May 2012 March 2012 January 2012
IMMEDIATE ACTION IS REQUIRED to avoid payment disruption. If you enrolled for Electronic Funds Transfer (EFT) with Pinnacle Business Solutions, Inc., Cahaba Government Benefits Administrators or Trailblazer Health Enterprises, look out for a letter from Novitas Solutions, Inc. requesting a CMS-588 EFT Authorization Agreement. Please read this letter carefully for instructions for completing and returning the Agreement. Failure to complete and submit the Agreement may result in a delay or interruption of your Medicare payments. Additional information here.
Version 5010 Enforcement Discretion Period Ends June 30, 2012. If you have not yet finalized your Version 5010 upgrade, you should be working to complete this step as soon as possible. This web page is dedicated to Version 5010 information, which includes a fact sheet discussing steps that should be taken to be compliant by June 30, 2012. Visit the ICD-10 website for the latest news and resources to help you prepare!
E/M SERVICES COMPARATIVE BILLING REPORT (CBR) WILL BE RELEASED On June 4 from CMS. These reports are not available to anyone except the providers who receive them. For more information, please visit the CBR Services website at http://www.safeguard-servicesllc.com/cbr/default.asp or call the SafeGuard Services’ Provider Help Desk, CBR Support Team at 530896-7080.
CMS Requires a compliance plan AND annual fraud, waste, and abuse (FWA) training for organizations providing health, prescription drug, or administrative services to Medicare Advantage (MA) or Prescription Drug Plan (PDP) enrollees. The compliance plan must incorporate measures to detect prevent, and correct fraud, waste, and abuse.
Fraud: an intentional act of deception, misrepresentation, or concealment in order to gain something of value. Waste: over-utilization of services (not caused by criminally negligent actions) and the misuse of resources. Abuse: excessive or improper use of services or actions that is inconsistent with acceptable business or medical practice. 1
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LCD (Local coverage Determinations) for Bone Mass Measurements Providers in Illinois, Michigan, Minnesota, Wisconsin, Iowa, Kansas, Missouri and Nebraska should review their LCD (Local Coverage Determination) for Bone Mass Measurements. The LCD lists the specific requirements for bone density exams. Medicare will allow a bone mass measurement every two years if at least 23 months have passed. Bone Mass Measurements may be allowed more frequently, if the requirements of LCD MS-004 are documented. Documentation must state the name of the osteoporosis drug the patient is taking. If the patient is on long-term glucocorticoid (steroid) therapy, state the name, the dosage, and the duration of the drug. There is additional information about bone mass measurements for Illinois, Michigan, Minnesota, and Wisconsin and for Iowa, Kansas, Missouri and Nebraska.
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According to the OIG (Office of Inspector General),
an effective compliance program for individual and small group physicians contain seven components that provide a solid basis, upon which a physician practice can create a voluntary compliance program. The components are: Conducting internal monitoring and auditing; Implementing compliance and practice standards; Designating a compliance officer or contact; Conducting appropriate training and education; Responding appropriately to detected offenses and developing corrective action; Developing open lines of communication; and Enforcing disciplinary standards through well-publicized guidelines
OIG has developed a list of four potential risk areas affecting physician practices. 1. Coding and billing 2. Reasonable and necessary services 3. Documentation 4. Improper inducements, kickbacks and self-referrals (Soliciting, offering, or receiving a kickback, bribe, or rebate (for example, paying for a referral of patients in exchange for the ordering of diagnostic tests and other services or medical equipment). This list of risk areas is not exhaustive, or all encompassing, but a starting point for an internal review of potential vulnerabilities within the physician practice.
Compliance Program Guidance for Third-Party Medical Billing Companies
Company penalized $351,255.44 for employing an individual who was excluded from Federal health care programs. The OIG alleges that companies should know if employees are excluded from participating in Federal health care programs.
Have you checked the exclusion lists? Check the OIG and General
GUIDE TO PRIVACY AND SECURITY OF HEALTH INFORMATION
Services Administration (GSA) exclusion lists for all new employees and at least once a year thereafter to validate employees and other entities that assist in the administration or delivery of services to Medicare beneficiaries are not on such lists. ďƒź OIG List of Excluded Individuals/Entities (LEIE) ďƒź
General Services Administration (GSA) database of excluded individuals/entities
A $100,000 settlement paid to US Department of HHS for posting appointments on an internet- based calendar that was publicly accessible. 2
All enrolled providers and suppliers must revalidate their enrollment information under new enrollment screening criteria through CMS. This
Technical Component of Physician Pathology Services Furnished to Hospital Patients No Longer Covered by Medicare for Certain Pathologists and Independent Labs (Part B) This moratorium expires on June 30, 2012. Therefore, pathologists and independent laboratories that provide the TC of physician pathology services furnished to hospital patients may no longer bill for and receive Medicare payment for these services, effective for claims with dates of service on and after July 1, 2012. MLN Matters® article MM5943 and MLN Matters® article MM5347.
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revalidation effort applies to those providers and suppliers enrolled prior to March 25, 2011. New providers and suppliers that enrolled on or after March 25, 2011, are not impacted. Between now and March 23, 2015, MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier. Providers and suppliers must wait to submit the revalidation until their MAC asks them to do so. Contact Information for Medicare Enrollment Contractors Tips to Facilitate the Medicare Enrollment Process FAQs
Complete Signing Your Medicare Enrollment Application Electronically: Internet-based PECOS (Provider Enrollment, Chain, and Ownership System) now allows providers to sign Medicare enrollment applications electronically. You can save time and expedite review of your application by utilizing the electronic signature process. This feature does not change who is required to sign the application. Read more...
What are Taxonomy Code Sets? A hierarchical code set that consists of
GetReady5010.org – Free webinars & resources
codes, descriptions, and definitions designed to categorize the type, classification, and/or specialization of health care providers. The codes are updated twice a year and effective April 1 and October 1. The code set is available from the Washington Publishing Company and maintained by the National Uniform Claim Committee. The Code Set is a HIPAA standard and is the only code set used in HIPAA standard transactions to report the type/classification/specialization of a health care provider when such reporting is required.
After determining your eligibility for the Electronic Health Record (EHR) Incentive Programs, you should register as early as possible for the Medicare and/or Medicaid program. CMS’ EHR Information Center is open to assist the EHR provider community with registration and other program-related inquiries. To reach the center call 1-888-734-6433 (primary number) or 888-734-6563 (TTY number) from 7:30 a.m. – 6:30 p.m. (Central Time) Monday through Friday, except federal holidays. More information about the EHR Incentive Programs Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice
HHS FINALIZES NEW RULES TO CUT REGULATIONS FOR HOSPITALS AND HEALTH CARE PROVIDERS. Among other changes, the final rules will require that all eligible candidates, including advanced practice registered nurses and physician assistants, be reviewed by medical staff for potential appointment to the hospital medical staff and then be granted all of the privileges, rights, and responsibilities accorded to appointed medical staff members.
Information from the Federation of State Medical Boards 3
Coding and Practice Management Educational Opportunities for 2012 These courses are designed for physicians, non-physician practitioners, coders, and billers.
Bridge the Gaps in Endocrine Coding
This activity has been approved for AMA PRA Category 1 CreditTM
Richmond, VA
Atlanta, GA
Date:
Date:
June 12-13
Location: Medical Society of VA 2924 Emerywood Parkway Suite 300 Richmond, VA 23294-3746 Cost: AACE members and/or their staff $350 Non AACE members $400
July 19
Location: The Commerce Club 191 Peachtree St. NE 49th Floor Atlanta, GA 30303 Cost: AACE members and/or their staff $300 Non AACE members $350 Space Provided by:
Participants may take the AACE sponsored Certified Endocrine Coder Exam at no additional cost! This is an open book exam with true/false and multiple-choice questions.
The Physicians Practice S.O.S Group www.ppsosgroup.com 4480 South Cobb Drive Suite H-236 Atlanta, GA 30080-6989 Office: 770-333-9405 Email: info@ppsosgroup.com
Fundamentals & Advanced Endocrine Coding Course
NEW
With AACE-sponsored Certified Endocrine Coder (AACE-CEC) Exam This activity has been approved for AMA PRA Category 1 CreditTM
Gainesville, FL Date:
June 29-30
Location: University of Florida 1600 SW Archer Rd Academic Research Building Room R4-265 Gainesville, Florida Cost for both courses and CEC exam: members/non-members/staff $550 20 Seats available!
Philadelphia, PA Date:
November 9-10
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 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 to12 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. All purchases and communications are between the attendee and the company. 5
Medical Decision Making Complexity of medical decision-making is the component for determining medical necessity for visits, procedures, and other services the patient obtains. Three categories determine the level of medical complexity and two of the three categories must be met or exceeded to appropriately calculate medical decision-making.
1. Number of Diagnoses and/or Management Options 2. Amount and/or Complexity of Data 3. Risk of Complications, Morbidity and/or Mortality
Number of Diagnosis and/or Management Options can be:
Straightforward 0-1 diagnosis and/or management options Low complexity 2 diagnosis and/or management options Moderate complexity 3 diagnosis and/or management options High Complexity 4 or more diagnosis and/or management options
Documentation should indicate:
If problem is new, worsened, stable, mild/serious exacerbation and or life threatening Assessment, clinical impression, or diagnosis Initiation or changes in treatment Patient and/or nursing instructions, therapies and medications Referrals, consult requests or advice sought
Amount and/or Complexity of Data can be:
Straightforward 0-1 items for the amount and/or complexity of data Low complexity 2 items for the amount and/or complexity of data Moderate complexity 3 items for the amount and/or complexity of data High complexity 4 or more items for the amount and/or complexity of data
Documentation should indicate:
Clinical lab tests - ordered/reviewed/performed Radiological tests - ordered/reviewed/performed Medical tests - ordered/reviewed/performed Test results discussed with performing/interpreting physician Obtaining/reviewing old medical records Obtaining case history from another source Personal visualization of images or specimens
Risk of Complications, Morbidity and/or Mortality Can be:
Minimal/straightforward Low/low complexity Moderate/moderate complexity High/high complexity
Documentation should indicate:
Presenting problem(s), diagnostic procedure(s) ordered, management options selected Comorbidities/underlying diseases or other factors that increase the complexity of medical decision making by increasing the risk of complications, morbidity and/or mortality Surgical or invasive diagnostic procedures ordered, planned or scheduled at time of E/M visit Referral for or decision to perform a surgical or invasive diagnostic procedure on an urgent basis
An example of appropriate calculation of the MDM will be provided in the upcoming edition of Endonomics™. 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 a free newsletter for both members and nonmembers. 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 • New physician specialty codes for sleep medicine and sports medicine have been established Effective Date: April 1, 2012. Implementation Date: October 1, 2012. Medicare specialty codes describe the specific or unique types of medical services that physicians and non-physician practitioners provide. Although physicians self-designate their Medicare physician specialty on their Medicare enrollment applications (i.e., CMS-855I), non-physician practitioners are assigned their Medicare specialty code when they enroll. The specialty code becomes associated with their submitted claims. Medicare contractors also use specialty code data to develop claim-processing edits. For additional information, see MLN Matters® article MM7600. • What is the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN)? The PTAN is the number that Medicare assigns and consists of 5 to 10 characters comprised of numeric or alpha characters for Part B providers and 6 characters for Part A providers. You may have heard it referred to as the Medicare provider number or PIN. When accessing the Interactive Voice Response (IVR) or contacting your Provider Contact Center, you will need the PTAN in addition to your NPI and the last five digits of the Tax Identification Number (TIN). Additional information can be found at MLN Matters® Number: SE1216 • HPSA bonus payments pertain only to physicians' professional services. Only the professional component will receive the bonus payment for services provided in an approved HPSA area containing both a professional and technical component, Additional information on HPSA bonus payments is here. • Technical component of physician pathology services furnished to hospital patients no longer covered by Medicare for certain pathologists and independent labs (Part B) as of June 30, 2012. For background and policy information regarding payment to pathologists and independent laboratories for the TC of physician pathology services furnished to hospital patients, refer to MLN Matters® article MM5943 and MLN Matters® article MM5347. • FREE Educational Course: Avoiding Medicare Fraud and Abuse: A Roadmap for Physicians.
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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