WCH Bulletin January 2012 VOLUME 3 ISSUE 1
Dear Doctors and Office Managers, Welcome to our first issue of 2012! Challenges that come with new year
WCH Service Bureau is a proud member of the following professional organizations:
INSIDE THIS ISSUE: WCH BUZZ Health care challenges that physician community is facing in 2012..................................................................................................3 Medicare Preventive Services.................................................................................................................................4 News from WCH Credentialing Department.........................................................................................11 Office site checklist review.................................................................................................................................12 Ways to Market your Practice...................................................................................................................................................13 Some simple Ways to Attract New Patients to Your Practice:.........................................................................................14
HEALTHCARE NEWS Medicare Adds Obesity Screening and Counseling Coverage...........................................................................14 Telehealth Services Expanded for 2012..................................................................................................14 Physical Medicine and Rehabilitation:..............................................................................................15 All Medicare Provider and Supplier Payments to be made by Electronic Funds Transfer.........................16 Timely Filing of Claims - Medicare Reimbursement...............................................................................16 Rehabilitation Visits Will Require Prior Authorization...................................................................................17 Questions and Answers.....................................................................................................................18 Contact information........................................................................................................................................19 Your Feedback is Important.......................................................................................................................20
VOLUME 3 ISSUE 1 Page 3
WCH BULLETIN
Here are few of the health care challenges that physician community is facing in 2012. Doctors in America are harboring an embarrassing secret: Many of them are going broke. This is quiet reality, which is spreading nationwide. Industry observers are saying that the trend is worrisome in a private practice setting. If the expected fee schedule cut will be in place it will lead to closing of many private medical practices which will lead to lack lost of vital healthcare care resource in the community. "A lot of independent practices are starting to see serious financial issues," said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances. Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. Source of information ( Doctors going broke By Parija Kavilanz, CNNMoney January 6, 2012) WCH understands the problems physicians are facing in 2012 and we working towards helping to find right solutions for our clients to help continuing to run their practice. With all the financial doom and gloom it is easy to be worried about financing challenges. This and the next article in this bulletin to fight with the financial challenges of the 2012. WCH strives to help our clients to success in their medical practice, we are not like any other billing companies, we are a service bureau that wants to establish a partner out of our client rather than just a billing client. We want our clients to grow with us and stay committed and trusted to our services and quality of work In 2012 physicians need: - to carefully assess your individual circumstances and determine the practice configuration that best meets yours needs and those of patients. - to vigilantly monitor your administrative burdens and take steps to minimize any further impact on your relationship with patients. - to evaluate how you can optimize your work time - to acquire new types of non-medical leadership skills that will help stands out from your competitors - to provide higher quality in an environment characterized by increased reporting, problematic reimbursement and high potential liability. - to have trustworthy medical billing, credentialing, marketing service.
WCH is the company for the job!
3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 4
WCH BULLETIN
Medicare Preventive Services Many of our clients are frequnently asking our billing department for ways to increase thier reimbursment by perfmorning new procedures and tests. Therefore, WCH billing team has created a chart that would guide physicians through the list of availbale and payable codes offered by the medicare program. Please ask your account representative for a more detailed desicption of the codes if needed: CPT
Description
Abdominal Aortic Aneurysm Screenings Frequency
G0389 Ultrasound, B‐scan and/or real time with image documentation; for Abdominal Aortic Aneurysm (AAA) ultrasound screening
CPT G0396
G0397
Description
Alcohol Misuse Counseling Frequency
Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g.,AUDIT, DAST), and intervention, greater than 30 minutes
$75.51
Description
Bone Mass Measurements Frequency
Single energy x‐ray absorptiometry (SEXA) bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) 1 or more sites; axial skeleton(e.g., hips, pelvis, spine)
77079
Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
77080
Dual‐energy x‐ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
77081 77083
76977
Dual‐energy x‐ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) Radiographic absorptiometry (e.g., photodensitometry, radiogrammetry),1 or more sites Ultrasound bone density measurement and interpretation, peripheral site(s), any method
CPT
80061
Description
82465
Cholesterol, serum or whole blood, total (For high density lipoprotein HDL, use 83718)
83718
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
84478
Triglycerides
3047 Avenue U, Brooklyn NY 11229
physicians and qualified non‐physician practitioners
Who can perform A qualified primary care doctor or other primary care provider must provide the counseling in a primary care setting.
Fee*
Who can perform
$40.19
Medicare provides coverage of a bone mass measurement that meets the criteria described above once every 2 years (i.e., at least 23 months after the last covered bone mass measurement test was performed). NOTE: If medically necessary, Medicare may provide coverage for a beneficiary more frequently than every two years. (See the text box on the right for examples of situations in which Medicare may provide more frequent coverage of bone mass measurements.)
$99.84
no in MPFS
$118.21
physicians and qualified non‐physician practitioners
$34
no in MPFS
$10.60
Cardiovascular Screening Blood Test Frequency
Lipid Panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)
Who can perform
Fee* $38.37
Computed tomography, bone mineral density study, Desciption CPT
77078
$133.23
Medicare covers one alcohol misuse Alcohol and/or substance (other than tobacco) abuse screening per year. People who screen structured assessment (e.g.,AUDIT, DAST), and brief positive can get up to 4 brief face‐to‐face intervention 15 to 30 minutes counseling sessions per year
CPT G0130
Medicare covers this one‐time screening ultrasound if you get a referral for it as a result of your "Welcome to Medicare" preventive visit. You must get the preventive visit and the screening ultrasound referral (not the ultrasound exam itself) within the first 12 months you have Medicare Part B.
Fee*
Medicare provides coverage of cardiovascular screening blood te st s fo r a l l a sy m p to m at i c beneficiaries every 5 years (i.e., at least 59 months after the last covered screening tests).
Fee*
Who can perform
no in MPFS
no in MPFS
Physician/Qualified Non‐Physician Practitioner
no in MPFS no in MPFS
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 2 ISSUE 1 5 Page 5 3
WCH BULLETIN
CPT
Description
Colorectal Cancer Screening Frequency Generally, once every 48 months, or 120 months after a previous screening colonoscopy for people not at high risk.
G0104
Colorectal cancer screening; flexible sigmoidoscopy
G0105
Colorectal cancer screening; colonoscopy on Generally, once every 48 months, or 120 months after a previous screening individual at high risk colonoscopy for people not at high risk.
G0106
Colorectal cancer screening; alternative to Generally once every 120 months (once G0104, screening sigmoidoscopy, barium every 24 months if you're at high risk), or 48 months after a previous flexible enema sigmoidoscopy.
82270
Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection)
CPT G0120
G0121
Your doctor can decide to use this test instead of a flexible sigmoidoscopy or colonoscopy. This test is covered every 24 months if you are at high risk for colorectal cancer and every 48 months if you aren't at high risk
Colorectal cancer screening; alternative to Medicare provides coverage of a G0105, screening colonoscopy, barium screening FOBT annually (i.e., at least 11 enema months have passed following the month in which the last covered screening FOBT was performed) for beneficiaries aged 50 and older. This screening requires a written order from the beneficiary’s attending physician. Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
Colorectal cancer screening; fecal occult blood test, immunoassay, 1‐3 simultaneous. (To ensure that Medicare and Medicaid only pay for a laboratory G0328* test categorized as waived complexity under CLIA, for dates of service on or after April 5, 2010, HCPCS code G0328 must be billed with modifier ‐ QW to be recognized as a waived test)
CPT
77052
Description
77057
Screening mammography, bilateral (2‐view film study of each breast)
G0202
Screening mammography, producing direct digital image, bilateral, all views
3047 Avenue U, Brooklyn NY 11229
$169.03
$472.16
$261.32
Who can perform Screening flexible sigmoidoscopies must beperformed by a doctor of medicine or osteopathy, a physician assistant, nurse practitioner, or clinical nurse specialist. Screening colonoscopies must be performed by a doctor of medicine or osteopathy. Screening flexible sigmoidoscopies must be performed by a doctor of medicine or osteopathy, a physician assistant, nurse practitioner, or clinical nurse specialist.
no in MPFS
$261.32
Screening flexible sigmoidoscopies must be performed by a doctor of medicine or osteopathy, a p hys i c i a n a s s i sta nt , n u rs e practitioner, or clinical nurse specialist.
$472.16
Screening colonoscopies must be performed by a doctor of medicine or osteopathy.
no in MPFS
Screening Mammography Frequency
Computer‐aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (List separately in addition to code for primary procedure)
Fee*
Aged 35 through 39: one baseline. Age 40 and older: annually.
Fee*
$13.02
Who can perform Mammography services must be provided in a Food and Drug Administration (FDA)‐certified radiological facility under the Mammography Quality Standards Act (MQSA). A qualified physician who is directly associated with the facility where the mammogram was taken mustinterpret the results.
$95.1
$166.06 Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 6
WCH BULLETIN
CPT 97802 97803 97804
Description
Medical Nutrition Therapy Frequency
Medical nutrition therapy; initial assessment and intervention, individual, face‐to‐face Medical nutrition therapy; re‐assessment and intervention, individual, face‐to‐face with the patient, each 15 minutes Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes
Medical nutrition therapy; reassessment and subsequent intervention(s) following second G0270 referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face‐to‐face with the patient, each 15 minutes
Description
$33.63
$16.84
First year: 3 hours of one‐on‐one counseling. Subsequent years: 2 hours.
No specific CPT code. Should be reported by
MNT services must be provided by a registered dietitian, or a nutrition professional who meets the provider qualification requirements, or a “grandfathered” dietitian or nutritionist who was licensed as of December 21, 2000.
$33.63
$16.84
Obesity Screening and Counseling Frequency
appropriate E&M code with ICD‐9 V77.8
Who can perform
$38.55
Medical nutrition therapy, reassessment and subsequent intervention(s) following second G0271 referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes
CPT
Fee*
No frequency determined
Fee* NOT IN FEE Schedule
Who can perform Primary care providers
Preventive visits
CPT
G0402
Description
Frequency
Initial preventive physical examination; face‐to‐face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
Fee*
$176.39
Once per lifetime (no later then 12 month after effective date of Medicare Part B coverage)
Who can perform Physician (a doctor of medicine or osteopathy), a qualified non‐physician practitioner (a physician assistant, nurse practitioner, or clinical nurse specialist), or by a medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner), or a team of such medical professionals who are working under the direct supervision of a physician.
$22.31
Physicians or qualified non‐physician practitioners
Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
$12.87
Physicians or qualified non‐physician practitioners
Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
$9.45
Physicians or qualified non‐physician practitioners
G0403
Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
G0403
G0403
3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 7
WCH BULLETIN
G0438 Annual wellness visit; includes a personalized
Once per lifetime
$189.18
prevention plan of service (pps), initial visit
G0439 Annual wellness visit; includes a personalized
Annually
$126.40
prevention plan of service (pps), subsequent visit
CPT
Description
Prostate Cancer Screenings Frequency
G0102 Prostate cancer screening; digital rectal Annually
G0103 Prostate cancer screening; prostate specific
$189.18
antigen test (PSA)
Physician (a doctor of medicine or osteopathy), a qualified non‐physician practitioner (a physician assistant, nurse practitioner, or clinical nurse specialist), or by a medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner), or a team of such medical professionals who are working under the direct supervision of a physician.
Fee* $22.65
examination
Physician (a doctor of medicine or osteopathy), a qualified non‐physician practitioner (a physician assistant, nurse practitioner, or clinical nurse specialist), or by a medical professional (including a health educator, registered dietitian, nutrition professional, or other licensed practitioner), or a team of such medical professionals who are working under the direct supervision of a physician.
Who can perform A physician is defined as a doctor of medicine or osteopathy and qualified NPP (PA, nursepractitioner)
Smoking Cessation
CPT
Description
Frequency
Fee*
Smoking and tobacco cessation counseling visit 2 cessation attempts per year. Each
G0436 for the asymptomatic patient; intermediate, attempt includes maximum of 4 greater than 3 minutes, up to 10 minutes
Smoking and tobacco cessation counseling visit
$15.25
intermediate or intensive sessions; up to 8 sessions in 12‐month period.
G0437 for the asymptomatic patient; intermediate,
$31.7
Who can perform A physician is defined as a doctor of medicine or osteopathy and qualified NPP ( PA , n u rs e p ra c t i t i o n e r, certified nurse midwife).
greater than 10 minutes
Flu Shots
CPT 90655
90656
90657
Description
Frequency
Influenza virus vaccine, split virus, preservative free, when administered to children 6‐35 months of age, for intramuscular use
Fee* $15.70
Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years Once per influenza season in the fall or and older, for intramuscular use winter. Medicare may provide additional Influenza virus vaccine, split virus, when flu shots if medically necessary. administered to children 6‐35 months of age,for intramuscular use
$12.37
$6.65
90660
Influenza virus vaccine, live, for intranasal use
$22.31
90662
Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity viaincreased antigen content, for intramuscular use
$30.92
3047 Avenue U, Brooklyn NY 11229
Who can perform
Phone: 888-WCHEXPERTS
Physicians or qualified non‐physician practitioners
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 8
WCH BULLETIN
Influenza virus vaccine, split virus, when
Q2035 administered to individuals 3 years of age and
$11.54
older, for intramuscular use (AFLURIA) Influenza virus vaccine, split virus, when Q2036 administered to individuals 3 years of age and older, for intramuscular use (FLULAVAL)
$8.78
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and Q2037 Once per influenza season in the fall or older, for intramuscular use (FLUVIRIN) winter. Medicare may provide additional Influenza virus vaccine, split virus, when flu shots if medically necessary. administered to individuals 3 years of age and Q2038 older, for intramuscular use (Fluzone) Influenza virus vaccine, split virus, when administered to individuals 3 years of age and Q2039 older, for intramuscular use (not otherwise specified)
$13.65
$13.30
Physicians or qualified non‐physician practitioners
no in MPFS
G0008 Administration of influenza virus vaccine
$28.42
*Medicare allowable for 09/01/11‐08/31/12 period.
CPT 90669
Description
Pneumococcal Shots Frequency
Pneumococcal conjugate vaccine, 7 valent, for
Fee*
Who can perform
$95.48
intramuscular use
90670
90732
Pneumococcal conjugate vaccine, 13 valent, Once in a lifetime Medicare may provide additional vaccinations based on risk and for intramuscular use provided that at least 5 years have passed Pneumococcal polysaccharide vaccine, since receipt of a previous dose 23‐valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
G0009 Administration of pneumococcal vaccine Pap Tests and Pelvic Exams Description Frequency CPT
$129.27
$57.19
$28.42
Fee*
Who can perform
national minimum payment amount for a cervical or vaginal Pap smear in 2012––$14.97
Screening cytopathology, cervical or vaginal G0123 (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision Screening cytopathology, cervical or vaginal Annually if at high‐risk for developing
G0124 (any reporting system), collected in c e r v i ca l o r va g i n a l ca n c e r, o r preservative fluid, automated thin layer childbearing age with abnormal Pap preparation, requiring interpretation by test within past 3 years. Every 24 physician months for all other women Screening cytopathology smears, cervical or G0141 vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
$33.88
$33.88 national minimum payment amount for a cervical or vaginal Pap smear in 2012––$14.97
Screening cytopathology, cervical or vaginal (any reporting system), collected in G0143 preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision
3047 Avenue U, Brooklyn NY 11229
Physicians or qualified non‐physician practitioners
Phone: 888-WCHEXPERTS
A doctor of medicine or osteopathy or other authorized qualified non‐physician practitioner (i.e., a certified nurse midwife, physician assistant, nurse practitioner, or clinical nurse specialist), who is authorized under state law to perform the examination, must order and collect the screening Pap test.
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 9
WCH BULLETIN
Screening cytopathology, cervical or vaginal
G0144 (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision Screening cytopathology, cervical or vaginal (any reporting system), collected in G0145 preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision
Annually if at high‐risk for developing Screening cytopathology smears, cervical or c e r v i ca l o r va g i n a l ca n c e r, o r G0147 vaginal, performed by automated system childbearing age with abnormal Pap under physician supervision test within past 3 years. Every 24 Screening cytopathology smears, cervical or months for all other women G0148 vaginal, performed by automated system with manual rescreening Screening Papanicolaou smear, cervical or P3000 vaginal, up to 3 smears, by technician under physician supervision
national minimum payment amount for a cervical or vaginal Pap smear in 2012––$14.97
Screening Papanicolaou smear, cervical or $33.88
P3001 va g i n a l , u p to 3 s m e a rs , re q u i r i n g interpretation by physician Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal Q0091 smear to laboratory Cervical or vaginal cancer screening; pelvic
G0101 and clinical breast examination
A doctor of medicine or osteopathy or other authorized qualified non‐physician practitioner (i.e., a certified nurse midwife, physician assistant, nurse practitioner, or clinical nurse specialist), who is authorized under state law to perform the examination, must order and collect the screening Pap test.
$52.22
Annually if at high‐risk for developing c e r v i c a l o r va g i n a l c a n c e r, o r childbearing age with abnormal Pap test within past 3 years. Every 24 months for all other women
$43.12
*http://www.g2reports.com/article/ART87871 2?C=zeCW0grvBv2GgD
Diabetes screening
CPT 82947 82950
82951
CPT
G0108
Description
Frequency
Glucose; quantitative, blood (except reagent 1."Medicare provides coverage of strip) diabetes screening tests for beneficiaries in the risk groups Glucose; post glucose dose (includes glucose) previously listed or those diagnosed with pre‐diabetes. Medicare provides coverage of diabetes screening tests as a Medicare Part B benefit after a referral Glucose; tolerance test (GTT), three specimens f r o m a p hy s i c i a n o r q u a l i f i e d non‐physician practitioner for a (includes glucose) beneficiary at risk for diabetes. 2. Medicare provides coverage for a maximum of 2 diabetes screening tests within a 12‐month period (but not less than 6 months apart) for beneficiaries diagnosed with pre‐diabetes.
Description
$5.52 $6.58
$18.12
Who can perform Medicare provides coverage of diabetes screening tests as a Medicare Part B benefit after a referral from a physician or qualified non‐physician practitioner for a beneficiary at risk for diabetes. A physician is defined as a doctor of medicine o r o s t e o p a t h y. Q u a l i f i e d Non‐Physician PractitionerFor the purpose of diabetes screening tests, a qualified non‐physician practitioner is a physician assistant, nurse practitioner, or clinical nurse specialist.
Diabetes Self‐Management Training (DSMT) Services Fee* Frequency
The initial year for DSMT is the 12‐month period following the required initial training certification. The initial training does not Diabetes outpatient self‐management training exceed a total of 10 hours (the 10 hours of services individual per 30 minutes training can be done in any combination of 30‐minute increments and can be spread over the 12‐month period or less)
3047 Avenue U, Brooklyn NY 11229
Fee*
Phone: 888-WCHEXPERTS
$60.16
Who can perform Medicare covers DSMT services when a certified provider who meets certain quality standards furnishes these services. DSMT services are intended to educate beneficiaries in the successful self‐management of
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 10
WCH BULLETIN
A qualified DSMT program includes the following services: • Instruction in self‐monitoring of blood glucose, • Education about diet and exercise, • An insulin treatment plan developedspecifically for insulin‐dependent beneficiaries, and • Motivation for beneficiaries to use the skills for self‐management Follow‐up training for subsequent years is based on a 12‐month calendar year after the completion of the full 10 hours of initial training. However, if the G0109 Diabetes outpatient self‐management training beneficiary exhausts 10 hours in the services, group session (2 or more), per 30 initial year then the beneficiary would be eligible for followup training in the next minutes calendar year. If the beneficiary does not exhaust 10 hours of initial training, he/she has 12 continuous months to exhaust initial training before the 2 hours of follow‐up training are available.
$18.49
Screening EKG
CPT
Description
Frequency
Fee*
Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial G0403 preventive physical examination with interpretation and report
$22.31
Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, G0404 performed as a screening for the initial preventive physical examination
$12.87
Medicare covers a one‐time screening EKG if you get a referral for it as a result of onetime "Welcome to Medicare" Preventive Visit (no later than 12 months after the date the beneficiary’s first Electrocardiogram, routine ECG with 12 leads; Medicare Part B coverage begins) interpretation and report only, performed as a G0405 screening for the initial preventive physical examination
CPT
Description
Glaucoma Screening Frequency
Glaucoma screening for high risk patients
G0117 furnished by an optometrist or........ Annually for beneficiaries in one of the ophthalmologist
$9.45
Glaucoma screening for high risk patients
$60.44
$43.28
optometrist or ophthalmologist
CPT 90740 90743 90744
Description
Hepatitis B Vaccinations Frequency
Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
Who can perform Medicare pays for glaucoma screenings in an office setting furnished by or under the direct supervision of an optometrist or ophthalmologist legally authorized to perform services under state law.
Fee*
Who can perform
$119.42
Scheduled dosages required $24.22
Hepatitis B vaccine, pediatric/adolescent dosage ( 3 dose schedule), for intramuscular use
3047 Avenue U, Brooklyn NY 11229
The IPPE must be furnished by either a physician or a qualified non‐physician practitioner: A physician is defined as a doctor of medicine or osteopathy. Q u a l i f i e d N o n ‐ P hy s i c i a n Practitioner: For the purpose of the IPPE, a qualified nonphysician practitioner is a physician assistant, nurse practitioner, or clinical nurse specialist.
Fee*
high-risk groups
G0118 furnished under the direct supervision of an
Who can perform
$24.22
Phone: 888-WCHEXPERTS
Medicare requires that the hepatitis B vaccine be administered under a physician’s order with supervision.
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 11
WCH BULLETIN
90746 90747
Hepatitis B vaccine, adult dosage, for intramuscular use Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
$59.71
Scheduled dosages required
G0010 Administration of Hepatitis B vaccine
CPT
Description
$119.42 $31.05
Human Immunodeficiency Virus Screening Frequency
Fee*
Infectious agent antibody detection by enzyme
G0432 immunoassay (EIA) technique, HIV‐1 or HIV‐2,
$21.23
screening Infectious agent antibody detection by G0433 enzyme‐linked immunosorbent assay (ELISA) technique, HIV‐1 and/or HIV‐2, screening
Annually for beneficiaries at increased risk. Three times per pregnancy for beneficiaries who are pregnant: a. When woman is diagnosed with pregnancy; b. During the 3rd trimester; and Infectious agent antibody detection by rapid c. At labor, if ordered by the woman’s G0435 antibody test, HIV‐1 and/or HIV‐2, screening clinician.
Medicare requires that the hepatitis B vaccine be administered under a p h y s i c i a n ’s o r d e r w i t h supervision.
$21.23
$18.57
Who can perform Must be furnished by either a physician or a qualified non‐physician practitioner: A physician is defined as a doctor of medicine or osteopathy. Q u a l i f i e d N o n ‐ P hy s i c i a n Practitioner: For the purpose of the IPPE, a qualified nonphysician practitioner is a physician assistant, nurse practitioner, or clinical nurse specialist.
News from WCH Credentialing Department WCH Credentialing Department can help you to increase your Medicare income by applying for Durable Medical Equipment (DME) Provider ID, if you are a physical therapist, podiatrist, physician providing medical supplies to your patients in the office. Who can apply for DME Provider ID with Medicare? Podiatrists, PTs, PMRs who had to refer their patients to pharmacy for any supplies, can now apply for DME PIN to provide DME supplies to Medicare patients themselves. What will WCH do? Since adding a new line of business is considered as new enrollment WCH will prepare application forms, attach all necessary documents and submit it for process to National Supplier Clearinghouse (Medicare DME Program). This carrier is responsible for enrollment and claims processing of all medical supplies. WCH will monitor the process of the request and provide the client with the feedback of the ongoing status. Please keep in mind that the process can take up to 90 calendar days and there is a site visit performed by the NSC program. DME Provider ID may give your practice an additional income for rendering/renting supplies. Those patients that are in need of these supplies will be able to get them directly from you. If you are interested in applying for DME Provider ID with Medicare, feel free to contact our Credentialing Department specialist Julia Bondarenko at (646) 434-5569 or via e-mail: YuliyaB@wchsb.com Contact us and we can do it for you!
3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 12
WCH BULLETIN
Many of our credentialing clients are often concerned with going through a site visit inspection which can be performed by any health plan and state/federal program. WCH Credentialing department has created a check list of all thing that inspector would check during the site visit. Please review the list and should you have any questions, please feel free to contact our credentialing line at ext 1102.
Office site checklist review The Health Plan performs an office site review as part of the provider credentialing/ recredentialing process for PCPs, OB/GYNs and behavioral health providers. Provider sites must meet the following standards for the credentialing process to proceed. Facility and Environment 1 Clean, private restroom for patients 1 Waiting and treatment rooms cleanliness, sanitary and of adequate size 1 Patient care areas ensure privacy 1 Handicap accessible Office Operations 1 Confidentiality policy for staff 1 Process to identify and contact patients who miss appointments Access to Care 1 Emergency coverage, 24 hours a day, seven days a week 1 Urgent medical care available within 24 hours 1 Adult base- line medical exam available within 12 weeks 1 Routine health maintenance care within four weeks 1 Non- urgent sick visits within 48 – 72 hours 1 Well – child visits within four weeks 1 Routine behavioral health care within 10 business days 1 Urgent behavioral health care within 48 hours Pharmaceuticals 1 Medications and supplies stored in secure location 1 Prescription pads stored in secure location Office Record Maintenance 1 System in place to ensure a neat and legible record for each patient 1 Patient name, ID number on each page, all entries dated, sequential and signed or initialed by author 1 Problem list included 1 Office records stored securely to maintain confidentiality and privacy 1 Records kept for individual patients 1 Records maintained for period required by law 1 System in place to ensure that provider reviews all clinical information 1 Allergies displayed prominently System to capture biographic and personal data and appropriate medical history 3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 13
WCH BULLETIN
Ways to Market your Practice According to the United States Bureau of Labor Statistics, the market for physicians and surgeons is projected to grow 22 percent between 2008 and 2018, much faster than the average for all occupations. Just because of the positive industry outlook doesn't mean physicians should neglect marketing. Marketing a medical practice is not complete with a simple advertisement, sending off an announcement to the local media will not suffice, and of course marketing without networking is doomed to fail. For effective practice marketing your approach should be methodical and varied. In this article we discuss planning a marketing strategy, potential tactics to use, and methods for implementation. Planning Building a practice marketing must first start with a plan. Your plan should include market analysis, market strategy, implementation, and follow-up. Developing this plan and making it effective must begin with plenty of background information. Consider: · What funds are available to market the medical practice? · Are you able to implement a marketing campaign? · Understand who makes up your community · Understand how big your community is. · Comprehend your strengths, weaknesses, and opportunities. · Appreciate the competition. With these facts and ideas in mind, you can choose which marketing methods will be most effective for your practice. Tactics Marketing a medical practice should involve an appropriate mix of networking, advertising/promotion, and community outreach: · Networking Physician marketing that attracts new Patients, · Media Grows,Revenues and promotes your brand! · Website www.physicianmarketing.us · Social media · Email Marketing If you like WCH can help you with creating a website, business cards, advertising brochure and any kind of marketing materials for your medical practice. WCH is a partner with radio FM and the designer team, can prepare a great video add, that help to promote your practice, additionally WCH can create Facebook profile for your office, varity of educational materials for your patients and many customized templates that are needed for practice. Implementation To get the most out of your plan, you should set goals for when specific tactics will be used. Your goals should be prioritized. What is most important to you now - getting referrals from new physicians or building a reputation in the community? Through a methodical process of abstract and tactical planning, and implementation, you will see your practice grow in patients and in revenues. 3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 14
WCH BULLETIN
HEALTHCARE NEWS Medicare Adds Obesity Screening and Counseling Coverage Medicare announced new coverage for preventive services to reduce obesity adding to its existing portfolio of preventive services available without cost sharing. Screening for obesity and counseling for eligible patients performed by primary care providers in settings such as physicians' offices may be covered under this Affordable Care Act benefit. For complete details, read the national coverage determination at www.smc.gov/medicare-coverage-database.
Telehealth Services Expanded for 2012 CMS is adding four codes for smoking cessation to the list of distant site telehealth services covered under Medicare Part B, effective January 1, 2012 and adding policy instructions to its manuals. The CPT and HCPCS Level II codes are: 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes, up to 10 minutes. 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes. G0436 Smoking and tobacco use cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes. G0437 Smoking and tobacco use cessation counseling visit for the asymptomatic patient; 3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 15
WCH BULLETIN intermediate, greater than 10 minutes
CMS also is allowing initial inpatient Telehealth consultation codes G0425- G0427 to be billed when the place of service is in the emergency departments. Note the descriptor changes (emphasized): G0425 TeleHealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via Telehealth. G0426 TeleHealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via Telehealth. G0427 TeleHealth consultation, emergency department or initial inpatient, typically 70 minutes communicating with the patient via Telehealth. These codes should be submitted with modifier GQ Via asynchronous telecommunications systems or GT Via interactive audio and video telecommunications systems to identify the Telehealth technology used to provide the service. Source: CMS Transmittal 2354, CR 7504, issued November 18 .......................... (www.cms.gov/transmittials/downloads/ R2354CP.pdf).
Physical Medicine and Rehabilitation: Multiple Therapy Procedure Reduction Policy Update to Align with CMS 2012 RVU United Healthcare will implement a new reimbursement policy in order to reduce the practice expense portion of certain physical, occupational and speech/language therapy procedures. Stated procedures will be reduced by 20% when these procedures are the secondary and/or subsequent procedures reported on a single date of service for the same patient. These procedures are identified with a multiple procedure indicator 5 on the Centers for Medicare & Medicaid Services (CMS) National Physician Fee Schedule. United Healthcare will utilize the ratio of the CMS practice expense Relative Value Unites (RVU) to total RVU assigned to a therapy procedure to determine which portion of the allowable amount will be reduced by 20% for the second and subsequent procedures. Reimbursement for the work expense and malpractice expense portion of the procedures RVU will not be affected by this reimbursement reduction. Multiple therapy procedure reduction payments will be applied only to claims submitted on a CMS 1500 claim form or its electronic equivalent. In accordance with CMS, United Healthcare will utilize the 2012 CMS RVU values to administer this policy for claims submitted with a date of service on or after March 1, 2012. These values will be reviewed and updated quarterly to align with CMS when changes are needed, going forward. The Appendix includes an updated list of codes and 2012 CMS RVU values that apply to this policy.
3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 16
WCH BULLETIN
All Medicare Provider and Supplier Payments to be made by Electronic Funds Transfer The current existing regulations of 42 CFR requires at the time of enrollment, providers and suppliers that expect to receive payment from Medicare for services provided must agree to receive Medicare payments through electronic funds transfer (EFT) as well. The ACA further expands Section 1862, the Social Security Act, by mandating federal payments to providers and suppliers only by electronic means. As part of CMS's revalidation efforts, all suppliers and providers who are not currently receiving EFT payments, will be identified, and required to submit the CMS 588 EFT form with the Provider Enrollment Revalidation application. WCH credentialing Department can help with the process setting up EFT; Direct Deposit for your provider files in Medicare. We Can Help!
Timely Filing of Claims - Medicare Reimbursement To be eligible for Medicare reimbursement, provider must file claims within a qualifying time limit. On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed to dodge fraud, waste, and abuse in the Medicare program. Under the new law, provider must file claims for services furnished on or after January 1, 2010, within one calendar year after the date of service. Patient Responsibility The provider may collect 20% of what would have been the Medicare fee schedule allowed amount, when the claim denies for late filing. The patient is not responsible for the entire billed amount. Claims Denied based on the Timely Filing Limit Do Not Have Appeal Rights Centers for Medicare & Medicaid Services (CMS) require Medicare contractors to deny claims submitted after the timely file limit is expired. Important Notice about Claim Denials WPS Medicare is seeing a dramatic increase in the number of claim denials when the provider submits a claim for more than one year following the date of the service. How to File a Waiver to Extend the Timely Filing Limit Providers who believe they have good cause for their delay in filing a timely claim must send a request to the WPS Medicare Claims Manager to extend the timely filing limit along with their claim for payment. It is important that the request for a waiver of timely filing and 3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 17
WCH BULLETIN
documentation supporting the request accompany the new claim. Since claims denied for timely filing do not have appeal rights, the WPS Medicare Redeterminations unit cannot grant any waiver to the timely filing deadline after the claim is processed. Therefore, do not send it to WPS Medicare using the Redetermination Form.
Rehabilitation Visits Will Require Prior Authorization · Medicaid Limits physical therapy, occupational therapy and speech therapy to 20 visits' each per a 12 month benefit period. · 02/23/2012 - Prior authorization will be required for physical therapy, occupational therapy and speech therapy provided to fee service Medicaid enrollees. - Enrollees who have received 20 or more visits' of physical therapy, occupational therapy and speech therapy between April 1, 2011 and September 30, 2011 will not be entitled to Medicaid reimbursement for additional units for that therapy type until April 1, 2012. · Article 28 facilities were initially notified that payment changes were expected to implement on October 1, 2011. However, the eMedNY system changes required to implement this new payment policy required an implementation delay, moving the implementation date to January 1, 2012. · Effective for dates of service on or after January 1, 2012, all claims submitted to Medicare on the institutional claim form (837i) will be processed through the eMedNY system. - This means that the choice to “opt out” of the crossover process is no longer available for institutional claims submitted on the 837i. - Clinic claims submitted to Medicare on the 837p will continue to be paid through the “opt out” crossover process as appropriate. · Effective January 1, 2012 Medicaid Part B crossover claims must contain a valid New York State Medicaid rate codes All claims must have a valid rate code when submitted to Medicaid as Medicare/ Medicaid crossover. If the claim crosses over to Medicaid without a valid rate code, that claim will be denied with the edit 02176, RATE CODE INVALID ON DIRECT CROSSOVER. - Claims containing valid rate codes submitted to Medicare as “14.00”. The reason for this is Medicare has an edit that will reject a claim if the sum of the Value Code Amount is greater than the Claim Charge Amount.
3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 18
WCH BULLETIN
QUESTIONS AND ANSWERS 1. Q: Who is Entitled to Medical Records When a Patient Dies? A: As anyone who has been to a doctor in the past decade knows, federal regulations commonly referred to as the HIPAA Privacy Rule to protect the confidentiality of medical records. You are unable to see a doctor until you have been advised of your privacy rights and signed an appropriate HIPAA acknowledgment. Try to obtain medical information about your adult child or your parent and you will bump into HIPAA again and State law as well. You can overcome this hurdle if your family member signs an authorization to permit you to have access to the records or if you are considered her “personal representative” under State or other applicable law.
2. Q: What happens to the confidentiality of a medical record when a person dies? A: The confidentiality lives on. In fact, those who had access when the patient was alive might not have access after their death. HIPAA provides that a decedent's executor, administrator, or other person authorized to act on behalf of a decedent's estate may request a decedent's medical record.
·
In New York, a distributee of a decedent's estate may also access the medical records if there is no administrator or executor that has been appointed to. · The distributee's attorney if he or she holds a power of attorney from the distributee explicitly authorizing the attorney to execute a written request for the deceased patient's information as well. Health care providers must ensure that they are familiar with HIPAA and their State's laws regarding access to a decedent's medical records. The provider may not turn over records unless it has received a written request, verified the status of the requestor, and ensured that the requestor is entitled to all the information sought. Documentation should be kept in the medical record. Violators of HIPAA privacy rules carry penalties, providers should consult with their legal counsel when they are unsure whether disclosure is appropriate or not.
3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 19
WCH BULLETIN
WCH Service Bureau, INC 3047 Avenue U, Brooklyn NY 11229 Phones: (718) 934-6714, (718) 934-6728, 888-WCHEXPERTS Fax: (718) 504-6072
3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com
VOLUME 3 ISSUE 1 Page 20
WCH BULLETIN
FEEDBACK Align yourself and your business with people and services that you can count on. Below, please provide any feedback that you think might help us and in turn help you, and our businesses. _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ ________________________________________________ Name_________________________________ E-Mail_________________________________ Thank you for your support!
3047 Avenue U, Brooklyn NY 11229
Phone: 888-WCHEXPERTS
Fax: (718) 504-6072
www.wchsb.com