3 rd Party References Providing… NOA, Medicare, Medicaid, and other resources to help you understand 3 rd party requirements and file 3 rd party claimsNOA,

33rdrd Party References Party ReferencesProviding…Providing…•NOA, Medicare, Medicaid, and other NOA, Medicare, Medicaid, and other resources to help you understand 3resources to help you understand 3rdrd party requirements and file 3party requirements and file 3rdrd party party claimsclaims

DisclaimersDisclaimers

This information was prepared by the 3rd Party Consultant to the Nebraska Optometric Association, Ed Schneider OD.

To the best of his knowledge, it was current and accurate at the time it was prepared. It is not guaranteed to be error or omission free.

It was prepared as general information to assist doctors and staff, and is not intended to grant rights or impose obligations.

DisclaimerDisclaimer

• The ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services.• The Nebraska Optometric Association, and its presenters, agents, consultants and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free or omission-free, and will bear no responsibility or liability for the results or consequences of the information contained herein.

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Coding ReferencesCoding References

• CPT CPT (Current Procedure Terminology)(Current Procedure Terminology)– Service CodesService Codes

• 92000 Ophthalmology92000 Ophthalmology• 99000 Evaluation & Mgmt99000 Evaluation & Mgmt

– Surgical Procedure CodesSurgical Procedure Codes• 65205 Removal of FB65205 Removal of FB• 67820 Epilation of Lashes67820 Epilation of Lashes

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Coding ReferencesCoding References

• Available fromAvailable from – AOA AOA http://www.aoa.org/x12590.xmlhttp://www.aoa.org/x12590.xml

– Combines multiple referencesCombines multiple references– Delivery later than someDelivery later than some

– AMA AMA – https://catalog.ama-assn.org/Catalog/;jsessionidhttps://catalog.ama-assn.org/Catalog/;jsessionid

=Q3YRMMKGBTFOLLA0MRPVX5Q?_requestid=1669537=Q3YRMMKGBTFOLLA0MRPVX5Q?_requestid=1669537

– Amazon.com Amazon.com http://www.amazon.com/http://www.amazon.com/

• UPDATE YEARLY – effective January 1stUPDATE YEARLY – effective January 1st

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Coding ReferencesCoding References

• ICD-9-CMICD-9-CM• International Classification of DiseasesInternational Classification of Diseases

– Refractive Diagnosis CodesRefractive Diagnosis Codes– Disease Diagnosis CodesDisease Diagnosis Codes– Injury Diagnosis Codes Injury Diagnosis Codes

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Coding ReferencesCoding References

• Available fromAvailable from – AOA AOA http://www.aoa.org/x12590.xmlhttp://www.aoa.org/x12590.xml

– Combines multiple referencesCombines multiple references– Delivery later than someDelivery later than some

– AMA AMA – https://catalog.ama-assn.org/Catalog/;jsessionidhttps://catalog.ama-assn.org/Catalog/;jsessionid

=Q3YRMMKGBTFOLLA0MRPVX5Q?_requestid=1669537=Q3YRMMKGBTFOLLA0MRPVX5Q?_requestid=1669537

– Amazon.com Amazon.com http://www.amazon.com/http://www.amazon.com/

• UPDATE YEARLY – UPDATE YEARLY – effective October 1effective October 1stst of previous of previous

yearyear (the 2013 issue is effective October 1(the 2013 issue is effective October 1stst, 2012.), 2012.)

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Coding ReferencesCoding References

• 1997 Documentation Guidelines 1997 Documentation Guidelines for Evaluation & Management for Evaluation & Management ServicesServices

– Explains how to code and document Explains how to code and document the 99000 codesthe 99000 codes

– Includes information on single organ Includes information on single organ systems (such as eyes)systems (such as eyes)

http://www.cms.hhs.gov/MLNProducts/downloads/referenceII.pdf

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CMS: Medicare Learning CMS: Medicare Learning NetworkNetwork

You can download it from:You can download it from:http://www.cms.hhs.gov/MLNProducts/downloads/physicianguide.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MLN_Suite_of_Products_and_Resources_for_Instructors.pdf

Medicare EducationMedicare Education NEW:NEW: How to Use the National Correct Coding How to Use the National Correct Coding

Initiative (NCCI) Tools Initiative (NCCI) Tools at at https://www.cms.gov/MLNProducts/downloads/How-To-Use-NCCI-https://www.cms.gov/MLNProducts/downloads/How-To-Use-NCCI-

Tools.pdfTools.pdf

---explains------explains--- National Correct Coding InitiativeNational Correct Coding Initiative NCCI Program to reduce incorrect coding based on NCCI Program to reduce incorrect coding based on

– Mutually exclusive codes (92083 & 92081) Mutually exclusive codes (92083 & 92081) – Anatomic considerations (cataract extraction & enucleation)Anatomic considerations (cataract extraction & enucleation)..

Medically Unlikely Edits (MUEs)Medically Unlikely Edits (MUEs)– Program to reduce errors due to clerical entries and incorrect Program to reduce errors due to clerical entries and incorrect

coding based on frequency of procedures oncoding based on frequency of procedures on same daysame day..

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NE NE MedicareMedicare BB References References

Our Medicare B Administrative Carrier is Our Medicare B Administrative Carrier is Wisconsin Physician Services [WPS]Wisconsin Physician Services [WPS]

http://www.wpsmedicare.com/j5macpartb/index.shtmlhttp://www.wpsmedicare.com/j5macpartb/index.shtml

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NE NE Medicare BMedicare B ReferencesReferences

MedicareMedicare BB– Local Coverage Determinations Local Coverage Determinations (LCDs)(LCDs)

– http://www.wpsmedicare.com/j5macpartb/policy/active/local/http://www.wpsmedicare.com/j5macpartb/policy/active/local/

• Standardizes what Medicare considers Standardizes what Medicare considers “Reasonable and Necessary”“Reasonable and Necessary”

• Lists very specific coding requirements for those Lists very specific coding requirements for those services & procedures that have a history or services & procedures that have a history or potential of abusepotential of abuse

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NE NE Medicare BMedicare B ReferencesReferences

WPS Medicare WPS Medicare CommuniquéCommuniqué Quarterly Newsletter Quarterly Newsletter

• Changes in CMS policyChanges in CMS policy• Updates in coding requirementsUpdates in coding requirements• Updates on documentation neededUpdates on documentation needed• FAQsFAQs• Changes in contact informationChanges in contact information• Changing in billing requirementsChanging in billing requirements

All Provider are legally responsible for All Provider are legally responsible for reading and abiding by this document.reading and abiding by this document.

https://corp-ws.wpsic.com/apps/commercial/unauth/medicareListservUserWelcomeLoadAction.do

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NE NE MedicareMedicare DMEDME ReferencesReferences

Medicare Durable Medical Equipment Medicare Durable Medical Equipment is for is for Cataract post-op glasses and CLs

Our DME Carrier is Our DME Carrier is Noridian Noridian

Administrative Services, LLCAdministrative Services, LLC

https://www.noridianmedicare.com/dme/index.htmlhttps://www.noridianmedicare.com/dme/index.html

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NE NE Medicare DMEMedicare DME ReferencesReferences

DME DME Supplier ManualSupplier Manual• What Documentation is requiredWhat Documentation is required

– Written orderWritten order– Proof of DeliveryProof of Delivery– ABNABN– Supplier StandardsSupplier Standards

• Claims SubmissionClaims Submission• V-codesV-codes• Pricing Pricing

https://www.noridianmedicare.com/dme/news/manual/index.html%3f

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NE NE Medicare DMEMedicare DME ReferencesReferences

DME Quarterly Newsletter DME Quarterly Newsletter HappeningsHappenings - - All All Provider are legally responsible for reading and Provider are legally responsible for reading and abiding by this document.abiding by this document.

DME Carrier newsletter DME Carrier newsletter • Changes in CMS policyChanges in CMS policy• Updates in coding requirementsUpdates in coding requirements• Updates on documentation neededUpdates on documentation needed• FAQsFAQs• Changes in contact information Changes in contact information • Changes in Billing RequirementsChanges in Billing Requirements

Listserv URLListserv URL https://https://naslists.noridian.com/list/subscribe.html?mContainernaslists.noridian.com/list/subscribe.html?mContainer=2&mOwner=G30392x2n39372t36=2&mOwner=G30392x2n39372t36

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https://www.noridianmedicare.com/dme/coverage/lcd.html

NE NE Medicare DMEMedicare DME References References

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Noridian LCD on Refractive Lenses

LCD Source: https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_lcds/refractive_lenses.htm

NE NE Medicare DMEMedicare DME References References

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Noridian Policy on Refractive Lenses

Policy Article Source: https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_articles/refractive_lenses.htm

NE NE Medicare DMEMedicare DME References References

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NE NE MediMedicaidcaid ReferencesReferences

Medicaid Provider ManualMedicaid Provider Manual Includes Visual Care Services Includes Visual Care Services

• Covered and Non-Covered ServicesCovered and Non-Covered Services• ExaminationExamination• LensesLenses• FramesFrames• Contact LensesContact Lenses• Billing Requirements Billing Requirements

2222

NE NE MedicaidMedicaid ReferencesReferences

Medicaid Provider Manual – Vision CareMedicaid Provider Manual – Vision Care http://dhhs.ne.gov/medicaid/Pages/med_phvis.aspxhttp://dhhs.ne.gov/medicaid/Pages/med_phvis.aspx

Visual Care ServicesVisual Care Services http://www.sos.state.ne.us/rules-and-regs/regsearch/Rules/Health_and_Human_Servhttp://www.sos.state.ne.us/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-24.pdfices_System/Title-471/Chapter-24.pdf

Payment Rules Payment Rules http://www.sos.ne.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Serviceshttp://www.sos.ne.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-03.pdf_System/Title-471/Chapter-03.pdf

Fee Schedule Fee Schedule http://dhhs.ne.gov/medicaid/Documents/471-000-524.pdfhttp://dhhs.ne.gov/medicaid/Documents/471-000-524.pdf

Billing Instructions Billing Instructions http://dhhs.ne.gov/medicaid/Documents/471-000-http://dhhs.ne.gov/medicaid/Documents/471-000-65.pdf65.pdf

Bulletins Bulletins (bottom of page)(bottom of page) http://dhhs.ne.gov/medicaid/Pages/med_phvis.aspxhttp://dhhs.ne.gov/medicaid/Pages/med_phvis.aspx

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NOA ReferencesNOA References

NOA 3NOA 3rdrd Party Newsletters Party Newsletters • Changes in Carrier PolicyChanges in Carrier Policy• LMRP Updates & RemindersLMRP Updates & Reminders• Unique Coding in NebraskaUnique Coding in Nebraska• Changes on the HorizonChanges on the Horizon• HIPAA UpdatesHIPAA Updates• Q & A PageQ & A Page

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Monthly Newsletter Mass Email:

NOA Reference

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NOA ReferencesNOA References NOA 3NOA 3rdrd Party Web Page Party Web Page

http://http://nebraska.aoa.org/prebuilt/NOA/index.htmnebraska.aoa.org/prebuilt/NOA/index.htm

Index page with over 1000 linksIndex page with over 1000 links Past Newsletter Articles by titlePast Newsletter Articles by title CMS, Medicare, Medicaid, BCBS, AOA, & other web sitesCMS, Medicare, Medicaid, BCBS, AOA, & other web sites

Archived newsletters by date publishedArchived newsletters by date published HIPAA page, including HIPAA manualHIPAA page, including HIPAA manual New Licensee pageNew Licensee page Previous 3Previous 3rdrd Party Presentations Party Presentations

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NOA ReferencesNOA References

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NOA 3NOA 3rdrd Party Consultation Party Consultation

• Contact MethodsContact Methods– EmailEmail [email protected]@msn.com

– Fax Fax 402 464-1214 (contact Ed first)402 464-1214 (contact Ed first)• Cover page: Cover page: Contains PHI-for Dr. Schneider’s Contains PHI-for Dr. Schneider’s

eyes onlyeyes only

• 24 hour turn-around time24 hour turn-around time