Medical Business Journal Issue 3 Volume 2 January 2012

THE MEDICAL BUSINESS JOURNAL The Monthly Newsletter for the Informed Healthcare Professional

Inside this Issue:

JANUARY 2012

ISSUE 1

VOLUME 3

Gain referral points from patients Detox: Not just for alcoholics anymore

Obamacare may be here to stay, no matter who wins ICD-10: Truth or myth?

Congress Agrees: Free should mean free

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THE MEDICAL BUSINESS JOURNAL January 2012

Table of Contents The Medical Business Journal 11.3 Features

Contents

6 USA: Well on the Way to

10 CMS Now Covers Depression Screenings.

Now covered by CMS! How to get paid for it.

Achieving EHR. Still shopping? Read this first.

17 10 Things to Think About in 2012. Tips to refocus your business objectives in a positive way [from Practice Management]

9 When Free Screenings Become More. Congress agrees free should mean free.

22 CMS to Audit EHR Incentive Recipients. Attestation records should be kept for six years [from CMS News Updates]

14 CPT Official Errata 2012.

Your pre-ordered 2012 CPT is missing this information.

24 ICD-10. Myths and truths.

27 Year of the Audits: 2012. EHR incentives....be prepared.

16 Practice Management.

Gain referralstips for your practice.

Learn how to win a free iPad2 on Facebook at “The Cork Board!”

Inside Every Issue Letter from the Editor.................................4

Healthcare Professionals...........................19

Patients/Patience........................................8

CMS News Updates.................................20

Health Nut: Detoxification.......................12

Coding Corner..........................................28

The Podium..............................................15

MBJ Games and Fun................................29

5 The Cork Board

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THE MEDICAL BUSINESS JOURNAL Letter from the Editor

Letter From the Editor

Jennifer Donovan, RMC, CPC, RMM

grown d we’ve s of ear! n Y a d w e e g t N e chan ere’s lo Happy ars hav last year. Th ny things to d n le a e ec w ma this tim gain, th sure ho brings Once a d wiser since 2. The year n year. Not acts at the n io f 1 older a ent about 20 it is an Elect e interesting , ll m m a e o ut s excit st of heck o le. Fir the tab e your vote? C s as to Curiou ’. to gaug on page 15. n o g a r g shui ater D Podium the ‘W ulted the Fen f o r a s e on ey also th ans, I c This is actly that me ulated x ke calc s much what e , which says: a t , lf e s e t 12 hold forecas rove on to imp . The year 20 in your life. r a e y alth ition ad, good “It’s a d to build we major trans d, or really b a n o a e o ater ay b ely g risks, extrem ighty W e and m promis r it turns out ou ride the m e y Wheth end on how this p e d l il eme of h w t e h t e n!” lines of mprov Drago ng the re hold?”. I ification lo a s e it go e futu with detox d build entally, does th n g Coincid issue “What ess by startin ulated risks a e n ’s r lc ll a h u t t e c u n ef mo nd w 12). Take e for th ealth a your h Nut on page your practic g (Health y re-inventin t page 16). b n life, the e h lt m wea and in r been nage a s s e M in e s as neve : In bu (Practic y times t sentiment h some great n a m a e een said ge. Th t’s mak It has b stant is chan That said, le n only co idely shared. re, here! w e ! He r o m r good o f s e g chan ly, tr u Yours novan Jen Do

Legend of Acronyms in issue 11.3 ACS – American Cancer Society AGA - American Gastroenterological Association AMA – American Medical Association A/R – Accounts/Receivables ARRA – American Reinvestment & Recovery Act CDC – Center for Disease Control and Prevention CMS – Center for Medicare and Medicaid Services DHHS – Department of Health and Human Services (aka EFT- Electronic Funds Transfer EHR – Electronic Health Record EMR – Electronic Medical Record HIPAA – Health Insurance Portability & Accountability Act of 1996 HR – Human Resources IUD – intrauterine device MAC – Medicare Administrative Contractor MU – Meaningful Use NPPES – National Plan & Provider Enumeration System PECOS – Provider Enrollment, Chain & Ownership System POS – Place of Service (sometimes also still referred to as SOS – Site of Service) TOB – Type of Bills TOB 77x – Federally Qualified Health center TOB 71x – Rural Health Centers USPSTF – U.S. Preventative Services Task Force WSJ – Wall Street Journal

Editor-in-Chief: Jennifer Donovan, RMC, CPC, RMM

The Medical Business Journal Issue 11 Volume 3 January 2012

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Managing Editor: Jennifer Donovan Copy Editor: Rob Hassett, RMC, Julia Scott, RMC, Carleigh Thomson Contributors: Jennifer Donovan, Carleigh Thomson, Maria Albo Layout and Design: Carleigh Thomson The Medical Business Journal is a monthly source of up-to-date information on all issues affecting the healthcare industry. Its content ranges from medical coding and billing to healthcare reform legislature and beyond. The MBJ is not affiliated in any way with the Department of Health and Human Services, Medicare, or the Centers for Medicare and Medicaid Services. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional services, and is not a substitute for individualized expert assistance.

The CPT codes, descriptors, and modifiers are copyrighted by the American Medical Association. For more information, please call MMI at: (770) 709.6928.

CB THE MEDICAL BUSINESS JOURNAL The Cork Board

The Cork Board At a Glance

The DHHS has announced their “Health and Technology” Contest.

Entries must be received by Feb. 16th. If you, or someone you know, is using technology (e.g. apps, youtube, fitness/ weight management robots, etc) to get healthy and meet your new year’s resolution, enter to win your piece of $5,000 in cash and prizes. http://healthynewyear.challenge.gov/

g to turnin t u o b ing a althy Think or he f y g o ol eck techn e? Ch c n a t 3. assis page 2 living n o m uto out A

CPT Errata The AMA has released 19 pages of corrections to be used in correlation with your 2012 CPT. A summary can be found on page 14 along with a link to the full document.

AAPC proposes to drop the scarlet letter

CPC-/ A

For years, you could take the same CPC exam, but if you don’t show the Academy proof of two years experience, they will award you with a CPC-A. The Academy feels this has proven to put these individuals at a disadvantage when it comes time to look for employment.

Employers interpreted the “A” as a lower grade, when in actuality the same skills were proven through the exam. The Academy has finally agreed that the experience and references outlined in the job-seeker’s resume can serve the purpose of the dreaded “A.” The proposal has yet to be approved, but we’ll keep you posted. The AAPC is accepting comments from members through Jan. 31st at www.aapc.com/cpc-acomment

MMI has gone social!

Join MMI on our Facebook Page where we provide helpful resources, upcoming courses and events, and interesting articles and sources. Right now, if you “Like” and/or Comment on our Facebook Page or Follow us on Twitter (#MMIclasses), you will be placed into our drawing for a Free iPad2! The winner will be announced March 1, 2012 ...it’s that easy. Good Luck! www.facebook.com/mmiclasses

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THE MEDICAL BUSINESS JOURNAL Features

USA: Well On the Way to Achieving EHR 2011 in review plus tips and stories from the front lines First off, regarding MU incentives, how did America finish out 2011: As of Dec. 31 2011: 1. 123,921 Eligible Professionals have registered for EHR Incentives, 15,255 have successfully attested to MU in the Medicare program.

2. 3,077 Eligible Hospitals have registered EHR Incentives and 604 of those have successfully attested to meaningful use.

3. $2,533,689,145 has been paid out in Medicare and Medicaid Incentives.

4. 277 hospitals have received payments under both Medicare and Medicaid, and of those, 12 were CAHs. 5. 22% of eligible professionals that have been paid EHR incentives are Family Practitioners and 20% are Internal Medicine.

6. 41 States’ Medicaid programs were open for registration. Two additional states launched in January of 2012.

7. More than 1,500 EHR products have been certified by ONC-ATCBs. http://www.hitechanswers.net/ehradoption-2/certified-technology/ Talk about being stuck between a rock and a hard place; physicians find themselves in quite a predicament in 2012: maintain revenue to sustain without implementing EMR. Thus, facing penalties beginning in 2015 or spend the money on EMR, attest and receive incentive money to lessen the blow, which may amply prepare the practice to grow beyond achieving EHR as a country. What to do, what to do...

EHR Deadline for 2011 ends February 29th, 2012. This is when you must make sure you have attested for 2011 in order to complete the program to earn the maximum $44,000, by 2015. Those who don’t meet the requirement and/or deadline, can still earn the maximum incentive dollars, but they will not complete attestation until 2016.

Attestation Survival Guide: Facts and Tips: • Fact: Tedious especially if attesting for multiple providers.

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• Fact: CMS created user-friendly webbased attestation process.

• Tip: Be sure EHR provides info in useful format. If you’ve succeeded to meet all required measures, come prepared; there’s no reason to be unsuccessful.

• Tip: Register in advance. Even though you can technically registered just before attesting, but the combination of the two tasks will be overwhelming.

Better to register as soon as possible and attest when its best.

• Tip: Make sure everything is up to date in NPPES and PECOS and have all necessary information.

• Fact: Make sure all measures have been met, if EHR doesn’t show percent for measures with thresholds, do the math to verify your success of each. CMS offers worksheets at www.cms.gov • Fact & Tip: Verify that other (nonnumerical) measures are met; if you fail to satisfy one – don’t attest at this time. Go back and try again at another reporting period.

What to have: • Document for education provider • Registration confirmation page with registration ID • Password • EHR certification number • Reporting period date (covers at least 90 days) • Print all MU measures; numerator and denominator, exclusions and reasons (when more than one possible reason applies) • Clinical Quality Measures Report: numerator and denominator, exclusions Before you submit: • Do not submit until you review the Attestation Summary • Double and triple check the data • Make sure you’ve answered “yes” to all yes/no measures and your numbers are entered accurately. Do the math to be sure they meet.

• Submit attestation and print the “Submission Report” as confirmation for your records. If all is done, the correction will state “all measures are

accepted and meet meaningful use standards” Closing Tip: Partner with someone in your office. Two pairs of eyes are better than one. “Do it nice so you don’t have to do it twice.” Get a complete list of measures here: h t t p s : / / w w w. c m s . g o v / EHRIncentivePrograms/Downloads/ EP-MU-TOC.pdf What do seasoned EMR users think?

View from the Sidelines EHR blogger Dr. Michael West, an EHR expert and endocrinologist based out of Wa s h i n g t o n , D C , p e r fo r m e d a n experiment to see [from a never-going-tosee-the-carrot point of view] if attesting is really worth it if you take the reward out of the picture. Note: Dr. West has fully implemented EMR in its practice.

He simply decided against attestation.

You know what they say, don’t do something you wouldn’t do for free…let’s see what he found: • The EHR incentive portal is very time consuming as you must go through the

“Talk about being stuck between a rock and a hard place; Physicians find themselves in quite a predicament in 2012...”

Final word: “I’m not poo-pooing the dogooders out there who want to give their time to the process and try to make the world a better place through being meaningful users of health IT. Just please don’t hate the business-oriented group of doctors out there who have done the math and dabbled in its enough to choose otherwise.” Check out his full blog at www.Happyemrdoctor.com Is EHR attestation one size fits all?

A specialty suffers While most radiologists are eligible to participate in the federal electronic health records incentive program, a large percent are still skeptical of or uniformed about meaningful use requirements. Here are some interesting figures on the subject: • Approximately 216 (40%) of these were concerned about lack of clarity in the guidelines or the decreased efficiency as a result of current meaningful use guidelines.

• Of the 60% who expressed interest in MU, only 25% are very involved in making the decisions regarding it and only 6% are considered educated on the subject at all.

• 25% felt their EHR vendor was prepared to help them meet the requirements. Some radiologists are concerned that current guidelines don’t take radiology into consideration. They feel clinical decision support was important, especially for referring physicians and saw this as a means to ensure the amount of unnecessary and costly imaging.

Others felt that radiation dose tracking and patient engagement were the least beneficial criteria. Radiologists have also stated in interviews that while they feel patients have a right to their images and reports, they indicated no obvious medical benefit or necessity for them to have electronic access.

What will EHR change?

As we move to ultimate EHR achievement, it will change everything about the way we run our practices.

HR Success Story Dr. John H. O’Neill came from a practice not unfamiliar with the paper-chase game. He states the office was “well run” with the exception of that pesky paper business. When he went solo, he also went electronic. All his records for existing and new patients have been converted and kept as EHR. He is now a strong advocate for the changeover and promotes the help offered by the U.S. DHHS Recovery Act. Catch his full success story here: http://www.hhs.gov/recovery/programs/ solo_doctor.html In the market?

Shopping for EHR With seemingly all possible EMRs being certified, how do you choose? As long as you know one size most certainly does not fit all, it’s a start. Check out these on-line posts for serious considerations: Hidden Expenses: http://www.emrandhipaa.com/emr-andhipaa/2011/08/19/common-emrimplementation-issues-unexpected-ehrexpenses/ Performance Issues http://www.emrandhipaa.com/emr-andhipaa/2011/08/24/common-emrimplementation-issue-ehr-performanceissues/ If you don’t have time to read the above posts, MBJ has compiled the 10 common hidden costs to look out for when implementing an EMR. Here is what we determined (in no particular order): 1. Is a telephone/Internet upgrade required? This is especially true if the practice has more than one location or if the practice is using an ASP model.

2. Count up your maximum required tablets/pads/etc. on any given shift and then add 50%. The practice will inevitably have one or more units “in the shop” over time.

3. Plan to buy extra batteries for all your portable equipment.

4. You will need to store your new equipment, safely and securely. Many doctors say they’ve had a few clients who have had their shiny new laptop

THE MEDICAL BUSINESS JOURNAL Features

lengthy entry process, before you are notified of all the areas along that way that you failed to meet the requirement.

• Each entry takes upwards of 10 minutes. That’s almost 17 hours for a doc with 100 Medicare patients!

Crude calculation: • Take 5 years of attestation at 365 days and you get 1,825 days, divide that by the $44,000 incentive over time and your incentive is $24/day for a heck of a lot of work.

collections stolen from the office. The practice will need space and to spend extra dollars in making this accommodations.

5. If you already have a Practice Management software in place, note that the interface integration charges can be significant. More importantly, the functionality can be unclear.

6. Training needs are something to be considered. It is the norm for vendors to limit your training – naturally; it’s the most expensive part of the deal.

Add to that configuration time, support requirements, and postonline follow up too. If your training is counted in hours, then be prepared to wish you had more…hours, that is.

7. Don’t overlook IT expenses. There have been some outlandish quotes given to our clients in the last 12 months. I know clients who pay more for a local IT service to load virus programs and “support” their network than they pay for their EHR or PM and all that entails. Lately, this is has been the biggest culprit for unexpected costs.

8. Be mindful of the long race. There are some big-ticket upgrades still on the horizon. A few vendors are making waves for charging for “ARRA” upgrades. They will soon be charging for “ICD-10” upgrades, etc.

A few well-known vendors made the WSJ back in 1999 when they made a fortune on Y2K upgrades.

9. Plan for reduced productivity. Some practices may lose little, if any, productivity but they are the exception, not the rule. In fact, some offices also have a lower E&M distribution after going on-line because they are finally charting properly.

10. Is there any chance that this revolutionary change in your office will cause you to lose any employees or providers? You’d be surprised how some people react to change.

Throwing in the towel happens more than we care to count.

Why even spend the money? What about the free ones out there? Before going the ‘free route’, you may want to read this: The Risk of EHR Starts to Cost: http://www.emrandhipaa.com/emr-andhipaa/2011/05/10/the-risk-of-free-ehrstarting-to-cost/  7

Patients/Patience THE MEDICAL BUSINESS JOURNAL Patients/Patience

Gain referral points for treating patients like people, not as health issues The patient experience starts with contacting your practice for an appointment. At this moment, they begin to form their opinion about the business. For a great many years, patients have been misled to think they must qualify to be a patient. It is still portrayed today on some drama series – good doctors have waiting lists and you must take what they give you and be happy they’re taking time out of their precious day to see you at all. Well, unless you’re in a one-horse town and you’re the only doc office for miles and miles and miles that just isn’t going to cut it nowadays.

Today, patients are empowered, as they should be. They are the consumer and should be treated just as you would expect to be treated at a fine restaurant (except here, they are occasionally asked to take off their shirt, put on a paper one and sit in a room by their self for 10 minutes). Physicians offer a service. Being in private practice puts you in the service industry. As such, you and your managers have the right (and the duty) to audit the hospitality skills in your office.

“Once you know what kind of brush you’re being painted with in terms of initial contact, you can then make adjustments and intervention solutions...”

How? First start by calling, or having a close family member or friend call, to schedule an appointment. This is a two-part process that can be gauged simultaneously, so read the whole thing before you jump right in to your secret mission. like to feel connected. Remember, experience doesn’t trump a Here are some routine things to look for (Remember, first impression. you are now the patient): Before closing the call, here are some things your How many rings before you get an answer? staff can do to make the patient’s initial experience Are you greeted by a machine or by a person?

If by a machine, is the phone tree organized in a pleasant and welcoming: manner that is easy for the user to navigate?

• Be sure they know where they are going. Give great • Were you put on hold? If so, how long did you hold? directions with landmarks.

• Was there a variance between the time you wanted • Give parking advice (especially if you’re in a large and the time slots available? building, have a large parking lot or practice in the • Did you leave a message? If so, how long did it take to city). get a call back?

• Give them a distinct indicator that will let them know • In order to survive in this business, you must appeal to they’ve found your location (“there is a four foot the younger patients (see Practice Management on knight by the front door”…or whatever it may be). page 16). Is there an on-line option to schedule • Be sure your staff smiles when they answer the phone. appointments? If so, is it up-to-date and integrated to o Yes, I know you can’t see over a traditional the main scheduling system in real-time? phone, but smiling while talking comes through in your voice. This projects a much Once you know what kind of brush you’re being painted with more pleasant sound than mumbles and in terms of initial contact, you can then make adjustments and grunts. intervention solutions like replacing people with technology, • After the appointment is scheduled, let the patient setting policies for the number of rings, hold times, call back, know what to bring with them, how long to expect the and new patient appointment requests. visit to last, and offer to send any paperwork they can complete in advance to save time on the intake While running through the mechanics involved in getting the process. patient in the door, there is also a quality (a mood, if you will) Make sure every interaction is positive.  • that should meet the standards of the practice as well. Patients • • •

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Patients are held responsible Last year debuted the first round of covered preventative screenings by the CMS. For patients, they hear “free” and think, well, “free.” But these screenings cause a bit of confusion when they produce findings. When a screening service turns into a diagnostic or procedural service, it becomes the patient’s responsibility. The coverage is only free if the service remains a screening. For example: the patient goes in for a colonoscopy and nothing is found. In this case, it’s free.

However, if the doctor removes just one non-cancerous polyp, the patient can owe hundreds or even thousands. This circumstance harms the patient financially as well as the relationship with the provider.

How can your practice help with this level of patient dissatisfaction? Patient education is key. As with Medicare patients, when a service runs the risk of not being covered, the patient must be notified via an ABN. Heck, if you take your car in for repairs, they run a diagnostic test and then notify you of what needs to be done in order to obtain approval before doing the work. So then, why are some patients waking up to a bill for a service they thought was supposed to be free?

Well, as a general rule, the larger the adenoma, the more likely it is to eventually become a cancer. As a result, large polyps are usually removed completely to allow for microscopic examination.

Colorectal cancer is the second leading cause of cancer deaths in the United States, accounting for 14 percent of cancer deaths. Colorectal cancer is preventable if precancerous polyps (i.e., adenomas) are detected and removed before they become malignant (cancerous). Over time, small polyps can change their structure and become cancerous.

Polyps are usually removed when they are found during a colonoscopy, which eliminates the chance for that polyp to become cancerous. But what about times when the doc must remove the polyp and there is no time to obtain permission from the patient and insurance doesn’t cover the removal? It’s a vicious cycle, isn’t it?

Due to the commonality of this scenario, the AGA and ACS are asking Congress to revise the laws to waive patient cost for the screening with or without polyp removal. Only time will tell. 

THE MEDICAL BUSINESS JOURNAL Features

When Free Screenings Become More

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THE MEDICAL BUSINESS JOURNAL Contents

CMS Now Covers Depression Screening Government for prevention continue Depression is a leading factor in a myriad of health issues including obesity, headaches, and suicide.

According to WebMD depression affects 19 million Americans annually and is estimated to contribute to half of reported suicides; about 5-10% of women and 2-5% of men will experience at least one major depressive episode during their adult life.

Although WebMD states depression affects people of all ages, races, gender, incomes, professions and religions, women are twice as likely as men and the elderly are five times more common to be diagnosed with depression. According to a Gullup-Healthways Well-being survey of over 250,000 Americans, one in six report history of depression. Most of these come from an income class of $24k or less, as well as separated or divorced individuals, and the groups least likely to report a diagnosis of depression are men, African Americans, Hispanics and Asians.

General causes include genetic, biological and environmental factors. Some people can trace the root to one single cause, others to many causes and for many they have no idea when their depression started or what started it. It is also said that people with these particular personality traits are more likely to become depressed: negative thinking, pessimism, excess worry, low self-esteem, hypersensitivity to perceived rejection, overdependence on others. Geez! Next thing you know they’re going to narrow that down to single-mothers

“Depression is a leading factor in a myriad of health issues including obesity, headaches, and suicide.”

and teenage heartbreak. In all seriousness, WebMD says superiority and alienation from others are ineffective responses to the condition.

Effective October 14, 2011, there’s some light at the end of the tunnel. The CMS is now covering a 15-minute annual depression screening for its beneficiaries. The elderly and disabled rank pretty high up on the depression chart. For the elderly depression can include diminished ability to think or concentrate, unexplained physical conditions (e.g. stomach pains, change in bowel movements, achy muscles, etc), memory impairment, the tendency to isolate and feelings of uselessness.

The following is how to report the USPSTF grade B provision that carries an economic burden of over $83 billion (according to Medpage Today): HCPCS code G0444 - Annual depression screening, 15 minutes.

(This code will appear on the January 2012 Medicare Physicians Fee Schedule update) Type Of Service The screenings are covered for adults for depression in the primary care setting that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up number.

As transmittal 2359 states, for purposes of this NCD: A primary care setting is defined as one in which there is provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing sustained partnership with patients, and practicing in the context of family and community. Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, inpatient rehabilitation facilities, and hospice are not considered primary care setting under this definition.

Place Of Service G0444 would be covered only when services are provided at the following Places of Service (POS): 11 - Office 22 - Outpatient hospital 49 - Independent clinic 50 – FQHCs 71 - State or local public health clinic 72 – RHCs

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THE MEDICAL BUSINESS JOURNAL Contents

Coverage Limitations Coverage is limited to screening services only. This does not include treatment options for depression or any diseases, complications, or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy, combination therapy (counseling and medications), or other interventions for depression. Self-help materials, telephone calls, and web-based counseling are not part of this NCD and are not separately reimbursable by Medicare.

Screening for depression is non-covered when performed more than one time in a 12-month period. Eleven full months must elapse after the month in which the last annual depression screening took place. Medicare coinsurance and Part B deductible are waived for this preventive service.

Medicare will not pay G0444 separately with another encounter/visit on the same day billed on TOBs 71X or 77X. This does not apply, however, to claims with the Initial Preventive Physical Examination (IPPE) containing modifier 59 or to 77X claims containing Diabetes Self-Management Training or Medical Nutrition Training services.

These programs promote collaboration among PCPs, mental health professionals and care management team. The focus is on proactive assessment and early intervention, with the goals of improving patients’ quality of life and treatment outcomes.

Things you may see in these programs: • A tool to screen for depression as well as monitor response to treatment • Reimbursement for depression screening and follow-up monitoring • Patient Health Questionnaire (PHQ-9) specifically developed for use in primary care • Self-administered, quick and easy • Specific for depression • Available in English and Spanish • Assistance with behavioral health referrals • The option to refer eligible patients to Depression in Primary Care program by telephone Program to be reported as follows: Before doing so, again, check with your payor:

• CPT code: 99420 Administration and Coinsurance and Deductibles interpretation of a health risk assessment Effective October 14, 2011, beneficiary coinsurance • ICD code: V79.0 (screening for depression)  and deductibles do not apply to claim lines with annual depression screening, G0444.

Did you know? According to a recent study, women who regularly drink coffee have 20% Private Payor Guidelines lower risk of depression than non-drinkers.

Check your contracts with your payors However, studies are not concluded as other Some Private Programs provide primary care studies show a very high level of caffeine can physicians (PCPs) with a one-stop resource to help increase anxiety and insomnia (potentially diagnose and treat patients with depression age 19 reversing any mood-lifting effects). years and older.

Sources: [http:// www.gallup.com/ poll/123821/ one-sixamericans-reporthistorydepression.aspx] [http:// www.emedicineh ealth.com/ depression/ page2_em.htm] [http:// well.blogs.nytimes .com/ 2011/09/26/ coffee-drinkinglinked-to-lessdepression-inwomen/]

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THE MEDICAL BUSINESS JOURNAL Health Nut

Health Nut Detox: Not just for alcoholics anymore Since we rang in the New Year, I’ve been humming Semisonic’s 1998 hit “Closing Time”. I know what you’re thinking…the anthem for bars at the end of the night when they want you out?: Well, yes. But other than that…the specific lyrics, “…every new beginning comes from some other beginning’s end”. This is your new beginning. 2012 is the year to make the changes that you haven’t had time for in the past. This year, you are going to put yourself first and learn to say “no”.

NO to running an extra errand. NO to picking up a coworkers slack. NO to getting up early to let someone else sleep in. Say it with me: “NO!” ...Doesn’t that feel good?

But where to start?

Recovery, whether it be from alcohol, illegal substances, food or a sedentary lifestyle, involves a certain amount of detoxification before you and your body can truly begin to heal. Like the old saying goes ,“garbage-in, garbage-out”...but if you’ve spent months, years, or in some cases decades loading your diet with garbage, how do you stop when your body starts to crave only the bad? The answer is to cleanse. Give yourself a truly fresh, clean start.

I’m not saying eat only bread and drink only water, hit the gym and finish the day with an empty stomach.

Thinking in the extreme only promotes unrealistic goals of instant gratification and more often than not the gratification is not what you expected or feel you deserve. So don’t go the “hurry up and fail” route.

Extreme measures make for short-lived results. You deserve a chance to become (and stay) healthy for the rest of your life.

So then…detoxification from what?

Simply put, the body reacts to unnatural things in a very, well, unnatural way. Certain foods and drinks can slowly poison your body, which results in s lug gis h n es s, feelin g g ro g g y, s l e e p i n e s s , sleeplessness and weight gain. If you eat foods that are processed in any way, shape, form or fashion…there are toxins present.

Re m e m b e r, j u s t because something is hot doesn’t mean its fresh and just because components of your meal are supposed to be healthy doesn’t mean it’s healthy as a whole. Prime 12

example: The Wrap. For many, this is the popular lunch go-to. Did you know that just the flour tortilla alone can be 300 calories! That’s a lot of calories for flour and water, which offers no nutritional value, and not to mention the process to make the tortilla is similar to that of paper-mache. Solution: make the wraps yourself.

Use a low fat, low carb tortilla and use oil and vinegar or salsa as opposed to the high-fat dressings you get in most restaurants and take-out joints.

First step to your detox: Eliminate Caffeine.

I can hear the groans. Tip: You may want to start this process during your days off, as not to throw off your work week completely. Here’s a suggested start (for the first 2 weeks): Eat protein for breakfast. You can mix in some good fats (Don’t go low-fat. Olive oil, nuts and avocados are good. Saturated and Trans fats…stay away!)

• For the first 3 days: Cut down your caffeine intake in half; • On the 4th day: Sub in 1 cup of green tea (steeped for 5 minutes in just boiled water – remove and discard the bag after 5 minutes, leaving the bag in your cup will make your tea bitter and, literally, leave a bad taste in your mouth); • On day 5: Take 1000 to 2000mg of Vitamin C powder – (there are products like Emergen-C that you can add to your water to make this step easier); • Each day: Drink 8-10 glasses of water.

• In addition to caffeine, eliminate sugar and white flour right from the start: Read your labels!

If the first ingredient in your bread choice doesn’t say “whole”, don’t eat it. Remember, just because the bread is brown, doesn’t mean the grains are whole.

Go cold turkey here. Going back and forth will only make your cravings worse (the more the body gets these “bad” carbs, the more it craves them). Don’t cheat! We’ll start adding good stuff in later, but the goal for this initial 2 week period is to detox and cleanse.

Snack, Snack, Snack. During this time, you want to snack. That’s right, I said snack. You want to eat 5-6 times a day: protein for breakfast, mid-morning snack, low-carb/high-protein lunch, afternoon snack, high protein/plenty o’ veggies dinner, after dinner snack. Try making your own trail mix with all your faves to make snacking fun (Try the recipe to the right).

Sub in Laughing Cow cheeses, fruit or whole grain fiber bars for the bag of chips or normal baked goods. If you like those trendy power bars remember they shouldn’t just taste like grain and fruit, go for the ones where you

After week 2, you will begin feeling more energetic and less drawn to bad foods. However, you don’t want to go back to your old ways. As you start incorporating “real” foods back into your diet, be sure to inventory how each food makes you feel overall and especially if you have any specific reaction.

Foods to keep on hand (Weeks 2-4): • Garlic, onions, leeks and shallots.

• Broccoli, cabbage, kale, collards, kohlrabi, brussels sprouts, bok choy, watercress.

• Berries (blue, black, straw), purple grapes, plums, beets, red onions, red cabbage, radicchio, arugula, spinach, parsley, cilantro, flax seed, peaches, sweet potatoes, squash, carrots, good extra virgin olive oil.

• Proteins: sardines, herring, wild salmon, sole, codfish, tilapia – as fresh as you can get it.

• Legumes are, of course, encouraged: black, red, and navy beans, lentils, etc.

• Don’t forget to spice things up with tumeric, rosemary, purple sage, garlic and ginger. Try to avoid salt and black pepper.

Additional Foods to Avoid: Alcohol Animal protein (except fish) Caffeine Corn Dairy products and eggs Gluten, white bread, and white rice Ketchup and tomatoes Peppers Eggplant Pasta Salad dressings (use olive oil, lemon and garlic instead) • Salt, sugar, and soy • Soda, fast food, and junk food • Foods that come in a box, package or can.

• • • • • • • • • • •

THE MEDICAL BUSINESS JOURNAL Health Nut

can actually see bits of fruit in the bar…if not, and you’re not running a marathon that d a y, you probably don’t need it.

Home-made Trail Mix Recipe Sub in your favorite fruit, nuts, and grains to customize your “trail!”

Ingredients ¼ cup sunflower seeds Nonstick cooking spray 1/3 cup maple syrup 2/3 cup packed brown sugar ½ cup unsweetened cranberry juice 1-1/2 ground cinnamon 2 cups old fashioned rolled oats (can sub ½ cup of oats for ½ cup of flax seed) ½ cup chopped roasted almonds ¼ teaspoon fine salt 1 cup dried fruit (cranberries, apricots, whatever you like)

Directions

Preheat the oven to 350º Toast the sunflower seeds for 8-10 mins (when you start to smell them, they are done).

Reduce the oven temp to 325.

Spray baking sheet with non-stick spray.

In a small saucepan over medium heat, combine the syrup, sugar, juice and cinnamon. In a bowl, toss together the oats, almonds, seeds and salt. Pour the maple mixture over the oats mixture and spread the mix onto the baking sheet [with the non-stick]. Bake for 20 mins.

Remove and stir in dried fruit. Bake for an additional 10 to 15 mins until brown. Cool completely. Can be stored in an airtight container for roughly a week.

New Rule Take time to take care of you. You’ll feel much better if you put in an extra 30 minutes to do something good for your body than if you save that time and have to take years to reap the fruits of your labor…if it ever comes at all.  13

THE MEDICAL BUSINESS JOURNAL Features

CPT Official Errata 2012 As posted by the AMA: What is the CPT errata and why do I need it?

What is an errata?

The definition of errata is a list of corrected errors appended to a book or published in a subsequent issue of a journal. At the close of every production cycle for the CPT® code set, AMA publishes an errata—also known as a corrections document— and makes it readily available in its entirety to all via the AMA Website. Creation of this document occurs every year, and the errata is updated continually throughout the year as needed.

The information contained in the errata is the result of the continued review of the CPT code set

by AMA staff as well as other users and reviewers.

Typically, the corrections detailed in the errata regard such issues as typographical errors, misspellings, transposed numbers, and missing punctuation. Occasionally, the CPT Editorial Panel m ay i s s u e a rev i s i o n t o c l a r i f y p ro p e r implementation of a code or guideline.

All corrections in the errata are ultimately included and published in the CPT code set for the following year.

Corrections to category 1, 2 and 3 codes and coding instructions can be found in the 2012 Errata from long definitions to small changes such as code 64479’s descriptor which changed from reading as singular to plural.

Here’s a summary of what you will find in the full corrections document:

New instructions defining “other qualified health care professionals” Defined as ‘an individual who by education, training, licensure/regulation, facility privilege (when applicable) who performs a professional service within his/her scope of practice and independently reports a professional service. These professionals are distinct from clinical staff. A clinical staff member is a person who works under the supervision of a physician or qualified health care professional and who is allowed by law, regulations and facility policy to perform or assist in the performance of a specified professional service.

Other policy may also affect who may report specific services. Registered Nurse (RN) or Licensed Professional Nurse (LPN) are not included independently and will be unable to independently 14

report certain services such as prolonged E/M, immunization administration (90460, 90461) and neuro-psychological and cognitive tests (96120, 96125, respectively).

CPT is not specialty specific The AMA reminds that the listing of a service or procedure and its code number in a specific section of the CPT does not restrict its use to a specific specialty group. Any procedure or service in any section may be used to designate the service rendered by the qualified physician or qualified health care professional or entity (e.g., hospital, clinical lab, or home health agency).

Four substantial instructions for cardiovascular system codes Describe vascular injections procedures “for purposes of coding interventional procedures in arteriovenous (AV) shunts created for dialysis (both arteriovenous fistulae (AVF) and arteriovenous graft (AVG)). The AV shunt is artificially divided into two vessel segments. For more, see page 5 & 6 of the 19 page corrections document found on the AMA Website: http://www.ama-assn.org/ama/pub/physicianresources/solutions-managing-your-practice/ coding-billing-insurance/cpt/about-cpt/ errata.page 

The Podium: 2012 Presidential Election THE MEDICAL BUSINESS JOURNAL The Podium

Obamacare may be here to stay, no matter who wins “With more focus on other areas, the healthcare law has become difficult to undo as it has worked its way into American life.

Political advisors say Republicans will make a mistake if they dwell on repealing the law.”

Remember, 2012 marks the 57th quadrennial U.S. Presidential Election. It will be held on Nov. 6, 2012 and is expected to feature the incumbent President Barack Obama for the Democrats and the yet to be decided Republican candidate as well as the increasingly obligatory third-party nominee (also yet to be decided). If you’re like many Americans, you vote because it’s your duty as a citizen. But also like many, there are still concerns about how the results will affect your everyday life.

There are many factors to weigh in before you cast your vote in November, but one of your top concerns may no longer be much of a concern at all- health care reform (aka.

“Obamacare”).

Although Republican presidential candidates are still vowing to repeal the ACA (though not as publicly), their main focus now is President Obama’s economic record. Why? The ACA has been overshadowed by the lagging economy (which is surveyed to be, by far, the top concern of voters), not to mention the nation’s employment situation. As a result, the opposing parties’ efforts to repeal is running out of gas. With more focus on other areas, the healthcare law has become difficult to undo as it has worked its way into American life. Political advisors say Republicans will make a mistake if they dwell on repealing the law. Many Americans don’t want to move backwards or start over. If there are problems, work out the kinks.

Two years ago, healthcare reform was a top issue; now talks have moved to debt, deficits, and spending. That said, it looks like the ACA may be here to stay. However, keep in mind that other topics can certainly have an affect on the existing reform strategy.

For information about how the electoral vote process works, check out this interactive map at http://www.270towin.com/ 

15

THE MEDICAL BUSINESS JOURNAL Features: Practice Management

Practice Management Tips and stories that can help your practice run more smoothly Marketing Your Practice Do’s, Don’ts and Why-nots Before we get into ways of how to market your practice to keep it viable, let’s quickly go over the “who”. We, as a nation of merchants, are selling to a variety of consumers. So before you just throw something out there, you must first understand what varieties there are and what avenues consumers use to find who they should spend their money with.

We are in a day and age where physicians are no longer the one great man in the village that everyone turns to for advice, comfort, and healing. Heck, docs are viewed as a dime-a-dozen these days; too competitive and by those two statements alone, often flat-out disrespected. If a patient doesn’t like what you have to say or doesn’t get the prescription they want, they smear your name all over the Internet and tell everyone they know not to go to you…for reasons other than clinical. What a world, huh?

With new crazes out there offering discounted services below insurance rates or for those with no insurance at all, it sure does make it difficult to know who you’re going to treat next…and if you’ll ever see them again. Kind of makes you feel dirty, doesn’t it?

Consider the generations to help with traditional marketing in your community.

The Baby Boomer (before 1964): Consumers in this generation appreciate this history of your practice, how long you’ve been in the community, your reputation, and tenure in the market place. These stats instill confidence and help gauge their overall comfort level. Since today’s technology was not taught to this demographic as standard schooling, these consumers prefer live or in-person, face-to-face communication.

Generation X (1965-1979): These guys focus on the future. They want to be acknowledged for their individuality and want to know what you plan to do going forward. This is also a very cynical generation so your certificates and degrees don’t deem you an expert; they need proof of action. Gen X-ers conduct a lot of on-line research before making any major decision. They are the toughest customers, but once won over, they are some of the loyalist ones you’ve ever had the pleasure of connecting with. When they are satisfied, they will spread the word. Additionally, Gen X-ers are now helping their maturing parents (Baby Boomers) make financial decisions so their influence goes beyond direct business with you. Email and texting is the preferred communication for Generation X. 16

Millennials (1980-2000) This demographic is entering the stage of major changes like moving out on their own; they’re also having children later. Many also have a close relationship with their parents, more like friends, but also like the Generation X-ers, they have a bit of influence in their parents’ decisions. Everything must be an immediate application for these guys. Talk about how you are going to work with them to come up with a shared decision about their unique circumstance.

Think About What Makes You Stand Out In 2011, many practices slashed their marketing budgets to reduce expenses. Why is that the automatic go-to? Think about it: You’re in business. You see other practices closing and cutting back staff, right?

This means…you got it: fresh clients to market your services to. So, what makes you stand out? How can you distance yourself from your competitors? Do you offer later hours? Weekend hours? Ideal location?

Ample parking? Patients dig that kind of stuff ! Inform the community of any positive news – contact health fairs, social media outlets, your website, and any materials that you give to patients or the public.

There are tools like GooglePlaces that allows businesses to share with the community. The things that make them unique are the ability to post contact info, photos, video and news about upcoming events and promotions.

Here are the 10 Things to Think About in 2012 1.

2.

Hire the right people and nurture their role. You may find exactly what you need in the traits of the unexpected.

Benchmark and monitor key indicators. If you don’t measure it, you can’t manage it. Think about what will happen if everything went wrong. What are your options?

3.

Personify with patients. Build rapport with the community. Work toward word-of-mouth referrals and social media.

4. Value lessons learned from mistakes.

What is it called when you do the same thing over and over again, expecting different results?

That’s the definition of “insane”…don’t do that to yourself. Another great saying; “learn from the mistakes of others – you can’t live long enough to make them all yourself ” – Martin Vanbee (author) 5. Develop a vision for your practice. What do you stand for and how can you demonstrate your values? Depict it in a way where others can see it and can get excited about achieving it with you. Work on moving everyone forward as a whole.

6. Enter into new relationships for the right reasons. Recognize the long-term necessity of making thoughtful, well-informed decisions.

Don’t buy into a smile and handshake…we’re in the age where information is right at our fingertips at all times; recognize when you need to use it, and do it.

7. Compete against your younger self. Now, I’m not saying to try and run a 4-minute mile like you did back in college (many of us didn’t have as much weight to pound down on our knees back then as we do now; not to mention our knees themselves were likely much less achy and squeaky). Think about a time when things were uncomplicated and you just wanted to do what you felt was right in your soul – before money, before bills, before CMS and private payors. Inquire with family and friends and take their outside points of views into consideration for an improved you.

8. Hypocrisy is not sexy. If you tell your patients to take care of themselves, take care of yourself too. It’s staggering to think about how much time people waste telling other people not to do what they are doing.

9. Accept less-than-perfect. Everyone’s human…even you.

10. Concentrate on what you can control.

Invest your time and energy wisely. “All energy is borrowed, and one day we have to give it back” – Avatar, 2009 

THE MEDICAL BUSINESS JOURNAL Feature:s Practice Management

Here are the top 6 ways patients look for physicians when entering a new community: Ask near strangers in person (this is popular with moms): Whether you are a new conventional mom or mom to a pet (e.g. dog), this most often occurs at a park, grocery store or school. They’ll straight-out ask: what doctor do you go to? Are they good? Are they accepting new patients?

On-line strangers: Some will explore sites like FourSquare or visit the communities Facebook page.

On-line listings and reviews: Have you Googled yourself lately? See what’s out there about you.

Actual physical mailbox: Many cities, especially the smaller ones, will greet new residents with “Welcome” packets filled with discount coupons and offerings for businesses in the area.

Signage and familiarity: This is where branding is key. If you have a familiar logo, some may find comfort in that. Or if you are part of a large practice (e.g., WellStar) this may bring more patients your way too, without having to do anything at all.

Gut Feeling: There are still some patients out there that go by gut feeling (even when seeing your name in their insurance list.) Ultimately, many will go by gut feeling once they meet you. If they’re not satisfied with the service, they will likely not return. 

Patients Seek On-Line, Daily Deals for Affordable Health Care Can this put doctors at risk?

The Associated Press has reported the rise in patient use of daily deal sites like Groupon to pick up the slack where insurance fails to come through. For those who are unfamiliar, Groupon has made quite an impact on the on-line marketing scene by offering limited-time discounts on a variety of discretionary goods and services. They made their debut in the market by offering group discounts for restaurants, wine tastings, spa visits and hotel stays. Recently there has been an increase in opportunities to receive 17

THE MEDICAL BUSINESS JOURNAL Features: Practice Management

discounts on high-cost and cosmetic services such as dentist appointments, eye exams, chiropractor visits and LASIK procedures. These services are new to Groupon and mean huge savings for people who just can’t feasibly afford to pay outrageous premiums anymore and especially for patients who’ve dropped additional coverage such as dental.

The CDC reveals 46.3% of Americans under the age of 65 years old do not have insurance. The good

“...If federally covered, and the patient pays for the service out-of-pocket, and the Doc is enrolled, there could be some legal risk...private payors still may not be safe.” news for the provider is unlike direct mailers that carry a low redemption rate and a high upfront cost (consider layout, print and postage), Groupon purchasers pay for the discounted rate at point-of-sale and subsequently book the appointment to redeem the offer before its expiration date.

According to what one consumer told cbsnews.com when asked why he dropped his insurance, he stated he “considered himself wasting money on something he rarely used.” Another consumer, Thomas Cho, purchased a Groupon offer for LASIK for $2,100 (the surgery is normally priced at $5,000). Dr. Gregg Fienerman states that by going through Groupon, he “was able to reach a whole new demographic that otherwise wouldn’t have found [him].” According to Dr. Fienerman, the $5,000 price tag was often viewed as much too rich for the under 30 crowd, but when he approached Groupon to sell the service for $3,000, they pushed him to $2,100 and he got exactly what he was looking for. Had Cho gone through his insurance, it would’ve only paid 20% leaving him responsible for $4,000. After upgrading his service to full-laser at an additional $1,000, Cho still saved $1,300 by not going through his insurance company.

Other recent top healthcare service Groupons are as follow: • New York: Groupon - Full Medical Check Up including blood, stool, urinalysis test for $69 (normally $200) • Chicago: Living Social sold dental exam, cleaning, x-ray and teeth whitening packages for $99 (savings of $142) • Seattle: AmazonLocal – Flu shot for $17 (down from $35) It has been reported in November 2011, 9% of deals through these means were for dental work or some other healthcare related treatment; this is up from 4.5% in early 2011. This number claims to have increased due to Groupon copycat sites, such as Google and Amazon who recently got in the game.

Other attempts have been made in the past year by big names such as Facebook and Yelp, but they have since dropped out of the race.

These deal offers benefit the provider with instant exposure and a “pop” in business while benefiting the consumer who wants to “try something new while saving money” and/or “saving money on something they already use.” Sounds too good to be true?

(C’mon - we’d be doing you a disservice if we didn’t make you think.) This type of marketing is revolutionary for the doctor who doesn’t participate in government programs or who specializes in cosmetic procedures only. For participating docs, this could mean a serious anti-kickback law penalty- so be careful.

Could Groupon and the likes be breaking laws?

Industry attorneys warn that the anti-kickback forbids health care professionals from paying or giving anything of value to someone including a website for sending patients. Being that Groupon reaps either half the revenue generated from a given offer or receives a “revenue-split” that varies depending on the volume of business, this constitutes as a kickback. To avoid this kind of attention, the services offered can’t be covered by traditional federal funding. However, if federally covered, and the patient pays for the service out-of-pocket, and the doc is enrolled, there could be some legal risk...private payors still may not be safe.

Many have stipulations in their contracts guaranteeing the best price. Worst case scenario here, the physician is forced to offer all services at the reduced price whether they purchased a Groupon or not.

Another point to ponder is what kind of patient will walk through your door? Will you attract the provider-hopping-patient who chases the next best deal or the long-time-loyal-patient who refers you to all their friends and family? The former makes it difficult to 1) build a lasting relationship with the patient, and 2) monitor their progress. While the latter is, for many, why they became a provider in the first place. But what about the patients who need care immediately, and don’t have time to wait for the deal that meets their needs?

Also in Industry works: Patient-controlled payment process, known as the self pay or cash pay trend that has become increasingly popular over the past year, in all aspects of health care. The prices of medical services, immediately necessary or trivial, are the highest they have ever been, leading even those who are insured to end up spending on average $3,000 to $4,000 each year out of pocket. Pricing transparency in the health care system has led informed patients to make wiser decisions when it comes to their health care, because they have been able to determine what they are truly paying for. It looks like solutions are being sought everywhere, by everyone and every group, but the ultimate goal remains: Get the patient more involved in their own health care. 

What are you doing to make this process more bearable? Share with us at mbj@mmiclasses.com

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As posted by Monster.com

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THE MEDICAL BUSINESS JOURNAL Healthcare Professionals

Healthcare Professionals

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THE MEDICAL BUSINESS JOURNAL CMS News Updates

CMS News Updates

21 Final Rule Allows Access to Medicare Data

21 HHS Moves to Streamline EHS

21 CMS Battles ID Theft

22 HEAT Releases Information to TRAIN

22 CMS to Audit EHR Incentives Report

22 The DHHS Publishes Initial Set of Measures

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CMS efforts toward transparency continue Pearl Harbor Day 2011 (that’s Dec. 7th) marks the day that gives qualified organizations access to provider and supplier claims data for the purpose of evaluating performance and general public reports. When evaluating, Congress requires multiple sources. In other words, they cannot only use the information within the Medicare claims data.

CMS’ Acting Administrator, Marilyn Tavenner, states this is a “giant step forward in making the health care system more transparent in promoting increased competition, accountability, quality and lower cost. This provision of the health care law will ensure consumers have the access they deserve to information that will help them receive the highest quality care and the best value for their dollar.”

This availability of Medicare data will also be used to gauge performance measures, such as: • Technical changes were made to the definitions of a qualified entity, provider, and supplier, as well as new definitions of claims data and clinical data. Clinical data is now defined as “registry data, chart abstracted data, laboratory results, electronic health record information, and other information relating to the care or services provided to patients that is not included in administrative claims data.”

• CMS clarified that qualified entities do not need to be a single organization. Applicants may contract with others to achieve the ability to meet the eligibility criteria.

• Changes to eligibility requirements were made to only require that entities demonstrate expertise in quality measurement and in the three areas of measurement (efficiency, effectiveness, and resource use) to the extent that they propose to use such measures.

• CMS added language that would require qualified entities to also disclose any violations of applicable federal and state privacy and security laws and regulations for the preceding 10-year period, in addition to requiring qualified entities to disclose any inappropriate disclosures of beneficiaries' identifiable information for the preceding 10-year period.

• CMS extended the time period between a qualified entity, sending a confidential report to a provider or supplier and public reporting of measure results to at least 60 calendar days.

The final rule also makes claims data less costly for qualified entities to obtain. In the proposed rule, CMS estimates the cost of providing data for 2.5 million beneficiaries to a qualified entity to be $200,000. The final rule drops the program management portion of costs to bring them down to $44,000 in the first year of the program, based on an estimated 25 qualified entities participating in the program.

Physicians’ offices will incur internal costs for reviewing their performance reports. CMS estimates physicians will spend an average of 5 hours reviewing their annual report at a rate of $42.88 per hour, for a total expense of $214. CMS also estimates that preparing and submitting an appeal would cost a physician another $429. 

THE MEDICAL BUSINESS JOURNAL CMS News Updates

Final Rule Allows Access to Medicare Data

HHS Moves to Streamline EFT Projected to save the healthcare system billions In early January 2012, HHS released a rule that adopts streamlined standards for the format and data content when a health plan transmits a claim from a provider to its bank when it wants to pay via EFT and wants to issue a notice of payment as well. HHS claims the effort will save the healthcare system billions of dollars over the next 10 years.

The AMA has been calling for improvements like these for years. The provisions to the ACA and HIPAA build upon regulations that set industry-wide standards for how health providers use electronic means to determine a patient’s eligibility for heath coverage and check on the status of a health claim.

In 2010, the AMA wrote a white paper calling on the government to “eliminate significant administrative waste from the healthcare system by simplifying and standardizing the current healthcare billing and payment process.” Also, in 2010, the Journal of Health Affairs published a study that found nearly 12% of every dollar physicians receive from a patient goes to fund paperwork and administrative tasks! The same study found that by simplifying these tasks, almost 9 hours could be saved per week. You know what they say; ”time is money,” and it certainly holds true with this.

CMS’ newly acting administrator, Marilyn Tavenner, who is a nurse herself, recently repeated a common refrain, noting in an HHS release, “…the less time a physician spends on paperwork, the more time he or she can devote to patient care…Having standardized procedures across the healthcare industry can only lead to lower costs and greater efficiencies all around.”

Organizations covered by HIPAA must comply with the new rule by January 1, 2014. 

CMS Battles Identity Theft MAC & OIG set up a hotline By no means are physicians immune from identity theft, especially in this day and age. Just about every other industry that houses personal information has been hit – credit card companies, banks, the mortgage industry; you name it.

Well, thieves have moved on to steal provider information to use it to file illegitimate Medicare claims that leave victimized providers with overpayment demands, tax liabilities, and credit degradation. In many cases, the doctor doesn’t even realize they have

21

THE MEDICAL BUSINESS JOURNAL CMS News Updates

been compromised until they get a demand letter from the MAC, at which time they contact the program integrity contractor comprised of program safeguard contractors (PSCs) and zone program integrity contractors (ZPICS). They then conduct extensive investigations and report findings to CMS. CMS makes the final decision to relieve the provider of liability and informs the affected provider of its decision in writing.

If you feel you may be a victim of identity theft, contact your jurisdictional MAC or the OIG hotline at 800-HHS-TIPS. 

HEAT Releases Information to Train on Fraud and Abuse Laws Free videos and podcasts available Compliments of the OIG, health care providers now have access to free videos and podcasts that cover major health care fraud and abuse laws, the basics of health care compliance, and what to do when compliance breaches arise…just to name a few. These modules are spinoffs of “Navigating the fraud and abuse laws”.

Additional titles include “Operating an effective compliance plan” and “Importance of Documentation”. Check them out here: http:// oig.hhs.gov/newsroom/video/2011/heat_modules.asp 

Latest Fraud Target Part D Prescription Drugs Sponsors are aiming to stop drug misuse and fraud, especially with pain killers (e.g., Oxycontin) which is the 5th most filled drug by Medicare at $3.9 billion. The GAO identified this problem and prompted CMS to convey the message: Investigate and Stop Payment for Suspect Claims • Medicare’s requirement that pharmacies receive prompt payment for prescription drugs does not prevent sponsors from investigating suspect claims and withholding payment for fraudulent claims.

• When a sponsor suspects fraud with respect to a particular claim, payment need not be made until the claim has been investigated further to determine that it is not fraudulent.

Use Tools to Help Manage Proper Drug Use • Prior authorization requirements are a common tool employed by Part D sponsors to ensure appropriate utilization and coverage under the Medicare Part D program.

• Pa r t D s p o n s o r s m ay i m p l e m e n t reasonable prior authorization requirements for drugs, such as opioids, that are more susceptible to abuse and diversion.

Limit Prescriptions to 30-Day Doses • The guidance encourages plan sponsors to work with doctors to prescribe less than 30 day

22

supplies for drugs that are more susceptible to abuse or diversion.

• The Obama administration is keen to continue its success in recovering $5.6 billion in fraudulent payments in 2011, which it says is a 167 percent increase from 2008. 

CMS to Audit EHR Incentive Recipients Attestation records should be kept for 6 years CMS clearly states that there will be audits: “All providers attesting to receive an EHR incentive payment for either Medicare or Medicaid EHR Incentive Programs should retain ALL relevant supporting documentation (in either paper or electronic) format used in the completion of the Attestation Module responses. Documentation to support the attestation should be retained for six years post-attestation. Documentation to support payment calculations (such as cost report data) should continue to follow the current documentation retention processes.”

CMS even tells us how to prepare for an audit: “To ensure you are prepared for a potential audit, save the supporting electronic or paper documentation that supports your Clinical Quality Measures (CQMs).

Hospitals should also maintain documentation to support their payment calculations.” See the EHR Guide segment on page 6..

HHS Publishes Initial Set of Measures Voluntary measures for Medicaid reporting program On January 4, 2012, HHS published 26 measures, down from the original 51. Although these are voluntary at first, it is expected they will eventually become required.

Many of the measures are similar to those of the CMS (who originally proposed these measures) such as breast cancer screening, cervical cancer screening, chlamydia screening for women, controlling high blood pressure, and smoking cessation assessment.

By September, the CMS intends to release technical specifications as a resource for states seeking to voluntarily collect and report the initial core set.

However, voluntary reporting will not officially begin until January 1, 2013, when the agency will issue guidance.

HHS said “States that chose to collect the initial core set will be better positioned to measure their performance and develop action plans to achieve the three part aims of better care, healthier people, and affordable care.” 

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THE MEDICAL BUSINESS JOURNAL Contents

ICD-10 Myths and Facts VS. Concerns and Opinions Healthcare facilities have honest concerns about the path to ICD-10-CM/PCS implementation. Healthcare experts emphasize that providers have lots of work to do to meet documentation requirements, adapt their software, and prepare for decreased billing productivity. On Oct. 1, 2013, the current system will expand to add approximately 55,000 new codes, and CMS will require all health professionals and facilities to transition with no grace period.

In late 2011 the ICD-10 was in the hot seat when the American Medical Association House of Delegates announced its opposition to the switch. AMA President Peter W. Carmel, MD, stated, "The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patient's care.

At a time when we are working to get the best value possible for our healthcare dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions."

Despite the AMA's opposition, CMS maintains that the 2013 implementation date for the new coding system stands.

We here at the MBJ answer many questions regarding the future of the industry. Many questions, in particular, about the ICD-10. In efforts to put an end to some of the rumors, the following list of Myths and Facts are from CMS directly and we’ve also blended in some Concerns and Opinions as they have been sited online and in-house.

Myth: The October 1, 2013 compliance date for implementation of ICD-10 should be considered a flexible date.

Fact: All Health Insurance Portability and Accountability Act (HIPAA) of 1996 covered entities MUST implement the new code sets with dates of service, or date of discharge for inpatients that occur on or after October 1, 2013.

Myth: Implementation planning should be undertaken with the assumption that the Department of Health and Human Services (HHS) will grant an extension beyond the October 1, 2013 compliance date.

Fact: HHS has no plans to extend the compliance date for implementation of ICD-10; therefore, covered entities should plan to complete the steps required in order to implement ICD-10 on October 1, 2013.

Myth: Non-covered entities, which are not covered by HIPAA such as Workers Compensation and auto insurance companies that use ICD-9-CM may choose not to implement ICD-10.

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Fact: Because ICD-9-CM will no longer be maintained after ICD-10 is implemented, it is in the non-covered entities’ best interest to use the new coding system. The increased detail in ICD-10 is of significant value to non-covered entities. CMS will work with non-covered entities to encourage their use of ICD-10. However, at this particular point, the non-covered entities do have a choice.

Myth: State Medicaid Programs will not be required to update their systems in order to utilize ICD-10 codes.

Fact: HIPAA requires the development of one official list of national medical code sets. CMS will work with State Medicaid Programs to ensure that ICD-10 is implemented on time.

“...The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patient’s care.”

AMA President Peter W. Carmel, MD

Myth: The increased number of codes in ICD-10 will make the new coding system impossible to use.

Fact: Just as an increase in the number of words in a dictionary doesn’t make it more difficult to use, the greater number of codes in ICD-10 doesn’t necessarily make it more complex to use. In fact, the greater number of codes in ICD-10 makes it easier to find the right code. Just as it isn't necessary to search the entire list of ICD-9 codes for the proper code, it is also not necessary to conduct searches of the entire list of ICD-10 codes. The Alphabetic Index and electronic coding tools will continue to facilitate proper code selection. It is anticipated that the improved structure and specificity of ICD-10 will facilitate the development of increasingly sophisticated electronic coding tools that will assist in faster code selection.

Because ICD-10 is much more specific, is more clinically accurate, and uses a more logical structure, it is much easier to use than ICD-9. Most physician practices use a relatively small number of diagnosis codes that are generally related to a specific type of specialty.

Concern: Payors will deny more claims with ICD-10 Opinion: Payors are very concerned with business continuity and continue to pay claims that they're really not looking for excuses to deny, because of simple inefficiency. Payors have their auto-adjudication rate. The percent of claims that come in that are fully adjudicated by their core claims

Concern: Providers will receive lower reimbursements under ICD-10.

Opinion: Payors are looking for "reimbursement neutrality." That means that overall; payors are looking to pay the same amount. Some claim reimbursements will increase but be offset by decreases in other reimbursements. (Joe Miller of E-business at AmeriHealth on www.healthcarepayernews.com)

Myth: ICD-10 was developed a number of years ago, so it is probably already dated.

Fact: ICD-10 codes have been updated annually since their original development in order to keep pace with advances in medicine and technology and changes in the health care environment. The coding systems will continue to be updated until such time that a decision is made to “freeze” the code sets prior to implementation. For instance, the health care community may request that ICD-9-CM and ICD-10 codes not be updated on October 1, 2012 and be frozen with the October 1, 2011 updates. If the freeze were approved through formal rule making, it would provide a year or more of stability and an opportunity to develop coding products and training materials. ICD-10 could then be updated again on October 1, 2014, after providers have had a year of experience under the new coding system.

Myth: ICD-10 was developed without clinical input.

Fact: The development of ICD-10 involved significant clinical input. A number of medical specialty societies contributed to the development of the coding systems.

“Providers shouldn’t be worried by higher (intentional) denial rates, except that it is every likely that payors will deny more claims because they are improperly coded, which isn’t the payor’s fault.”

Myth: There will be no hard copy ICD-10-CM and ICD-10PCS codebooks. When ICD-10 is implemented, all coding will need to be performed electronically.

Fact: ICD-10-CM and ICD-10-PCS codebooks are already available and are a manageable size (one publisher’s book is two inches thick). The use of ICD-10 is not predicated on the use of electronic hardware and software.

THE MEDICAL BUSINESS JOURNAL Contents

systems without being touched in any way by a person.

Payors want to ensure that flow of claims keep going.

Providers shouldn't be worried by higher (intentional) denial rates, except that it is very likely that payors will deny more claims because they are improperly coded, which isn't the payor’s fault. Remember, they're just trying to be efficient…at first. At some later point, some payors may add some edits for ICD-10 around “unspecified codes” and “that”.

Myth: Unnecessary detailed medical record documentation will be required when ICD-10 is implemented.

Fact: As with ICD-9-CM, ICD-10 codes should be based on medical record documentation. While documentation supporting accurate and specific codes will result in higher-quality data, nonspecific codes are still available for use when documentation doesn’t support a higher level of specificity. As demonstrated by the American Hospital Association (AHA)/American Health Information Management Association (AHIMA) field testing study, much of the detail contained in ICD-10-CM is already in medical record documentation but is not currently needed for ICD-9-CM coding.

Myth: Implementation of ICD-10 can wait until after electronic health records and other health care initiatives have been established.

Fact: Implementation of ICD-10 cannot wait for the implementation of other health care initiatives. As management of health information becomes increasingly electronic, the cost of implementing a new coding system will increase due to required systems and applications upgrades.

Myth: ICD-10-CM-based super bills will be too long or too complex to be of much use.

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THE MEDICAL BUSINESS JOURNAL Contents

Fact: Practices may continue to create super bills that contain the most common diagnosis codes used in their practice.

ICD-10-CM-based super bills will not necessarily be longer or more complex than ICD-9-CM-based super bills. Neither currently used super bills nor ICD-10-CMbased super bills provide all possible code options for many conditions. The super bill conversion process includes: • Conducting a review that includes removing rarely used codes • Cross-walking common codes from ICD-9-CM to ICD-10-CM, which can be accomplished by looking up codes in the ICD-10-CM codebook or using the General Equivalence Mappings (GEM).

“In fact, ICD-10-CM contains many more codes for signs and symptoms than ICD-9-CM, and it is better designed for use in ambulatory encounters when definitive diagnoses are often not yet known.”

Myth: The GEMs are intended to facilitate the process of coding medical records.

Fact: Mapping is not the same as coding: • Mapping links concepts in two code sets without consideration of patient medical record information; and • Coding involves the assignment of the most appropriate code based on medical record documentation and applicable coding rules/guidelines.

The GEMs can be used to convert the following databases from ICD-9-CM to ICD-10: • Payment systems • Quality measures • Payment and coverage edits • A variety of research applications involving trend data • Risk adjustment logic Myth: Each payor will be required to develop their own mappings between ICD-9-CM and ICD-10, as the GEMs that have been developed by CMS and the Centers for Disease Control and Prevention (CDC) are for Medicare use only.

Fact: The GEMs are a crosswalk tool developed by CMS and CDC for use by ALL providers, payors, and data users.

The mappings are free of charge and are in the public domain.

Myth: Clearinghouses will help providers comply with ICD-10.

Fact: They're helping with HIPAA 5010, which is considered a change in the format that data is transferred. Providers have to submit ICD-10 data on Oct. 1, 2013.

Myth: Medically unnecessary diagnostic tests will need to be performed in order to assign an ICD-10-CM code.

Fact: As with ICD-9-CM, ICD-10-CM codes are derived from documentation in the medical record. Therefore, if a diagnosis has not yet been established, the condition should be coded to its highest degree of certainty (which may be a sign or symptom) when using both coding systems. In fact, ICD-10-CM contains many more codes for signs and symptoms than ICD-9-CM, and it is better designed for use in ambulatory encounters when definitive diagnoses are often not yet known. Nonspecific codes are still available in ICD-10 for use when more detailed clinical information is not known.

Myth: Current Procedural Terminology (CPT) will be replaced

by ICD-10-PCS. Fact: ICD-10-PCS will only be used for facility reporting of hospital inpatient procedures and will NOT affect the use of CPT. 

For additional ICD-10 information, including the GEMs and educational resources, visit http://www.cms.gov/ICD10

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Who’s afraid of the big bad wolf ? RACs, ZPICs, EHR Incentive audits, oh my!

Another cycle closes and another sigh of relief. Don’t move so fast. Are you sure your process is squeaky clean? Are you one of the many practices out there just waiting to be audited to avoid having to pay for a professional to come in, but begging for someone to tell you if they are doing something wrong?

Well this may be your year.

Auditors will be out in force, auditing in the true CMS fashion of “pay and chase.� That’s right- you thought they outgrew that, but not quite. Over $2.5 billion was paid out in 2011, and in 2012 you may have to give it back. See “CMS to Audit EHR Incentive Recipients� article on page 22.  The subject of an Audit always has many, many questions. To help, CMS has even told us how to prepare for an audit: “To

ensure you are prepared for a potential audit, save the supporting electronic or paper documentation that support your attestation. Also save the documentation to support your Clinical Quality Measures (CQMs). Hospitals should also maintain documentation to support their payment calculations.�

“To ensure you are prepared for a potential audit, save the supporting electronic or paper documentation that support your attestation...�

CMS

In next month’s issue, we will give you a list of preparation tips as well as FAQs... stay tuned! ď ¨

THE MEDICAL BUSINESS JOURNAL Contents

Year of the Audits 2012

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THE MEDICAL BUSINESS JOURNAL Coding Corner

Coding Corner “Thank you for being there when I have questions.”

-Kim D. McKinney, TX

Q: Is there a code I can use for silver nitrate being used to Q: Should I bill both CPT codes if I know one is bundled cauterize a new bleed. Ex: Patient comes in for IUD insertion and the cervix continues to bleed from the tenaculum usage. Silver Nitrate is used to stop the bleeding.

A: If granulation tissue was present, you may want to take a look at 17250. 17250=The physician uses chemical cauterization to destroy granulation tissue such as excess scar tissue, also referred to as proud flesh, or a sinus or fistula.

Liquid silver nitrate applied with a Q-tip or a silver nitrate stick is dabbed onto the granulation tissue. This is done during the last stages of healing of an open wound.

However, if the bleeding started and continued due to tenaculum usage only...Here is an answer from the American College of Obstetrics to a similar question: "There is no specific code for chemical cautery of the cervix.

This is because, normally, the procedure simply involves the application of a silver nitrate stick to the cervix, and does not require specialized equipment or expensive materials. If you think you can make a case for significant physician work in applying the silver nitrate, you can bill this as an unlisted procedure (58999).

Otherwise, I would simply consider this incidental to the exam and bill only an evaluation and management service. You can, however, bill for the supplies using 99070 (supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered)."

Q: When billing smoking cessation with EM code or Well Woman Exam do I need to append a 25 modifier to the E&M or Wellness code?

A: Modifier 25 is not needed.

However, be sure the

amount of time is recorded since these are time-based codes.

Note: if it is below 3 mins (brief counseling), it may not be separately reportable, but to be sure you will want to check your payor contract.

with the primary code? Example: 58541 and 58660

A: When a code is bundled within another code, you will only report one - the more complex of the two.

Q: When a woman comes in and has had a “+” pregnancy test at home and wants to confirm the pregnancy here at the office. Is it appropriate to bill and E&M code and ultrasound (limited) with the diagnosis code 626.0 amenorrhea? Our Ultrasounds are not covered with the V72.42.

A: If the physician uses the ultrasound only to confirm pregnancy, you can report the limited ultrasound code 76815 (Ultrasound, pregnant uterus, real time with image documentation, limited [e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume], one or more fetuses) or the transvaginal code 76817 (Ultrasound, pregnant uterus, real time with image documentation, transvaginal), if performed by this route.

Note: Some practices do not charge for this ultrasound at all because it tends to be a quick check just to see if there is a heartbeat.

As for diagnosis coding, you have some options depending on the stated reason for the visit. You should not use V72.4 (Pregnancy examination or test, pregnancy unconfirmed), however, because you will know at the end of the visit whether the patient is pregnant. Code 626.8 (Other disorders of menstruation and other abnormal bleeding from female genital tract; other) is one possibility if the patient had missed a period or, in this case, had a positive home pregnancy test with a missed period.

If you have already started the obstetric care at this visit, other possibilities include antenatal screening (V28.8, Other specified antenatal screening) or the code for uterine size-date discrepancy (646.83). If the ob-gyn is following intrauterine growth retardation, you should submit 656.53 (Poor fetal growth; antepartum condition or complication). 

Send us your “Q’s” via email (cc@mmiclasses.com), phone (866-892-2765), or our Facebook Page (www.facebook.com/MMIfan)

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THE MEDICAL BUSINESS JOURNAL MBJ Games and Fun

In 2011, MedScape held a series for write-your-caption contests For your enjoyment, here are a few of the winners!

As Posted by MedScape

Winning caption: "No wonder you are feeling low. Your battery is just 10%."

Second place: "There's a long protocol to follow to have this removed. But luckily enough, there's an app for that."

Third place: "Can you grow one out of your other ear? I have a family plan for my cell phones."

Winning caption: "Obviously the patient misunderstood me when I asked if he could pass a football."

Second place: "Perhaps we need a review of the term 'first down.'"

Third place: "It's too big for a gastroscopic snare, but no razors or lasers â&#x20AC;&#x201C; it's signed by Aaron Rodgers!"

Winning caption: "Looks like that omega-3 fish oil really works!"

Second place: "I've seen a fistula before, but never a fishtula!"

Third place: "Doctor, can you prescribe me a Spawning-after pill?"

Winning caption: "Take us to your primary payer!"

Second place: "Looks like they have outsourced the emergency helicopter service."

Third place: "Giant killer platelet, with persecution complex, seeks to avenge years of antiplatelet use at Metro General."

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THE MEDICAL BUSINESS JOURNAL MBJ Games and Fun

oss Puzzle

Meaningful Use & EHR Crossword Puzzle http://puzzlemaker.discoveryeducation.com/code/BuildCrissCro..

Print out this puzzle and have a little fun testing your MBJ knowledge!

Meaningful Use & EHR Created by Puzzlemaker at DiscoveryEducation.com

Across: 1. Centers for Medicare and Medicaid Services 5. Health Information Exchange 6. Stimulating 8. American Gastroenterology Association 10. Technology that deals with electronic Across circuits 1. Centers for11.Medicare and Medicaid Services Essential Character 5. Health Information Exchange 13. Evaluation 6. Stimulating14. Provider Enrollment, Chain, Ownership 8. American Gastroenterology Association System

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10. Technology that deals with electronic cicuits 11. Essential Character 13. Evaluation 14. Provider Enrollment, Chain, Ownership System Down

Down: 1. Certification Commission of Healthcare Information Technology 2. Electronic Health Record 3. Objectives that providers must meet to qualify for the EHR incentive 4. Provide or serve as clear evidence of 7. to ascertain the number of 9. Health Insurance Portability Accountability Act of 1996 12. Making, usage and knowledge of tools, machines and techniques

Need 12 CEUs? 1.Subscribe to BC Advantage Magazine Visit www.billing-coding.com/subscribe to start your BC Advantage Magazine subscription today and receive a FREE 12-Month Online CEU center membership!

2. Login and read a collection of articles Login to your own personal CEU account at www.billing-coding.com/ceu. Select a CEU package or Audio conference. Read the articles or listen to the audio for that package. Take a quick online quiz.

3.Print your CEU certificate After you have completed the online quiz, select the association you need the CEUs for and print your CEU certificate. Easy!

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2012 BOOK DEALS

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