June/July 2012 March 2012 January 2012
Why Has My Allowed or Paid Amount Been Reduced? Medicare allowed and paid amount reductions may occur for a variety of reasons. Read the complete update on various conditions that may reduce allowed and paid amounts under the Medicare program offered by Noridian Administrative Services, LLC, a Medicare Administrative Contractor. The Internet Only Manual (IOM) location of each reduction is provided with the explanation for each reduction. In the absence of an IOM reference, another published reference is used.
The OCR HIPAA Audit program analyzes processes, controls, and policies of selected covered entities pursuant to the HITECH Act audit mandate. OCR established a comprehensive audit protocol that contains the requirements to be assessed through these performance audits. The audit protocol covers Privacy Rule requirements for (1) notice of privacy practices for PHI, (2) rights to request privacy protection for PHI, (3) access of individuals to PHI, (4) administrative requirements, (5) uses and disclosures of PHI, (6) amendment of PHI, and (7) accounting of disclosures. The protocol covers Security Rule requirements for administrative, physical, and technical safeguards.
Alaska Settles HIPAA Security Case for $1,700,000 Over the course of it’s investigation, the Office of Civil Rights (OCR) found evidence that there were not adequate policies and procedures in place to safeguard ePHI. Further, the evidence indicated that Alaska’s Department of Health and Social Services (DHSS) had not completed a risk analysis, implemented sufficient risk management measures, completed security training for its workforce members, implemented device and media controls, or addressed device and media encryption as required by the HIPAA Security Rule.
Version 5010 Transaction Standards Enforcement Discretion Period Ended June 30, 2012 CMS Office of E-Health Standards and Services ended its enforcement discretion period for ASC X12 Version 5010 (Version 5010) standards on June 30, 2012. All HIPAAcovered entities must now be fully compliant with upgraded transaction standards for Version 5010 and NCPDP Versions D.0 and 3.0. Read the complete update
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Signatures must be legible and handwritten or electronic and should include the provider's first and last name.
Correct Coding for Hydration Administration: Hydration is defined as the replacement of necessary fluids via an IV infusion which consists of pre-packaged fluids and electrolytes. Hydration services are reported by using CPT codes 96360 (initial 31 minutes to 1 hour) and 96361 (each additional hour). IV fluids reported for hydration lasting 30 minutes or less is not reported using infusion codes. Read more...
These forms of signature documentation are not acceptable and will be considered errors upon review: • Signed but not read • Signed before reading • Dictated by • Electronically signed and sent without review to avoid delay • Signature on file • Provider name typed but not signed Acceptable forms of signature are as follows: 1. Handwritten: Handwritten signatures must be legible; many records we received cannot be verified to be that of the provider due to illegibility. If the signature is illegible, a signature card or sample of his/her signature with his/her name printed/typed beside it should be included with the requested documentation. 2. Electronic: An electronic signature is part of an electronic record and must be executed by the person who performs the service. This form of signature must adhere to security standards in the Health Insurance Portability and Accountability Act (HIPAA). In the instance of an electronic signature, the record should state one of the following, along with the typed name of person signing record: Electronically signed by Electronically verified by Reviewed by Authenticated by Accepted by 3. Digital: An electronic image is an individual's handwritten signature reproduced in its identical form using a pen tablet. (Note; this is an “actual” real time signature done electronically, like the digital sign-out with a credit card transaction). If using the digitized signature method of a written signature that is typically generated by special encrypted software that allows for sole usage, also submit your protocol outlining the guidelines followed by each user. The legible (signature) identifier requirement applies to documentation for ANY service performed and billed to Medicare.
Take Short Part B News Survey, Get Free Preventive ServicesTool Evaluation and Management Services (E&M): Recently Medical Review at CGS has received questions concerning the requirements for the key elements (history, physical exam, and medical decision making) for E&M services involving an established patient. Discussion around the requirement of a physical exam has prompted the need for clarification of documentation requirements. Read more...
Physicians practices: Part B News wants to know how the Affordable Care Act (ACA) will affect your practice. Do you expect to see more patients? Will you now join an ACO? Fill out this 12-question survey and we’ll send you a free tool to bill CMS’ five new preventive services accurately to increase your revenue. Read full story
Attention Physicians Who Order/Refer Services for Medicare Beneficiaries Residing in Home Health Agencies – When billing Medicare, Home Health Agencies (HHAs) must use the individual National Provider Identifier (NPI) of the physician who orders/refers services, not the NPI of the physician’s group practice. If an HHA asks for your NPI, be sure to provide your individual NPI.Don’t know your individual NPI? You may verify your NPI on the NPI Registry on the CMS Website.
Ordering/Referring Provider Edits – Is Your Provider Enrollment Information Updated in PECOS? CMS will soon begin denying Part B, DME, and Part A HHA claims that fail the ordering/referring provider edits. These edits ensure that physicians and others who are eligible to order and refer items or services have established their Medicare enrollment records and are of a specialty that is eligible to order and refer. If you order or refer items or services for Medicare beneficiaries and you do not have a Medicare enrollment record, you need to submit an enrollment application to Medicare. You can do this using Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) or by completing the paper enrollment application (CMS855O)
. Here is the link to the MLN Matters® article SE1221
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Staph Infections Tied to Misuse of Drug Vials Clinic divided medication intended for a single patient and administered doses to multiple patients, according to NPR. Injection Safety Checklist CDC Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care.
An Introduction to the Medicaid EHR Incentive Program for Eligible Professionals from CMS
Interest Rate for Medicare Overpayments and Underpayments – July 2012 Notice Medicare Regulation 42 CFR Section 405.378 provides for the charging and payment of interest on overpayments and underpayments to Medicare providers. The Secretary of Treasury certifies an interest rate quarterly.
Effective July 18, 2012, the overpayment and underpayment interest rate is 11.00%.
The Affordable Care Act requires employers to report the cost of coverage under an employer-sponsored group health plan. Reporting the cost of health care coverage on the Form W-2 does not mean that the coverage is taxable. This reporting is for informational purposes only and will provide employees useful and comparable consumer information on the cost of their health care coverage. Employers that provide "applicable employer-sponsored coverage" under a group health plan are subject to the reporting requirement. This includes businesses, taxexempt organizations, and federal, state and local government entities (except with respect to plans maintained primarily for members of the military and their families).
Welcome to the HIMSS ICD-10 Play Book Financial Risk Calculator. This tool helps providers assess their ICD-10 financial risk exposure, identify the steps that they can take to mitigate that risk, and identify ways to augment their accounts receivable. The survey covers a wide range of financial topics including cash flow, revenue, and operational cost.
Steps to Assess How the ICD-10 Transition Will Affect Your Organization A critical step in planning for the transition is to conduct an impact assessment of how the new code sets will affect your organization. Your impact assessment should include the following: • Documentation Changes: • Reimbursement Structures: • Systems and Vendor Contracts Business Practices • Testing CMS provides the following tips to prepare for documentation changes and improvements with ICD-10. • Inventory systems and identify discrepancies • Evaluate Current Software Systems • Train and Educate Staff • Test the Documentation Process CMS’ ICD-10 Implementation Guide for Small and Medium Practices
July 2012 Average Sales Price Files now Available! All are available for download on the 2012 ASP Drug Pricing Files Web page.
Keep Up-to-Date Sign up for CMS ICD-10 Industry E-mail Updates Follow @CMSGov on Twitter Subscribe to Latest News Page Watch
Access the AMA's "Workers' compensation eBilling vendor" listing to learn about some of the many practice management system and clearinghouse vendors offering workers' compensation eBilling solutions. 3
The Quarterly Provider Update – June 2012 The Quarterly Provider Update provides a listing of Agency regulations and meeting notices. Nonregulatory changes to the Medicare and Medicaid programs, consisting of manual instructions, are also included in this listing.
Need to have a basic understanding of the Physician Quality Reporting System and e-Rx programs? CGS, a Medicare Administrative Contractor offers FREE educational video presentations
Alphabetical Contact Index for Part B Medicare Administrative Contractors Do you know who your Part B Medicare Administrative Carrier (MAC) is? Do you know your MAC’s Medical Director? Find this and more information in the link. List of contractor Web sites
HHS ANNOUNCES 88 NEW ACCOUNTABLE CARE ORGANIZATIONS The 88 ACOs announced on July 9, 2012, bring the total number of organizations participating in Medicare shared savings initiatives to 153, including the 32 ACOs participating in the testing of the Pioneer ACO Model by the Center for Medicare and Medicaid Innovation (Innovation Center) that were announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011.
Physician Value-Based Payment Modifier and the Physician Feedback Program On July 6, 2012, CMS issued a proposed rule that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (MPFS) on or after Jan. 1, 2013. The proposed rule also proposes changes to several of the quality reporting initiatives that are associated with MPFS payments – the Physician Quality Reporting System (PQRS), the Electronic Prescribing (eRx) Incentive Program, and the PQRS-EHR Incentive Pilot – as well as changes to the Physician Compare tool on the Medicare.gov website. Finally, the proposed rule includes proposals for implementing the physician value-based payment modifier (Value Modifier) required by the Affordable Care Act that would affect payment rates to physician groups based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare Fee-forService program. Read more
EVALUATION AND MANAGEMENT SERVICES COMPARATIVE BILLING REPORTS TO BE RELEASED: On June 4, CMS will release a national provider Comparative Billing Report (CBR) addressing E/M services. These reports are not available to anyone except the providers who receive them. For more information on Comparative Billing Reports, or to view a sample, please visit the CBR Services website or call the SafeGuard Services’ Provider Help Desk, CBR Support Team at 530-896-7080. All Medicare Provider and Supplier Payments to Be Made By Electronic Funds Transfer As part of CMS’s revalidation efforts, all suppliers and providers who are not currently receiving EFT payments are required to submit the CMS-588 EFT form with the Provider Enrollment Revalidation application, or at the time any change is being made to the provider enrollment record by the provider or supplier, or delegated official. For more information about provider enrollment revalidation, review the Medicare Learning Network’s Special Edition Article #SE1126, titled “Further Details on the Revalidation of Provider Enrollment Information.”
Help ensure your success in the EHR incentive programs by registering early! 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. If you register early, you can verify that your information is current in all of CMS’ systems and resolve any issues, so you may participate in the EHR incentive programs. If you do not resolve registration problems in time, you will not be able to attest and could potentially miss a payment year. 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. 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. Any provider attesting to receive an EHR incentive payment for either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program potentially may4be subject to an audit. More information
Coding and Practice Management Educational Opportunities for 2012 These courses are designed for physicians, non-physician practitioners, coders, and billers.
Accountable Care Organizations and Their Impact on Your Future Webinar/Audio Conference August 2, 2012 12:00 – 1:30 PM CT Presented by: The Practice Management Institute and Maxine Inman Collins, MBA, CPA, CMC, CMIS, CMOM Focus Areas • Understand the implications of ACOs and future practice operations • Review ACO options to make informed decisions that positively impact your practice's future • Form a plan for addressing ACO in your office • Plan now for successful practice operations tomorrow • Find creative, unique ways to become more efficient. New ACO applications will be accepted by CMS annually. To participate in 2013 practices have from August 1 through September 6 to apply.
Use AACE as the Promotional code when registering through PMI AACE assumes no liability for the purchase(s) of these programs. The content of the program(s) does not necessarily represent
Fundamentals & Advanced Endocrine Coding Course With AACE-sponsored Certified Endocrine Coder (AACE-CEC) Exam This activity has been approved for AMA PRA Category 1 CreditTM
Philadelphia, PA November 9-10, 2012 Location: Embassy Suites Philadelphia Airport 9000 Bartram Avenue Philadelphia, PA 19153 Cost for both courses: AACE members and/or their staff $650 Non AACE members $725
REGISTER
Register by October 10 & Save $100
Contact Vanessa Lankford at vlankford@aace.com or 904-353-7878 for additional information. AACE reserves the right to cancel any 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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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) Front Office Breach Mastering Medical Decision Making Translating Efficiencies to Profit (6/21/12) HCPCS Modifiers (6/28/12) E&M Documentation (scheduled for 7/10/2012) Conducting “Payer Proof” E/M Chart Audits (scheduled for 7/11/2012) Top 5 Concerns of Medical Practice Managers (7/26/12) Compliance is NOT an Option (scheduled for 8/2/2012)
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 •
As the billing provider, it is your responsibility to obtain the medical records to support services billed to Medicare, regardless of where the records are housed. The Comprehensive Error Rate Testing (CERT) contractor should not be referred to a third party to obtain medical records. For further information, visit our CERT FAQ web page at http://www.wpsmedicare.com/part_b/faqs/departmental/cert_faq.s html.
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Modifier 52 and 53 Reimbursement Clarification Provided by Noridian Administrative Services, LLC, a Medicare Administrative Contractor.
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CGS, a Medicare Administrative Contractor offers an explanation on The Difference Between Denial Codes and Return/Reject Codes
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What is the National Association of Insurance Commissioners?
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.
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