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September 2011

PQRS and eRx Incentive Programs (remember t here are 3 separat e programs)

“2011 Physician Quality Reporting System Maintenance of Certification Program� Fact Sheet has been released in downloadable format on this link. This fact sheet provides education on the incentive payment to identified eligible professionals and includes information on the additional 0.5 percent incentive payment when Maintenance of Certification Program Incentive requirements have also been met.

FAQ on eRx (electronic prescribing) Program Question: Either my vendor, my clearinghouse, or I did not include the Quality Data Codes (QDC) on the original claim. May I now resubmit the claim adding the QDC so I can be eligible for the incentive or prevent the 2012 payment adjustment? Answer: No. CMS requires the QDC to come into Medicare on the original claim. Medicare may view a deliberate submission of a duplicate request for payment on the same service as an abusive or fraudulent activity. For PQRS, a provider would still have the opportunity to meet the qualifications for the incentive program through submitting claims through the rest of 2011, or they may choose to participate in the program using a registry or EHR. As long as the provider met the requirements using one of the approved methods, the payment of an incentive may be appropriate. For e-Prescribing, a provider cannot resubmit those claims already submitted. Providers who have not met the requirements with services by June 30, 2011, may be subject to the 2012 payment adjustment based on multiple criteria. Please see the CMS website for possible exceptions: .


Practice Management Less Than 122 Days Left Before 5010 Implementation!

& Coding Educational Opportunities for 2011 A l l C o ur s e s

In 4 months, you will need to submit your claims not only to Medicare, but to ALL your payers using Version 5010A1. If you are not prepared to do that as of January 1, 2012, you will not get paid! Version 5010 and D.0 transaction resources Educational resources such as MLN articles, fact sheets, checklists, reference guides, etc.

Fundamentals and Advanced Endocrine Coding Course December 2-3, 2011 Phoenix, AZ Phoenix Marriott Mesa The Fundamentals of Endocrine Coding provides attendees with foundational coding, billing, and documentation knowledge, required to stay compliant and obtain maximum reimbursement. Fundamentals Course Agenda and Learning Objectives Presenter: Vanessa Lankford, CPC, CMOM, AACE-CEC Course Duration: 8:00am – 4:30pm The Advanced Course provides the physician and staff with additional knowledge and skill in understanding the business side of the office. Advanced Course Agenda and Learning Objectives AACE-CEC General Information Presenter: Anita Henderson-Sumpter, MHA, MBA, CPC Course Duration: 8:00am - 4:00pm AACE-CEC Exam: 4:00pm - 6:00pm

At the end of the course, attendees will have the opportunity to take the AACEsponsored Certified Endocrine Coder (AACE-CEC) exam. All courses are subject to change.

For more information, please visit ses-and-webinars

CMS has stated that there will be no extension of the January 1, 2012, deadline.

Is your office preparing for a smooth transition to ICD-10 on October 1, 2013? CMS subject matter experts discussed ways that physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding on a recent national call on August 3, 2011. The slide presentation can be found at this link .

Annual Update of ICD-9-CM – Effective Oct. 1, 2011 This MLN Matters article informs you of the ICD-9-CM update that is effective for the dates of service on and after October 1, 2011. Please be sure to inform your staff of these updates.


ICD9-CM and ICD-10 Coding Conventions and Guidelines Comparison for the Endocrine, Nutritional, and Metabolic Diseases & Immunity Disorders chapters. (All information is subject to change). AACE prepared a comparison of the guidelines and conventions between ICD9 and ICD10.

Medicare & Other Government News and Information A L E R T ! All providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to submit their enrollment information so they can be revalidated under new risk screening criteria required by the Affordable Care Act (section 6401a). For more information about provider revalidation, review the Medicare Learning Network's Special Edition Article #SE1126, titled "Further Details on the Revalidation of Provider Enrollment Information."

or contact


Changes to the Laboratory National Coverage Determination Edit Software for October 2011. See MLN Matters article MM7507 and make sure billing staff know about these changes.

Additional HCPCS Codes Subject to CLIA Edits will inform your Medicare Carriers and MACs about the addition of 4 codes with modifiers that are subject to CLIA edits and were not mentioned in prior change requests. Be sure that your staff is informed of these changes.

Looking for the latest Medicare Fee-For-Service (FFS) information? Then subscribe to a Medicare FFS Provider listserv that suits your needs! For information on how to register and start receiving the latest news, go to this link on the Centers for Medicare & Medicaid Services (CMS) website.

October Quarterly Update to Correct Coding Initiative Edits Click here for additional information about CCI.

Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesOctober 2011 Update Medicare will use these files to determine the payment limit for claims for separately payable Medicare Part B drugs processed or reprocessed on or after October 1, 2011, with dates of service October 1, 2011, through December 31, 2011. Contractors will not search and adjust claims that have already been processed unless brought to their attention. Please ensure that your staff is aware of this update.

The“Medicare Physician Guide” is designed to provide education on the Medicare Program. The guide includes information on an introduction to the Medicare Program, becoming a Medicare provider or supplier, Medicare reimbursement, Medicare services, protecting the Medicare Trust Fund, Medicare overpayments and Fee-For-Service appeals, and provider outreach and education.

“Introduction to the Medicare Program” is now available in print format and is designed to provide education on the Medicare Program and includes information about the four parts of the Medicare Program, other health insurance plans, and organizations of interest to providers and beneficiaries. To place your order, visit, scroll to “Related Links Inside CMS,” and select “MLN Product Ordering Page.”

Medicare Quarterly Provider Compliance Newsletter Now Available for July 2011 This educational tool is designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program. To download, print, and search newsletters from previous quarters, go to this link.

Medicare Record Authentication Tips for Physicians CERT contractors are noting that the majority of CERT errors are related to the inability to identify the author of a medical record. Medical record authorship is generally accomplished through a handwritten or electronic signature (signature stamps are not acceptable); however, when the author of a record is unclear, document(s) must be authenticated. Signature logs or attestation statements are two acceptable methods to authenticate a record (excluding orders and Certificates of Medical Necessity [CMNs]).


Understand and Avoid Common Billing Errors and other improper activities Educational FFS provider materials on this page help you understand – and avoid – common billing errors and other improper activities identified through claim review programs. You can review quick tips on relevant provider compliance issues and corrective actions directly from the webpage. Bookmark the page and check back often as a new “fast fact” is added each month!

Recovery Audit Program: MACs Issued Demand Letters- As a result, when a Recovery Auditor finds that improper payments have been made to you, they will submit claim adjustments to your Medicare (claims processing) contractor. Your Medicare contractor will then establish receivables and issue automated demand letters for any Recovery Auditor identified overpayment effective as of January 3, 2012.

Recovery Audit Contractors (RACs) and Medicare The Who, What, When, Where, How and Why? This slideshow is from CMS and is available for free.

The “Medicare Billing Information for Rural Providers and Suppliers” publication is designed to provide education on when Medicare rural billing has been revised.

This publication provides information about the collection of Medicare

physician and supplier overpayments:   

“The Notifier” The use of the Advance Beneficiary Notice of Noncoverage (ABN) is a very beneficial tool in relaying information to Medicare patients. In ABN reviews performed by the CERT and other review contractors, the most common error seen involves the “Notifier(s)” section (A) of the form. Entities who issue ABNs are collectively known as notifiers. These entities can include physicians, non physician practitioners, providers (including laboratories), and suppliers. Notifiers must place their name, address, and telephone number (including TTY number when necessary) at the top of the ABN. This information can be typed, hand written, pre-printed, in a label, or other means.

Definition of an overpayment; The overpayment collection process; and Resources.

What Physician Executives Need to Know about HIPAA

CBR Released on Diabetic Supplies- Comparative billing reports (CBRs) compare a provider’s billing and payment patterns to those of their peers located in the state and across the nation. These reports are not available to anyone but the providers who receive them. For more information and to review a sample of the Ordering Durable Medical Equipment: Diabetic Supplies CBR, please visit or call the SafeGuard Services Provider Help Desk, CBR Support Team at 530-896-7080.

News Flash – The Medicare Learning Network® has released a new CD-ROM titled “The Interactive Guide to the Medicare Learning Network.” This CD-ROM allows for a two-way flow of information between Fee-For-Service (FFS) providers and the Medicare Learning Network (MLN). Providers and other healthcare professionals can link directly from the products described on the CD-ROM to the MLN web pages and the MLN Catalog of Products. Once there, users can confidently download and print copies of the most up-to-date and accurate MLN products. To order the CD-ROM through the MLN Product Ordering System, visit on the CMS website.

See the full article 4

Advanced Diagnostic Imaging (ADI) A free slide show from CMS on Education and Outreach for Contractors and Suppliers Session Objectives:

United Healthcare Bulletin Now Available

 Understand the Accreditation Requirements effecting any supplier of the technical component of advanced diagnostic imaging

United Healthcare provides a bimonthly online/e-mail publication that provides policy and protocol changes, clinical resources and administrative information.

 Understand what information will be transmitted to PECOS from the accreditation organizations  Identify which codes will be used to deny claims for services billed on or after 1/1/12

Immunization Awareness- CMS asks healthcare providers to help protect Medicare patients from vaccine-preventable diseases. This can be done by ensuring their immunizations are up-to-date, educating them on risk factors, and encouraging their use of appropriate Medicare-covered immunizations. (Note that if you provide the Medicare Annual Wellness Visit to your eligible Medicare patients, please ensure that a written screening schedule for immunizations is reflected on their personalized preventive service plan.)

Medicare Part B Immunization Benefits

Are You a Victim of Identity Theft? A group of unknown individuals are soliciting personal identification information from physicians through various corrupt schemes. Once obtained, the personal information is used to complete fraudulent Medicare provider applications for new practice locations. Once the new provider number is established, these individuals rapidly submit a large volume of claims to the Medicare Carrier for payment. More Information

Seasonal Influenza Immunization – Medicare provides payment for the vaccine and its administration for all people with Medicare, once per influenza season. Medicare may cover additional influenza vaccinations, if medically necessary.

Pneumococcal Immunization – Medicare provides payment for the vaccine and its administration for all beneficiaries, generally once in a lifetime. Medicare may cover additional vaccinations based on risk.

Hepatitis B Immunization – Medicare provides payment for the vaccine and its administration for beneficiaries at medium to high risk of contracting hepatitis B For More Information:     

   

The CMS Guide to Medicare Preventive Services Medicare Immunizations Billing Quick Reference Chart CMS Adult Immunizations Brochure CMS Adult Immunizations Webpage ® CMS Medicare Learning Network (MLN) Preventive Services Educational Products Webpage – This site provides access to MLN educational resources developed by CMS for Fee-For-Service providers and suppliers related to preventive services covered by Medicare, including immunizations covered by Part B. The CDC Vaccines and Immunizations Webpage National Immunization Awareness Month 2011 Toolkit Annual Wellness Visit Brochure – A brochure for healthcare professionals. The ABCs of Providing the Annual Wellness Visit Quick Reference Chart

You may visit the Centers for Disease Control and Prevention (CDC) website for the latest 2011-2012 seasonal flu recommendations and alerts. 5

OSHA provides resources and information for smaller employers such as safety and health tools and publications, easy-to-follow 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

guides for specific OSHA standards, and descriptions of benefits that small businesses receive from OSHA. The Safety and Health Achievement Recognition Program (SHARP) recognizes small employers who operate an exemplary safety and health management system. OSHA's Free On-site Consultation Program provides on-site assistance to small employers in protecting their workers from potential occupational hazards. In FY 2010, OSHA provided free assistance to over 30,000 small businesses covering 1.5 million workers in helping them create safe and healthy work environments. Read more about OSHA's Free On-site Consultation Program!

AACE now offers subscriptions for Allied Health Professionals (AHPs) such as PAs, NPs, RNs, CDEs, practice and/or office administrators, coders, billers, etc., 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 practice, educational and professional needs. For more information go to or contact

Did you know that being a member of AACE can save you money on payment processing? 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 client’s attention. Call 1-800-393-2223 for more information or go to AACE Impact Graphics

AACE and TSYS Merchant Solutions are pleased to announce a new discounted credit card acceptance program available through AACE Member Rewards Program! In addition to cost savings for you, we have selected this top ten payment processor for their first-rate services, more than 55 years experience in the industry, and the great advantages they offer. Some of these benefits include: ® ®  Discounted group rates on Visa®, MasterCard and Discover transactions.  Merchant processing services, including debit card acceptance and check verification/guarantee services.  Free online statements and account access. Click here or call 888-749-7860 for a free cost analysis.

Are you curious about what to pay your new employees? As an AACE AHP member, you can receive complimentary detailed compensation reports that are customized to your practice’s unique needs. Find out what total compensation and benefits are typically offered in your local market so that your practice can be more competitive. For more information contact Nikki Vorwerk at or call 1-800-393-2223.


New Revised & Invalid ICD-9-CM Codes

Effective October 1, 2011

We want to hear from you! Tell us what you think of Endonomics! Please take a few minutes to take this 4 question 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 Are you or your physician a member of AACE? o What other topics would you like to see offered in Endonomics? o Other comments…

Coding Tips on Reimbursement And Coding 

A scheduled fine needle aspiration does not warrant an additional E/M unless there is supporting documentation of a significant and separately identifiable service above and beyond the pre and postoperative work involved with the procedure. Medicare allows for pre and post operative work in the total reimbursement of the fine needle aspiration. If documentation supports a significant and separately identifiable E/M, modifier 25 would be added to the E/M CPT® code.

Modifier 59 is one of the most commonly misused modifiers. Below are some tips for appropriate use of modifier- 59.

Helpful Hints for Appropriate Modifier 59 Usage 1. Used for services not normally reported together 2. Affects payment 3. Only use if there is no other modifier to use 4. Documentation MUST support o Different procedure o Different surgery o Different site o Different organ system o Separate incision/excision o Separate lesions o Separate injury 5. Do NOT use with E/M codes 6. Not all bundled procedures can be billed with a modifier 59 When another already established modifier is appropriate, it should be used rather than modifier -59. If there is no other descriptive modifier available, and the use of modifier -59 best explains the circumstances, then modifier -59 may be used. Modifier 59 does not replace modifiers 24, 25, 50, 51, 78 ,79, RT and LT.

AACE's Socioeconomic and Member Advocacy Department's goal is to reach out into the endocrinology business world and become the one stop 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 with their name, phone and fax numbers, location and preferred e-mail address to be added to our Practice Support Network database.

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 2010 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.


Endonomics September 2011  

Practice Management guide for Endocrinology Practices

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