Endonomics June 2011
5
1 Federal Incentive Plans (Three Separate Programs) E lectronic Prescribing (eR x) Incentive Program – Reimbursement Reduced for Eligible Professionals Who Do Not Participate. For more information, please see the special edition MLN Matters article SE1107 . • Eligible professionals may begin reporting the eRx measure at any time throughout the 2011 program year of January 1-December 31, 2011, to be eligible for the 2011 incentive. • Eligible professionals must have reported the eRx measures before June 30, 2011 to be exempt from the 2012 eRx payment adjustment. More Information Proposed R ule for Changes to the 2011 eR x Incentive Program The presentation materials are now available under the “Downloads” section on this link . EHR Incentive Programs-To get your EHR incentive payment, you must attest (legally state) through Medicare's secure Web site that you have OR WILL be demonstrating "meaningful use" with certified EHR technology. Registration can be done before an EHR is installed and should be done as soon as possible. Do you have questions about attestation? • How will I attest for the Medicare and Medicaid Incentive Programs? • When can I attest? And What can I do now to prepare for attestation? • Where can I find user guides and other resources? • What will I need to login to the Attestation System? • Can I designate a third party to register and/or attest on my behalf? • When will I get paid? And How will I get paid? EHR Templates are important to consider during your EHR selection. AmericanEHR Blog JUNE 2011
description
Endocrine practice management newsletter from the American Association of Clinical Endocrinologists
Transcript of Endonomics June 2011
1
F ederal Incentive P lans (T hree S eparate P rograms ) E lec tronic P res c ribing (eR x) Inc entive P rogram ndash Reimbursement Reduced for Eligible Professionals Who Do Not Participate For more information please see the special edition MLN Matters article SE1107
bull Eligible professionals may begin reporting the eRx measure at any time throughout the 2011 program year of January 1-December 31 2011 to be eligible for the 2011 incentive
bull Eligible professionals must have reported the eRx measures before June 30 2011 to be exempt from the 2012 eRx payment adjustment More Information
P ropos ed R ule for C hanges to the 2011 eR x Inc entive P rogram The presentation materials are now available under the ldquoDownloadsrdquo section on this link
EHR Incentive Programs-To get your EHR incentive payment you must attest (legally state) through Medicares secure Web site that you have OR WILL be demonstrating meaningful use with certified EHR technology Registration can be done before an EHR is installed and should be done as soon as possible Do you have questions about attestation
bull How will I attest for the Medicare and Medicaid Incentive Programs bull When can I attest And What can I do now to prepare for attestation bull Where can I find user guides and other resources bull What will I need to login to the Attestation System bull Can I designate a third party to register andor attest on my behalf bull When will I get paid And How will I get paid
EHR Templates are important to consider during your EHR selection AmericanEHR Blog
JUNE 2011
2
Federal News HIPAA 5010ndash Compliance Deadline is Six Months Away National 5010 Testing Day is August 24 2011 Electronic claims will require a street address GetReady5010org ndash Free webinars and resources 5010D0 Errata requirements and testing schedule Contact your MAC for their testing schedule Have you done the following to be ready for 5010D0 What do you need to have in place to test with your MAC Do you know the implications of not being ready
Quarterly ICD-10 Article Reminds Industry to Get Ready for Version 5010 This article provides steps to help reach compliance and new resources and tools CMS is developing to help you prepare for the transitions
ICD-10-CM Impact Analysis Report from CMS analyzes the transition from ICD-9 to ICD-10 on CMS policies processes and systems Scroll down to the Downloads section on this link
The 2011 ICD-10-CM files on this page contain information on the new diagnosis coding system ICD-10-CM (effective October 1 2013)
CMS implements a partial ICD-9 code freeze on October 1 2011 Starting October 1 2012 there will be only limited code updates to ICDndash9ndashCM and ICDndash10 code sets to capture new technology and new diseases AACE ICD-10 Course July 28-29th Sign up for CMS ICD-10 email updates FREE CMS sponsored ICD-10 teleconferences ICD-10 Basics from AACE AAPC ICD-10 Resources
Medicare Coverage amp Other Information
CMS Proposes a NEW Rule about Signatures on Lab Requisitions Released June 29 2011 The proposed new rule would retract the policy adopted in the calendar year 2011 Physician Fee Schedule final rule and would reinstate the prior policy that the signature of a physician or qualified non-physician practitioner is not required on a requisition for Medicare purposes for a clinical diagnostic laboratory test paid under the CLFS(clinical laboratory fee schedule)
Medicare is administered under the local MACrsquos (Medicare Administrative Contactor) authority also referred to as the ldquoMedicare Local Carrierrdquo There were originally 15 MACs awarded administration of Medicare part A and B plans Over the next several years CMS will consolidate them into ten AB MAC workloads List of MAC Web sites Contact for Part B MACs Durable Medical Equipment MACs
Prac t i ce Man ag emen t amp
C od in g Ed u ca t io n a l Op p o r t u n i t i es f o r
201 1
A l l co u rses
How to Prepare for an Audit
Live Webinar Series July 13th amp July 27th 1200 pm ndash 130 pmET
Find out who the auditors are why they are auditing your practice what information they are looking for and what is required for documentation More information
Charting a Course for ICD10 July 28 amp 29th Jacksonville Florida
The transition to ICD-10 takes effect in October 2013 ndash and CMS has indicated that there will be no delay Its time to start planning now L imited S eating
More information
Bridge Gaps in Endocrine
Coding August 13th Chicago IL
This one-day course is for experienced coders and will cover
bull Components of a Medical Record
bull Fine Needle Aspirations bull Injections amp Infusions bull Nurse Visits bull EM Codes and When to Utilize
with Procedures And more
L imited S eating More information
3
Medicare provides coverage for HIV screening as a Part B benefit for eligible beneficiaries at no out-of-pocket cost (no coinsurance copayment or deductible) bull CMS National Coverage Determination ndash NCD for Screening for HIV bull Medicare Learning Networkrsquos ldquoGuide to Medicare Preventive Servicesrdquo bull MLN Matters Article MM6786 ldquoScreening for HIVrdquo bull MLNrsquos ldquoHIV Screeningrdquo Brochure
Medicare enrollment application forms are fillable on your computer Signatures are still required to be handwritten
Advanced Beneficiary Notice Fast Facts Provided to beneficiaries enrolled in Original (Fee-For-Service) Medicare Allows the beneficiary to make an informed decision about whether to receive
services and accept financial responsibility if Medicare does not pay Serves as proof that the beneficiary had knowledge prior to receiving the
service that Medicare might not pay If a health care providersupplier does not deliver a valid ABN to the beneficiary when required by statute the beneficiary cannot be billed for the service and the provider may be held financially liable ABN Booklet From MLN
RememberhellipMedicare covers smoking amp tobacco use cessation counseling This is a list of resources to support providers in the delivery of counseling and organizations promoting cessation
Resources for Medicarersquos Annual Wellness Visit Information on coverage coding billing reimbursement and claims filing procedures
bull Quick Reference Information The ABCs of Providing the Annual Wellness Visit
bull MLN Matters Article MM7079 ldquoAnnual Wellness Visit (AWV) Including Personalized Prevention Plan Services (PPPS)rdquo
bull Medicare Learning Networkreg Preventive Services webpage bull Order materials to start the conversation about Medicarersquos preventive
services including Questions to Ask about Medicare Preventive Services
Common Comprehensive Error Rate Testing (CERT) Program errors related to signature requirements See CERT FAQs also
16 Compliance Training webcasts from the HEAT (Healthcare fraud prevention amp enforcement action team) hosted on YouTubecom
The Medicare Learning Networkreg (MLN) Provider Compliance web page contains educational products on avoiding common billing errors
(Almost) Everything You
Need to Know About Those Incentive
Programs
August 26th Ft Lauderdale FL Is your Medicare patient population 30 or greater If so you are looking at a reduction of Medicare reimbursements by as much as 5 of your total Medicare allowable charges due to lack of participation in CMSrsquo incentive programs More information
C e r t i f i e d M e d i c a l O f f i c e M a n a g e r
September 15-18th
Richmond VA
Objectives include
bull Defining budget guidelines terminology and financial policies
bull Demonstrating effective communication on financial projections
bull Defining ways to control practice expenses and set cost control goals
bull Reviewing effective strategies on billing and collecting
bull Explaining how to use medical records in malpractice suits
bull Defining current HIPAA and OIG compliance statues
And much more
Additional Information L i m i t e d S e a t i n g
4
The Office of Inspector General (OIG) has several physician education training materials to assist in teaching about Federal Laws regarding fraud and abuse of the Medicare and Medicaid programs
Beware CMS Press Release ldquoNew Technology to Help Fight Medicare Fraudrdquo
The Provider Outreach and Education Team at NHIC Corp developed a guide on Medicare Part B billing information and a guide on Medicare Part B CMS-1500 Claim Form Instructions
Check out CMSrsquo Practice Administration Center for
Billing and payment information Part B drugs and drug coverage Medicare Secondary Payer And More
OIGrsquos Most Wanted Healthcare Fugitives
Who is the OIG (office of inspector general) and what do they do
Are any of your P ayers not acc epting 2011 C P T c odes R eport them
from the AMA (American Medical As s oc iation) The rejection of a valid Current Procedural Terminology (CPTreg) code is a violation of the Health Insurance Portability and Accountability Act of 1996
(HIPAA) Included within the Healthcare Common Procedure Coding System (HCPCS) code set CPT is one of the medical data code sets adopted under
HIPAA Additionally HIPAA covered entitiesmdashincluding payersmdashare required to use the applicable medical data code set valid at the time the health care is
furnished According to the HIPAA rule ldquoeach code set is valid within the dates specified by the organization responsible for maintaining that code setrdquo 45 CFR sect 1621011 The introduction of the CPT book provides instruction for use of the
CPT codes and it states that January 1 is the effective date for use of the updated CPT code set
We encourage you to report HIPAA violations Simply file a complaint through the Centers for Medicare and Medicaid Services Administrative Simplification
Enforcement Tool or file the online AMA Health Plan Complaint Form
AMA members and their practice staff can visit wwwama-assnorggotemplateletters to download a sample appeal letter and customize it
for use in their practice
Medicare Beyond the Basics
FREE Webinar
Hosted by Palmetta GBA
(A Medicare Adminis trator) July 26 2011 10 am ET This webinar will provide Medicare information useful to experienced billing staff
This session is free to all participants
Medicare training modules
Certificate of Medical
Necessity Diagnosis coding HIPAA EDI
Standards Medicare Preventive
services And more
F R E E
STOP An errata has been
released on the corrections to the
2011 CPT Book from June 28 2011 It is
also listed on the AMA web site
5
United Healthcare Will No Longer Cover Androgelreg Under
Pharmacy Benefit Effective July 1 2011 United Healthcare will no longer cover Androgelreg under their pharmacy benefit Testimreg will change from a previously excluded medication to a medication covered under Tier 2 United Healthcares pharmacy benefit allows the exclusion of a medication with the same active ingredient or a modified version of an active ingredient if it is therapeutically equivalent to a covered medication United Healthcare defines therapeutically equivalent as providing essentially the same therapeutic outcome and adverse event profile The United Healthcare National Pharmacy and Therapeutics Committee recently reviewed Androgelreg and determined it to be therapeutically equivalent to Testimreg
Proposed new rules under the Affordable Care Act fact sheet Final rules to will come out later this year
C oding T ips on R eimburs ement A nd C oding
bull Make sure CPTreg codes 60100 and 1002110022 are being reported correctly CPTreg code 60100 reports a percutaneous core needle biopsy and is completely different than a fine needle aspiration of the thyroid (see CPTreg codes 1002110022)
bull According to Medicarersquos MUEs CPTreg code 88172 (Cytopathology evaluation of FNA immediate cytohistologic study to determine adequacy for diagnosis First evaluation episode each site) can only be reported two times per date of service
bull Modifier Fact Sheets from WPS a Medicare Administrative Carrier
bull 3 Reminders from Noridian a Medicare Administrative Carrier on Ordered andor referred services
bull Diabetes-related information begins on page 103 of The Guide to Medicare Preventive Services
bull Medicares bone mass measurements benefit
bull Medical necessity and the patientrsquos condition drive correct EM coding
bull Medicare Quarterly Provider Compliance Newsletter
Specializing in medical graphic
designs AACE Impact Graphics is nationally recognized from a medical
association you can trust
You only have a few seconds to catch a clientrsquos attention
Call 1-800-393-2223 for more information
or go to AACE Impact Graphics
AES specializes in the development
and management of continuing medical education programs
including the development and distribution of enduring educational
materials
Call 1-800-393-2223 for more information AACE Educational Services - AES
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2010 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use 5
AACE now offers subscriptions for Allied Health Professionals (AHPs) who are not members of
AACE but would like to participate in a wide range of AACE educational activities and services that may be
useful in their ongoing practice educational and professional needs
For more information go to wwwaacecom or contact
afolsomaacecom
2
Federal News HIPAA 5010ndash Compliance Deadline is Six Months Away National 5010 Testing Day is August 24 2011 Electronic claims will require a street address GetReady5010org ndash Free webinars and resources 5010D0 Errata requirements and testing schedule Contact your MAC for their testing schedule Have you done the following to be ready for 5010D0 What do you need to have in place to test with your MAC Do you know the implications of not being ready
Quarterly ICD-10 Article Reminds Industry to Get Ready for Version 5010 This article provides steps to help reach compliance and new resources and tools CMS is developing to help you prepare for the transitions
ICD-10-CM Impact Analysis Report from CMS analyzes the transition from ICD-9 to ICD-10 on CMS policies processes and systems Scroll down to the Downloads section on this link
The 2011 ICD-10-CM files on this page contain information on the new diagnosis coding system ICD-10-CM (effective October 1 2013)
CMS implements a partial ICD-9 code freeze on October 1 2011 Starting October 1 2012 there will be only limited code updates to ICDndash9ndashCM and ICDndash10 code sets to capture new technology and new diseases AACE ICD-10 Course July 28-29th Sign up for CMS ICD-10 email updates FREE CMS sponsored ICD-10 teleconferences ICD-10 Basics from AACE AAPC ICD-10 Resources
Medicare Coverage amp Other Information
CMS Proposes a NEW Rule about Signatures on Lab Requisitions Released June 29 2011 The proposed new rule would retract the policy adopted in the calendar year 2011 Physician Fee Schedule final rule and would reinstate the prior policy that the signature of a physician or qualified non-physician practitioner is not required on a requisition for Medicare purposes for a clinical diagnostic laboratory test paid under the CLFS(clinical laboratory fee schedule)
Medicare is administered under the local MACrsquos (Medicare Administrative Contactor) authority also referred to as the ldquoMedicare Local Carrierrdquo There were originally 15 MACs awarded administration of Medicare part A and B plans Over the next several years CMS will consolidate them into ten AB MAC workloads List of MAC Web sites Contact for Part B MACs Durable Medical Equipment MACs
Prac t i ce Man ag emen t amp
C od in g Ed u ca t io n a l Op p o r t u n i t i es f o r
201 1
A l l co u rses
How to Prepare for an Audit
Live Webinar Series July 13th amp July 27th 1200 pm ndash 130 pmET
Find out who the auditors are why they are auditing your practice what information they are looking for and what is required for documentation More information
Charting a Course for ICD10 July 28 amp 29th Jacksonville Florida
The transition to ICD-10 takes effect in October 2013 ndash and CMS has indicated that there will be no delay Its time to start planning now L imited S eating
More information
Bridge Gaps in Endocrine
Coding August 13th Chicago IL
This one-day course is for experienced coders and will cover
bull Components of a Medical Record
bull Fine Needle Aspirations bull Injections amp Infusions bull Nurse Visits bull EM Codes and When to Utilize
with Procedures And more
L imited S eating More information
3
Medicare provides coverage for HIV screening as a Part B benefit for eligible beneficiaries at no out-of-pocket cost (no coinsurance copayment or deductible) bull CMS National Coverage Determination ndash NCD for Screening for HIV bull Medicare Learning Networkrsquos ldquoGuide to Medicare Preventive Servicesrdquo bull MLN Matters Article MM6786 ldquoScreening for HIVrdquo bull MLNrsquos ldquoHIV Screeningrdquo Brochure
Medicare enrollment application forms are fillable on your computer Signatures are still required to be handwritten
Advanced Beneficiary Notice Fast Facts Provided to beneficiaries enrolled in Original (Fee-For-Service) Medicare Allows the beneficiary to make an informed decision about whether to receive
services and accept financial responsibility if Medicare does not pay Serves as proof that the beneficiary had knowledge prior to receiving the
service that Medicare might not pay If a health care providersupplier does not deliver a valid ABN to the beneficiary when required by statute the beneficiary cannot be billed for the service and the provider may be held financially liable ABN Booklet From MLN
RememberhellipMedicare covers smoking amp tobacco use cessation counseling This is a list of resources to support providers in the delivery of counseling and organizations promoting cessation
Resources for Medicarersquos Annual Wellness Visit Information on coverage coding billing reimbursement and claims filing procedures
bull Quick Reference Information The ABCs of Providing the Annual Wellness Visit
bull MLN Matters Article MM7079 ldquoAnnual Wellness Visit (AWV) Including Personalized Prevention Plan Services (PPPS)rdquo
bull Medicare Learning Networkreg Preventive Services webpage bull Order materials to start the conversation about Medicarersquos preventive
services including Questions to Ask about Medicare Preventive Services
Common Comprehensive Error Rate Testing (CERT) Program errors related to signature requirements See CERT FAQs also
16 Compliance Training webcasts from the HEAT (Healthcare fraud prevention amp enforcement action team) hosted on YouTubecom
The Medicare Learning Networkreg (MLN) Provider Compliance web page contains educational products on avoiding common billing errors
(Almost) Everything You
Need to Know About Those Incentive
Programs
August 26th Ft Lauderdale FL Is your Medicare patient population 30 or greater If so you are looking at a reduction of Medicare reimbursements by as much as 5 of your total Medicare allowable charges due to lack of participation in CMSrsquo incentive programs More information
C e r t i f i e d M e d i c a l O f f i c e M a n a g e r
September 15-18th
Richmond VA
Objectives include
bull Defining budget guidelines terminology and financial policies
bull Demonstrating effective communication on financial projections
bull Defining ways to control practice expenses and set cost control goals
bull Reviewing effective strategies on billing and collecting
bull Explaining how to use medical records in malpractice suits
bull Defining current HIPAA and OIG compliance statues
And much more
Additional Information L i m i t e d S e a t i n g
4
The Office of Inspector General (OIG) has several physician education training materials to assist in teaching about Federal Laws regarding fraud and abuse of the Medicare and Medicaid programs
Beware CMS Press Release ldquoNew Technology to Help Fight Medicare Fraudrdquo
The Provider Outreach and Education Team at NHIC Corp developed a guide on Medicare Part B billing information and a guide on Medicare Part B CMS-1500 Claim Form Instructions
Check out CMSrsquo Practice Administration Center for
Billing and payment information Part B drugs and drug coverage Medicare Secondary Payer And More
OIGrsquos Most Wanted Healthcare Fugitives
Who is the OIG (office of inspector general) and what do they do
Are any of your P ayers not acc epting 2011 C P T c odes R eport them
from the AMA (American Medical As s oc iation) The rejection of a valid Current Procedural Terminology (CPTreg) code is a violation of the Health Insurance Portability and Accountability Act of 1996
(HIPAA) Included within the Healthcare Common Procedure Coding System (HCPCS) code set CPT is one of the medical data code sets adopted under
HIPAA Additionally HIPAA covered entitiesmdashincluding payersmdashare required to use the applicable medical data code set valid at the time the health care is
furnished According to the HIPAA rule ldquoeach code set is valid within the dates specified by the organization responsible for maintaining that code setrdquo 45 CFR sect 1621011 The introduction of the CPT book provides instruction for use of the
CPT codes and it states that January 1 is the effective date for use of the updated CPT code set
We encourage you to report HIPAA violations Simply file a complaint through the Centers for Medicare and Medicaid Services Administrative Simplification
Enforcement Tool or file the online AMA Health Plan Complaint Form
AMA members and their practice staff can visit wwwama-assnorggotemplateletters to download a sample appeal letter and customize it
for use in their practice
Medicare Beyond the Basics
FREE Webinar
Hosted by Palmetta GBA
(A Medicare Adminis trator) July 26 2011 10 am ET This webinar will provide Medicare information useful to experienced billing staff
This session is free to all participants
Medicare training modules
Certificate of Medical
Necessity Diagnosis coding HIPAA EDI
Standards Medicare Preventive
services And more
F R E E
STOP An errata has been
released on the corrections to the
2011 CPT Book from June 28 2011 It is
also listed on the AMA web site
5
United Healthcare Will No Longer Cover Androgelreg Under
Pharmacy Benefit Effective July 1 2011 United Healthcare will no longer cover Androgelreg under their pharmacy benefit Testimreg will change from a previously excluded medication to a medication covered under Tier 2 United Healthcares pharmacy benefit allows the exclusion of a medication with the same active ingredient or a modified version of an active ingredient if it is therapeutically equivalent to a covered medication United Healthcare defines therapeutically equivalent as providing essentially the same therapeutic outcome and adverse event profile The United Healthcare National Pharmacy and Therapeutics Committee recently reviewed Androgelreg and determined it to be therapeutically equivalent to Testimreg
Proposed new rules under the Affordable Care Act fact sheet Final rules to will come out later this year
C oding T ips on R eimburs ement A nd C oding
bull Make sure CPTreg codes 60100 and 1002110022 are being reported correctly CPTreg code 60100 reports a percutaneous core needle biopsy and is completely different than a fine needle aspiration of the thyroid (see CPTreg codes 1002110022)
bull According to Medicarersquos MUEs CPTreg code 88172 (Cytopathology evaluation of FNA immediate cytohistologic study to determine adequacy for diagnosis First evaluation episode each site) can only be reported two times per date of service
bull Modifier Fact Sheets from WPS a Medicare Administrative Carrier
bull 3 Reminders from Noridian a Medicare Administrative Carrier on Ordered andor referred services
bull Diabetes-related information begins on page 103 of The Guide to Medicare Preventive Services
bull Medicares bone mass measurements benefit
bull Medical necessity and the patientrsquos condition drive correct EM coding
bull Medicare Quarterly Provider Compliance Newsletter
Specializing in medical graphic
designs AACE Impact Graphics is nationally recognized from a medical
association you can trust
You only have a few seconds to catch a clientrsquos attention
Call 1-800-393-2223 for more information
or go to AACE Impact Graphics
AES specializes in the development
and management of continuing medical education programs
including the development and distribution of enduring educational
materials
Call 1-800-393-2223 for more information AACE Educational Services - AES
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2010 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use 5
AACE now offers subscriptions for Allied Health Professionals (AHPs) who are not members of
AACE but would like to participate in a wide range of AACE educational activities and services that may be
useful in their ongoing practice educational and professional needs
For more information go to wwwaacecom or contact
afolsomaacecom
3
Medicare provides coverage for HIV screening as a Part B benefit for eligible beneficiaries at no out-of-pocket cost (no coinsurance copayment or deductible) bull CMS National Coverage Determination ndash NCD for Screening for HIV bull Medicare Learning Networkrsquos ldquoGuide to Medicare Preventive Servicesrdquo bull MLN Matters Article MM6786 ldquoScreening for HIVrdquo bull MLNrsquos ldquoHIV Screeningrdquo Brochure
Medicare enrollment application forms are fillable on your computer Signatures are still required to be handwritten
Advanced Beneficiary Notice Fast Facts Provided to beneficiaries enrolled in Original (Fee-For-Service) Medicare Allows the beneficiary to make an informed decision about whether to receive
services and accept financial responsibility if Medicare does not pay Serves as proof that the beneficiary had knowledge prior to receiving the
service that Medicare might not pay If a health care providersupplier does not deliver a valid ABN to the beneficiary when required by statute the beneficiary cannot be billed for the service and the provider may be held financially liable ABN Booklet From MLN
RememberhellipMedicare covers smoking amp tobacco use cessation counseling This is a list of resources to support providers in the delivery of counseling and organizations promoting cessation
Resources for Medicarersquos Annual Wellness Visit Information on coverage coding billing reimbursement and claims filing procedures
bull Quick Reference Information The ABCs of Providing the Annual Wellness Visit
bull MLN Matters Article MM7079 ldquoAnnual Wellness Visit (AWV) Including Personalized Prevention Plan Services (PPPS)rdquo
bull Medicare Learning Networkreg Preventive Services webpage bull Order materials to start the conversation about Medicarersquos preventive
services including Questions to Ask about Medicare Preventive Services
Common Comprehensive Error Rate Testing (CERT) Program errors related to signature requirements See CERT FAQs also
16 Compliance Training webcasts from the HEAT (Healthcare fraud prevention amp enforcement action team) hosted on YouTubecom
The Medicare Learning Networkreg (MLN) Provider Compliance web page contains educational products on avoiding common billing errors
(Almost) Everything You
Need to Know About Those Incentive
Programs
August 26th Ft Lauderdale FL Is your Medicare patient population 30 or greater If so you are looking at a reduction of Medicare reimbursements by as much as 5 of your total Medicare allowable charges due to lack of participation in CMSrsquo incentive programs More information
C e r t i f i e d M e d i c a l O f f i c e M a n a g e r
September 15-18th
Richmond VA
Objectives include
bull Defining budget guidelines terminology and financial policies
bull Demonstrating effective communication on financial projections
bull Defining ways to control practice expenses and set cost control goals
bull Reviewing effective strategies on billing and collecting
bull Explaining how to use medical records in malpractice suits
bull Defining current HIPAA and OIG compliance statues
And much more
Additional Information L i m i t e d S e a t i n g
4
The Office of Inspector General (OIG) has several physician education training materials to assist in teaching about Federal Laws regarding fraud and abuse of the Medicare and Medicaid programs
Beware CMS Press Release ldquoNew Technology to Help Fight Medicare Fraudrdquo
The Provider Outreach and Education Team at NHIC Corp developed a guide on Medicare Part B billing information and a guide on Medicare Part B CMS-1500 Claim Form Instructions
Check out CMSrsquo Practice Administration Center for
Billing and payment information Part B drugs and drug coverage Medicare Secondary Payer And More
OIGrsquos Most Wanted Healthcare Fugitives
Who is the OIG (office of inspector general) and what do they do
Are any of your P ayers not acc epting 2011 C P T c odes R eport them
from the AMA (American Medical As s oc iation) The rejection of a valid Current Procedural Terminology (CPTreg) code is a violation of the Health Insurance Portability and Accountability Act of 1996
(HIPAA) Included within the Healthcare Common Procedure Coding System (HCPCS) code set CPT is one of the medical data code sets adopted under
HIPAA Additionally HIPAA covered entitiesmdashincluding payersmdashare required to use the applicable medical data code set valid at the time the health care is
furnished According to the HIPAA rule ldquoeach code set is valid within the dates specified by the organization responsible for maintaining that code setrdquo 45 CFR sect 1621011 The introduction of the CPT book provides instruction for use of the
CPT codes and it states that January 1 is the effective date for use of the updated CPT code set
We encourage you to report HIPAA violations Simply file a complaint through the Centers for Medicare and Medicaid Services Administrative Simplification
Enforcement Tool or file the online AMA Health Plan Complaint Form
AMA members and their practice staff can visit wwwama-assnorggotemplateletters to download a sample appeal letter and customize it
for use in their practice
Medicare Beyond the Basics
FREE Webinar
Hosted by Palmetta GBA
(A Medicare Adminis trator) July 26 2011 10 am ET This webinar will provide Medicare information useful to experienced billing staff
This session is free to all participants
Medicare training modules
Certificate of Medical
Necessity Diagnosis coding HIPAA EDI
Standards Medicare Preventive
services And more
F R E E
STOP An errata has been
released on the corrections to the
2011 CPT Book from June 28 2011 It is
also listed on the AMA web site
5
United Healthcare Will No Longer Cover Androgelreg Under
Pharmacy Benefit Effective July 1 2011 United Healthcare will no longer cover Androgelreg under their pharmacy benefit Testimreg will change from a previously excluded medication to a medication covered under Tier 2 United Healthcares pharmacy benefit allows the exclusion of a medication with the same active ingredient or a modified version of an active ingredient if it is therapeutically equivalent to a covered medication United Healthcare defines therapeutically equivalent as providing essentially the same therapeutic outcome and adverse event profile The United Healthcare National Pharmacy and Therapeutics Committee recently reviewed Androgelreg and determined it to be therapeutically equivalent to Testimreg
Proposed new rules under the Affordable Care Act fact sheet Final rules to will come out later this year
C oding T ips on R eimburs ement A nd C oding
bull Make sure CPTreg codes 60100 and 1002110022 are being reported correctly CPTreg code 60100 reports a percutaneous core needle biopsy and is completely different than a fine needle aspiration of the thyroid (see CPTreg codes 1002110022)
bull According to Medicarersquos MUEs CPTreg code 88172 (Cytopathology evaluation of FNA immediate cytohistologic study to determine adequacy for diagnosis First evaluation episode each site) can only be reported two times per date of service
bull Modifier Fact Sheets from WPS a Medicare Administrative Carrier
bull 3 Reminders from Noridian a Medicare Administrative Carrier on Ordered andor referred services
bull Diabetes-related information begins on page 103 of The Guide to Medicare Preventive Services
bull Medicares bone mass measurements benefit
bull Medical necessity and the patientrsquos condition drive correct EM coding
bull Medicare Quarterly Provider Compliance Newsletter
Specializing in medical graphic
designs AACE Impact Graphics is nationally recognized from a medical
association you can trust
You only have a few seconds to catch a clientrsquos attention
Call 1-800-393-2223 for more information
or go to AACE Impact Graphics
AES specializes in the development
and management of continuing medical education programs
including the development and distribution of enduring educational
materials
Call 1-800-393-2223 for more information AACE Educational Services - AES
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2010 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use 5
AACE now offers subscriptions for Allied Health Professionals (AHPs) who are not members of
AACE but would like to participate in a wide range of AACE educational activities and services that may be
useful in their ongoing practice educational and professional needs
For more information go to wwwaacecom or contact
afolsomaacecom
4
The Office of Inspector General (OIG) has several physician education training materials to assist in teaching about Federal Laws regarding fraud and abuse of the Medicare and Medicaid programs
Beware CMS Press Release ldquoNew Technology to Help Fight Medicare Fraudrdquo
The Provider Outreach and Education Team at NHIC Corp developed a guide on Medicare Part B billing information and a guide on Medicare Part B CMS-1500 Claim Form Instructions
Check out CMSrsquo Practice Administration Center for
Billing and payment information Part B drugs and drug coverage Medicare Secondary Payer And More
OIGrsquos Most Wanted Healthcare Fugitives
Who is the OIG (office of inspector general) and what do they do
Are any of your P ayers not acc epting 2011 C P T c odes R eport them
from the AMA (American Medical As s oc iation) The rejection of a valid Current Procedural Terminology (CPTreg) code is a violation of the Health Insurance Portability and Accountability Act of 1996
(HIPAA) Included within the Healthcare Common Procedure Coding System (HCPCS) code set CPT is one of the medical data code sets adopted under
HIPAA Additionally HIPAA covered entitiesmdashincluding payersmdashare required to use the applicable medical data code set valid at the time the health care is
furnished According to the HIPAA rule ldquoeach code set is valid within the dates specified by the organization responsible for maintaining that code setrdquo 45 CFR sect 1621011 The introduction of the CPT book provides instruction for use of the
CPT codes and it states that January 1 is the effective date for use of the updated CPT code set
We encourage you to report HIPAA violations Simply file a complaint through the Centers for Medicare and Medicaid Services Administrative Simplification
Enforcement Tool or file the online AMA Health Plan Complaint Form
AMA members and their practice staff can visit wwwama-assnorggotemplateletters to download a sample appeal letter and customize it
for use in their practice
Medicare Beyond the Basics
FREE Webinar
Hosted by Palmetta GBA
(A Medicare Adminis trator) July 26 2011 10 am ET This webinar will provide Medicare information useful to experienced billing staff
This session is free to all participants
Medicare training modules
Certificate of Medical
Necessity Diagnosis coding HIPAA EDI
Standards Medicare Preventive
services And more
F R E E
STOP An errata has been
released on the corrections to the
2011 CPT Book from June 28 2011 It is
also listed on the AMA web site
5
United Healthcare Will No Longer Cover Androgelreg Under
Pharmacy Benefit Effective July 1 2011 United Healthcare will no longer cover Androgelreg under their pharmacy benefit Testimreg will change from a previously excluded medication to a medication covered under Tier 2 United Healthcares pharmacy benefit allows the exclusion of a medication with the same active ingredient or a modified version of an active ingredient if it is therapeutically equivalent to a covered medication United Healthcare defines therapeutically equivalent as providing essentially the same therapeutic outcome and adverse event profile The United Healthcare National Pharmacy and Therapeutics Committee recently reviewed Androgelreg and determined it to be therapeutically equivalent to Testimreg
Proposed new rules under the Affordable Care Act fact sheet Final rules to will come out later this year
C oding T ips on R eimburs ement A nd C oding
bull Make sure CPTreg codes 60100 and 1002110022 are being reported correctly CPTreg code 60100 reports a percutaneous core needle biopsy and is completely different than a fine needle aspiration of the thyroid (see CPTreg codes 1002110022)
bull According to Medicarersquos MUEs CPTreg code 88172 (Cytopathology evaluation of FNA immediate cytohistologic study to determine adequacy for diagnosis First evaluation episode each site) can only be reported two times per date of service
bull Modifier Fact Sheets from WPS a Medicare Administrative Carrier
bull 3 Reminders from Noridian a Medicare Administrative Carrier on Ordered andor referred services
bull Diabetes-related information begins on page 103 of The Guide to Medicare Preventive Services
bull Medicares bone mass measurements benefit
bull Medical necessity and the patientrsquos condition drive correct EM coding
bull Medicare Quarterly Provider Compliance Newsletter
Specializing in medical graphic
designs AACE Impact Graphics is nationally recognized from a medical
association you can trust
You only have a few seconds to catch a clientrsquos attention
Call 1-800-393-2223 for more information
or go to AACE Impact Graphics
AES specializes in the development
and management of continuing medical education programs
including the development and distribution of enduring educational
materials
Call 1-800-393-2223 for more information AACE Educational Services - AES
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2010 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use 5
AACE now offers subscriptions for Allied Health Professionals (AHPs) who are not members of
AACE but would like to participate in a wide range of AACE educational activities and services that may be
useful in their ongoing practice educational and professional needs
For more information go to wwwaacecom or contact
afolsomaacecom
5
United Healthcare Will No Longer Cover Androgelreg Under
Pharmacy Benefit Effective July 1 2011 United Healthcare will no longer cover Androgelreg under their pharmacy benefit Testimreg will change from a previously excluded medication to a medication covered under Tier 2 United Healthcares pharmacy benefit allows the exclusion of a medication with the same active ingredient or a modified version of an active ingredient if it is therapeutically equivalent to a covered medication United Healthcare defines therapeutically equivalent as providing essentially the same therapeutic outcome and adverse event profile The United Healthcare National Pharmacy and Therapeutics Committee recently reviewed Androgelreg and determined it to be therapeutically equivalent to Testimreg
Proposed new rules under the Affordable Care Act fact sheet Final rules to will come out later this year
C oding T ips on R eimburs ement A nd C oding
bull Make sure CPTreg codes 60100 and 1002110022 are being reported correctly CPTreg code 60100 reports a percutaneous core needle biopsy and is completely different than a fine needle aspiration of the thyroid (see CPTreg codes 1002110022)
bull According to Medicarersquos MUEs CPTreg code 88172 (Cytopathology evaluation of FNA immediate cytohistologic study to determine adequacy for diagnosis First evaluation episode each site) can only be reported two times per date of service
bull Modifier Fact Sheets from WPS a Medicare Administrative Carrier
bull 3 Reminders from Noridian a Medicare Administrative Carrier on Ordered andor referred services
bull Diabetes-related information begins on page 103 of The Guide to Medicare Preventive Services
bull Medicares bone mass measurements benefit
bull Medical necessity and the patientrsquos condition drive correct EM coding
bull Medicare Quarterly Provider Compliance Newsletter
Specializing in medical graphic
designs AACE Impact Graphics is nationally recognized from a medical
association you can trust
You only have a few seconds to catch a clientrsquos attention
Call 1-800-393-2223 for more information
or go to AACE Impact Graphics
AES specializes in the development
and management of continuing medical education programs
including the development and distribution of enduring educational
materials
Call 1-800-393-2223 for more information AACE Educational Services - AES
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2010 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use 5
AACE now offers subscriptions for Allied Health Professionals (AHPs) who are not members of
AACE but would like to participate in a wide range of AACE educational activities and services that may be
useful in their ongoing practice educational and professional needs
For more information go to wwwaacecom or contact
afolsomaacecom
