September/October 2012 March 2012 January 2012
Fiscal Year 2013 HHS OIG Work Plan: The HHS
Recovery Auditor Contractor (RAC) Connolly to begin audits for evaluation and management services in physician offices specifically for CPT code 99215. Connolly is the recovery audit contractor for AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV, Puerto Rico and the Virgin Islands. Additional information on RACs can be found here.
Attention Mississippi Part B EDI Billers: Due to the Enterprise Data Center (EDC) transition for Jurisdiction H, the delivery of the 277 claim status responses and the Electronic Remittance Advice (ERA) for October 23- 26 may have been delayed to validate accuracy prior to distribution. For additional information click here.
AACE Members in NC, SC, VA, & WV: The J11 A/B MAC Medical Review department will perform servicespecific prepay review on evaluation and management (E/M) services for CPT® code 99233 (Subsequent Hospital Care, Per Day, for the Evaluation and Management). Click here for more information.
Office of Inspector General (OIG) Work Plan for Fiscal Year 2013 provides brief descriptions of activities that the OIG plans to initiate or continue with respect to HHS programs and operations in fiscal year 2013. The items listed below are just a few of the new reviews that endocrinologists may need to be aware of. Diabetes Testing Supplies—Improper Supplier Billing for Test Strips in Competitive Bidding Areas (New) They will determine the extent to which suppliers improperly billed Medicare non-mail-order diabetes test strips in Competitive Bidding Areas (CBA) in 2011. They will also describe billing trends for test strips in CBAs between 2010 and 2011 and the extent to which suppliers conducted activities that they determined to be inappropriate (i.e., waiving copayments, contacting beneficiaries, sending unsolicited test strips in 2010 or 2011). Program Integrity—Payments to Providers Subject to Debt Collection (New) They will review providers and suppliers that received Medicare payments after CMS referred them to the Department of the Treasury (Treasury) for failure to refund overpayments.
Program Integrity—Improper Use of Commercial Mailboxes (New) They will determine the extent to which Medicare Part B providers and suppliers had practice locations that matched commercial mailbox addresses in 2011. Medicare providers and suppliers are required to establish physical business facilities of adequate size with permanent, visible signs and must provide CMS with specific street addresses (not mailboxes) recognized by the U. S. Postal Service. Claims Processing Errors—Medicare Payments for Part B Claims With G Modifiers (New) They will determine the extent to which Medicare improperly paid claims from 2002 to 2011 in which providers entered GA, GX, GY, or GZ service code modifiers, indicating that Medicare denial was expected.
1
Diabetes Testing Supplies—Supplier Compliance With Requirements for Non-Mail-Order Claims (New) They will determine whether Part B payments for non-mail-order diabetes testing supplies (e.g., supplies purchased from suppliers that have physical locations) were made in accordance with Medicare requirements.
Payments for Incarcerated Beneficiaries (New) They will determine whether Medicare payments for incarcerated beneficiaries complied with Federal requirements.
Payments for Alien Beneficiaries Unlawfully Present in the United States on the Dates of Service (New) They will determine whether Medicare payments were made on behalf of beneficiaries who were unlawfully present in the United States on the dates of services.
New Comparison Tables Highlight the Differences Between the Two Stages of Meaningful Use There is a table for both EPs and for eligible hospitals and CAHs. See which measures are new, which are changing, and which are being removed. The tables are online in the Stage 2 section of the CMS EHR Incentive Programs web site.
Previous items listed on the OIG work plan that are still currently in effect for 2013 that endocrinologists should be aware of are: Laboratory Tests—Part B Payments for Glycated Hemoglobin A1C Tests Physicians—Error Rate for Incident-To Services Performed by Nonphysicians Evaluation and Management Services—Potentially Inappropriate Payments in 2010 Medicare as Secondary Payer—Improper Medicare Payments for Beneficiaries With Other Insurance Coverage 2013 Work Plan as a single document OIG's email list subscribers automatically receive notification as new reports are posted to the website.
Which EHR works best for endocrinology offices? We would like the opportunity to provide this information to our members. This survey addresses the high and low points encountered as a current or prospective EHR user about selection and purchase, implementation and training, as well as the pros and cons of your everyday experiences.
Attention All General Practice, Family Practice and Internal Medicine Providers (Specialty Codes 01, 08 & 11) Physicians who are in the same group practice and share "like" specialties (General Practice, Family Practice and Internal Medicine) commonly receive duplicate claim denials when performing Evaluation & Management (E&M) Services on the same beneficiary on the same date of service. In an effort to reduce E&M duplicate claim denials, NHIC, Corp., a Medicare contractor, encourages provider-billing groups with primary specialty codes 01, 08 & 11 to declare their secondary specialties, if applicable. This will mitigate duplicate denials and the need for subsequent redeterminations. In order to do this, billing groups should complete the form CMS 855I for Individual Health Care Practitioners either online through the Internet-based Provider Enrollment Chain and Ownership System (PECOS) or the paper enrollment application process. The following sections should be completed: • Section 1A PTAN/NPI and check off Change • Section 2A 2D Identifying Info, Specialty, etc. • Section 3 Adverse Action • Section 13 Contact Person • Section 15 Signature Upon receipt of your application, you may be required to provide additional information in order to process your request. Internet-based PECOS: https://pecos.cms.hhs.gov/pecos/login.do Paper Applications process: http://www.medicarenhic.com/ne_prov/enroll_forms.shtml 2
MLN Matters® Special Edition Article #SE1227, “Important Reminder About Medicare Secondary Payer Laws” was released and is now available in
Updated ICD-10 Implementation Information This MLN Matters® special edition article replaces article SE1019 and provides updated information about the implementation ICD-10CM/ICD-10-PCS code sets to help you better understand and prepare for change from ICD-9CM to ICD-10 for medical diagnosis and inpatient hospital procedure coding.
ICD9, HCPCS, and CPT Updates for 2013 Pertinent to Endocrinologists Fast Facts: • No updates to ICD9 on October 1, 2012 •
Limited updates to both ICD9 and ICD10 on October 1, 2013
•
Limited code updates to ICD10 only on October 1, 2014
•
October 1, 2015, regular updates to ICD10 begin
downloadable format. This article is designed to provide education on Medicare Secondary Payer laws, which state that providers must bill Medicare as the secondary payer after the primary payer has made payment. It includes a description of the law and what providers should do to comply and bill correctly.
NEW WAIVED TESTS CLIA requires that for each test it performs, a laboratory facility must be appropriately certified. The CPT® codes that CMS considers laboratory tests under CLIA (and thus requiring certification) change each year. CR 8054 informs carriers and MACs about the latest new CPT® codes that are subject to CLIA edits. Make sure that your billing staff is aware of these changes. (MM8054) New Waived Tests
PLACE OF SERVICE (POS) This article is based on Change Request (CR) 7631. It revises and clarifies national policy for place of service (POS) code assignment. Instructions are provided in CR7631 regarding the assignment of POS for all services paid under the MPFS and for certain services provided by independent laboratories. In addition to establishing a national policy for the correct assignment of POS codes, instructions are provided for the interpretation or Professional Component (PC) and the Technical Component of diagnostic tests. Please make sure your billing staff is aware of these changes. For more information, click here (MM7631 Revised) Revised and Clarified Place of Service Coding Instructions
The AMA Practice Management Alerts provided information on new resources on health IT that are available. The Office of the National Coordinator has developed a Health IT Dashboard to depict a variety of health information technology (IT) statistics that can be found at http://dashboard.healthit.gov. There are also other free resources available to physicians online at www.healthit.gov to help them: • • •
implement EHRs navigate the Meaningful Use requirements meet Health Insurance Portability and Accountability Act (HIPAA) privacy and security requirements
There is a new online game training tool that physicians and practice staff in small practice settings can use to train on HIPAA and privacy settings. Sign up here for the AMA Practice Management Alerts to receive future alerts like this one. 3
Join NCQA and the nation's thought leaders as we explore prospects for advancing delivery system reform following the 2012 elections. The NCQA's 7th Annual Policy Conference, December 5 in Washington, DC, will explore prospects for advancing delivery system reforms that improve the quality, experience and cost of care. Panels with some of the nation's foremost experts will address:
Eligible professionals who do not participate in the 2013 e-Rx incentive program will receive 98% of their Medicare Part B allowable charges for their professional services.
Driving Delivery System Reform: The Next Four Years Merge Ahead: Improving Care for Dual Eligibles Bridging the Gap: Improving Primary Care and Specialty Coordination Bringing it All Home: Building on the PCMH Infrastructure December 5, 2012 8am - 4:30pm Hyatt Regency Washington on Capitol Hill Washington, DC
United Healthcare Network September Bulletin
Are you eligible? Begin participation today!
Unconnected providers grant program to provide up to $1.1 million to support implementation of health information exchange: The Arizona Strategic Enterprise Technology office (ASET)
What is the impact of Medicare payment cuts for DXA on your practice? Participation in this brief 16question survey will provide important new data that can be used this fall in AACE advocacy efforts on Capitol Hill. New data will help AACE make the case to Congress that current Medicare payment policy is harming access to osteoporosis testing and treatment services. Take the survey
announced a competitive grant program to support the implementation of health information exchange among unconnected providers as part of its state Health Information Exchange Cooperative (HIE) Agreement program. These unconnected providers - Arizona health care providers that serve medically underserved and lowincome populations - will be able to compete for grant funds to support the implementation of health information exchange solutions among health care providers and health care entities. The ASET office will award grants of up to $50,000 per individual organization or up to $100,000 if two or more organizations apply jointly for funding that will run from January 1, 2013 through June 30, 2013. Priority will be given to organizations that propose exchange between unaffiliated organizations. All grant applications are due to ASET by November 16, 2012. For additional information click here.
Medicare’s offers a Quick Reference chart for administrations, diagnosis, vaccine codes and descriptions for immunizations. This chart also provides information on the frequency limitations of the vaccines. Medicare’s Seasonal Influenza, Pneumococcal, and Hepatitis B vaccination service guide begins on page 61 of this booklet. Influenza Vaccine Payment Allowances- Annual Update for 20122013 Season
4
You and/or Your Staff Can Become an
AACE- Certified Endocrine Coder REGISTER
Philadelphia, PA November 9-10
Click here for more information
What is an AACE-Certified Endocrine Coder? Contact Vanessa Lankford at vlankford@aace.com or 904-353-7878 for additional information. Cancellations must be received in writing to the AACE office 48 hours in advance of the webinar 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. Please fax your cancellation to 904-404-4183 or email vlankford@aace.com .
AACE Members and their staff receive discounts on Webinars offered through PMI! www.pmimd.com
Coding & Billing for Mid-Level Providers- Webinar/Audio Conference Offered by Practice Management Institute Wednesday, October 31, 12 noon to 1:30 p.m. Central Time (10 a.m. Pacific, 1 p.m. Eastern) Presented by Linda D'Spain, CMPE, CMCO, CMC, CMIS, CMOM $199 per listening site (invite multiple people to participate) This session will address compliance concerns regarding mid-level provider billing patterns. The doctor has left the building. Now what? Can we still bill Incident-to? Understand why the OIG is looking at Incident-to services this year and get clarification on the guidelines and billing requirements. The rules and guidelines for Medicare and other third-party carriers can get confusing when billing for non-physicians practitioners. Linda D'Spain will help you better understand the rules and avoid possible fraudulent billing for your mid-level practitioners. Additional information and registration can be found here.
Upcoming Webinars:
From Trailblazers to Novitas – Transitioning MACs Modifier Myths and Must Knows Creating Outstanding Patient Experiences that Increase Referral Volumes Compliance 101 for Medical Office Managers Documentation & ICD-10: The Front Office is Where it Begins Get Paid Now: Collecting in the Face of Recession & Reform
Pre-recorded November 7, 2012 November 15, 2012 November 20, 2012 November 29, 2012 December 4, 2012
AACE assumes no liability for the purchase(s) of these programs. The content of the program(s) does not necessarily represent the policies or opinions of AACE. All purchases and communications are between the attendee and the company.
5
www.pmimd.com
Distance Learning and Total Access with PMI® Month by month - cancel at any time
$225 per month AACE members & staff *Registrants must use promotional code “AACE” to receive discount. $249 Non AACE members • Live weekly webinars where you can ask specific questions and get direct answers on a variety of current topics important to your practice • 24-hour access to TOTAL ACCESS Audio Library with almost 200 hours of pre-recorded training sessions and choose from 100+ topics • A fast way to bring both experienced and new staff up-to-speed on current issues • Include your physician to learn about important coding, billing, compliance and operational updates • Inexpensive, convenient way to develop your own talent without leaving the office to attend training classes • Use your office's speakerphone so that multiple staff can participate Topics include:
ICD-10 Diagnosis Coding for Endocrinology (pre-recorded) Teambuilding for Practice Success (scheduled for 9/6/2012) HB 300- HIPAA Privacy is No longer Just a Federal Concern (scheduled for 9/13/2012) Mastering Medical Decision Making (previously recorded) Translating Efficiencies to Profit (previously recorded) Conducting “Payer Proof” E/M Chart Audits (previously recorded) Top 5 Concerns of Medical Practice Managers (Listen to a sample of the prerecorded material in the middle of the page here) Compliance is NOT an Option (previously recorded)
PMI National Certifications via Webinar Live Certification Webinars include 10 to 12 90-minute learning sessions taught in a live Webinar format via your computer. Interact, ask questions and get answers real-time. This option includes the full course manual shipped to the candidate's address plus access to the streamed versions of the live sessions to review anytime. Once the candidate is ready to take the exam, he/she will arrange with PMI for an exam proctor to administer the test live in a nearby community. Learn more. Certified Medical Insurance Specialist Certified Medical Coder Certified Medical Compliance Officer Certified Medical Office Manager Payment plans available!
*Use promotional code AACE when registering. For more information or to register call 800-259-5562 x242.
AACE assumes no liability for the purchase(s) of these programs. The content of the program(s) does not necessarily represent the policies or opinions of AACE. All purchases and communications are between the attendee and the company.
6
We want to hear from you! Tell us what you think of Endonomics! Please take a few minutes 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 currently a free newsletter for both members and non-members. Interested parties should send an email to Endonomics@aace.com with their name, phone and fax numbers, location and preferred email address to be added to our Practice Support Network database.
Coding TRAC Tips on Reimbursement And Coding
Q. If a patient has seen the physician in the past but is coming in to see the NP or PA, can the visit be reported to Medicare as a new patient office visit code? A. According to Medicare, for purposes of billing for E/M services, patients are identified as either new or established, depending on previous encounters with the provider. A new patient is defined as an individual who has not received any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous three years. An established patient is an individual who has received professional services from the physician/NPP or another physician of the same specialty who belongs to the same group practice within the previous three years. Additional information found here.
Did you know The Centers for Medicare & Medicaid Services (CMS) offers over 50 educational products to the public free of charge, many of which are available in downloadable format? Before ordering a product, please check to see whether a downloadable version of the product is available.
Please submit comments or questions to Endonomics@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 2011 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/DFARS restrictions apply to government use. 7