1 US-GUIDANCE FOR NEEDLE PLACEMENT IS DRASTICALLY CUT IN PHYSICIAN FEE SCHEDULE FINAL RULE CMS released the final rule for the 2014 Physician Fee Schedule on November 27. The rule implements an approximate 24% payment cut for services paid under the fee schedule due to the SGR formula, unless Congress takes action before December 31. The rule also implements a payment cut of approximately 65% for ultrasound guidance for needle placement (CPT code 76942). This is due to a change in equipment inputs used to calculate payment and a reduction in the procedure time assumptions, including a reduction in clinical labor and equipment time, used to calculate payment. This level of payment for CPT code 76942 assumes congressional intervention to block the 24% SGR cut; payment cuts will be much steeper if the full SGR cut goes into effect. AACE argued against these changes when they were published in the proposed rule. On a positive note, CMS reversed a provision contained in the proposed rule to reduce the practice expense paid for certain services performed in a physician’s office to the level of practice expense paid in the Ambulatory Surgical Center (ASC) or hospital out-patient department. As a result, payments for continuous glucose monitoring (CPT code 95250) and fine needle aspiration without ultrasound guidance (CPT code 10021) remain unchanged in 2014.To access the rule, please click here. Effective January 6, 2014, CMS will turn on the edits to deny Part B clinical laboratory and imaging, DME, and Part A HHA claims that fail the ordering/referring provider edits. On December 1, 2013 Novitas Solutions, the Medicare Administrative Contractor for PA, NJ, DE, MD, TX, CO, NM, OK, AR, LA, MS began using New Reimbursement Guidelines for Radiopharmaceutical Procedure Codes. Reimbursement for radiopharmaceuticals will be based on the acquisition cost reported on the claim. If the total acquisition cost is not listed on the claim the service will be denied. Please make sure your billing staff is aware of these changes. November/December 2013 “Experts in health information technology caution that EHR (electronic health records) technology can make it easier to commit fraud. “ Not all recommended fraud safeguards have been implemented in the hospital EHR technology. Click here for the complete report from the Office of Inspector General. ⃰We encourage AACE members to check with your EHR vendors to determine if they offer any technical safeguards through your system that can assist you and your staff in maintaining compliance with documentation and coding in your electronic medical records.
Endonomics an AACE Practice Management Newsletter November December 2013
Apr 03, 2016
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1
J a n u a r y 2 0 1 2
US-GUIDANCE FOR NEEDLE PLACEMENT IS DRASTICALLY CUT IN PHYSICIAN FEE SCHEDULE FINAL RULE CMS released
the final rule for the 2014 Physician Fee Schedule on November 27. The rule implements an approximate 24% payment cut for services paid under the fee schedule due to the SGR formula, unless Congress takes action before December 31. The rule also implements a payment cut of approximately 65% for ultrasound guidance for needle placement (CPT code 76942). This is due to a change in equipment inputs used to calculate payment and a reduction in the procedure time assumptions, including a reduction in clinical labor and equipment time, used to calculate payment. This level of payment for CPT code 76942 assumes congressional intervention to block the 24% SGR cut; payment cuts will be much steeper if the full SGR cut goes into effect. AACE argued against these changes when they were published in the proposed rule. On a positive note, CMS reversed a provision contained in the proposed rule to reduce the practice expense paid for certain services performed in a physician’s office to the level of practice expense paid in the Ambulatory Surgical Center (ASC) or hospital out-patient department. As a result, payments for continuous glucose monitoring (CPT code 95250) and fine needle aspiration without ultrasound guidance (CPT code 10021) remain unchanged in 2014.To access the rule, please click here.
Effective January 6, 2014, CMS will turn on the edits to deny Part B
clinical laboratory and imaging, DME, and Part A HHA claims that fail the ordering/referring provider edits.
On December 1, 2013 Novitas Solutions, the Medicare Administrative Contractor for PA, NJ, DE, MD, TX, CO, NM, OK, AR, LA, MS began using
New Reimbursement Guidelines for Radiopharmaceutical Procedure Codes. Reimbursement for radiopharmaceuticals will be based
on the acquisition cost reported on the claim. If the total acquisition cost is not listed on the claim the service will be denied. Please make sure your billing staff is aware of these changes.
N o v e m b e r / D e c e m b e r 2 0 1 3
“Experts in health information technology
caution that EHR (electronic health records) technology
can make it easier to commit fraud. “ Not all recommended fraud
safeguards have been implemented in the hospital EHR technology. Click
here for the complete report from the Office of Inspector General.
We encourage AACE members to check with your EHR
vendors to determine if they offer any technical safeguards through your system that can
assist you and your staff in maintaining compliance with documentation and coding in
your electronic medical records.
2
CMS proposed a new timeline for the implementation of meaningful use for EHR Incentive Programs. Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. Click here for more information.
The 2014 Annual Participation Enrollment Program allows eligible physicians, practitioners, and suppliers an opportunity to change their participation status by December 31, 2013. Due to the later than usual release of the Medicare
Physician Fee Schedule Final Rule, CMS is extending the 2014 annual participation enrollment period through January 31, 2014. Therefore, participation elections and withdrawals must be post-
marked on or before January 31, 2014. The effective date for any participation status changes elected by providers during the extension remains January 1, 2014.
CMS makes the issue of duplicate claim submissions by Medicare providers a major concern. Medicare contractors are
instructed to screen for patterns of duplicate billing in the provider community. Providers who, over a period of time, continue to have high instances of claims rejected for duplicate billing may be referred to the Medicare ZPICs for investigation of possible fraud and abuse. MM8121: Clarification of Detection of Duplicate Claims Section of the CMS Internet Only Manual
New Influenza Virus Vaccine Code is effective
for claims with dates of service on or after January
1, 2014.
Click here for complete details.
The MLN Connects™ Provider e-News is a weekly, electronic publication for health care providers with news and information about:
CMS program and policy details Updates and announcements Press releases National Provider Call and other event reminders Code, claim, and pricer information MLN educational material announcements Other news and information of interest to health care providers and
their staff MLN Connects is a part of the Medicare Learning Network® (MLN)*.
Subscribe Now
Follow MLN Connects Provider eNews content on Twitter (@CMSgov) by searching #CMSMLN.
The Medicare Learning Network® (MLN), a registered trademark of the Centers
for Medicare & Medicaid Services (CMS), is the brand name for official
information health care professionals can trust.
CDC Announces National Diabetes Month Webpage
To view, click here.
WPS, a Medicare Administrative
Contractor, released clarification for
“standing orders” here.
They define routine and recurring orders, treatment protocols,
laboratory orders, and standing orders for
consultations. Please check your Medicare
Administrative Contractor’s website to see if they provide additional or different
clarifications for providers in your
area.
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All Medicare MACs (Medicare Administrative Contractors- click here to find your MAC) and the DME MACs contractors to implement an ICD-10 testing week with trading partners. The event will be conducted virtually and will be posted on each MAC's and the CEDI website as well as the CMS website. Click here for more information.
New 1500 Claim Form Accommodates ICD-10 Reporting Needs and Deletes Some Fields Click here to “Understand the Changes to the Form”. The timeline below aligns with Medicare’s transition timeline.
January 6, 2014: Payers begin receiving and processing paper claims submitted on the revised 1500 Claim Form (version 02/12).
January 6 through March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05).
April 1, 2014: Payers receive and process paper claims submitted only on the revised 1500 Claim Form (version 02/12).
National Government Services, the Medicare Administrative Contractor for Illinois, recently released a statement on non-physician practitioners performing the technical component of radiology procedures. The current policy for Illinois Part B does not allow non-physician practitioners to bill for radiological technical components (TC) or global procedures but they can perform the interpretations. Clarification was provided on the supervision of diagnostic testing in this article.
UHC Medicare Solutions Diabetic Strips and Lancets “During a recent review of Physician Diabetic supplies, we identified payment issues relating to some claims in which providers are billing without the appropriate modifiers. Per CMS regulations, providers are required to submit claims with the appropriate modifiers when the “indications and limitations of coverage and/or medical necessity” have been met. See page 48 in this document for additional information.
The Office of Inspector General’s Strategic Plan, 2014-2018, outlines the vision, goals and priorities guiding the office in the coming years. The OIG will release their work plan in January 2014. Review the OIG’s work plan from 2013 here, which includes review of E/M services, place of service coding errors, error rate for incident-to services performed by nonphysicians, and various reviews of diabetes testing supplies.
United Healthcare November 2013 Network Bulletin
“Effective Compliance” Encompasses Far More than Merely Coding and Billing Obligations. Discrimination Can Result in Serious Enforcement by the Office of Civil Rights (OCR). Written by Robert Liles July 2013
“Two Sides of the Audit Coin:
Part 1- Prevention Written by PMI Staff September 2013
Part 2- The Audit
Written by PMI Staff November 2013
The errata and technical corrections
updates for CPT® 2013 and CPT® 2014 are posted on the AMA
website.
(MM8477) Quarterly Update to the Correct Coding Initiative Edits, Version 20.0, Effective
January 1, 2014
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Education American Association of Clinical Endocrinologists sponsors
live conferences, symposia, online education, and other opportunities.
Noted below is the current list of educational activities available.
These activities are intended for: MD's, DO's, NP's, RN's, PA's, CDE's, pharmacists and other interested health care providers.
JANUARY
01/18
Diabetes Day for Primary Care Providers
Riverside, CA
01/25
Diabetes Day for Primary Care Providers
Atlanta, GA
FEBRUARY
02/08
Diabetes Day for Primary Care Providers
Orlando, FL
02/15
Diabetes Day for Primary Care Providers
Albuquerque, NM
02/22
Diabetes Day for Primary Care Providers
Corpus Christi, TX
MARCH
03/08
Diabetes Day for Primary Care Providers
Tucson, AZ
03/22
Diabetes Day for Primary Care Providers
Greensboro, NC
03/22
Diabetes Day for Primary Care Providers
Arlington, VA
03/23 – 03/24
AACE/ACE Consensus Conference on Obesity: Building an Evidence Base for Comprehensive Action
Washington, DC
03/29
Diabetes Day for Primary Care Providers
Boston, MA
APRIL
04/05
Diabetes Day for Primary Care Providers
Lansing, MI
04/26
Diabetes Day for Primary Care Providers
Lombard, IL
MAY
05/14 – 05/18
AACE 23rd
Annual Scientific and Clinical Congress
Las Vegas, NV
ONLINE LEARNING
Scenes and Seminars on Hypoglycemia Management in Diabetes
Injectables for Type 2 Diabetes: The Future of Treatment
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NY, NY ● Indianapolis, IN ● Seattle, WA ● Charlotte, NC
Dates TBA in January!
Physicians and office staff who attend AACE’s “Preparing for ICD10-CM: The Endocrinology Way”
gain confidence using ICD10-CM guidelines specific to endocrine, nutritional and metabolic diseases
through hands-on experience using “real life” examples. Further application of these concepts are
visualized with the “Evaluation and Management Documentation for Endocrinology” course which
discusses key components (history, exam, medical decision making) in detail and participants learn
the importance of clear, concise and consistent documentation within the medical record required for
audits from commercial and federal carriers.
Agenda Items:
If It’s Not Documented, It Didn’t Happen- Doesn’t Count- and You Won’t Be Reimbursed!
The Main Characters of Your Story are Now Alpha AND Numeric
Wow! This Book Is Big!
I Didn’t Know There was a Code for That!
Here’s Your Sign (Symptom or Definitive Diagnosis)!
Agenda Items:
Medical Necessity in the Medical Record and Why It’s Important
Classifications and Levels of Evaluation and Management
History and Exam: Two of the THREE Key Components in Evaluation and Management Services
Medical Decision Making and Proper Calculations of Evaluation and Management Services
Audit Sample Notes and Q&A
AACE member/staff of member $400 per person- per course
Non Member $475 per person- per course
Attend both courses for $650 per person
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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
Q. Where can I find the “Incident To” guidelines based on Medicare’s guidelines?
A. Medicare's “incident to” requirements are primarily contained
in the Code of Federal Regulations (CFR) 410.26 and in CMS Medicare Benefit Policy Manual, Chapter 15, Section 60.
Q. Does the physician have to own the CGM device to be able
to bill for the interpretation of the downloaded data, which is reported with CPT® code 95251?
A. A physician who provides an interpretation of the CGM data
may bill CPT® code 95251. It does not matter if the CGM device is owned by the patient or owned by the physician.
Q . Who can provide the service for 95250?
A. The glucose sensor start and technical training may be
provided by a physician or his/her staff.
Q. Who can provide the professional interpretation of a CGM?
A. A privileged provider or non-physician practitioner may
provide the professional interpretation of CGM. (examples
include: MD, DO, NP, PA, CNP, and CNS)
Please submit comments or questions to [email protected].
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