WSMA Coding and Billing Assistance/Advocacy
Administrative Simplification Guidelines—Washington
Healthcare Forum
Administrative simplification—reducing the hassle
factor, streamlining policies and procedures and decreasing
nonproductive work—has been a key focus of the Washington
State Medical Association (WSMA) for several years. As part
of that commitment, we have been an active participant in
the Washington Healthcare Forum, (the Forum) a statewide
organization committed to improving the health care system.
The policies, and new initiatives that are being developed
by the Forum, are now available only at the new Forum Web
site, http://wahealthcareforum.org/
In addition to administrative simplification initiatives,
you'll also find information on Health Insurance Portability
and Accountability Act (HIPAA) transactions. The Forum site
also will post information about future workshops and other
activities designed to improve the health care system.
Back to top
AMA Discount Publications
All WSMA/WSMGA members can purchase AMA Publications
at a discounted rate. Members have unique needs, and these
AMA products offer resources to help meet these needs from
Practice Management to Coding.
For more information, contact Jenelle C. Dalit at the WSMA's
Health Care Economics Department at (206) 441-9762 or 1 (800) 552-0612,
or via email.
To download the Order Form, click here
[PDF].
Back to top
athenahealth, Inc.
athenahealth, Inc. provides the only physician revenue and
clinical cycle management offering that integrates web-based
practice management and EMR software, continually updated
payer knowledge, and back office processing specialists
into a single service. The results are faster payment at
lower cost, improved patient care, higher revenue retention
and less hassle for the more than 11,500 providers in 54 specialties using
athenahealth nationwide.
WSMA recommends the industry's leading billing and practice management solution, athenahealth's ahtenaCollector, to members. WSMA members can receive a 6% discount for athenaCollector services provided they have their principal place of business in Washington State and all of the physicians in the practice are WSMA members.
In addition to the discounted services the following resources
and content may be of interest/value to WSMA members:
If you have questions about this product or are interested
in more information, please contact Michelle M. Lott at
(206) 441-9762 or 1 (800) 552-0612 or via email.
Back to top
DecisionHealth - Health Care Newsletters,
Publications and Educational Tools
DecisionHealth delivers unbiased
healthcare news as a completely independent source. Their
flagship publications include Part B News, Medicare Compliance
Alert, and Private Payer News.
In addition to these publications, DecisionHealth offers
a variety of in-person conferences, audio conferences, and
audio conference tapes and CDs. To keep WSMA members abreast
of current issues directly affecting our profession, our
patients and our organization, we have partnered with DecisionHealth
to provide special member-only-discounts on offered by DecisionHealth.
If you are interested in signing up for one of DecisionHealth's
conferences, please visit their site. Conference information is listed on the left. When registering
online be sure to use discount code WSMADH
in order to receive your 15% WSMA member
discount.
Here is a list of the types of audioconferences that DecisionHealth
produces annually:
- Billing, Reimbursement
- Pay for Performance
- Private Payer Contracting
- Managing Non-Physician Practitioners
- Medicare Provider Enrollment
- Specialty Coding and Billing
- ASC reimbursement and management
- Medicare Part D
- Managing Practice Expenses
- Preventative Medicine Billing
- E/M Coding
You'll benefit from their experienced team of journalists
and professionals. If you have questions about your subscription,
please contact DecisionHealth's customer relations staff
at 877-397-1496 or via email at customer@decisionhealth.com .
For more information on DecisionHealth, click www.decisionhealth.com. Back to top
Insurance Claim/Assistance Request (ICAR)
The WSMA continues to hear from physicians and practice
managers regarding unresolved claims problems with health
plans. To better assist our members in addressing these
concerns, the WSMA is pleased to offer this service, the
WSMA Insurance Claim-Assistance Request (ICAR).
Use this form to advise the WSMA when you encounter problems
with specific insurance claims. Here's how the process works:
the WSMA will facilitate communication between the physician's
practice and appropriate parties at the health plan. In
compliance with the recently implemented HIPAA privacy regulations,
WSMA has instituted policies to protect patients' "Health
Information" we receive from WSMA members.
Important: Before a WSMA member
sends us any "protected" health information, the WSMA will
need to receive a signed Business Associate Agreement. Click
here to
download a copy of the WSMA's Business Associate Agreement
[PDF].
Upon receipt of your completed ICAR form and a signed
Business Associate Agreement, the WSMA will track each ICAR,
and forward a copy to the relevant health plan. We'll ask
the health plan to act upon that request to resolve the
claim, and to advise the WSMA of their actions. We will
forward a copy of the health plan's response to the inquiring
physician.
This free service is available only to WSMA member physicians
and their practice staff. For more information, contact
the WSMA's Health Care Economics Department at (206) 441-9762
or 1(800) 552-0612, or via email.
To download a WSMA Insurance Claim-Assistance Request,
click here.
[PDF]
To download a WSMA Business Associate Agreement,
click here.
[PDF]
Back to top
Rapid Practice Assessment Service (RPAS)®
It is unfortunate that many physicians' practices encounter
operational problems that can be seriously damaging yet
frequently go undetected until serious repercussions occur.
Such problems can be related to a practice's general business
operations, financial management, revenue cycle, billing
and coding or personnel issues.
One solution is to obtain an "inspection" of your practice
by a qualified consultant. The Washington State Medical
Association (WSMA) has arranged to help you do just that.
In response to requests from member physicians and their
practice managers, the WSMA is pleased to offer this service,
the WSMA Rapid Practice Assessment Service
(RPAS)®.
Here's how the process works: The WSMA will facilitate
communication between the physician's practice and a qualified
consultant to conduct a review and assessment of key areas.
This program is designed for small to medium sized (1-10
physicians) single specialty practices. During this initial
rollout phase, we will limit the number of practices accepted
to three practices per month.
To receive additional information on how this process works
and related costs, please contact Bob Perna, Director of
Health Care Economics at the Washington State Medical Association
by phone: 206.441.9762 or rjp@wsma.org.
Back to top
Insurance "Prompt Payment"
Letters (Prompt Payment Request Letter)
The WSMA continues to receive reports from physicians and
practice managers that unpaid claims—submitted to health
insurers—drive up administrative costs, impair their
cash flow and can potentially put the practice in jeopardy.
To better assist our members in adressing these concerns,
the WSMA is pleased to offer the Prompt Payment Request
Letter.
Use this form when you encounter problems with specific
insurance claims.
This is available to WSMA member physicians and their practice
staff. For more information, contact the WSMA's Health Care
Economics Department at (206) 441-9762 or 1-800 552-0612,
or via email at wsma@wsma.org.
To download a WSMA Prompt Payment Request Letter,
click here. [PDF]
Back to top
WSMA Coding Hotline
For better or worse, codes determine your reimbursement. Correct coding also keeps the auditors away.
Guidance on CPT, ICD-9 and HCPCS coding is now available from the WSMA's certified coders through the WSMA Coding Hotline.
The WSMA Coding Hotline is available to members by calling Susan Reehill, CPC at (206) 441-9762 or 1 (800) 552-0612 or via email.
Any WSMA member physician can receive three free inquiries per practice per month. After the third inquiry, a charge of $25 per inquiry will be assessed.
This service is available to WSMA and WSMGMA member practice managers. Non-members of either the WSMA or WSMGMA can access this service for a prepaid fee of $120 per month for three questions per practice per month.
Note the WSMA's Insurance Claim Assistance Request (ICAR) service is still an unlimited benefit to WSMA and WSMGMA members.
What We Offer:
Free Coding Hotline: Coding Hotline is available to members for clarification of CPT, ICD and HCPCS coding issues by calling (206) 441-9762.
- Offers 3 calls per month per practice free to WSMA Members
- Track inquiries; Summarize findings
- Use findings as: basis for contact with Payers to advocate for changes in coding practices and payment policies
Back to top
|
