May/June 2013
Solo practitioners and physicians nearing retirement age wouldn’t have to adopt electronic health record (EHR) systems to avoid meaningful use penalties, if H.R. 1331 passes. Without the legislation, Electronic Health Records Improvement Act that was introduced March 21, physicians risk a 1% cut to Medicare payments in 2015. The legislation was referred to the House Committee on Energy and Commerce. Click here for additional information.
Speaking of EHRs, CGS, a Medicare Administrative Contractor, has
Click here to find information on EHRs such as: which agencies certify EHRs which EHRs are certified obtain a list of currently certified EHRS and more! Take AACE’s EHR survey here and help other endocrinology offices with their common questions or concerns!
some useful tips regarding electronic medical records here. They also offer some guidance on amendments, corrections, and addenda in a medical record here.
Are you hoping for an incentive payment for participating in the EHR program? If so, take a look at the EHR Incentive Program Audits Overview here.
Expect to receive only 98% of your Medicare Part B PFS (physician fee schedule) amount for covered professional services in 2014 if you did not file 10 unique encounters before June 30, 2013.
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Payment Alert!
88172 and 88177 Subject to CLIA Edits Effective January 1, 2013 and require the facility to have a CLIA certificate. The implementation date of this request is April 1, 2013. To see the complete Change Request from CMS click here. 88172 [Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site] 88177 [Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (list separately in addition to code for primary procedure
CMS is helping the health care industry deliver high quality, efficient health care through its eHealth programs. eHealth provides an integrated approach to simplify the adoption of electronic standards and health information technology. Members of the listserv will receive information about eHealth, how CMS' programs work together, and how to participate. Subscribers will also hear about the latest program developments, the availability of new resources, and upcoming deadlines and milestones for the different eHealth programs. Click here information.
for
more
Medicare Physician Fee Schedule (MPFS): How the fees are calculated CGS, a Medicare Administrative contractor provides a well written article on how the calculations are done. Click here for the full article.
Non-Physicians Acting as Scribes for Physicians CGS, a Medicare Administrative Contractor for CMS, provides information on non-physicians acting as scribes here.
Temporary Delay for Ordering & Referring Denial Edits These edits will check certain claims for an approved or validly opted-out physician or nonphysician who is an eligible specialty type with a valid individual National Provider Identifier (NPI).The following are examples of claims that would be denied if this information were missing or incorrect. • Laboratories for ordered tests • Imaging centers for ordered imaging procedures • Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for ordered DMEPOS CMS will advise us of the new implementation date in the near future. Informational messages will continue to be sent for those claims that would have been denied had the edits been in place. Click here for additional information.
Suppliers submitting claims for imaging services must identify the ordering or referring physician or practitioner. Please note that according to CMS, if billing globally, both components will be impacted by the edits and the entire claim will deny if it doesn't meet the ordering and referring requirements. It is recommended that providers and suppliers bill the global claims separately to prevent a denial for the professional component. Click here for more information under the category of “Claims, Pricer, and Code Updates.”
New HCPCS Code for Zometa and/or Reclast Medicare requires HCPCS code otherwise specified, 1mg) to be claims with dates of service July J3488 will no longer be payable MM8286 for the further details.
Q2051 (Injection, Zoledronic Acid, not reported for Zometa and/or Reclast for 1, 2013 and forward. Codes J3487 and ® for Medicare. Please see MLN Matters
Please check with your commercial carriers to determine what HCPCS codes are required for reporting Zometa and/or Reclast injections. HCPCS codes J3487 and J3488 may or may not be used to report Zometa and/or Reclast injections to commercial carriers. 2
General ICD-10 &
Endocrine Specific ICD-10 Information here The Office of Inspector General (OIG) offers information on provider selfdisclosure protocol. Click here to find out:
Background info Why disclosure is important Benefits of disclosure Eligibility criteria and guidance and more!
AACE members have access to an ICD-9 to ICD-10 Coding Convention Comparison here Click here for AACE membership Information
Dates of Service: Is it ICD-9 or ICD-10? Visit the CMS ICD-10 website for the latest news and resources and the ICD-10 continuing medical education modules developed by CMS in partnership with Medscape to help you prepare for the October 1, 2014, deadline.
Pass the word! New Medicare Administrative Contractor for Connecticut, Maine, Massachusetts, New Hampshire, New York, and Rhode Island. Click here for the implementation schedule!
AACE encourages members to validate that their provider enrollment information is current in PECOS (Provider Enrollment Chain and Ownership System) in lieu of the delay to ensure there are no impacts/delays in patient care. Click here for additional information
Changes in the requirements for written orders regarding DME go into effect July 1. In order to be reimbursed for certain DME (durable medical equipment), the physician, PA, NP, or CNS must have a face to face encounter with the patient 6 months prior to ordering items such as insulin pumps, home blood glucose monitors, etc. Click here for more information.
This fact sheet describes common CERT (Comprehensive Error Rate Testing) errors related to glucose testing supplies and provides a checklist of the documentation needed to support a claim submitted to Medicare for glucose testing supplies.
Effective July 1, 2013, Medicare will implement a national mailorder program for diabetic testing supplies. Beneficiaries who have their diabetic testing supplies shipped or delivered to their homes must use a national mail order contracted supplier with Medicare. Click here for additional information.
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Limited Seating
Open to AACE members and non-members & their staff!
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. ICD-10-CM, scheduled to be effective October 1, 2014, will bring greater challenges with additional training demands and more specific documentation requirements for physicians and other providers of service. CMS and third party payers are spending millions of dollars investigating physician billing practices and the federal government is recovering billions of dollars in healthcare fraud related settlements and judgments through the False Claims Act. A large percentage of these recovery efforts are due to miscoding of claims, misunderstanding of policies, rules and regulations. Physicians and medical practices are facing increased challenges on the business and financial end of the endocrine practice with healthcare reform, dwindling reimbursements, and increased audit requests. Attending one or more of AACE’s educational opportunities can help you keep up with the latest and greatest coding challenges and be prepared when the auditors show up at the door! 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.
Fundamentals and Advanced Endocrine Coding
Register
This activity has been approved for AMA PRA Category 1 Credit(s)™
September 19-20 ● Las Vegas, NV
Las Vegas Agenda
December 5-6 ● Miami, FL
Miami Agenda
Bridge the Gaps in Endocrine Coding
Register
This activity has been approved for AMA PRA Category 1 Credit(s)™
July 22 ● Jacksonville, FL
Jacksonville Agenda
August 15 ● Atlanta, GA
Atlanta Agenda
Evaluation and Management (E/M) Documentation for Endocrinologists “What’s in your record?” Register This activity has been approved for AMA PRA Category 1 Credit(s)™
July 23 ● Jacksonville, FL
Jacksonville Agenda
August 16 ● Atlanta, GA
Atlanta Agenda
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.
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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…
Coding TRAC Tips on Reimbursement And Coding
What is the Medicare National Correct Coding Initiative (NCCI)? The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment. NCCI code pair edits are automated prepayment edits that prevent improper payment when certain codes are submitted together for Part B-covered services. In addition to code pair edits, the NCCI includes a set of edits known as Medically Unlikely Edits (MUEs).
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.
An MUE is a
maximum number of Units of Service (UOS) allowable under most
circumstances
for
a
single
Healthcare
Common
Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) code billed by a provider on a date of service for a single beneficiary.
For information about the Medicaid NCCI program, refer to The National Correct Coding Initiative on Medicaid’s web page.
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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. 5 5