Endonomics- An AACE Practice Management Newsletter July August 2013 by AACE

July/August 2013

Your patients may not get their diabetic supplies covered by Medicare if the supplies are coming from a DME contractor who is not contracted through Medicare. Click here for more information from the Medicare Learning Network or here for additional information and resources surrounding the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) program.”

Patients Who Travel: DME claims must be filed to the DME MAC for the jurisdiction in which the patient resides. The Medicare Claims Processing Manual, Chapter 1: 10.1.5.1 Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, Supplies, Parental and Enteral Nutrition (PEN) states, “The claims processing jurisdiction among DME MACs is determined by the beneficiary’s permanent address. A beneficiary’s permanent address is determined by where the beneficiary resides for more than six months of a year.”

survey to collect data regarding member experiences with blood glucose testing supplies distributed as part of the Competitive Bidding Program. AACE is conducting a

Over 300 CPT Changes in 2014 • • •

175 new codes 107 revised codes 47 deleted codes

Make sure to order your books soon to get the most up-to-date information for your office! Bundled packages may be cheaper and discounts extended to members too! Books may be ordered from the AMA, AAPC, and most book stores as well.

We will use that data to make a case to both CMS and the FDA to correct the issues created by the Competitive Bidding Program. We encourage you to take a moment to complete the survey which is located here.

If a physician or treating practitioner prescribes a particular brand or mode of delivery for a beneficiary to avoid an adverse medical outcome, the contract supplier must ensure that the beneficiary receives the needed item. Medicare will pay the single payment amount for covered competitively bid items furnished through the Physician Authorization Process. The physician or treating practitioner must document in the beneficiary's medical record the reason why the specific brand or mode of delivery is necessary to avoid an adverse medical outcome. For more information about the Physician Authorization Process, please see the Referral Agents Fact Sheet on the CMS website. 1

You may want to review MLN Matters Article MM8100, entitled "Effect

of Beneficiary Agreements Not to Use Medicare Coverage and When Payment May be Made to a Beneficiary for Service of an Opt-Out Physician/Practitioner," available on the CMS website. The official Medicare requirements for opting out are in the Chapter 15, Section 40, of the "Medicare Benefit Policy Manual" available at on the CMS website.

Medicare Administrative Contractors joined forces to create the CERT A/B Contractor Task Force. This task force, fully supported by CMS, will serve to enhance, not replace, the ongoing educational activities by CMS, the Medicare Learning Network

New Medscape Module Available on EHRs in Practice: The Meaning of Meaningful Use This roundtable discussion among Electronic Health Record (EHR) early adopters focuses on the requirements of Meaningful Use 1 and 2 and how their implementation can improve workflow and patient interactions. Physician CME credits are available. Join Medscape for free and view the module.

Take AACE’s EHR survey here and help other endocrinology offices with their common questions or concerns!

(MLN), and the MACs within their jurisdictions. The CERT A/B Contractor Task Force looks forward to collaborating for error-free Medicare claims and documentation with

Resources from the AMA such as the Administrative Burden Index (ABI) and the National Health Insurer Report Card may assist practices with

identifying areas for improvement in cost efficiencies on the business side of a practice.

providers, associations and societies across the nation. Over the next few months, the CERT A/B Contractor Task Force will conduct a campaign to inform hospitals, home health, hospice, physician billing and compliance staff, and practitioners within all jurisdictions on this new

The Office of Civil Rights (OCR) has 3 educational programs for health care providers on compliance with various aspects of the HIPAA Each program is available with free Continuing Medical Education (CME) credits for physicians and Continuing Education (CE) credits for health care professionals. They are available at Medscape.org: • • •

Patient Privacy: A Guide for Providers HIPAA and You: Building a Culture of Compliance Examining Compliance with the HIPAA Privacy Rule

initiative.

August Was National Immunization Office of Inspector General (OIG) Compliance Program for Individual and Small Group Physician Practices

Awareness Month Medicare Part B covers these immunizations and their administration for qualified beneficiaries.

October Updates For CMS:  CY 2013 Medicare Physician Fee Schedule Database (MPFSDB)MM8386  Quarterly Average Sales Price (ASP)

Announcing “MLN Connects™”; connecting health care professionals to trusted CMS program news and information. MLN Connects™ is a part of the Medicare Learning Network® (MLN), a registered trademark of CMS and the brand name for official information health care professionals can trust. The following education and outreach programs you may have come to rely on have been renamed as follows: • CMS Medicare FFS Provider e-News is now the MLN Connects Provider eNews • MLN National Provider Calls (NPCs) are now MLN Connects National Provider Calls • MLN Provider Partnership Program is now MLN Connects Provider Association Partnerships The newsletter, calls, and provider association partnership now form MLN Connects. CMS encourages you to visit any of the webpages listed above for more information.

New resources available to help consumers navigate the Health Insurance Marketplace Health and Human Services (HHS)

CMS will deny your enrollment when an existing or delinquent overpayment exits.

announced $67 million in grant awards to 105 Navigator grant applicants in Federally-facilitated and State Partnership Marketplaces. These Navigator grantees and their staff will serve as an in-person resource for Americans who want additional assistance in shopping for and enrolling in plans in the Health Insurance Marketplace beginning this fall. HHS also recognized more than 100 national organizations and businesses who have volunteered to help Americans learn about the health care coverage available in the Marketplace.

Let Your Voice Be Heard! Share your views about your Medicare Administrative Contractor (MAC) with CMS. Click here for more details from CMS.

Have you Received a Revalidation Letter from CMS? All enrolled providers must revalidate their enrollment information under CMS’ new enrollment screening criteria.

 Click here for general information on ICD-10 &

Endocrine-Specific ICD-10 Did you miss the National Provider Call on ICD10 basics on August 22? If so, click here to see

 AACE Members can access an ICD-9 to ICD-10

Coding Convention Comparison here Join AACE

The files below have been created by the National Center for Health Statistics (NCHS), under authorization by the World Health Organization. Any questions regarding typographical or other errors noted on this release may be reported to Donna Pickett, e-mail dfp4@cdc.gov.

the full presentation.  During the call, CMS indicated all Medicare Administrative Contractors (MACs) have committed to having their LCD (local coverage determinations) reflecting appropriate ICD10 codes by April 2014. ICD10 codes go into effect October 1, 2014!

2014 release of ICD-10-CM • • • • • • •

Preface [PDF - 35 KB] ICD-10-CM Guidelines [PDF - 512 KB] ICD-10-CM PDF Format ICD-10-CM XML Format ICD-10-CM 2014 Addenda ICD-10-CM List of codes and Descriptions (updated 7/3/2013) General Equivalence Mapping Files

KEEP UP TO DATE ON ICD-10 Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates and follow them on Twitter.

This activity has been approved for AMA PRA Category 1 Credit(s)™

It is becoming a necessity for physicians and their staff to gain advanced knowledge and resources to maximize reimbursements, comply with federal and commercial guidelines, and stay compliant with the various state, federal, and commercial regulations. Why should I update my coding skills?  To ensure all of your work is captured and reimbursed appropriately

Open to AACE members, staff of AACE members and non-members.

 To protect yourself from auditing nightmares Medicare received a 215% increase in resources from 2010 to 2012 to recover improper payments made to physicians and other providers of service. A large percentage of the recovery efforts are due to miscoding claims and/or misunderstanding policies, rules and regulations. Do you… …Know the two guidelines to choose from to document and code for evaluation & management services? …Have expertise with The False Claims Act and what it says about diagnosis and procedure coding? …Know how ICD10 (diagnosis coding) will affect you and your staff on October 1, 2014? …Utilize modifiers appropriately or routinely use them to “get things paid”? …Support medical necessity in your documentation from a coding and clinical standpoint?

Find the answers to these questions and more at AACE’s Coding course! All classes are designed to assist physicians, non-physicians, coders, billers, and collectors, practice managers, etc., in obtaining all allowable reimbursement and complying with federal and commercial guidelines. Contact Endocoding@aace.com or 904-353-7878 for additional information. All courses, dates and locations are subject to change. Cancellations must be received in writing to the AACE office 48 hours in advance of the course in order to receive a full refund. No-shows or cancellations received after this time are not eligible for a refund. AACE reserves the right to cancel the course with a minimum 48-hour notification. Participants will have the option to attend in an alternate course (if available) or request a full refund. 5

Education

American Association of Clinical Endocrinologists sponsors live conferences and symposia, online education, and other opportunities to earn continuing medical education (CME) credits. Noted below is the current list of CME educational activities available. These activities are intended for: MD's, DO's, NP's, RN's, PA's, CDE's, Pharmacists and other interested health care providers. SEPTEMBER 09/11