November/December 2012 March 2012 January 2012
January 31 Deadline to File for 2013 Medicare eRx Hardship This will allow physicians to avoid the eRx penalty. Exemptions for physicians include: • Unable to ePrescribe due to state, federal or local law/regulation • Fewer than 100 prescriptions between January 1, and June 30, 2012 • Rural areas without sufficient high-speed Internet access • Areas without enough pharmacies available for ePrescribing Additional information _________________________________________________________________
Alert: New instructions for auditors from CMS discuss inappropriate templates and insufficient documentation regarding coding and coverage for Medicare reimbursement. The Medicare Program Integrity Manual states, “Some templates provide limited options and/or space for the collection of information such as by using “check boxes,” predefined answers, limited space to enter information, etc. For additional information click here. _________________________________________________________________ Thyroid Awareness Month is January The public relations staff at AACE is gearing up for the 18th year of Thyroid Awareness Month. ACE and Abbott Labs are partnering again to bring public awareness to thyroid issues, conditions and diseases. We are asking all AACE members to get involved not only during January, but on a continuing basis. You can show your support by using the many resources we are offering, like our educational materials such as the neck check cards, car magnets, lapel pins and many more items. You can also post the blue paisley ribbon, a symbol of thyroid awareness month to your Facebook or Twitter profile. Just go to http://twibbon.com/support/thyroidawareness-month and choose how you’d like to support the campaign. Also, please encourage your patients to visit www.thyroidawareness.com.
Alert: Anthem Blue Cross sent warning letters to California providers who bill E/M codes with modifier 25 “significantly more often than other physicians within the same specialty,” based on claims paid between May 2011 and April 2012. _________________________________________________________________
Alert: Punctuation can get your claims denied! Medicare began rejecting claims processed October 1, 2012, and after as unprocessable when the patient's name and/or Medicare number on the claim do not match their records. Common errors include omission of the suffix Jr. or Sr., incorrect punctuation within the name such as omitting an apostrophe (O Connor or OConnor instead of O'Connor) or inserting a comma after the last name and before Jr. or Sr. when the name on the card does not contain a comma. When providers receive this rejection, they must verify the information with the patient and submit a claim with the name and Medicare number exactly as it is on the patient's most recent Medicare card. Unprocessable rejections do not have any appeal rights nor can we reopen them. Providers must correct the claim and resubmit it. ________________________________________________________________ Alert: Post office box addresses are not acceptable and will result in delayed or incorrect reimbursement! It is critical that all physicians, providers, and suppliers check with their designated FI, carrier, DME MAC or A/B MAC to make certain that your physical office address is on file. P.O. Boxes are not an acceptable address format and will result in delayed or incorrectly processed claims and other key correspondence associated with your office.
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Alert:
AMA has learned that Preferred Medical Claims Solutions (PMCS), a client
of MultiPlan, is attaching notifications to reimbursement checks stating that by depositing the check, your practice agrees to being reimbursed by your MultiPlan contracted rate within 10 working days and that you wish to participate in the Advanced Funded Program (AFP) with PMCS going forward. If you do not wish to be included in the PMCS AFP program for a specific individual claim or any future claims, do not deposit the check and contact PMCS. You are encouraged to visit the PMCS website at www.pmcsonline.com, or call PMCS at (800) 905-2589 with any questions. You are also encouraged to visit the AMA website to access Provider/Rental Network Contract resources to learn how payers could be taking advantage of your lowest contracted payment rate more often than you think. ________________________________________________________________
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.
Please call Novitas toll free at 1-855-761-1069 with any Hurricane Sandy emergencies/questions. If you leave a message, someone will contact you within 24 hours. Please note that this number is to be used for Hurricane Sandy issues only; all other calls will be referred to our Customer Contact Center ________________________________________________________________
Simple Steps to Improve Clinical Documentation
Are you eligible? Begin participation today!
On October 1, 2014, your practice and the clearinghouses, payers, and billing companies that you work with will need to use ICD-10 codes. One way to help your practice prepare for ICD-10 is to work on improving how you document your clinical services. This will help you and your coding staff become more accustomed to the specific, detailed clinical documentation needed to assign ICD-10 codes.
Take a look at documentation for the most often used codes in your practice, and work with your coding staff to determine if the documentation would be specific and detailed enough to select the best ICD-10 codes. For example, laterality is expanded in ICD-10-CM. Therefore, clinical documentation for diagnoses should include information on which side of the body is affected (i.e., right, left, or bilateral).
This is the last year for Medicare eligible professionals (EPs) to start participating in the EHR incentive programs in order to receive their full Medicare incentive payments. Registering does not mean you are required to participate - so register today. CMS recommends that all eligible professionals (EPs) register as early as possible for Medicare and Medicaid’s EHR incentive programs. For more information on registration in the EHR incentive programs, visit the Registration section of the EHR incentive programs Web page for the latest news and updates on the EHR incentive programs.
For example for diabetes mellitus, physicians must document the following information:
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Type of diabetes
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Body system affected
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Complication or manifestation If type 2 diabetes, long-term insulin use
Remember, ICD-10 will not affect the way you provide patient care. It will just be important to make your documentation as detailed as possible since ICD10 gives more specific choices for coding diagnoses. This information is likely already being shared by the patient during your visit—it’s just a matter of recording it for your coding staff. Good documentation will also help reduce the need to follow-up on submitted claims—saving you time and money. Keep Up to Date on ICD-10 Visit the CMS ICD-10 website for the latest news and resources to help you prepare.
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Register with Your State Medicaid Board to Receive Increased Medicaid Payments!
Starting January 1, 2013, and running through December 31, 2014, state Medicaid programs will increase payments for primary care services to Medicare payment levels for physicians with a primary specialty designation of family medicine, general internal medicine and pediatric medicine, as well as all subspecialties that fall under those designations. For more information, click here.
Are you protecting the privacy of your patient information effectively? Preserving the integrity of Protected Health Information (PHI) is of paramount importance in the day-to-day operation of your practice. This page provides guidance about methods and approaches to achieve optimal compliance in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule. We strongly encourage you to take a few moments to review your office’s HIPAA plan to avoid serious consequences associated with noncompliance and negligent privacy practices.
The 2013 Medicare Physician Fee Schedule (MPFS) rule was published on November 16, 2012. It will take effect January 1, 2013. The final rule updates payment policies and payment rates for services furnished under the PFS and includes changes to the quality reporting initiatives associated with the PFS; the Physician Quality Reporting System (PQRS), the Electronic Prescribing (eRx) Incentive Program, and the physician value-based payment modifier.
EmPower Magazine: A Resource for Every Patient Are you looking for an engaging, fun way to educate your patients about endocrine disorders? Well, EmPower Magazine is a great resource with educational, easy-toread articles written by endocrinologists! Currently, there are 11 issues of EmPower Magazine that address multiple topics including diabetes, thyroid dysfunction, osteoporosis and more. All issues of EmPower Magazine can be found online at http://empoweryourhealth.org/empo wer-magazine. If you would like to receive physical copies of EmPower Magazine, please contact AACE at 800-3932223.
Do you really know how Medicare sets drug pricing payment limits? We encourage you to inform yourself as to the data utilized in order for CMS to set the payment limit for Medicare Part B drug claims processed or rest processed during the 1 quarter of 2013. To best educate yourself with regards to this most important issue and the process by which the data is calculated, we ask that you access January 2013 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
Did you know that healthcare services can be provided by someone else other than the physician but be billed under the practitioner’s NPI? CGS, a Medicare Administrative Contractor (MAC), offers information on “incident to” services and supplies here. It is called “incident to” and under the Medicare provision, services are submitted under the physician’s NPI but are actually performed by someone else. However, caution should be exercised since there are very specific and targeted restrictions placed upon the types of services that ancillary personnel may perform under this provision.
The Medicare Learning Network (MLN) is an excellent source of information for any provider who submits claims to Medicare. Engaging articles include, but are not limited to, the following:
Expansion of Medicare Telehealth Services for Calendar Year (CY) 2013 Update to Medicare Deductible, Coinsurance, and Premium Rates for 2013 Quarterly Update to Correct Coding Initiative (CCI) Edits, Effective October 1, 2012 Quarterly Update to Correct Coding Initiative (CCI) Edits, Effective April 1, 2013 Expansion of Medicare Telehealth Services for Calendar Year (CY) 2013 Update to Medicare Deductible, Coinsurance, and Premium Rates for 2013 Quarterly Update to Correct Coding Initiative (CCI) Edits, Effective October 1, 2012
Quarterly Update to Correct Coding Initiative (CCI) Edits, Effective April 1, 2013
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Remember – the influenza and pneumococcal vaccines and their administration fees are covered Part B benefits.
2013 Coding & Practice Management Educational Opportunities
Webinar- Medicare Updates for 2013 February 7 or 8
Electronic health Record (EHR) Incentive ProgramsWhat Does “Meaningful Use” Have to Do with It? February 20
CMS has posted the 2012-2013 Seasonal Influenza Vaccines Pricing List. You may also refer to the MLN Matters® article #MM8047, “Influenza Vaccine Payment Allowances - Annual Update for 2012-2013 Season.” Please visit the CMS Medicare Learning Network® Preventive Services Educational Products and CMS Immunizations Web pages for more information on coverage and billing of the flu and pneumococcal vaccines and their administration fees. While some providers may offer the flu vaccine, those who do not can help their patients locate a vaccine provider within their local community. The HealthMap Vaccine Finder is a free, online service where users can find nearby locations offering flu vaccines.
Guidance on patient communication and education, care coordination and aging patients is now at your fingertips, thanks to an expanded library of resources on the AMA Practice Management Center website. Taking the time to inform and engage your patients, coordinate care, and address the needs of aging patients can increase patient satisfaction—and your practice’s overall efficiency. The expanded website includes resources to:
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Help you better communicate with your patients, including “Health literacy and patient safety: Help patients understand” Distribute to your patients, including “Team up to stay healthy”, and the “Caregiver self-assessment questionnaire” (both resources are also available in Spanish) Assist you in care coordination, including the “Physician resource guide to patient self-management support” and “Medical Management of the Home Care Patient: Guidelines for Physicians, 4th edition” Aid your practice in caring for aging patients, including the brochure, “Medicare preventive services,” its related webinar, “Medicare preventive services: Welcome to Medicare, annual wellness visit, and beyond,” and the “Physician's guide to assessing and counseling older drivers”
Explore these new resources and more on the AMA Practice Management Center website.
Brush up on general E/M documentation requirements by listening to a teleconference Palmetto GBA (a Medicare Administrative Contractor) offered on Tuesday, December 11, 2012 titled “General Documentation Requirements and E/M Overview”. Palmetto’s disclaimer can be found here.
Recommend Endocrine Practice to Your Institution’s Library Endocrine Practice is an essential publication for the practicing clinical endocrinologist and serves as a valuable resource in endocrine care. Institutional subscriptions to Endocrine Practice are available in print and online formats. If your medical library doesn’t subscribe to Endocrine Practice, now is the time to act. Please complete an online library recommendation form, or download a form, complete, and submit to the AACE Publications Department (fax: 904-4044189; e-mail: publications@aace.com) and we will submit it on your behalf. Thank you for your help.
FDA Approves Signifor for Cushing’s Disease On Monday, the Food and Drug Administration (FDA) approved Signifor (pasireotide diaspartate) injection for the treatment of Cushing’s disease patients who cannot be helped through surgery. For more information and to view the FDA news release, click here.
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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) Teambuidling for Practice Success HB 300- HIPAA Privacy is No longer Just a Federal Concern 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. 5
Coding TRAC Tips on Reimbursement And Coding
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…
The Taxpayer Identification Number (TIN) determines a group. The enrollment application determines the same specialty. If there are different TINs, the physicians are not part of the same group for Medicare billing. If there are different primary specialties in the enrollment application, they are not the same specialty. For more information, see our Evaluation and Management (E/M) website homepage here. Medicare’s 3-day (or 1-day) payment window applies to outpatient services that hospitals and hospitals’ wholly owned or wholly operated Part B entities furnish to Medicare beneficiaries. The statute requires hospitals to bundle the technical component of all outpatient diagnostic services and related non-diagnostic services (e.g., therapeutic) with the claim for an inpatient stay when services are furnished to a Medicare beneficiary in the 3 days (or, in the case of a hospital that is not a subsection (d) hospital, during the 1-day) preceding an inpatient admission in compliance with Section 1886 of the Social Security Act. The JW modifier may or may not be warranted for discarded drugs. Check with your individual Medicare Administrative Contractor (MAC) for their guidelines. ®
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. Please submit comments or questions to Endonomics@aace.com.
A hospital discharge service (CPT code 99238 or 99239) must be reported for the date of the actual visit by the physician or qualified non-physician practitioner even if the patient is discharged from the facility on a different calendar date. For more information, please visit the Medicare Claims Processing Manual, 100-04, chapter 12, Section 30.6.9.2 B at CMS website. Ohio and Kentucky: Effective for dates of service on or after October ® 1, 2012, ICD-9 code V82.81 is a covered diagnosis for CPT code 77080. This diagnosis is only covered for this particular code in the Bone Mass Measurement LCD (L31854).
We wish you & your family a Happy New Year!
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 2012 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. 6