For Participating Medical Practitioners April Real-time Clinician Review for Radiology Services

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1 HMSA s For Participating Medical Practitioners April 2012 ADMINISTRATIVE CMS Evaluates Delay in ICD-10 Implementation What s Inside By the Numbers 2 Policy News 2 Electronic 3 Plans & Programs 4 TriCare 5 In February 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that HHS will initiate a process to postpone the ICD-10 compliance date. The original 2011 compliance date was set in In January 2009, a final rule adopting ICD-10 as the standard moved the compliance date to Oct. 1, HMSA will continue to maintain its current activities in anticipation of the Oct. 1, 2013, date until a new compliance date is announced by HHS. This is consistent with recommendations from entities such as the American Hospital Association, the Health Information Systems Society, and the American Health Information Management Association. We encourage providers to continue their efforts to support the ICD-10 transition at this time. Real-time Clinician Review for Radiology Services HMSA s radiology management partner, National Imaging Associates (NIA), provides precertification services for outpatient advanced imaging. RadMD is a user-friendly, real-time tool offered by NIA that provides instant access to advanced imaging authorization and support information. Immediate approval is received for many studies; if additional clinical information is needed, you can quickly upload the necessary information. To expedite requests, you can upload clinical information directly onto RadMD. It is automatically attached to the case and forwarded to NIA s clinicians for review. To get started, go to click the New User button, and set up a unique user name/account ID and password for each user in your office Hawai i Medical Service Association 818 Keeaumoku St. P.O. Box 860 Honolulu, HI Phone: (808) Branch offices located on Hawaii Island, Kauai, and Maui Internet address: hmsa.com Provider Resource Center: hhin.hmsa.com

2 2 Provider Update - Medical Practitioners April 2012 BY THE NUMBERS The PCMH program has shifted to its 2012 criteria. To learn more and to participate, interested physicians can access the 2012 PCMH Program Guide at Pay-for-Quality January 2012 February 2012 Number of providers 1,016 1,016 Average number of providers that have logged in to HBIOnline Number of providers who have 2011 Program* submitted supplemental data claims per month 2012 Program* N/A 40 Number of supplemental data submissions per month 2011 Program* 2,287 1, Program* N/A 4,606 PCMH Number of physician organizations Number of providers * Note: The last day to submit supplemental data for the 2011 program was Feb. 10, The first day to submit supplemental data for the 2012 program was Feb. 22, POLICY NEWS New Policy Drafts Online for Review New medical policies are now posted online for your review. Please check zav_mm htm in the Provider E-Library for drafts of policies that may affect your practice. Comments should be sent before the due date indicated online and may be ed to medical_policy@hmsa.com or faxed to on Oahu. Questions? Call Provider Services at on Oahu or 1 (800) , ext. 6377, toll-free on the Neighbor Islands. 90-Day Notice for Policy Changes Effective July 1, 2012 Pemetrexed (Alimta): The criteria/guidelines section has been revised. Annual Review of Medical Policies The following policies have been reviewed and updated and are in the Provider E-Library at provider/zav_in.mm00_medical_policies_current_index. htm. Copies are available on request. Blepharoplasty and Repair of Blepharoptosis. Charged-Particle (Proton or Helium Ion) Radiation Therapy. Computerized Corneal Topography. Cosmetic and Reconstructive Surgery and Services. Lung Volume Reduction Surgery. Panniculectomy/Abdominoplasty. Treatment of Varicose Veins: The limitations/exclusions and administrative guidelines sections have been revised.

3 3 Provider Update - Medical Practitioners April 2012 ELECTRONIC HHIN Displays Benefit Limits for Preventive Services This article, originally published in the March 2012 Provider Update, is included in this issue to inform participating facilities new to the Provider Update newsletter. Affordable Care Act (ACA) requirements have been implemented for eligible HMSA plans and can be accessed through HHIN. For details on the preventive services and a list of coverage codes, refer to the HMSA Provider Resource Center online. ACA Coverage Code List: htm. Preventive Services: Preventive_Services.htm. HHIN Quick Steps: Visit the member s Eligibility Detail page. Click on the Benefit Detail drop-down arrow. Select the appropriate service type. Example: 98 Professional (Physician) Visit Office. Click on the link in the limitations section to view additional information. View the limitation summary see example below. To schedule a HHIN training session for your office, contact Traci Tabladillo at on Oahu or 1 (800) , ext. 5851, toll-free on the Neighbor Islands.

4 4 Provider Update - Medical Practitioners April 2012 PLANS AND PROGRAMS PRG Update Effective June 1, 2012 CPT Code Description PRG Removal of implants; superficial, (e.g., buried wire, pin, or rod) (separate procedure) Excision, tumor, soft tissue of face or scalp, subcutaneous; 2cm or greater Laparoscopy, surgical; orchiopexy for intra-abdominal testis Vitrectomy, mechanical, pars plana approach, with removal of subretinal membrane (e.g., choroidal neovascularization); includes, if performed, intraocular tamponade (i.e., air, gas, or silicone oil), and laser photocoagulation. 3 MAC Fee Changes The following fee changes went into effect March 1, 2012; CPT code 90670: Pneumococcal Vaccine 13 val (Prevnar), $ HCPCS code E0604: Breast pump, hospital grade, electric (AC and/or DC), any time, rental, $80 per month. BCBSA Quarterly Audit Auditors contracted by the Blue Cross and Blue Shield Association will be in touch with HMSA participating providers for quarterly audits during Providers can expect to hear from the auditors April to verify their location, telephone numbers, and other demographic information for the BlueWeb Doctor Finder System. Audits will also occur in July and October. Thank you in advance for your cooperation with this audit. Administration Fee for Part B Vaccinations at Point of Sale Effective May 15, 2012, pharmacies may submit a fee up to $26.84 for the administration of Part B vaccines. The amount should be submitted in the vaccine admin./incentive field, the same field you currently use to submit a Part D administration fee.

5 5 Provider Update - Medical Practitioners April 2012 TRICARE Streamline Your Work Attend a TRICARE Provider Seminar For the latest information on TRICARE referrals and authorizations, claims and reimbursement, and TriWest s secure provider website, plan to attend the 2012 TRICARE provider seminars. Presented by TriWest Healthcare Alliance (TriWest), seminars in Hawaii will be held in August and September. To register go to TriWest.com/ Provider>Stay Updated>TRICARE Provider Seminar Registration. Who Should Attend? Providers, practice managers, and office staff responsible for eligibility verification, referrals and authorizations, and claims and collections, as well as practice managers, should attend. This seminar was not developed for providers or staff new to TRICARE. If you are not already experienced with TRICARE, you should take a TRICARE 101 or Behavioral Health TRICARE 101 webinar or eseminar before attending a live seminar. Go to TriWest.com/Provider>Stay Updated to register for a webinar or take an eseminar. What to Expect This year s seminars are for experienced TRICARE staff and will focus primarily on referrals/authorizations, claims/ reimbursement, and secure website functionality. When you attend a seminar, you will receive: The newest Provider Handbook and Quick Reference Guides Updates on the latest enhanced functionality of the secure provider website The length of the seminars is approximately 2½ hours. End times may vary based on audience participation. There is no charge to attend a seminar. What Should I Do Prior to Attending a Seminar? If you are not already registered for the secure provider website, register before attending the seminar so you can obtain the full benefit while attending the live seminar. If you are not already experienced with TRICARE administrative requirements, please take a TRICARE 101 or Behavioral Health TRICARE 101 webinar or eseminar before attending the live seminar. If you wish to have a copy of the seminar slides for notetaking or reference purposes, please print the slides and bring them with you to the seminar. Several days prior to the seminar, you will receive an with a link to the seminar slides. Benefits of Online Seminar Registration Registering online is the most convenient way to preregister for a seminar and includes these benefits: Immediate confirmation of your registration. Reminder notices prior to your scheduled seminar. Eligibility to participate in a drawing for a small prize at the seminar. Please note that confirmations are ed to you only when your address has been provided to us with your registration. Please add pseminar@triwest.com to your safe sender list to ensure that you receive your confirmation from TriWest. Note: we will not sell or distribute your address to other companies, with the exception of your Local TRICARE Representative. Questions Please pseminar@triwest.com if you have questions about: How to register for a seminar. How to change your registration to attend a different seminar, cancel your registration, or add additional people to your registration. How to register if six or more people from your practice or facility wish to attend. TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved.