Endonomics June 2011

JUNE 2011

F ederal Inc entive P lans

(T hree S eparate P rograms )

E lec tronic P res c ribing (eR x) Inc entive P rogram – Reimbursement Reduced for Eligible Professionals Who Do Not Participate. For more information, please see the special edition MLN Matters article SE1107.

• Eligible professionals may begin reporting the eRx measure at any time throughout the 2011 program year of January 1-December 31, 2011, to be eligible for the 2011 incentive.

• Eligible professionals must have reported the eRx measures before June 30, 2011 to be exempt from the 2012 eRx payment adjustment. More Information

P ropos ed R ule for C hanges to the 2011 eR x Inc entive P rogram The presentation materials are now available under the “Downloads” section on this link.

EHR Incentive Programs-To get your EHR incentive payment, you must attest (legally state) through Medicare's secure Web site that you have OR WILL be demonstrating "meaningful use" with certified EHR technology. Registration can be done before an EHR is installed and should be done as soon as possible.

Do you have questions about attestation?

• • • • • •

How will I attest for the Medicare and Medicaid Incentive Programs?

When can I attest? And What can I do now to prepare for attestation?

Where can I find user guides and other resources?

What will I need to login to the Attestation System?

Can I designate a third party to register and/or attest on my behalf?

When will I get paid? And How will I get paid?

EHR Templates are important to consider during your EHR selection.

AmericanEHR Blog

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Practice Management & Coding Educational Opportunities for 2011 All courses

Federal News HIPAA 5010– Compliance Deadline is Six Months Away!

National 5010 Testing Day is August 24, 2011  Electronic claims will require a street address  GetReady5010.org – Free webinars and resources  5010/D.0 Errata requirements and testing schedule  Contact your MAC for their testing schedule  Have you done the following to be ready for 5010/D.0?  What do you need to have in place to test with your MAC?  Do you know the implications of not being ready?

How to Prepare for an Audit

Quarterly ICD-10 Article Reminds Industry to Get Ready for Version 5010 This article provides steps to help reach compliance and new

Live Webinar Series th & July 27th July 13 12:00 p.m. – 1:30 p.m.ET

resources and tools CMS is developing to help you prepare for the transitions.

Find out who the auditors are, why they are auditing your practice, what information they are looking for and what is required for documentation.

More information

Charting a Course for ICD10 th

July 28 & 29

Jacksonville, Florida

The transition to ICD-10 takes effect in October 2013 – and CMS has indicated that there will be no delay. It's time to start planning now!

L imited S eating!

More information

Bridge Gaps in Endocrine Coding August 13th

Chicago, IL

This one-day course is for experienced coders and will cover: • Components of a Medical Record • Fine Needle Aspirations • Injections & Infusions • Nurse Visits • E/M Codes and When to Utilize with Procedures And more!

L imited S eating!

More information

ICD-10-CM Impact Analysis Report from CMS analyzes the transition from ICD-9 to ICD-10 on CMS policies, processes and systems. Scroll down to the Downloads section on this link.

The 2011 ICD-10-CM files on this page contain information on the new diagnosis coding system, ICD-10-CM (effective October 1, 2013).

CMS implements a partial ICD-9 code freeze on October 1, 2011.

Starting October 1, 2012 there will be only limited code updates to ICD–9–CM and ICD–10 code sets to capture new technology and new diseases.

AACE ICD-10 Course July 28-29th Sign up for CMS ICD-10 email updates FREE CMS sponsored ICD-10 teleconferences ICD-10 Basics from AACE AAPC ICD-10 Resources

Medicare Coverage & Other Information

CMS Proposes a NEW Rule about Signatures on Lab Requisitions Released June 29, 2011 The proposed new rule would retract the policy adopted in the calendar year 2011 Physician Fee Schedule final rule and would reinstate the prior policy that the signature of a physician or qualified non-physician practitioner is not required on a requisition for Medicare purposes for a clinical diagnostic laboratory test paid under the CLFS(clinical laboratory fee schedule).

Medicare is administered under the local MAC’s (Medicare Administrative Contactor) authority, also referred to as the “Medicare Local Carrier.” There were originally 15 MACs awarded administration of Medicare part A and B plans. Over the next several years, CMS will consolidate them into ten A/B MAC workloads.   

List of MAC Web sites Contact for Part B MACs Durable Medical Equipment MACs

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(Almost) Everything You Need to Know About Those Incentive Programs August 26th

Ft. Lauderdale, FL

Is your Medicare patient population 30% or greater? If so, you are looking at a reduction of Medicare reimbursements by as much as 5% of your total Medicare allowable charges due to lack of participation in CMS’ incentive programs.

Medicare provides coverage for HIV screening as a Part B benefit for eligible beneficiaries at no out-of-pocket cost (no coinsurance, copayment, or deductible).

• CMS National Coverage Determination – NCD for Screening for HIV • Medicare Learning Network’s “Guide to Medicare Preventive Services” • MLN Matters Article MM6786, “Screening for HIV” • MLN’s “HIV Screening” Brochure

Medicare enrollment application forms are fillable on your computer.

Signatures are still required to be handwritten.

More information

Advanced Beneficiary Notice Fast Facts:  

Provided to beneficiaries enrolled in Original (Fee-For-Service) Medicare Allows the beneficiary to make an informed decision about whether to receive services and accept financial responsibility if Medicare does not pay  Serves as proof that the beneficiary had knowledge prior to receiving the service that Medicare might not pay. **If a health care provider/supplier does not deliver a valid ABN to the beneficiary when required by statute, the beneficiary cannot be billed for the service and the provider may be held financially liable. ABN Booklet From MLN

Certified Medical Office Manager September 15-18th Richmond, VA

Remember…Medicare covers smoking & tobacco use cessation counseling. This is a list of resources to support providers in the delivery of counseling and organizations promoting cessation.

Resources for Medicare’s Annual Wellness Visit: Information on Objectives include: • • • • • •

Defining budget guidelines, terminology, and financial policies Demonstrating effective communication on financial projections Defining ways to control practice expenses and set cost control goals Reviewing effective strategies on billing and collecting Explaining how to use medical records in malpractice suits Defining current HIPAA and OIG compliance statues

And much more!

coverage, coding, billing, reimbursement, and claims filing procedures.

• • • •

Quick Reference Information: The ABCs of Providing the Annual Wellness Visit MLN Matters Article MM7079: “Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)” ® Medicare Learning Network Preventive Services webpage Order materials to start the conversation about Medicare’s preventive services, including "Questions to Ask about Medicare Preventive Services."

Common Comprehensive Error Rate Testing (CERT) Program errors related to signature requirements. See CERT FAQs also.

16 Compliance Training webcasts from the HEAT (Healthcare fraud prevention & enforcement action team) hosted on YouTube.com.

The Medicare Learning Network® (MLN) Provider Compliance web page contains educational products on avoiding common billing errors.

Additional Information

Limited Seating!

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Medicare: Beyond the Basics FREE Webinar

The Office of Inspector General (OIG) has several physician education training materials to assist in teaching about Federal Laws regarding fraud and abuse of the Medicare and Medicaid programs.

Hosted by Palmetta GBA (A Medic are Adminis trator)

July 26, 2011 10 a.m. ET This webinar will provide Medicare information useful to experienced billing staff.

This session is free to all participants.

Beware! CMS Press Release “New Technology to Help Fight Medicare Fraud”

The Provider Outreach and Education Team at NHIC, Corp. developed a guide on Medicare Part B billing information and a guide on Medicare Part B CMS-1500 Claim Form Instructions.

Check out CMS’ Practice Administration Center for:  Billing and payment information  Part B drugs and drug coverage  Medicare Secondary Payer And More!

FREE

Medicare training modules    

Certificate of Medical Necessity Diagnosis coding HIPAA EDI Standards Medicare Preventive services

And more!

STOP An errata has been released on the corrections to the 2011 CPT Book from June 28, 2011. It is also listed on the AMA web site

OIG’s Most Wanted Healthcare Fugitives

Who is the OIG (office of inspector general) and what do they do?

Are any of your P ayers not ac c epting 2011 C P T c odes ?

R eport them!

from the AMA (Americ an Medic al As s oc iation) The rejection of a valid Current Procedural Terminology (CPT®) code is a violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Included within the Healthcare Common Procedure Coding System (HCPCS) code set, CPT is one of the medical data code sets adopted under HIPAA. Additionally, HIPAA covered entities—including payers—are required to use the applicable medical data code set valid at the time the health care is furnished. According to the HIPAA rule “each code set is valid within the dates specified by the organization responsible for maintaining that code set.” 45 CFR § 162.1011. The introduction of the CPT book provides instruction for use of the CPT codes, and it states that January 1 is the effective date for use of the updated CPT code set.

We encourage you to report HIPAA violations. Simply file a complaint through the Centers for Medicare and Medicaid Services' Administrative Simplification Enforcement Tool, or file the online AMA Health Plan Complaint Form.

AMA members and their practice staff can visit www.amaassn.org/go/templateletters to download a sample appeal letter and customize it for use in their practice.

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AACE now offers subscriptions for

Allied Health Professionals (AHPs) who are not members of AACE, but would like to participate in a wide range of AACE educational activities and services that may be useful in their ongoing practice, educational and professional needs.

For more information go to www.aace.com or contact afolsom@aace.com

United Healthcare Will No Longer Cover Androgel® Under Pharmacy Benefit Effective July 1, 2011, United Healthcare will no longer cover Androgel® under their pharmacy benefit. Testim® will change from a previously excluded medication to a medication covered under Tier 2. United Healthcare's pharmacy benefit allows the exclusion of a medication with the same active ingredient or a modified version of an active ingredient if it is therapeutically equivalent to a covered medication. United Healthcare defines therapeutically equivalent as providing essentially the same therapeutic outcome and adverse event profile. The United Healthcare National Pharmacy and Therapeutics Committee recently reviewed Androgel® and determined it to be therapeutically equivalent to Testim®.

Proposed new rules under the Affordable Care Act fact sheet Final rules to will come out later this year.

Specializing in medical graphic designs, AACE Impact Graphics is nationally recognized from a medical association you can trust.

You only have a few seconds to catch a client’s attention.

Call 1-800-393-2223 for more information or go to AACE Impact Graphics

C oding T ips on R eimburs ement A nd C oding • Make sure CPT® codes 60100 and 10021/10022 are being reported correctly. CPT® code 60100 reports a percutaneous core needle biopsy and is completely different than a fine needle aspiration of the thyroid. (see CPT® codes 10021/10022) • According to Medicare’s MUEs CPT® code 88172 (Cytopathology, evaluation of FNA; immediate cytohistologic study to determine adequacy for diagnosis. First evaluation episode, each site) can only be reported two times per date of service.

• Modifier Fact Sheets from WPS, a Medicare Administrative Carrier AES specializes in the development and management of continuing medical education programs, including the development and distribution of enduring educational materials.

Call 1-800-393-2223 for more information

AACE Educational Services - AES

• 3 Reminders from Noridian, a Medicare Administrative Carrier on Ordered and/or referred services • Diabetes-related information begins on page 103 of The Guide to Medicare Preventive Services • Medicare's bone mass measurements benefit • Medical necessity and the patient’s condition drive correct E/M coding • Medicare Quarterly Provider Compliance Newsletter

All medical coding must be supported with documentation and medical necessity. **While this document represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will recognize and accept the coding and documentation recommendations. As CPT®, ICD-9-CM and HCPCS codes change annually, you should reference the current CPT®, ICD-9-CM and HCPCS manuals and follow the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information. This information is taken from publicly available sources. The American Association of Clinical Endocrinologists cannot guarantee reimbursement for services as an outcome of the information and/or data used and disclaims any responsibility for denial of reimbursement. This information is intended for informational purposes only and should not be deemed as legal advice, which should be obtained from competent local counsel. Current Procedural Terminology (CPT©) is copyright and trademark of the 2010 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, 5 relative values, or related listings are included in CPT©. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

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