Palmetto GBA E-mail Update: Monday, December 28, 2015

Holding of 2016 Date-of-Service Claims for Services Paid Under the 2016 Medicare Physician Fee Schedule

On October 30, 2015, the CY 2016 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2016 services paid under the MPFS for up to 14 calendar days (i.e., Friday January 1, 2016 through Thursday January 14, 2016). Please share with appropriate staff.

President’s Monthly Message

Dear Fellow NCMGMA Members,

Jacob Rodman, 2015-16 NCMGMA President

As 2015 winds down and we begin 2016, I would like to take a minute to reflect on where we have been and where we are going as a North Carolina healthcare-focused organization.

In 2015:

• NCMGMA had an extremely successful Advocacy Days where many of our members met with congressional leaders;
• We hosted a great spring conference in Myrtle Beach;
• We held our first ever Leadership Summit which was very successful; and, most importantly,
• We saw our organization’s mission and influence continue to grow.

In 2016:

• We look forward to our Annual Conference, May 11-13 in Charleston, SC;
• We will host two regional Roadshows scheduled for August 5th in Asheville and October 14th in New Bern; and
• Our first-ever Merging Medicine & Management (M3) conference will be held September 15-18 at the Grandover in Greensboro, to be held in conjunction with the North Carolina Medical Society.

We will continue to grow as an organization and forge new partnerships while also keeping our eye on what truly matters: providing unparalleled value to our members.  Healthcare has changed, our organization has changed, our methods for providing education have changed, and our jobs have changed, but one thing has remained steadfast: our need to network and come together to stand as a group and let our voices be heard.

I am honored to be part of such a wonderful organization and even more humbled to be the president of this great organization that I love.   As we find ourselves in the middle of December and completely focused on our practice, staff, and  physicians, may we never lose sight of why we do what we do to serve and positively affect the lives of the many patients our organizations touch each year.

Thank you for gifting NCMGMA the honor of your time and membership commitment. I would like to wish you and your families a joyous holiday season and a bright and prosperous New Year.

Sincerely,

Jacob Rodman
2015-16 NCMGMA President

December 16th Webinar Recording and Presentation

Thank you to everyone who participated in the December 16th Webinar “Legal Hot Topics.” The recording of the webinar (MP4) and the accompanying PowerPoint presentation (PDF) are available in the Members-only section of the NCMGMA website.

To access the December 16th webinar materials, please visit the NCMGMA website, log in to the members-only section and click on the main “Members” page. From there you will see the links to the webinar recording and presentation under the “NCMGMA Webinars” sub-heading.

Thank you to Medical Mutual for sponsoring this webinar.

New Master of Health Administration Degree at App State

The University of North Carolina Board of Governors approved a new Master of Health Administration (MHA) degree at Appalachian State University during its December meeting in Chapel Hill Dec. 11.

The MHA will be offered primarily online. It is designed for health care professionals seeking to advance their careers in management or administration of health care organizations. The 46-credit hour program will offer two tracks, one in health care leadership and one in health information systems. The program will begin accepting students in January 2016. Classes will begin in Fall 2016.

• MHA Degree Flyer

For more information on the Master of Health Administration program and other programs in the Beaver College of Health Sciences, contact Dr. Sandi Lane (lanesj1@appstate.edu) or Dr. Dave Williams (willimsdr@appstate.edu) or visit healthsciences.appstate.edu.

Welcome New Members

Our membership continues to grow! Take a look at the list of healthcare professionals and students who have recently joined NCMGMA (October 28, 2015 through December 2, 2015):

Active

Jordan Allred, Salem Neurological Center, P.A., Winston Salem, NC
Amy Chernault, East Carolina Anesthesia Associates PLLC, Greenville, NC
Joanie Cochran, Healthcare Business Solutions, High Point, NC
Cynthia Cox, Raleigh Medical Group PA, Raleigh, NC
Matthew Fitzsimmons, Duke Triangle Heart Associates, Durham, NC
Bryan Gouin, IPC Healthcare, Raleigh, NC
Sally Hammond, Cone Health Medical Group, Greensboro, NC
Lisa Heath, ECU Physicians, East Carolina University, Greenville, NC
Dylan Holmes, Rock Hill Eye Center, Charlotte, NC
Kimberly Howell, ECU Physicians, East Carolina University, Greenville, NC
Linda Joyner, Downtown Primary Care, Williamston, NC
Liz Parrott, Raleigh Ophthalmology, Raleigh, NC
Cindy Rogers, Duke Primary Care, Durham, NC
Maria Saucedo, Children’s Health of Carolina dba Raeford Pediatrics, Raeford, NC
Jamie Smith, Thomasville Family Practice, Thomasville, NC
Mike Vander Baan, Carolina Neurosurgery @ Spine Associates (CSNA), Charlotte, NC
Jason Wheeler, Duke Neurosciences of Raleigh, Raleigh, NC
Tamara Williamson, Women’s Center of Lexington, Lexington, NC

Affiliate

Susan Greenman, Greenman Eye Associates, Charlotte, NC
Brian Nix, Greenway Health, Wilmington, NC

Student

Susan Carney, East Carolina University, Greenville, NC
Stephanie Turner, Catawba Valley Community Collge, Rutherford College, NC

2016 ACMPE Examinations

Register for the ACMPE Examinations

The time to get started is now. Below you will find information on the 2016 exam dates, the location of the exams and when the registration opens and closes. You can also find complete information on the ACMPE page of the MGMA website.

• February 13 – 27
  Nationwide computerized testing (view locations)
  Registration is open December 30, 2015 – January 13, 2016
• June 11 – 25
  Nationwide computerized testing (view locations)
  Registration is open April 27 – May 9
• September 10 – 24
  Nationwide computerized testing (view locations)
  Registration is open July 27 – August 8
• December 3 – 17
  Nationwide computerized testing (view locations)
  Registration is open October 19 – November 2

Fees
Registration fees for exams are $165 and are not transferable.

How to Register for Computerized Exams

1. Exam Eligibility – Before registering for the exams, you must be an active participant in the ACMPE program (Your application, application fee and documentation of a minimum of two years’ experience in an ambulatory or other healthcare management position and a minimum of six months in a supervisory role must be approved.) For additional information, please read more on how to Get Started.
2. Exam registration fees – You can pay your exam registration fees through the MGMA online store or by calling toll-free 877.275.6462, ext. 1888.
3. Confirmation of eligibility – Within five business days of paying your exam registration fees, you will receive a Notice to Schedule email. You will receive one Notice to Schedule per exam. This will include your personal user name and password allowing you to make your exam appointment at a designated testing facility.
4. Select exam date, time and location – With your user name and password in hand, you must follow the link provided to locate your specific exam site and schedule a date and time to take the exams. Please note that you must book one appointment per exam. If you have registered for both exams, you will need to book two appointments. Exam site hours vary by location. You will be able to choose any available appointment that works for you during the exam window. Please note that exam appointments are made on a first-come, first-served basis, so scheduling early will help ensure the best choice of appointment time and location. Directions to your selected exam site, procedures and other information will be provided to you in an email from our testing vendor, Castle.

About the Examinations

• Multiple choice: Fee $165
  A 175-item, multiple-choice test taken within three hours and 15 minutes. This exam assesses your on-the-job knowledge of the broad scope of group practice management principles and practices as described in the Body of Knowledge for Medical Practice Management
• Essay: Fee $165
  Responses to questions about three real-life practice management situations must be answered in formal essay style within one and a half hours. This exam assesses in-depth knowledge of medical practice management principles and issues, problem-solving and decision-making skills and the ability to communicate in formal writing style.

Computerized exams locations
ACMPE has partnered with Castle centers to offer approximately 500 exam sites. Once you register for an exam through the MGMA store and your eligibility has been confirmed, you will be provided with a user name and password that will allow you to select your exam location, date and time. Please note that you won’t be able to schedule your exam appointment at a Castle testing site until you have submitted your registration fees and eligibility requirement.

Exam cancellation and rescheduling policy

• To reschedule an exam: If you need to reschedule within the current exam date block, you may do so by calling Castle Worldwide at 919.572.6880. Please note that a $50 per exam rescheduling fee applies.
• To cancel an exam:  To cancel your exam, please contact MGMA at 877.275-6462, ext. 1888. If you are canceling four or more days prior to your exam date, you will receive a $100 refund per exam. No-shows for the testing appointment, and cancellations occurring less than four days in advance, will not receive a refund. All cancellations prior to scheduling an exam appointment are subject to a $25 fee per exam.

Exam registration fees are only valid for current exam dates and are not transferrable. If you wish to reschedule your exam for a different period, you must first cancel your current registration and register during the exam period of your choice.

If you have questions please contact MGMA toll-free at 877.275-6462, ext. 1888.

Palmetto GBA E-mail Update: Tuesday, December 15, 2015

January 2016 “Dark” Days for the Common Working File (CWF)
For the upcoming January 2016 Release, CWF will be observing one business “dark” day on Thursday, December 31, 2015. The CWF Host will also be observing the holiday on Friday, January 1, 2016, so this will also be considered a “dark” day. This means Medicare Administrative Contractors (MACs) will not have access to the Health Insurance Master Record (HIMR) and Beneficiary Dat a Streamlining (BDS) transactions. Eligibility information in HIQA and HIQH will also not be available to providers. On the dark days please use Palmetto GBA’s eServices or the Interactive Voice Response unit to eligibility and beneficiary verification for claim detail, etc. The Provider Contact Center will not have access to CWF during this time.

Applies to:

• JM Home Health and Hospice//General
• JM Part A//General
• JM Part B//General

ICD-10 Post-Implementation: Coding Basics Revisited MLN Connects Video
In this Centers for Medicare & Medicaid Services (CMS) ICD-10 video, Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) discuss the unique characteristics and features of the ICD-10 coding system.

Applies to:

• JM Home Health and Hospice//General
• JM Part A//General
• JM Part B//General
• Railroad Medicare (RRB)//General – Railroad Medicare

ICD-10 Website Wheel: A Guide to CMS Medicare FFS Resources
CMS recently released an updated ICD-10 Website Wheel for Medicare Fee-for-Service (FFS) providers. The Website Wheel provides easy access to official resources on CMS ICD-10 web pages.

Applies to:

• JM Home Health and Hospice//General
• JM Part A//General
• JM Part B//General
• Railroad Medicare (RRB)//General – Railroad Medicare

Updated eServices Minimum System Requirements Now Available
What are the minimum system requirements for Palmetto GBA’s eServices?
In an effort to maintain the security of the information available through eServices, users must now ensure that TLS 1.1 or higher is checked in their browser settings in order to successfully access the portal. This option is typically located on the Advanced tab under Internet Options in your browser. To optimize usability of Palmetto GBA’s eServices, we recommend that users verif y their system adheres to the most current version of eServices minimum system requirements. Please read this article to learn more.

Applies to:

• JM Home Health and Hospice//General
• JM Part A//General
• JM Part B//General
• Railroad Medicare (RRB)//General – Railroad Medicare
  eServices//General Information

BCBSNC Updates: December 11, 2015

The following are the latest updates and important reminders from BCBSNC:

Release Dates: December 3-9, 2015

• Individual BCBSNC Membership Will Be on New Technology Platform January 1, 2016
• Risk-Adjustment Webinars in December (12/14 and 12/21)
• Tell Us About Your Experiences With BCBSNC’s Utilization Management and Case Management Processes
• New HEDIS Measure Tool: Initiation and Engagement of Alcohol and Other Drug Dependency Treatment
• Provider IDs on Blue Medicare Claims Must Agree With Provider Enrollment Data (actually pertains to all lines of business)
• Time to Complete and Submit SOAP Notes for Medicare Advantage Patients

Important Reminders:

• Have you signed up for our convenient EFT service?  Please note that electronic funds transfer (EFT) will become BCBSNC’s standard provider payment method as of March 1, 2016.  Sign up today!
• As of December 1, Medical Records Can Be Submitted Upfront to Support Medical Necessity
• New Response Time for Emergency Inpatient Admission Authorizations Effective December 1, 2015
• BCBSNC’s Contract With Carteret Health Care in Morehead City to end February 1, 2016.

BCBS Committee Update: December 2015

The following are notes from the most recent meeting with BCBSNC.  If you have specific questions or concerns, please contact a BCBS committee representative to assist you.

Narrow Networks

Narrow network product Blue Value was first introduced in 2013.  Last year, we saw a narrow network, Blue Local, added in the Charlotte market and in 2016 we will see Blue Local in the Triangle market.  These plans are here to stay for now and practices cannot “apply” for participation in these narrow network products, but please see the letter below from our NCMGMA President regarding advocacy surrounding these types of plans:

Good Morning Fellow NCMGMA Members,

I wanted to write to you briefly and let everyone know that NCMGMA, the BCBS Committee, the NC Medical Society and the Advocacy Task Force are heavily involved in these issues and will continue to both monitor the changes in addition to having a seat at the table with the stakeholders surrounding these networks.  As with many issues, much of the work goes on behind the scenes and I can assure you these issues are not taken lightly.  Our committees and task forces are hard at work. 

We posted a great article from Modern Healthcare on the blog yesterday regarding this very topic, I highly recommend the read.  https://ncmgm.wordpress.com/2015/12/01/cms-looks-to-imposing-minimum-standards-to-narrow-provider-networks

Please do not hesitate to reach out to myself, Melissa White (BCBS Chair) or Cameron Cox (Advocacy Chair) with any specific issues.  We are  here to help! 

Respectfully,

Jacob A. Rodman
2015-2016 NCMGMA President
jrodman@raleighneurosurgical.com

TouchCare – Telemedicine

The BCBS investment arm along with Medical Mutual and Fortress Investments are investing in Durham based TouchCare, a telemedicine company.  TouchCare was created in 2013 and aims to connect patients to THEIR healthcare providers in the mobile space.  Practices are using it to provide better access, increase compliance with follow up visits, and to aid in provider to provider calls.

• http://www.touchcare.com/

BCBS Telehealth policy:

• http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/telehealth.pdf

Medical Records

Proactive submission of medical records to support medical necessity is now available as of December 1st.  Please refer to the following link for the services typically requiring medical records and the protocols for submission of proactive records.

• http://www.bcbsnc.com/content/providers/news-and-information/news/Medical_Records_Process_Change_FINAL.htm

Electronic Solutions

Blue Medicare Advantage and Blue Supplement are now merged with Blue E.  You no longer need to use HealthTrio for these lines of business.

Credentialing / Contracting

• Rolled out a new provider information management system.
• Working on a bulk upload enhancement for mass enrollment, terminations and updates.

State Health Plan Overpayments

Affected practices will receive a bar coded invoice containing the overpayments.  You may return a check or choose to have voucher deductions.

• https://www.bcbsnc.com/content/providers/news-and-information/news/SHP_Duplicate_Payments_UPDATE.htm

EFT Requirement

If you are not currently enrolled for EFT payments, please do so before the end of February 2016.

• https://www.bcbsnc.com/assets/providers/public/pdfs/eftrequest-form.pdf

Smartphone Apps: A Growing Trend in Medicine

By Lizabeth Brott, J.D., ProAssurance Regional Vice President, Risk Resource

A smartphone isn’t just a phone; it’s a miniature computer. We surf the web, email, play games, and use smartphones and other wireless devices as tools for work. This explosive growth in use has been aided by mobile applications (“apps”). Today physicians can monitor a patient’s vital signs, download patient schedules, access medical records, dictate office notes, and consult with other physicians without entering a clinical setting.

Greater Access, New Risks
As with any new medical device, there are risks to consider. Mobile devices “are considered one of the most vulnerable areas for [privacy] breaches.”¹ This is in part due to security assessments that failed to address the use of mobile devices.² The Health Information Technology for Economic and Clinical Health (HITECH) Act requires notification whenever a breach of unsecured protected health information (PHI) occurs.³ Additionally, the Department of Health and Human Services requires security of PHI on storage devices (hard drives), transmission media (cyberspace), and portable electronic media (e.g., smartphones).⁴

Reference guides, such as Epocrates, should not be a HIPAA risk. However, apps that transmit PHI could be intercepted by hackers or corrupted by a virus. Regardless of whether a physician’s mobile device is used to access, transmit, or store PHI, consider all HIPAA and HITECH requirements. HIPAA requires data security and proper destruction, and retention of PHI, when appropriate.

What Can You Do?

• Review potential wireless apps to ensure security of PHI at all levels;
• Limit the type of app that can be used based upon the individual app’s level of security;
• Use encryption software that makes data unusable by intercepting parties;
• Develop a security policy addressing mobile devices and the types of apps that can be used, along with the appropriate use and destruction of PHI data;
• Develop an eDiscovery policy for retaining PHI in the event of litigation; seek assistance from your attorney or your medical professional liability carrier’s risk management staff; and
• Work closely with IT personnel to address all security issues.

¹Dolan, P. “Large settlement for data breach sends message to lock up laptops and smartphones.”
American Medical News, September 28, 2012, http://www.amednews.com/article/20120928/
business/309289995/8/ (accessed August 27, 2013).
^{2, 3, 4}“Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act.

Copyright © 2015 ProAssurance Corporation

This article is not intended to provide legal advice, and no attempt is made to suggest more or less appropriate medical conduct.

ProAssurance is a national provider of medical professional liability insurance and risk resource services. For more information about the company, visit www.ProAssurance.com.