Save the date: Cervical Cancer Screening Expansion webinar

Clinical Corner - Second Biopsy Case

Question: We have a 44 year old that had multiple suspicious masses that were noted as microcalcifications on her mammogram report. Her ultrasound reports noted 5 hypoechoic masses with irregular margins and a Birads-5 result. Patient proceeded to have two left ultrasound guided core breast biopsies and a left breast ultrasound guided lymph node biopsy. Now that WWC will reimburse for a second breast biopsy on the same day, what should we enter in eCaST for proper reimbursement on this case?

WWC Care Coordination final diagnosis and lost to follow-up in eCaST

Clients enrolled into the Care Coordination Grant Program (CCGP) follow the same final diagnosis and lost to follow-up guidance as those who are enrolled in Clinical Services. Please ensure that the Final Diagnosis section is completed for all WWC Care Coordination and Clinical Services clients. If the Final Diagnosis is “Lost to follow-up," three attempts or interventions to contact the client must also be documented in eCaST under Case Management Information.

Cervical cancer screening expansion is coming to WWC Clinical Services and Care Coordination!

Women’s Wellness Connection (WWC) is expanding cervical cancer services to include women ages 21-39, tentatively starting January 2017, coinciding with Cervical Health Awareness Month. An initial announcement was made to WWC agencies and stakeholders May 2016. This policy change allows the WWC program, both Clinical Services and Care Coordination, to align with national guidelines for cervical cancer screening age recommendations. Women must continue to meet all other WWC eligibility requirements (income, lawful presence, insurance status) for enrollment. WWC age eligibility for breast cancer screenings will remain for women ages 40-64. To start preparing for this policy change:

• Look for additional information in the WWC Forum and WWC Update in the coming months, including a Cervical Expansion FAQs sheet and cervical case studies involving women 21-39.
• Attend the clinical webinar scheduled for October 5, 2016 from 12-1 p.m. Dr. Jan Shepherd will be discussing cervical cancer screening, diagnostic and treatment services for this younger age population.
• Start planning for EHR and form changes, staff training needs, and internal policy/workflow updates that will include enrolling women ages 21-39 into WWC for cervical screenings.

Please contact the nurse consultant, Angela.FellersLeMire@state.co.us with any clinical questions, including questions regarding the upcoming cervical cancer screening expansion.

BPS and CPT Code List for Fiscal Year 2017

The new 2016-2017 WWC Clinical Services CPT Code List is now available. There are no changes in CPT code rates compared to the previous CPT Code List released January 2016. The current CPT Code List is valid from June 30, 2016 through June 29, 2017. Rates are based on information found on the Centers for Medicare and Medicaid website, under physician fee schedule and clinical laboratory fee schedule. As per CMS, the new CPT codes became effective January 1, 2016. As of June 30, 2016, WWC can no longer reimburse for procedures using 2015 CPT codes. The Bundled Payment System (BPS) has also been updated and can be found on the WWC website.

Starting January 2016 HPV genotyping CPT code 87625 was added to the allowable CPT code list. As of June 30th, WWC has added reimbursement for HPV genotyping to the Bundled Payment System at the C3 level. CPT code 87625 should be used for HPV genotyping reimbursement. HPV genotyping determines if a patient is positive for HPV types 16 and 18, and is commonly used following an atypical squamous cells of undetermined significance (ASCUS) result to determine if the patient is a candidate for colposcopy. 

Effective June 30: When a same day second diagnostic breast procedure (i.e. breast biopsy) is required in order to reach a final breast diagnosis, agencies may now request additional reimbursement at the CPT code procedure rate. Please email the nurse consultant after both procedure results are entered into eCaST for administrative approval and timely reimbursement. 

Please see the fiscal year 2017 Clinical Services Bundled Payment System and CPT Code List to review these changes.

Important: Cervical Cancer Screening Expansion

We are so pleased to share with you a major legislative victory that will improve women’s health in Colorado by expanding Women’s Wellness Connection (WWC) cervical cancer screenings to women starting at age 21, instead of 40, tentatively starting January 2017.

Governor Hickenlooper recently signed HB16-1405, the Long Appropriations Bill for 2016-17 which is Colorado’s state budget. While the Long Bill includes many important items, the Colorado Department of Public Health and Environment (CDPHE) is excited to announce that the bill includes expanded eligibility for cervical cancer screening within the WWC program.

Women must continue to meet all other WWC eligibility requirements (income, lawful presence, etc.). This change allows the WWC program to align with national guidelines for age and cervical cancer screening and make great strides to improve women’s health. WWC age eligibility for breast cancer screenings will remain for women ages 40-64.

Women who meet WWC age and income eligibility criteria who are diagnosed with breast and/or cervical cancers may be eligible for enrollment into the Breast and Cervical Cancer Program (BCCP) through Medicaid. Therefore, in order to implement this programmatic change, both CDPHE and the Colorado Department of Health Care Policy and Financing (HCPF) are working together to modify each program’s systems, guidelines and processes to provide screening, diagnostic and treatment services, if needed, to eligible women in this expanded age group. 

We will continue to update you when additional information is available as we move closer to implementation. Please contact Angela Fellers LeMire, WWC Nurse Consultant at 303-692-2323 or Angela.FellersLeMire@state.co.us if you have questions about this change.

The 2016 WWC CPT Code List is available on the website

The updated list includes 2016 allowable CPT codes for WWC clinical services agencies. New codes are indicated in bold and deleted codes are indicated with a strikethrough. 

Rates are based on information found on the Centers for Medicare and Medicaid website, under physician fee schedule and clinical laboratory fee schedule. As per CMS, the new CPT codes became effective January 1, 2016. WWC allows both new and recently deleted codes to be reimbursed through June 29, 2016. The Bundled Payment System (BPS) is updated annually and will be released for the new fiscal year.

Changes to the 2016 WWC CPT Code List include:

• 87625- Human Papillomavirus, types 16 and 18 only. WWC funds may now be used for HPV genotyping.

Other clarifications include:

• Breast tomosynthesis (CPT codes G0279, 77061, 77062 and 77063) are specifically NOT allowed.
• Human Papillomavirus, low-risk types (CPT code 87623) is specifically NOT allowed.
• G0461 and G0462 codes for immunohistochemistry were deleted codes in 2015. Please be sure your agency is using the most recent immunohistochemistry antibody slide codes, 88341 and 88342.
• ICD-10 will not have an impact on CPT codes or rates. Changes in CPT codes are set by the American Medical Association and CPT code rates are set by CMS.

Please contact the nurse consultant, Angie Fellers LeMire with any questions.

Attendance performance indicator clarification

In the past, the attendance performance indicator requirement included attendance of one agency representative at 100% of WWC clinical webinars. For this fiscal year, the requirement will include any clinical webinar, training or conference that included topics related to breast or cervical cancer across the cancer continuum. Examples include: ASCCP conferences and patient navigation training. This does not include HIT calls or eCaST User Group calls. If you have questions on whether an educational opportunity qualifies, please contact me, Angie Fellers LeMire.

Updated maps on breast and cervical cancer screening and late stage incidence

CDPHE has updated its maps showing breast and cervical cancer screening (Pap test or mammogram) compliance and late-stage cancer incidence by health statistic region. Each map shows WWC clinical services sites and quantifies screening rates into four groups (depicted by circles) and late stage cancer incidence by shading of regions. These maps should be used to identify geographic areas of additional need for cancer screening and early detection. For more information on these maps and how they can be used, please review the end of Health Improvement Team (HIT) call from February 2015.

Clinical Corner: Evaluating clients with a past history of breast cancer

Question: Currently, we are allowed to reimburse for evaluation of clients with a past history of breast cancer after treatment is complete. What are the parameters and/or time periods allowed for "after completing treatment?"

Could clients with Medicare Part B qualify for WWC services as underinsured?

Question: Clients with only Medicare Part A qualify for WWC clinical services. Could clients with Medicare Part B qualify as underinsured if they are unable to pay their co-pay/co-insurance?

Answer: Clients who have Medicare Part B as health insurance are not eligible for WWC clinical services. If they are under 65, however, they can be enrolled in WWC care coordination.

In general, Medicare Part A covers hospital care, skilled nursing facility care, nursing home care, hospice, and home health services. Medicare Part B cover two types of services, medically necessary services and preventive services. Part B will cover a screening mammogram once every 12 months and diagnostic mammography when medically necessary in women 40 or older. Part B also covers Pap tests, pelvic exams, and clinical breast exams every 24 months for all women and every 12 months for those considered high risk for cervical cancer.

Additional information can be found here: https://www.medicare.gov/coverage/your-medicare-coverage.html.

Tips on preparing for mid-year data clean up

Budgets for WWC clinical services, WWC care coordination, and WISEWOMAN programs will be reviewed and adjusted based on spending as of the Jan. 15, 2016 bill run. Therefore it is important to make sure you data is up to date in eCaST before that time. The data team compiled tips to ensure your agency’s data are an accurate reflection of services provided since July 2015.

FY 2016 Shirley Hass Schuett Quality Award recipients

The Shirley Hass Schuett Quality Award is presented annually to the Women’s Wellness Connection (WWC) clinical services agency that provided the highest quality care to women as demonstrated by meeting program performance indicators and improving performance during the preceding fiscal year.

Shirley Hass Schuett was a nurse practitioner who served as the nurse consultant for WWC and was instrumental in the program's success in achieving positive clinical outcomes for women and helping the program to meet all core performance indicators.

The FY 2016 regional award winners, announced at this year’s Road Shows, were selected by WWC staff based on FY 2015 performance indicators. The staff selected agencies that were top performers in program performance indicators and agencies that demonstrated the most improvement in these measures.

Updated guidance on combined WWC clinical services and care coordination consent

We’ve received a couple of questions from agencies regarding the combined WWC clinical services and care coordination grant program consent, specifically regarding clients who move between the two programs and whether or not the same consent is valid for both programs.

After reviewing the current combined consent, our legal staff person noted that the instructions say “Please choose the left or right box to complete.” This means that the client is consenting to only one of the programs and therefore the client would need to fill out a new consent to enroll in the other program. In addition, if the client did not check all of the boxes on the current consent, the agency would need to go back and have the client to check the boxes to make their consent official.

To making obtaining consent from clients easier, we will be modifying the combined WWC clinical services and care coordination consent by changing most of the check boxes to bullets and changing the language to allow the client to consent for either program if they are eligible or become eligible.

We apologize if we have given conflicting guidance on these consents previously. Please assist us in ensuring your clients have a complete and signed consent for the program(s) for which you are requesting reimbursement. Please go back and obtain appropriate consents if you find you do not have them. We will let you know as soon as new consents become available.

If you have any questions about this, please contact your program coordinator.

December bill run is complete!

Your December 2015 grant activity statement is now available. Please run your grant activity statement from eCaST using December 1-31 as your date parameters. Make sure to select fiscal year 2016. When choosing the contract type, select "WWC" for WWC clinical services or "CCGP" for the care coordination grant program

Please contact either Nick Roth or Marina Milzer for any questions regarding viewing your reports.

If you have questions about your bill or spending in general, contact your WWC program coordinator, either Ivy Hontz or Kris McCracken.

Quick Review before HIT Call on 12/17: What are the CDC Core Performance Indicators?

The U.S. Centers for Disease Control and Prevention (CDC) Core Performance Indicators are evidence-based benchmarks established by the CDC to measure progress toward program goals for screening and quality clinical care. WWC clinical services agencies are required to meet or exceed all six indicators.

1. Rarely or never screened for cervical cancer: At least 20 percent of all clients newly enrolled for cervical cancer screening should be clients who have never been screened for cervical cancer or who have not had a Pap test in the past five years (rarely screened).
2. Women 50 and older receiving mammograms: At least 75 percent of all screening mammograms performed should be provided to clients who are 50 years of age and older.
3. Percentage of abnormal breast cases with complete follow-up should be at least 90 percent. Follow-up is complete when cases have a final diagnosis, cancer or not cancer.
4. Timeliness of follow up for breast cases: At least 75 percent of all completed abnormal breast cases must be completed within 60 days or less.
5. Percentage of abnormal cervical cases with complete follow-up should be at least 90 percent. Follow-up is complete when cases have a final diagnosis, cancer or not cancer.
6. Timeliness of follow up for cervical cases: At least 75 percent of all completed abnormal cervical cases must be completed within 60 days or less.

Join the HIT call Thursday, Dec. 17 from 11:00 a.m. to 12:00 p.m to discuss these indicators and get your questions answered​! To gain access, go to https://stateofcolorado.centurylinkccc.com/CenturylinkWeb/WWC. Click on the “Guest” tab, enter your name, and email address. Century Link will prompt you to provide a phone number to join the webinar, however you will still need to call 1-877-820-7831 and enter pass code: 335241# (Press # after the pass code) for audio.

Clinical Corner - Cryotherapy Reimbursement

Question: We have a patient that has a history of persistent CIN I and the provider wants to do cryotherapy instead of a LEEP. The provider states that a LEEP is too invasive and cryotherapy is more appropriate. Can we use WWC funds for this procedure?

Answer: Cryotherapy is considered treatment for this patient and WWC funds cannot be used for treatment. WWC reimburses for diagnostic LEEPs only. WWC would not cover the LEEP if it is for treatment purposes.

If you have a clinical question that you would like answered, please email Angela.FellersLeMire@state.co.us.

Does your agency have a new WWC clinical provider? Are you a new WWC clinical provider?

Welcome to WWC! As a new WWC clinical provider, you will want to become familiar with the Provider Resources web page and Part 4: Clinical Services of the WWC toolkit. These sections of the toolkit include the clinical policies and guidelines that both WWC Clinical Services and WWC Care Coordination programs must follow. 

November bill run is complete!

Your November 2015 grant activity statement is now available. Please run your grant activity statement from eCaST using November 1-30 as your date parameters. Make sure to select fiscal year 2016. When choosing the contract type, select "WWC" for WWC clinical services or "CCGP" for the care coordination grant program

Please contact either Nick Roth or Marina Milzer for any questions regarding viewing your reports. Nicholas.Roth@state.co.us or Marina.Milzer@state.co.us

If you have questions about your bill or spending in general, contact your WWC program coordinator, either Flora Martinez, Ivy Hontz, or Kris McCracken.

Remember: Check insurance status before each procedure!

Recently we have had a few agencies report to us that clients seen through WWC Clinical Services last fiscal year (June 30, 2014 to June 29, 2015) were actually billed to and paid by Medicaid. While agencies are not required to switch funding from WWC Clinical Services to Medicaid for services rendered between the client’s enrollment notification date and back-dated enrollment date, it is not allowable to charge the same service to two funders (i.e., WWC Clinical Services and Medicaid). When another funder has been charged for services rendered in a previous fiscal year, agencies must refund CDPHE funds paid for these services by sending CDPHE a check. If your agency identifies a change in funding source for services performed during the active fiscal year, simply update the funding source for affected procedures and the funds will be automatically reversed on your next grant activity statement.

While we know this may be inevitable for services performed last fiscal year, below are some best practices to help you avoid this in the future. We will remind agencies during our major mid-year and end-of-year data entry pushes. 

• Follow the new policy that insurance status be assessed before each clinical service is provided with WWC funds. 
• Verify regularly that WWC Clinical Services clients have not retroactively been billed to Medicaid. 

Please contact Emily, Marina or your WWC program coordinator with any questions.