August/September 2014
August/September 2014
Alert for NY, NJ and CT Providers Effective September 1, 2014, Cigna updated their policy to include endocrinologists who have completed the ECNU certification program. Please contact your local Cigna customer service unit if you are an ECNU certified physician and receive ® denials for CPT code 76536 (Ultrasound, soft tissues of head and neck (eg. Thyroid, parathyroid, parotid), real time with image documentation). If you would like more information on the ECNU program, click here.
It’s Our Business to Know Your Business! Let us help make your practice work better for you. When you attend the AACE 24th Annual Scientific and Clinical Congress in Nashville, TN May 13-17, 2015, take advantage of the Wednesday Socioeconomic Sessions that include topics on: Negotiating Difficult Healthcare Situations with Administrators, Colleagues and Patients The Wonderful World of RVUs: what they are, how they are calculated, and how to evaluate the achievability of expectations by your organization Optimal Incorporation of Extenders into an Endocrine Practice
October 3 is the last day for st
1 year eligible professionals to begin the 2014 reporting period for the Medicare EHR Incentive Program
Social Media and the New Endocrinologist Look for more details on the Annual Meeting over the next few months as new programs are added! 1
You play a vital role in protecting the integrity of the Medicare Program! “Medicare Fraud & Abuse: Prevention, Detection, and Reporting”
Fingerprint-based Background Checks Began August 6, 2014 for all individuals with a 5% or greater ownership interest in a provider or supplier that falls into the high risk category and is currently enrolled in Medicare or has submitted an initial enrollment application.
CMS requires providers to submit claims electronically, unless they meet an Administrative Simplification Compliance Act (ASCA) exception and have an ASCA waiver form on file with their Medicare Administrative Contractor (MAC). Refer to the following resources for further information on ASCA, including the limited exceptions, definition of a small provider, and more: On July 7, 2014, CMS changed the requirements for collecting provider overpayments. If a Medicare overpayment remains outstanding and collectible, an Intent to Refer (ITR) letter will be issued 66 days from the initial demand letter date. This is a change from 120 days from the initial demand letter date. Click here for the full article.
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Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 24, Section 90 ASCA Frequently Asked Questions Medicare University
On July 21, CMS launched Physician Compare Update, an e-newsletter dedicated solely to communicating Physician Compare related news, updates, alerts, and announcements. View the first issue and subscribe.
2014 Is the last year eligible professionals can earn an incentive payment! The MLN Connects™ National Provider Call, “PQRS: How to Avoid the Negative Payment Adjustments for CMS Medicare Quality Reporting Programs” provided an overview of the 2016 negative payment adjustment for several Medicare Quality Reporting Programs.
Click here if you are confused on items and services not normally covered by Medicare!
The new CMS Rule allows flexibility in certified EHR technology and helps providers meet meaningful use for an EHR Incentive Program reporting period for 2014. Click here for more information. For more information about the EHR Incentive Program, visit the EHR Incentive Programs website. For more information about CEHRT, please visit the HealthIT.gov website. Full text of this excerpted CMS press release (issued August 29).
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The “Medicare Learning Network® (MLN) Suite of Products & Resources for Billers and Coders” is an educational tool now available in downloadable format. Please share with your coding and billing staff.
The Joint Commission offers a FREE publication to educate health care organization and health care works on the risks of misusing vials of injectable medical products.
Visit EmPower Magazine’s website for expanded endocrine patient information.
CMS released an Informational Bulletin providing information to states on reporting Medicaid drug rebates on the CMS-64 in the Medicaid Budget and Expenditure System (MBES).
Changes to the Provider Enrollment Chain and Ownership System (PECOS) Effective January 1, 2015 Physicians and suppliers billing anti-markup and reference laboratory claims must report the NPI of the physician or supplier who actually performed the service. This new requirement applies to all claims, including claims for services where the performing physician/supplier is out of the processing MAC’s jurisdiction. Click here for more information.
This MLN Connects™ video presentation on The CMS Value-Based Payment Modifier: What Medicare Eligible Professionals Need to Know in 2014 A full description of the video is available on the MLN Connects™ Videos web page. MLN Connects™ Videos are a part of the Medicare Learning Network®.
"When advanced practice nurses and physician assistants are working with physicians, they are considered as working in the exact same specialty and exact same subspecialties as the physician.” See AMA’s CPT Book page 5
October Quarterly Update for 2014 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
October Update to the CY 2014 Medicare Physician Fee Schedule Database (MPFSDB)
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United HealthCare Policy Updates •
Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes Effective July 1, 2014
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Gynecomastia Treatment Effective August 1, 2014
September 2014 Bulletin
New ICD-10 Compliance Date: October 1, 2015 The 2015 ICD-10-CM files are posted on the 2015 ICD-10-CM and GEMs web page. Click here learn how to Access the Updates to ICD10 Local Coverage Determinations (LCD) in the CMS Medicare Coverage Database CMS instructed all Medicare Administrative Contractors to promote ICD-10 Acknowledgement Testing with trading partners during three separate testing weeks, and to collect data about the testing. These testing weeks will be: o November 17 – 21, 2014 o March 2 – 6, 2015 o June 1 – 5, 2015 Are you unable to complete the necessary systems changes to submit claims with ICD-10 codes by October 1, 2015? If so, please investigate downloading the free billing software that CMS offers via their MAC websites. More information found on the MAC's website.
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Patient Recruiter Pleads Guilty in Miami for Role in $205 Million Health Care Fraud Scheme
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New Jersey Doctor Sentenced To 21 Months In Prison For Taking Cash Kickbacks For Patient Referrals
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Board-Certified New Jersey Pediatrician And Internist Sentenced To 20 Months In Prison For Taking Kickbacks…
CMS Released an ICD-10 training and preparation webcast that has information on ICD-10 training and preparation from the “Road to 10” tool. Accessible through the “Road to 10” link on the CMS website, the webcast discusses key elements to include in training plans. This is the second webcast in the new “Road to 10” series. Four more webcasts will follow—all aimed at helping small physician practices get ready for ICD-10 by the October 1, 2015, compliance date. Go to the CMS ICD10 website to get started on the “Road to 10” today.
Keep Up to Date on ICD-10 by visiting the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Industry Email Updates and follow them on Twitter.
AACE members can click here to find I9 to I10 crosswalks for diabetes, diabetes secondary, adrenal, parathyroid, thyroid disorders, and common “V” codes.
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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.
Coding TRAC Tips on Reimbursement and Coding ALERT
New Coding Requirements Related Modifier 59 Beginning January 1, 2015!
to
Proper Use of Modifier 59 from CMS
Revised Modification to Medically Unlikely Edits (MUE) This information informs the Medicare Administrative Contractors (MACs) about additional modifications updated in the Medically Unlikely Edit (MUE) Program. The updates include clarifications, general processing instructions, and detailed explanations of MUE requirements and specifications.
What are MUE (Medically Unlikely Edits) and how do they affect reimbursements and coding?
What are the NCCI (National correct coding initiative) edits? How do I use them in coding? Do they affect my reimbursements?
CMS’ Scenarios and Coding Instructions for Submitting Requests to Reopen Claims that are Beyond the Claim Filing Timeframes
eHealthUniversity provides resources to help users navigate the eHealth programs. Fact sheets, checklists, webinars, and videos are available at the beginner, intermediate and advanced levels to help providers with different education backgrounds successfully participate in each of the programs.
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/DFARS restrictions apply to government use. 5