Endonomics a practice management newsletter march april may 2014

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State laws governing NPPs' scope of practice can vary significantly. As an example, APNs [advanced practice nurses] in 17 states can diagnose and treat patients without physician supervision, whereas physician assistants work under the supervision of physicians in all settings."

Nonphysician Practitioner Scope of Practice for Radiology Services within Illinois, Minnesota, and Wisconsin This article clarifies which nonphysician practitioners can provide supervision, who can bill the technical, professional, and global components, etc.

HHS OIG’s (Office of Inspector General) Work Plan

OIG’s Outlook for 2014

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Certification is now a requirement for

endocrinologists participating with Horizon who perform thyroid ultrasound and ultrasonic guidance for biopsy. Application deadline has been extended to June 13, 2014. Click here to review the letter sent to the Medical Society of New Jersey.

CMS announced that for the first time, quality measures have been added to Physician Compare, a website that helps

consumers search for information about hundreds of

thousands of physicians and other health care professionals. The site helps consumers make

informed choices about their care.

N e w R e s o u r c e f o r A A C E M e m b e r s !

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CMS revised the

“Intensive Behavioral Therapy (IBT) for Obesity”

Booklet. This booklet includes information about obesity rates, approaches on treating obesity, and other resources on obesity.

HHS Office of the National Coordinator for Health Information Technology (ONC) issued proposals for the next edition (the “2015 Edition”) of electronic health record (EHR) technology certification criteria.

Not all recommended fraud safeguards are implemented in hospital EHR technologies – a report by Daniel R. Levinson Inspector

General

UnitedHealthcare March 2014 Network Bulletin -

includes timely news about procedure, program and policy updates and changes, as well as

other important administrative and clinical information.

Bone Density Coverage

CGM & Insulin Delivery (effective June 1, 2014)

Pharmacy Benefit Update see page 72-73 here (effective July 1, 2014)

Changes to Zometa and Reclast Billing (see page 80 here)

This card is an example of an illegal solicitation of Medicare patients, promising quick money for diabetes test strips.

Fraud associated with the illegal billing of diabetes supplies became so prevalent that OIG issued Special Fraud Alerts—aimed at suppliers and telemarketers as well as consumers—and a podcast to target the fraud from all angles.

Medicare Quarterly Provider Compliance

Newsletter

Guidance to Address Billing Errors

Provider compliance

Products

The HHS Office of the National Coordinator for Health Information Technology

(ONCHIT) and Office for Civil Rights (OCR) recently released a security risk assessment (SRA) tool for small- to medium-size practices.

Videos found here indicate what a risk assessment may involve.

Medical Nutrition therapy is

a Medicare benefit when provided by a nurse practitioner or registered dietician in an outpatient hospital setting, for a beneficiary with diabetes… All other nutritional services are not covered under Medicare. Effective May 30, 2014. Sources: National Coverage Determination (NCD) for Medical Nutrition Therapy (180.1); Change Request (CR) 2373; Social Security Act (SSA) 1861(s)(2)(V)

Noridian Revised Policy on Medical Nutrition Therapy

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Industry Updates and Quotes Regarding ICD-10 Transition Readiness…

CGS, a Medicare Contractor translated all ICD-9 codes into ICD-10 for their LCDs (local coverage determinations)

*“Medicaid is ready” said Godwin Odia, PhD, NHA, RHIA, CMS’ Implementation Lead for Medicaid

*“CMS was absolutely ready for October 2014…our systems have been ready for over a year and the eHealth Steering Committee was ready to flip a switch” Denise Buenning, MsM, Acting Deputy Director, Office of e-Health Standards and Services at CMS

July ICD-10 End-to-End Testing Canceled: Additional Testing Planned for 2015 CMS planned to conduct ICD-10 testing during the week of July 21-25, 2014,

to give a sample group of providers the opportunity to participate in end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The July testing has been canceled due to the ICD-10 implementation delay. Additional opportunities for end-to-end testing will be available in 2015.

The U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015.

CMS eHealth University is a resource to help providers understand, implement,

and successfully participate in ICD-10 and other CMS eHealth programs. The

education modules are organized by level, from beginner to advanced and complex information in a variety of formats, including fact sheets, guides, videos, checklists,

webinar recordings, and more. Visit the eHealth University website to find these

resources.

CMS’ Road to 10: The Small Physician Practice’s Route to ICD-10

Adult Immunization: Are You

Meeting the Standards for Patient Care? A Message

from the CDC

The National Vaccine Advisory Committee (NVAC) recently revised and updated

the Standards for Adult Immunization Practice to

reflect the important role that all healthcare professionals play in ensuring that adults

are getting the vaccines they need.

New MLN Provider Compliance Fast Fact

The MLN Provider Compliance web page provides the latest MLN Educational Products and MLN Matters® articles designed to help Medicare FFS providers understand common billing errors and avoid improper payments. Please bookmark this page and check back often as a new fast fact is added each month.

*Quotes from AHIMA’s ICD-10-CM/PCS CAC Coding Summit, April 22-23 in Washington DC http://journal.ahima.org/category/icd-10-cac-summit/

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Since the announcement of the delay of ICD10 until at least October 1, 2015, many of you might be asking yourself, “Is it

still important to educate myself NOW, or should I just wait until NEXT YEAR?” or “How do we know that it won’t get

delayed AGAIN?!”

“Is it still important to educate myself NOW, or should I just wait until NEXT YEAR?”

“You cannot escape the responsibility of tomorrow by evading it today.” ― Abraham Lincoln

The answer is, NOW! Why stress out trying to prepare for ICD10 at the last minute when you can start today? Physicians

who take the time to learn to document appropriately now will be ahead of the game when any new code set comes up

in the future, they will have more understanding of what the auditors are looking at and will be able to support medical

necessity easier. Physicians and coders who start preparing for ICD10 now will have time to work out kinks in their

systems (from a technical standpoint and a work flow standpoint). Basically, once documentation is up to par, matching

the actual ICD codes will not be very difficult.

“How do we know that it won’t get delayed AGAIN?!”

The answer is, WE DON’T! We were “sure” it wouldn’t be delayed in 2014 and look what happened! What we can be

sure of is that change is coming, and the best thing we can do is be proactive and prepare for it...AHEAD OF TIME! This

delay provides an avenue for physicians to take time to gain a better understanding of what needs to be in the

documentation from a coding and clinical perspective. Physicians can “ignore” the codes and focus solely on improving

documentation- which, in the bigger picture, is really more important than learning the codes. All payers are auditing

physicians’ documentation first and looking at the codes second. The codes (whether ICD-9, ICD-10 etc.) may be specific

(which helps get “things paid”) but the documentation does not reflect the codes accurately and that’s the disconnect.

With the utilization of proper, detailed documentation, the rest will be easy!

Let us help you prepare and stay ahead of the game!

For more information on pricing and availability, please visit

https://www.aace.com/advocacy/socioeconomics/courses/icd10-emdoc

Register early- seating is limited!

T h e W e s t i n S e a t t l e

S e a t t l e , W A

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T h e W i n g a t e b y W i n d h a m

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ICD10 and E/M Documentation and Coding for Endocr inology

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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 2013 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.

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Coding TRAC

Tips on Reimbursement and Coding

Comprehensive Error Rate Testing (CERT): Evaluation and Management (E/M) Services Errors

Specific errors identified for the following E/M categories:

E/M Office Visits Established (CPT 99211 - 99215)

E/M Hospital Initial (CPT 99221- 99223)

E/M Hospital Subsequent (CPT 99231 - 99233)

Medical record documentation must be accurate and support reasonable and medically necessary services. The correct level of E/M codes must be billed on each claim submitted to avoid up coding and down coding errors. For additional information on CERT education, examples of E/M errors with compliance recommendations, review the following articles and references:

Recent Comprehensive Error Rate Testing (CERT) – November 2013 Findings

Part B Monthly CERT Findings (scroll down the page; click on a specific month; review article and click on the highlighted word “summary”; scroll to view CERT E/M errors)

Documentation Guidelines for Evaluation and Management (E/M) Services

Medicare Claims Processing Manual; Chapter 12 - Physicians/Nonphysician Practitioners, Section 30.6 - Evaluation and Management Service Codes - General (Codes 99201 - 99499)

Cahaba GBA Medical Review webpage

CERT: Complying with Medicare Signature Requirements

Please submit comments or questions to [email protected].