MA a rpcrhi l 2 200112 2 January 2012
On March 26, 2012, CMS announced it would not initiate enforcement action regarding fees and penalties with respect to any HIPAA-covered entity that is noncompliant with the ASC X12 (Version 5010) until July 1, 2012. This does not
mean the compliance date has been delayed; it only means they will not enforce fees or penalties for non-compliant claims coming in after that date. What types of transactions are affected by HIPAA 5010? • • • •
claims and encounter information payment and remittance advice claims status eligibility
• • • •
enrollment and disenrollment referrals and authorizations coordination of benefits premium payment
What code sets should be used in all transactions? • • • •
HCPCS (Ancillary Services/Procedures) CPT-4 (Physicians Procedures) ICD-9 (Diagnosis and Hospital Inpatient Procedures) ICD-10 (as of October 1, 2013, possibly October 1, 2014) NDC (National Drug Codes) Unique identifiers
Information and resources to assist you in troubleshooting some of the difficulties you may experience with HIPAA 5010 transitions. CMS HIPAA 101
Delays in Medicare Reimbursement AACE’s Socioeconomics & Member Advocacy Department has received several inquiries from AACE members regarding delays they are experiencing in Medicare reimbursement. Three issues have been identified that may be impacting your office practice. To learn more information about these issues click here. 1
CMS announced the scheduled release of modifications
to the Healthcare Common Procedure Coding System (HCPCS) code set. These changes have been posted to the HCPCS web site at this link. General information on HCPCs
The Quarterly CMS Provider Update is a comprehensive resource published by the CMS on the first business day of each quarter.
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 18.2, is effective July 1, 2012.
What is cloud computing? Security issues associated with the cloud and dimensions of cloud security
Quality Measurement Continuing Medical Education Series CMS uses quality measures in its various quality initiatives that include quality improvement, pay for reporting, pay for performance, and public reporting. Continuing educational activities about quality measures can help healthcare professionals gain new knowledge to improve the quality of care they provide to their patients. CMS provides continuing educational opportunities that are accredited by the Accreditation Council for Continuing Medical Education (ACCME). The information in this series is useful to all professionals, but you must be a physician in order to receive CME credit for these activities.
Clinical Quality Measures (CQMs) Clinical Quality Measures, also known as CQMs, are a mechanism for assessing observations, treatment, processes, experience, and/or outcomes of patient care. CQMs are required as part of meaningful use requirements for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Click on the links below to learn more about a particular topic: • • • • •
General Program Definitions EP CQMs Program Year 2011-2012 Eligible Hospital and CAH CQMs for Program Year 2011-2012 Information on the EHR Incentive Program Electronic Reporting Pilot Other General Information and Resources Regarding CQMs
Workplace violence has emerged as an important safety and health issue in today's workplace. The Occupational Safety and Health Administration's (OSHA's) response to the problem of workplace violence in certain industries has been the production of OSHA's guidelines and recommendations to those industries for implementing workplace violence prevention programs.
Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers, OSHA 3148 OSHA Fact Sheet
Novitas Solutions, Inc. will be the new Medicare Administrative Contractor for Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas for Part A and B. They are currently the Part B Medicare Administrative Contractor for Delaware, New Jersey, Pennsylvania, Maryland, District of Columbia, the counties of Arlington and Fairfax in Virginia and the City of Alexandria in Virginia. The Welcome Letter contains additional information pertinent to the JH transition to Novitas.
TrailBlazer’s eBulletin for March 2
The 30-Day Comment Period is Now Open for the HHS Proposed Rule to Delay ICD-10 New CMS Medicare Billing Certificate Programs for Part A and Part B Providers CMS has launched new Medicare Billing Certificate Programs for Part A and Part B providers. To earn the certificate, candidates will learn about the Medicare program, complete all required readings and web-based training courses, and must achieve a 75% or higher score on the post-assessment. To participate in either the Part A or Part B provider type program, visit http://www.CMS.gov/MLNprodu cts and select the "Web-Based Training Modules" link under the heading "Related Links Inside CMS."
Last week, HHS Secretary Kathleen Sebelius announced a proposed rule that would delay the compliance date for ICD-10 from October 1, 2013 to October 1, 2014. This proposed rule has now been posted to the Federal Register, which marks the beginning of the 30-day comment period, with all comments due to HHS no later than 5:00 pm ET on May 17, 2012.
Non-Physicians Acting as Scribes for Physicians April 9, 2012, CGS Medicare Administrative Contractor This may be inappropriate and education is especially important with the increased implementation of Electronic Medical records (EMRs).
CUSTOMER SERVICE: The Other Medical Specialty Survey results printed in a national publication indicated that customers believe there to be a marked decrease in quality customer service over the last 5 years. Among the top 10 areas, the medical office ranked number four (4). As healthcare professionals, we have the unique opportunity to impact every aspect of our patient's lives. So why is customer service so important to a patient who goes to the doctor specifically for medical care?
Practice Management Institute®
Tips on Selecting a Reputable Billing Company Make sure you do your homework when choosing a billing company to ensure that you are not taken for a ride. Practice Management Institute®
CMS has not yet decided when it will begin to reject claims if an ordering/referring provider does not have a PECOS record. Read more here
New AMA resources can help you remove the mystery from the complex physician data reports you receive from health insurers. Read this week’s editorial from American Medical News about the AMA’s new resource, “Take charge of your data: A physician guide to reviewing and using claims data to improve your profile, practice and payment,” and its companion Standardized Physician Data Reporting Form. Used together, these resources can help you understand your own practice data to maximize the quality and efficiency of your practice, while also helping to ensure that insurers and third-party payers are not using your practice data irresponsibly. Visit www.ama-assn.org/go/physiciandata to access these free resources, and the related AMA “Guidelines for Reporting Physician Data,” designed to encourage improvements in health insurers’ physician profiling reports. Was this alert helpful? Forward it to a friend, and invite them to sign up for the AMA Practice Management Alerts to receive future alerts like this one.
Coding and Practice Management Educational Opportunities for 2012 These courses are designed for physicians, non physician practitioners, coders, and billers.
Chart Auditing for Physician Services Presented by Practice Management Institute速 Jacksonville, FL
Register here and use AACE as the Promotional Code!
Date: May 25, 2012 Cost: $299
Bridge the Gaps in Endocrine Coding
This activity has been approved for AMA PRA Category 1 CreditTM
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
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:
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: email@example.com
Fundamentals & Advanced Endocrine Coding Course
With AACE-sponsored Certified Endocrine Coder (AACE-CEC) Exam
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 LIMITED SEATING!
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 10th & Save $100
Contact Vanessa Lankford at firstname.lastname@example.org 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.
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
*Must use promotional code “AACE” to receive discount.
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 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.
Calculating the EXAM Element
Based on CMS’ 1995 Guidelines
*The CMS guidelines do not define the number of elements for the types of exam. Extensive research revealed the general physician population, coding experts, and auditing organizations define the number of elements as indicated above. We encourage you to review your commercial carriers and Medicare Administrative Contractors’ administrative guidelines to determine if further guidance is provided regarding E/M guidelines.
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. Examination revealed normal pharyngeal findings, mucosa normal, no drainage seen. On her posterior neck she had skin findings of acanthosis Nigerians. The salivar y glands and lymph nodes were normal. Her thyroid was enlarged and firm, with a 1 centimeter nodule palpable in the lower portion of the left lobe. There was no tenderness noted anywhere in the neck.
Organ Systems: Constitutional Eyes
Ear, nose, mouth, throat- DETAILED Cardiovascular Respiratory Gastrointestinal Genitourinary
Hematologic/lymphatic/immunologic- DETAILED Problem Focused - a limited examination of the affected body area or organ system (*1 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) (*2-7 body areas or organ systems)
Detailed - an extended examination of the affected body area(s) and other symptomatic or related organ system(s) (*2-7 body areas or organ systems WITH detail) Comprehensive - a general multi-system examination or complete examination of a single organ system (*8 or more body areas or organ systems)
Additional Guidelines: 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. 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 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.
Tips on Reimbursement And Coding •
Take time to update your mailing address and help reduce unnecessary administrative costs to the Medicare Trust Fund. The Code of Federal Regulations (CFR) requires Medicare providers to notify Medicare of a change of address within 30 days of the effective date of the change. Compliance with this regulation helps save Medicare Trust Fund dollars. Please do your part to protect the Medicare Trust Fund.
As outlined in the Medicare Program Integrity Manual, Medicare requires all services provided/ordered be authenticated by the author with a legible identifier in the form of handwritten, electronic signature, or via e-prescribing method. WPS, a Medicare Administrative Contractor, has an article, "Guidance for Provider Signature Requirements," that provides additional information.
CERT is reporting an increase in the number of errors due to inadequate provider signatures on documentation submitted for medical review. While documentation must support the medical necessity of the services provided when submitted without the proper signature of the rendering/billing provider, records cannot be validated and services will be denied. CGS, a Medicare Administrative Contractor provides more information at this link.
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.