know that
insurance weak points; which allows us
to navigate the provider credentialing
process to achieve positive results.
Contact us today for your credentialing needs.
WCH specializes in enrollment of:
Independent Diagnostic Testing Facility (IDTF)
Durable Medical Supply (DME)
Pharmacies
Multi-Specialty Groups
Laboratories
Solo Groups and Physician Groups
Civil Surgeons
Individual contracts (all specialties)
Transportation Companies
Early Intervention Agency (EIA)
Home Health Agency(HHA)
Sleep Centers
WCH BULLETIN VOLUME 2 ISSUE 3
Page 3
3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
Our Credentialing Process
From years of experience WCH understands the importance of accurate credentialing process and contract negotiating that will guide your practice to success. The credentialing process at WCH is simple for every type of healthcare provider.
Step 1: WCH - meets with Clients and discusses what credentialing services are needed.
Step 2: WCH - Signs the credentialing agreement, and sends it along with the credentialing information form and the invoice to the client.
Step 3: WCH - Verify panel availability. Request contracts. This process can take approximately 2-3 weeks
Step 4: WCH - Meets with the client to sign the insurance contracts/applications.
Step 5: WCH - Completes, mails the contracts/applications to insurance companies and reports to cli-ents Step 6: WCH - Conducts weekly phone calls to request status updates from the respective insurance companies, and submit additional information if required. Update providers and weekly notes
Step 7: WCH - Upon contract approval, contact providers and update them on the effective date, pro-vider ID. Case is closed
Step 8: Providers can begin billing for services. WCH billing team is ready for the client
WCH BULLETIN VOLUME 2 ISSUE 3
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Please visit our new sites for more information about credentialing services:
http://credentialingsite.com/
http://insuranceenrollment.net/
3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
Specialty Projected 2012 spending (in millions)
Change
Allergy/immunology $194 1%
Anesthesiology $1,847 2%
Cardiology $6,778 -1%
Colon and rectal surgery $146 1%
Critical care $252 0%
Emergency medicine $2,658 -1%
Family practice $5,640 1%
Gastroenterology $1,837 0%
General practice $656 1%
Geriatrics $200 1%
Internal medicine $10,737 1%
Multispecialty clinic/other $84 0%
Neurology $1,520 2%
Nuclear medicine $53 -3%
Obstetrics-gynecology $678 0%
Ophthalmology $5,316 2%
Orthopedic surgery $3,572 1%
Pathology $1,122 -1%
Pediatrics $68 1%
Physical medicine $928 2%
Psychiatry $1,134 0%
Pulmonary disease $1,758 0%
Radiology $4,722 -4%
The Medicare Payment Advisory Commission in its June report to Congress recommended tighter re-views of spending on diagnostic imaging, among
other advice.
MedPAC recommended that:
Congress reduces the professional component for multiple diagnostic imaging services when interpreted by the same physician for the same patient session. Congress reduces the physician work component of diagnostic imaging services ordered and performed by the same physician. Congress establishes a prior authorization program for very frequent users of ad-vanced diagnostic imaging services. The Health and Human Services secretary accelerate ongoing efforts to bundle certain physician Medicare payments. Congress provides Medicare funding to physicians, hospitals and other health pro-fessionals so they can contract directly with quality improvement organizations.
Source: "June 2011 Report to the Congress: Medicare and the Health Care Delivery System," Medicare Pay-
ment Advisory Commission, June (www.medpac.gov/documents/jun11_entirereport.pdf)
3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
Aetna regularly adjusts its clinical, payment and coding policy positions as part of our ongoing pol-
icy review processes. In developing the policies, Aetna may consult with external professional organi-
zations, medical societies and the independent Physician Advisory Board, which provides advice to us
on issues of importance to physicians.
The accompanying chart outlines coding and policy changes:
WCH BULLETIN VOLUME 2 ISSUE 3
Page 8
Procedure Implementation date Implementation date
Laboratory and diagnostic interpretation
Reminder Aetna allows payment for the diagnostic interpretation of one lab or diagnostic test performed per date of service (DOS) across providers.
Precertification will not override incidental procedure denial
New effective date: 9/12/2011
Precertifications will not override related services that are considered incidental. The effective date of this policy changed from 9/1/2011 to 9/12/2011.
Multiple procedure reductions for therapy procedures
11/14/2011 Effective for dates of service on or after November 14, 2011, multiple procedure reductions will be applied to certain therapy procedures. The procedure with the highest practice expense RVU will be allowed at 100 percent. The practice expense portion of each additional therapy service performed by the same provider group on the same date of service will be allowed at 80 percent. The Therapies – Modalities per Date of Service payment policy still applies.
Per day limits 12/1/2011 Per day limits will apply to the following codes effective 12/1/2011: 97802 and 97803 Medical nutrition therapy 4 units per date of service (2 units per site, per side (LT, RT)) for: L2755 Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepeg composite, per segment
3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
WCH BULLETIN VOLUME 2 ISSUE 3
Page 8
Procedure Implementation date Implementation date
Laboratory and diagnostic interpretation
Reminder Aetna allows payment for the diagnostic interpretation of one lab or diagnostic test performed per date of service (DOS) across providers.
Precertification will not override incidental procedure denial
New effective date: 9/12/2011
Precertifications will not override related services that are considered incidental. The effective date of this policy changed from 9/1/2011 to 9/12/2011.
Multiple procedure reductions for therapy procedures
11/14/2011 Effective for dates of service on or after November 14, 2011, multiple procedure reductions will be applied to certain therapy procedures. The procedure with the highest practice expense RVU will be allowed at 100 percent. The practice expense portion of each additional therapy service performed by the same provider group on the same date of service will be allowed at 80 percent. The Therapies – Modalities per Date of Service payment policy still applies.
Per day limits 12/1/2011 Per day limits will apply to the following codes effective 12/1/2011: 97802 and 97803 Medical nutrition therapy 4 units per date of service (2 units per site, per side (LT, RT)) for: L2755 Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepeg composite, per segment
Procedure Implementation date Implementation date
Per day limits 12/1/2011 L5618 – L5626 Addition to lower extremity, test socket L5673 and L5679 Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for/for use with locking mechanism 12 units per date of service for: 80101 Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class 20 units per date of service for: +97598 Debridement, open wound, including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq. cm, or part thereof
3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
ValueOptions to Administer Emblem Behav-ioral Health Services to HIP and GHI HMO
Members
This fall, ValueOptions® will become the benefit administrator for inpatient and outpatient be-
havioral health services for most EmblemHealth, GHI HMO and HIP members.
ValueOptions will be responsible for the following:
credentialing
claims processing and payment
utilization management, case management, appeals,
And all other provider service issues related to behavioral health treatment. You will receive
additional information and instructions shortly.
Applications for Electronic Record Subsidies End This Week
The New York City Department of Health is giving away the last of its subsidized Electronic
Health Record (EHR) licenses to primary care providers with at least 10 percent of their patients
enrolled in Medicaid. In addition to subsidized EHR implementation, practices will be given sup-
port to achieve CMS Meaningful Use designation and additional earnings potential of up to
$63,750. Act quickly; the deadline to apply is June 3, 2011.
CPT-4 Codes for Tobacco Cessation Counseling EmblemHealth reimburses for tobacco cessation counseling based on current CMS guidelines. In addition, studies
show that a follow-up visit within one week of the patient's quit date can double the effectiveness of any intervention.
Please schedule these critical office visits and use the following CPT-4 codes for your services:
99406 Smoking and tobacco-use cessation counseling visit, intermediate, greater than three minutes up to 10 minutes.
99407 Smoking and tobacco-use cessation counseling visit, intensive, greater than 10 minutes.
3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
Frequently Asked by Physical Therapist Clients: How long must I maintain patient records? All patient Records must be kept for six years. Records for children must be kept until the
child is 22, even if that means keeping the records for more than six years.
Can I accept a referral from a physician assistant for physical therapy treatment?
A physician assistant may perform services when under the supervision of a physician. Medi-
cal services which may be performed by a physician assistant include a referral to a physical
therapist for treatment. In making such referral, the physician assistant is acting as the agent
of the physician.
Answer to both questions are obtained from New York State Physical Therapy Board:
www.op.nysed.gov
WCH BULLETIN VOLUME 2 ISSUE 3
Page 19
Stay tune to our upcoming Fall Issue
Comments, Feedback, or requests for future bulletins? Please e-mail them to [email protected]
3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Phone: 888-WCHEXPERTS www.wchsb.com
Contact Us for more information
WCH Service Bureau, INC 3047 Avenue U, Brooklyn NY 1122 Phones: (718) 934-6714, (718) 934-6728, 888-WCHEXPERTS Fax: (718) 504-6072