January/February 2014
Payment Alert! Certification may be required for ultrasound reimbursement. The American Association of Clinical Endocrinologist’s Endocrine Certification in Neck Ultrasound (ECNU) program was created in response to an increasing number of payers denying payment to Endocrinologists for ultrasound procedures despite their expertise and experience in diagnosis and treatment of thyroid conditions. ECNUE is a professional certification/designation in neck ultrasound. ECNU certification is an affirmation of quality and consistency both to patients and insurance carriers by the provider. ECNU is recognized by the American Institute of Ultrasound in Medicine (AIUM), one of the preeminent national accreditation bodies for ultrasound practices, and allows those with ECNU credential to be directors of ultrasound laboratories and apply for AIUM Practice Accreditation. AIUM recognizes successful completion of the ECNU program as evidence of sufficient physician training in thyroid and parathyroid ultrasound. While applying for AIUM office accreditation is currently voluntary, it is rapidly becoming increasingly important, as a growing number of insurance companies require both professional certification and practice accreditation as a condition of payment. Why is ECNU important? •
The ECNU credential signifies that an individual has passed the Comprehensive Certification Examination (CCE) and has successfully completed the Validation of Competency Process (VCP).
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Helps facilitate payment for ultrasound services provided in the office.
To learn more about ECNU, please visit www.aace.com/ecnu. If you have questions, please contact Nickie Mizell, Certification Manager at nmizell@aace.com or by phone at (904) 353-7878 ext. 145. 1
The 6-month 2014 eRx payment adjustmentreporting period, which began on January 1, 2013, and ended on June 30, 2013, was the final reporting period to avoid the 2014 eRx payment adjustment. You do not need to report G-code (G8553) for 2014 eRx events. Content will remain available on the eRx Incentive Program website so participants have an opportunity to access reference materials associated with the eRx incentive payment, payment adjustment, and feedback reports. There are 4,417 acronyms found on the CMS’s HHS.gov website and other acronyms commonly used. Can you name two of the 23 acronyms that begin with the letter “X”? Click here for a complete list on CMS’ website.
Guidelines for mandatory and voluntary use of the ABN (Advanced Beneficiary Notice) are published in the Medicare Claims Processing Manual, Chapter 30 Section 50.
Healthcare Common Procedure Coding System (HCPCS) codes subject to exclusion from CLIA edits MLN Matters® Number: MM8567.
New EHR Attestation Deadline for Eligible Professionals is March 31, 2014! Click here for the full article from CMS. The OIG targeted hospitals that could be putting themselves at risk for fraud by using the copy-paste feature in their EHR systems. Click here for complete article. “Experts in health information technology caution that EHR (electronic health records) technology can make it easier to commit fraud.” Not all recommended fraud safeguards have been implemented in the hospital EHR technology. Click here for the complete report from the Office of Inspector General.
Pfizer announces LEVOXYL (levothyroxine sodium) will be available around March 3.
⃰We encourage AACE members to check with your EHR vendors to determine if they offer any technical safeguards through your system that can assist you and your staff in maintaining compliance with documentation and coding in your electronic medical records.
Show auditers you are serious about FRAUD and ABUSE- The OIG Hotline posters and flyers make great additions to employee bulletin boards! Click here to download and print the ones appropriate for your office. FREE compliance training from the OIG here. 2
Time is Running Out! Registration is Now Available for the National ICD-10 Testing Week The National ICD-10 Testing Week is an opportunity for trading partners, software vendors, clearinghouses and billing services to come together and test their ICD-10 compliance efforts already underway with electronic data interchange (EDI) and with the added benefit of real-time Help Desk support. Don’t forget to sign up with your Medicare Administrative Contractor to test ICD10 for the week of March 3- 7! Click here for more information. Make sure that your billing staff is aware of these upcoming testing periods for ICD-10.
This MLN Matters® Special Edition article is intended for all health care professionals who order, refer, or provide flu vaccines and vaccine administration to Medicare beneficiaries. •
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Take advantage of each office visit as an opportunity to encourage your patients to protect themselves from the flu and serious complications by getting a flu shot. Continue to provide the flu shot as long as you have vaccine available, even after the new year.
• Don’t forget to immunize yourself and your staff.
New 1500 Claim Form Accommodates ICD-10 Reporting Needs and Deletes Some Fields Click here to “Understand the Changes to the Form.” The timeline below aligns with Medicare’s transition timeline. • January 6, 2014: Payers began receiving and processing paper claims submitted on the revised 1500 Claim Form (version 02/12). •
January 6 - March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05).
April 1, 2014: Payers receive and process paper claims submitted only on the revised 1500 Claim Form (version 02/12).
New PQRS Interactive Timeline- CMS wants to help you navigate the deadlines! The timeline helps you identify key program dates for PQRS between 2014 and 2016 and directs you to related resources.
United Healthcare January 2014 Bulletin features important protocol and policy changes, as well as useful administrative information and clinical resources. Please share with your billing and coding staff.
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Education
American Association of Clinical Endocrinologists sponsors live conferences, symposia, online education, and other opportunities. Noted below is the current list of educational activities available. These activities are intended for: MDs, DOs, NPs, RNs, PAs, CDEs, pharmacists and other interested health care providers. MARCH 03/08
Diabetes Day for Primary Care Providers
Tucson, AZ
03/22
Diabetes Day for Primary Care Providers
Greensboro, NC
03/22
Diabetes Day for Primary Care Providers
Arlington, VA
03/23 – AACE/ACE Consensus Conference on Obesity: Building an Evidence Base for Comprehensive Action 03/24
03/29
Diabetes Day for Primary Care Providers
Washington, DC
Boston, MA
APRIL 04/05
Diabetes Day for Primary Care Providers
Lansing, MI
04/26
Diabetes Day for Primary Care Providers
Lombard, IL
MAY 05/14 – 05/18
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AACE 23 Annual Scientific and Clinical Congress
Las Vegas, NV
ONLINE LEARNING Scenes and Seminars on Hypoglycemia Management in Diabetes Injectables for Type 2 Diabetes: The Future of Treatment
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Register early- seating is limited!
Successful implementation of ICD-10 should focus on 5 R’s for easy transition: 1. REVIEW: What is ICD, where did it come from, who uses the code sets, what are the codes used for, when codes are used and who is affected/effected by the upcoming change. 2. REFRESH: Physicians and other providers of service must refresh basic and endocrine-specific coding guidelines and conventions as well as the ICD-10-CM book formats and set up of other endocrine-related codes. 3. REVISE: Capturing diagnosis codes at the highest level of specificity will require a REVISED approach to documentation. 4. RENDER: Each office must RENDER training to all staff at some level and be consistent and compliant with continuing education as new and advanced technology spur growth in the code sets. 5. REPORT: Understanding the relevance and significance of consistently following guidelines and coding to the highest level of specificity through complete and concise documentation will result in REPORTING diagnosis that could ultimately improve patient care from a clinical and quality standpoint.
2014 Course Locations New York, NY ● Las Vegas, NV ● Indianapolis, IN ● Lake Charles, LA ● Albuquerque, NM ●
Portland, ME ● Seattle, WA Lexington, KY ● Charlotte, NC
Agenda Items: •
If It’s Not Documented, It Didn’t Happen- Doesn’t Count- and You Won’t Be Reimbursed!
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The Main Characters of Your Story are Now Alpha AND Numeric
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Wow! This Book Is Big!
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I Didn’t Know There was a Code for That!
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Here’s Your Sign (Symptom or Definitive Diagnosis)! Click here for information or to register
Agenda Items: •
Medical Necessity in the Medical Record and Why It’s Important
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Classifications and Levels of Evaluation and Management
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History and Exam: Two of the THREE Key Components in Evaluation and Management Services
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Medical Decision Making and Proper Calculations of Evaluation and Management Services
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Audit Sample Notes and Q&A
All course locations and dates are subject to change.
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Coding TRAC Tips on Reimbursement and Coding
We want to hear from you! Tell us what you think of Endonomics! Please take a minute to take this survey. Your feedback is very important to us as we strive to assist you with a profitable and compliant business office. o Is Endonomics™ valuable and useful for your office? o What other topics would you like to see offered in Endonomics™? o Other comments… AACE's Socioeconomics and Member Advocacy Department's goal is to reach out to the endocrinology business world and become the onestop- shop, not only for endocrinology clinicians, but their support staff as ™ well. Currently, Endonomics is a free newsletter for both members and non-members. Interested parties should send an e-mail to Endonomics@aace.com with their name, phone and fax numbers, location and preferred e-mail address to be added to our Practice Support Network database.
Q. Where can I find information for compliance officers in physician offices? A. The Medicare Learning Network® (MLN) offers a suite of products and resources for compliance officers here. They also offer products for educators and students here, and billers and coders here. Q. What is the required time for physician offices to retain EOBs (explanation of benefits)? A. Each state may vary in rules for maintaining records and financial statements. We recommend contacting your malpractice and/or healthcare attorney regarding questions for maintaining and storing records. Q. What is a signature log? A. According to Medicare, a signature log is a “typed listing of the provider(s) identifying their name with a corresponding handwritten signature. This may be an individual log or a group log. A signature log may be used to establish signature identify as needed throughout the medical record.” Please see CMS “Medicare Program Integrity Manual” (Pub. 100.08), Chapter 3, Section 3.3.2.4B or click here.
Please submit comments or questions to Endocoding@aace.com.
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 2013 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or © related listings are included in CPT . The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS6 restrictions apply to government use.