Endonomics - March 2012 by AACE

March 2012 January 2012

HIPAA 5010 Delayed! No enforcement action is needed for an additional three (3) months, through June 30, 2012, against any covered entity that is required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA): ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0.   

GetReady5010.org – Free webinars & resources MLN Matters articles MM7041 & MM7306 - Delayed Implementation of X12N Version 5010 Paperwork Segment Important Reminders About HIPAA 5010 Implementation SE1106

Medicare revalidation efforts apply to those physicians, other health professionals and suppliers that were enrolled prior to March 25, 2011. Newly enrolled physicians and suppliers that submitted their enrollment applications to CMS 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 physician and supplier.

Physicians and other health professionals and suppliers must wait to submit the revalidation only after being asked by their MAC to do so. MLN Matters: SE1126 Medicare Fee-for-Service Provider Enrollment Contact List FAQs on Revalidations On this page under the downloads section, find out if you were mailed a revalidation letter between September 2011 and January 2012.

Off-cycle revalidation requests from CMS have hit 126,184 providers since Jan.1. Tens of thousands more physicians, providers, and facilities are targeted every month Sample Provider Revalidation Letter 1

To qualify for the 2013 e-Rx incentive payments, eligible professionals must report at least 10 eligible patient encounters during the first 6 months of 2012, January 1, 2012, through June 30, 2012. The remaining 15 eligible patient encounters may be reported throughout the year until December 31, 2012. Three ways to report e-prescribing measures: (1) Via claims-based reporting, i.e.,electronic claims or on the CMS-1500 claim form (2) Via a qualified registry (3) Via a qualified electronic health record (EHR) product Available educational resources

At the 11th Annual National Medicare Provider Enrollment Workshop, the only conference that focuses specifically on Medicare credentialing, youâ&#x20AC;&#x2122;ll get up-tothe-minute information that will protect you from payment-freezing mistakes and compliance risks.

Changing to a clearinghouse or billing service? You must complete the electronic media claims (EMC) change of information form to update your physician/provider-to-submitter relationship. This physician/provider to submitter relationship must also be maintained by an electronic data interchange (EDI) enrollment if your NPI/PTAN (national provider identifier/ provider transaction access form number) changes. Any file received without this physician/provider-to-submitter linkage will reject at the 277CA. An electronic data request form must also be completed if the 835 remittance advice is being returned to the new clearinghouse or billing service. HHS Secretary Sebelius Announces Next Stage for Physicians and other Health Professionals Adopting EHRs and receiving incentive payments from Medicare and Medicaid. These proposed rules, from CMS and the Office of the National Coordinator for Health Information Technology (ONC), will govern stage 2 of the Medicare and Medicaid EHR Incentive Programs. Read the complete update

Fraud Alert for People with Diabetes Although the precise method may vary, the scheme generally involves someone pretending to be from the Government, a diabetes association, or even Medicare, calling. The caller offers "free" diabetic supplies, such as glucose meters, diabetic test strips, or lancets. The caller may also offer other supplies such as heating pads, lift seats, foot orthotics, or joint braces, in exchange for the beneficiaries' Medicare or financial information, or confirmation of this type of personal information. Additionally, patients may receive items in the mail that they did not order. The call is a scam. If patients receive such a call, OIG recommends the following actions.

Any physician or other health care professional attesting to receive an EHR incentive payment for either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program potentially may be subject to an audit. More information

Over the past several weeks, many physician/practitioner billing

offices have notified their servicing A/B Medicare Administrative Contractor or Part B Carrier that various supplemental payers have directed payment, arising from Medicare crossover claims, to incorrect payment addresses. The problem appears to have escalated as the supplemental payers have transitioned from receipt of crossover claims in the HIPAA 4010A1 837 professional claims format to the version 5010A1 837 professional claims format. For more information see this article. CMS has provided the most up to date information regarding coding, billing and reimbursement for Intensive Behavioral Therapy for Obesity in the MLN Matter MM7641.

Physicians and other health care professionals and suppliers frequently report the incorrect place of service (POS) in which they furnish services particularly in outpatient hospitals and ambulatory surgical centers (ASCs). Instructions for the correct assignment of POS codes can be found on the MLN MattersÂŽ article MM7631. 2

HIPAA Privacy & Security Audit Program OCR will audit as wide a range of types and sizes of covered entities as possible; covered individual and organizational providers of health services, health plans of all sizes and functions, and health care clearinghouses may all be considered for an audit. Business associates will be included in future audits.

Covered entities should provide the auditors their full cooperation and support and remind them of their cooperation obligations under the HIPAA Enforcement Rule. Health Reform Law Ends Lifetime Limits for 105 Million Americans HHS Secretary Sebelius released a new report on Monday, March 5 on how the health reform law has eliminated lifetime limits on coverage for more than 105 million Americans. Before health reform, many Americans with serious illnesses such as cancer risked hitting the lifetime limit on the dollar amount their insurance companies would cover for their healthcare benefits. Read the complete update

United Healthcare Bulletin March 2012 United Health Care Advance Notification - for Physicians, Health Care Professionals and Ancillary Providers Advance Notification is required for certain planned services in the Advance Notification List section of the Administration Guide. Notification is required at least five business days prior to the planned service date. If services are planned less than five business days prior to the service date, notification is required as soon as the service is scheduled.

The Errata listing the corrections to the 2012 CPT Book was revised on February 27, 2012, and posted to the AMA Web site.

According to a Payment accuracy web site from the Government,

“Improper payments” occur when • funds go to the wrong recipient • the recipient receives the incorrect amount of funds (including overpayments and underpayments) • documentation is not available to support a payment • the recipient uses funds in an improper manner Federal agencies recaptured $1.26 billion in overpayments to contractors in fiscal year (FY) 2011. This amount includes approximately $460 million recaptured through agency payment recapture audits—a significant effort—and $800 million recovered through the Medicare Recovery Audit Contractor (RAC) program. In total, the Federal Government has recaptured $1.95 billion in FYs 2010 and 2011 combined. As required by the President’s Executive Order, this web site contains information about: 1. Current and historical rates and amounts of improper payments 2. Why improper payments occur 3. What agencies are doing to reduce and recover improper payments

Effective for dates of service April 19, 2012, and after, WPS Medicare Part B will no

longer apply the statement from the 1997 DG to documentation when practitioners use the 1995 DG. The 1995 DG states: "An extended HPI consists of four or more elements of the HPI." The 1997 DG states: "An extended HPI consists of at least four elements of the HPI or the status of at least three chronic or inactive conditions." The CERT contractor does not have that same communication and does not adjudicate documentation that way.

Medicare Redesigns Claims and Benefits Statement The redesigned statement, known as the Medicare Summary Notice (MSN), will be available online and, starting in 2013, mailed out quarterly to beneficiaries. This MSN redesign is part of a new initiative – “Your Medicare Information: Clearer, Simpler, At Your Fingertips” – which aims to make Medicare information clearer, more accessible, and easier for beneficiaries and their caregivers to understand. To see a side-by-side comparison of the former and redesigned MSNs, please visit http://www.CMS.gov/apps/files/msn_changes.pdf. Click here to view the full agenda with session details, or print the brochure. 3

2012 Medical Coding & Practice Management

Educational Opportunities for Members & Nonmembers of AACE These courses are designed for physicians, non physician practitioners, coders, and billers.

Chart Auditing for Physician Services

Only 35 Seats Available!

Presented by Practice Management Institute® Register here and use AACE as the Promotional Code! Jacksonville, FL Date: May 25, 2012 Cost: $299 Who should attend Chart Auditing for Physician Services? This course is for physicians, non-physician practitioners, coders and billing staff who have a strong foundation in coding. New skills you will take away from this program: • Uncover missed revenue when auditing charts based on fact • Ensure that chart documentation supports the claim submitted • Better knowledge of level-of-service audits • Higher aptitude for cross-checking and code selection Class includes self-check forms and tools that will help participants gauge how well they are doing on an ongoing basis.

AACE- Bridge the Gaps in Endocrine Coding Only 35 seats available! Richmond, VA June 12 - 13, 2012 Cost: AACE members and/or their staff $350 Nonmembers $400 This activity has been approved for AMA PRA Category 1 Credit™.

Space provided by: Medical Society of VA 2924 Emerywood Parkway Suite 300 Richmond, VA 23294-3746

AACE- Bridge the Gaps in Endocrine Coding Atlanta, GA July 19, 2012 Cost: AACE members and/or their staff $300 Nonmembers $350

Only 35 seats available! REGISTER NOW

Space provided by: The Physicians Practice S.O.S Group Seminars and Office Solutions™ 4480 South Cobb Dr. Suite H236 Atlanta, GA 30080-6989 Office: 770.333.9405 Fax: 770.333.9406 4

Educational Opportunities *Use Promotional Code AACE when registering Distance Learning and Total Access with PMI® Month by month - cancel at any time • Live weekly webinars each month. • 24-hour access to more than 80 topics with over 100 hours of pre-recorded training. Topics include:

           

ICD-10 Diagnosis Coding for Endocrinology Revenue Cycle Management for Medical Practices Front Office Breach Mastering Medical Decision Making Compliance enforcement and Penalties Transforming the Front Desk Staff ICD-10 Prep: Anatomy & Medical Terminology Compliance is NOT an Option Revenue Cycle Management for Medical Practices HIPAA Compliance Analyzing Managed Care Contracts Billing for Non Physician Practitioners  Budgeting and Cash Flow

$225 per month AACE members & staff $249 Non AACE members

PMI National Certifications via Webinar: 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 contact Paige Moskaitis at 800-259-5562 x242 or pmoskaitis@pmiMD.com

AACE assumes no liability for the purchase(s) of these programs. All purchases and communications are between the attendee and the company.

EXAM Element Based on 1995 Guidelines The levels of E/M services are based on four types of examination that are defined as follows: Problem Focused - a limited examination of the affected body area or organ system. Expanded Problem Focused -a limited examination of the affected body area or organ system and other symptomatic or related organ system(s). Detailed - an extended examination of the affected body area(s) and other symptomatic or related organ system(s). Comprehensive - a general multi-system examination or complete examination of a single organ system. For purposes of examination, the following body areas are recognized: • Head, including the face • Neck • Chest, including breasts and axillae • Abdomen • Genitalia, groin, buttocks • Back, including spine • Each extremity For purposes of examination, the following organ systems are recognized: • Constitutional (e.g., vital signs, general appearance) • Eyes • Ears, nose, mouth, and throat • Cardiovascular • Respiratory • Gastrointestinal • Genitourinary • Musculoskeletal • Skin • Neurologic • Psychiatric • Hematologic/lymphatic/immunologic

The extent of examinations performed and documented is dependent upon clinical judgment and the nature of the presenting problem(s). They range from limited examinations of single body areas to general multi-system or complete single organ system examinations. Specific abnormal and relevant negative findings of the examination of the affected or symptomatic body area(s) or organ system(s) should be documented. A notation of "abnormal” without elaboration is insufficient. Abnormal or unexpected findings of the examination of the unaffected or asymptomatic body area(s) or organ system(s) should be described. A brief statement or notation indicating "negative" or "normal" is sufficient to document normal findings related to unaffected area(s) or asymptomatic organ system(s). The medical record for a general multi-system examination should include findings about 8 or more of the 12 organ systems.

So how is the exam calculated? Find out in the April Edition of Endonomics!

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 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.

**A face-to-face encounter with the patient must occur and be documented in the medical record in order to bill an E/M service to ANY Medicare Administrative Contractor. Documentation requirements for 99211 (per Trailblazer, a Medicare Administrative contractor)

Q. What is the difference in the glucose tests and when do I use 36415/36415? 89247 Glucose; quantitative, blood (except reagent strip) ® CPT 82947 is for blood glucose, quantitative test where capillary or venous ® blood is collected. (No reagent strip is used) CPT 36415 or 36416 would be ® with 82947 to report the METHOD of the blood collection. CPT 36415 is for collection of blood through a venipuncture into a tube that is sent to a ® laboratory. CPT 36416 is for collection of blood through capillaries into a tube that is sent to a laboratory. 82948 Glucose; blood, reagent strip ® CPT 82948 is for a blood, glucose test using a reagent strip. A drop of blood is placed on a glucose oxidase strip and after the reaction occurs the color of the strip is compared visually against color blocks on the container with the unused reagent strips. No machine or device is used to determine the glucose result. 82962 Glucose, blood by glucose monitoring device(s) cleared by FDA specifically for home use ® CPT 82962 is for a glucose test as well. A drop of blood goes on a strip and is assayed by glucose oxidase, hexokinase, or electrochemical methods using a ® portable device that is FDA approved. The CPT code 82962 states “for home ® use”, however according to the CPT assistant, these FDA approved devices may be used in the home or outpatient settings such as outpatient hospital, physician offices, home visits, or in clinics. 36415 and/or 36416 would NOT be used with 82962 and/or 82948 because only a drop of blood is used with these tests but there is no blood collection.

Q. We perform a diagnostic service in the office; the physician reviews the test, and makes notes in the patient's chart. Is this documentation sufficient to submit a charge for the professional component?

A. No. CMS IOM Publication 100-04, Chapter 13, Section 100.1 shows carriers generally distinguish between an "interpretation and report" of an x-ray or an EKG procedure and a "review" of the procedure. A professional component billing based on a review of the findings of these procedures, without a complete, written report similar to what would be prepared by a specialist in the field, does not meet the conditions for separate payment of the service.

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.