Please see the CMS e-mail from yesterday and click on the link provided for the article.


    From: CMS MLNMatters-L [mailto:MedlearnMatters-L@CMS.HHS.GOV]
    To: MLNMATTERS-L@LIST.NIH.GOV
    Sent: Wed, 02 Aug 2017 06:36:15 -0500
    Subject: New Article Posted to MLN Matters     

    MM10176 – Updated Editing of Always Therapy Services - MCS

    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10176.pdf

     
Debra Farley
Billing Director
BILLPro Management Systems
8-2-17
     

Please click on the link below to access the NEW article published by CMS on 5-16-2017 titled "MM10057 – MCS Implementation of the Restructured Clinical Lab Fee Schedule."

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10057.pdf

It states, in part, "the payment amount for a test on the CLFS (clinical laboratory fee schedule) furnished on or after January 1, 2018, will be equal to the weighted median of private payer rates determined for the test, based on data collected from laboratories during a specified data collection period."

The changes are effective 1-1-2018.

Debra Farley
Billing Director
BILLPro Management Systems
5-19-17

We are in receipt of a May 1 , 2017 letter from SummaCare with the subject "CODING TO SPECIFICITY."  It states

Since the implementation of ICD-10, SummaCare has not denied claims based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the correct family.

Effective June 1, 2017, SummaCare will begin rejecting claims that are not coded to the highest level of specificity.  The ICD-10 code set allows clinicians to more precisely describe diseases and conditions than they could before.

CMS instituted the 1-year grace period to help physicians get to speed on correct diagnostic coding.  SummaCare followed this rule and also allowed the grace period.  However, SummaCare will begin rejecting claims on June 1, 2017 if a specific ICD-10 diagnosis code is not submitted.

Please Note:  This rejection is not based on date of service, but is based on the date the claim is submitted.

To avoid payment delays, please make sure your billing and coding departments are aware of this requirement.

If you have questions about this communication, please contact SummaCare Provider Support Services at contactproviderservices@summacare.com or call 330-996-8400 or 800-996-8401.

Sincerely,

Provider Support Services


BILLPro has seen other payers are slowly following suit!

Debra Farley
Billing Director
BILLPro Management Systems
5-5-17

Yesterday, 4-25-17 a CMS/Medicare national provider call took place on "Global Surgery:  Required Data Reporting for Post-Operative Care."
 
The description of this call was "The CY 2017 Medicare Physician Fee Schedule (PFS) final rule adopted a data reporting requirement for practitioners furnishing specified global procedures in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island. CMS will use reported data, along with other data to establish payment rates under the PFS. During this call, learn about the new requirements that go into effect July 1, 2017, and resources you can use for reporting.

The target audience was for "Physicians, physician assistants, nurse practitioners and other clinicians who furnish global services; coders; billers; and practice managers in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island. Practitioners who only work in practices with fewer than 10 practitioners and those furnishing services in other states are not required to report but may report voluntarily."

The detailed presentation is available at https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2017-04-25-Global-Surgery-Presentation.pdf
 
    On Page 13 are links to obtain more information on this reporting including the following link of the current listing of
    procedure codes that require post-operative visit reporting:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Codes-for-Required-Global-Surgery-Reporting-CY-2017.zip

    The codes are in the 10040-69436 range.

    The "Frequently Asked Questions" start on page 14.  Amongst other items "reporting is only required for traditional
    fee-for-service Medicare patients."  This would include Railroad Medicare.

IMPORTANT:  If you will be participating in this reporting commencing with a 7-1-17 date of service or sooner*, please inform your account manager at BILLPro of this as CPT 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason{s} related to the original procedure) must be submitted with a $0.01 charge.  We are working with our software developer to permit 99024 to be submitted/released on claims for those who will be reporting as, currently, this code is entered for internal reporting only.

    *Please see page 12 of the presentation, "When do the reporting requirements take effect?"  One can begin reporting
       anytime after  1-1-2017 but we suggest commencing with a 7-1-17 date of service because  on page 22 of
       the presentation CMS states "we are currently working with contractors to ensure appropriate processing;
       we are working with contractors to ensure providers can put a 1 cent charge on the claim if the provider's
       software requires it."   This usually means the Medicare contractors' systems are not yet ready to
       accommodate this reporting.

Debra Farley
Billing Director
BILLPro Management Systems
4-26-17

CMS just released a revised Provider Compliance Products Fact Sheet to learn how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program.  It contains provider-specific compliance tips.  It is available at

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/ICN909307.html?DLPage=1&DLEntries=10&DLFilter=provider%20compliance%20products&DLSort=0&DLSortDir=ascending

Debra Farley
Billing Director
BILLPro Management Systems
4-21-17

ATTENTION ALL PROVIDERS:

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. While there are no changes to the form itself, providers should take note of the newly incorporated expiration date. The effective date for use of this ABN form is 6/21/2017.  More information on the ABN and the ABN form instructions can be found at:

https://www.cms.gov/MEDICARE/medicare-general-information/bni/abn.html

The ABN is able to be downloaded from the above link. Please make sure your staff is aware of this information.

Beneficiary Notice Initiative: New Email Address for Questions

Send questions about Fee-For-Service beneficiary notices to BNImailbox@cms.hhs.gov. Continue to send questions regarding the Medicare Outpatient Observation Notice to MOONMailbox@cms.hhs.gov.

Debra Farley
Billing Director
BILLPro Management Systems
4-21-17

I was able to locate the written Caresource/Caresource MyCare policies for what services require prior auth in nursing facilities.

    For Caresource Medicaid (not Mycare), go to       

    https://www.caresource.com/providers/ohio/ohio-providers/authorization-claims-appeals/prior-authorization/
           
        Under "Services that Require Prior Authorization, "click on the "Prior Authorization List" that is underlined.You will see that
        nursing facility services require prior auth (this means POS 31 AND 32)

    For Caresource Mycare, go to

    https://www.caresource.com/members/ohio/caresource-mycare-ohio/my-benefits-services/

        Scroll down and under "Prior Authorization" you will see "skilled nursing facility services" (POS) 31 which means nursing facility
        services with POS 32 does NOT need prior auth, only POS 31.

        See the following link for "MyCare Long Term Care (LTC) Nursing Facility FAQS
       
            https://www.caresource.com/documents/mycare-long-term-care-ltc-nursing-facility-faqs/   

    Saying all of the above, whether Caresource Medicaid or primary Caresource Mycare, if the nursing facility obtains an auth, your provider's services will be covered under that auth.   If not, the client must request their own prior auth.



    Debra Farley
    Billing Director
    BILLPro Management Systems

ATTN: MDs, DOs, NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS WHO BILL MEDICARE. 

Please scroll down to the CMS article announcing "Connected Care: New Educational Initiative to Raise Awareness of Chronic Care Management" which is self-explanatory.  New, wonderful resources have been developed and are available at

https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/chronic-care-management.html

Debra Farley
Billing Director
BILLPro Management Systems

    From: Centers for Medicare & Medicaid Services [mailto:cmslists@subscriptions.cms.hhs.gov]
    To: debra@billpro.net
    Sent: Wed, 15 Mar 2017 12:34:45 -0500
    Subject: Connected Care: New Educational Initiative to Raise Awareness of Chronic Care Management

    Connected Care: New Educational Initiative to Raise Awareness of Chronic Care Management
    FOR IMMEDIATE RELEASE
    March 15, 2017

    Contact: CMS Media Relations
    (202) 690-6145 | CMS Media Inquiries

    Today, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) and the Federal Office of Rural Health Policy at the Health Resources and Service Administration (HRSA) introduced Connected Care, an educational initiative to raise awareness of the benefits of chronic care management (CCM) services for Medicare beneficiaries with multiple chronic conditions and to provide health care professionals with support to implement CCM programs. Connected Care is a nationwide effort within fee-for-service Medicare that includes a focus on racial and ethnic minorities as well as rural populations, who tend to have higher rates of chronic disease.

    Two-thirds of Medicare beneficiaries have two or more chronic conditions, and one-third have four or more chronic conditions. Many health care professionals are providing these patients with chronic care management, non-face-to-face services such as reviewing test results or coordinating with other providers, but are not aware of the separate payments under the Medicare Physician Fee Schedule and are not receiving the full separate payments that are now available for CCM services under Medicare Part B.

    “This important initiative builds on our efforts to help providers care for patients with multiple chronic conditions. We are excited to be working with the Health Resources and Services Administration to reach vulnerable populations,” said Cara James, PhD, Director of the Centers for Medicare & Medicaid Services Office of Minority Health.

    As part of the Connected Care education initiative, CMS and HRSA or FORHP developed new resources to help educate patients and provide information for health care professionals. Some of the resources include:

    •   A toolkit for health care professionals with detailed information about CCM, and resources to help providers implement CCM;

    •   A partner toolkit that includes downloadable resources and suggested activities to get involved in the Connected Care initiative; and

    •   Patient education resources, including a poster and postcard that can be used in a clinical or community setting.

    All resources are available online at go.cms.gov/ccm and can be ordered at no cost.

    “We are thrilled to be joining CMS to educate health care professionals and patients about the value of chronic care management with the goal of improving overall patient care for millions of Americans and reducing overall health care costs,” said Tom Morris, Associate Administrator, Federal Office of Rural Health Policy at the Health Resources and Services Administration.   

    By offering CCM services, health care professionals can deliver the coordinated care their patients need and deserve and help patients stay on track by getting support between visits.     

    For more information on how to get involved with the CCM initiative and learn more about chronic care management, visit

        https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/chronic-care-management.html                     

   
     
 

Respective to Chronic Care Management Services, the presentation for the national provider call on 2-21-17 on "Understanding and Promoting the Value of Chronic Care Management Services," is available at

   https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2017-02-21-CCM-Presentation.pdf

Debra Farley
Billing Director
BILLPro Management Systems
3-3-17

On 12-28-16 CMS released the following NEW article

New:

MM9903 – 2017 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List


http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9903.pdf

 
Please do review it and keep for reference, if applicable to your practice.


Debra Farley
Billing Director
BILLPro Management Systems
12-30-16

CMS released on 12-19-16 the following  NEW article:

MM9844 – Summary of Policies in the Calendar Year (CY) 2017 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, and CT Modifier Reduction List

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9844.pdf

 
To obtain official instruction, please click on the first link under "Additional Information" in the article.

Debra Farley
Billing Director
BILLPro Management Systems
12-21-16

Please scroll down to the CMS email below with the subject "Update to Editing of Therapy Services to Reflect Coding Changes" effective 1-1-2017.

Debra Farley
Billing Director
BILLPro Management Systems
12-13-16


        From: CMS MLNMattersTeam [mailto:MLNMattersTeam@CMS.HHS.GOV]

            To: MLNMATTERS-L@LIST.NIH.GOV
            Sent: Thu, 08 Dec 2016 06:39:54 -0500
     
             
            New:

            MM9698 – Update to Editing of Therapy Services to Reflect Coding Changes

            http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9698.pdf

             

Attached is a document prepared by BILLPro titled "2017 CPT (Current Procedural Terminology) Category I Coding Updates - WHAT YOU MUST DO TO PREPARE."  All updates are effective with 1-1-2017 date of service. 

It must necessarily be the responsibility of each client to review the changes.  As all are aware, the provider of service holds the ultimate responsibility for the correct coding of his/her services.  Nothing takes the place of reviewing each code currently billed against the 2017 CPT code book.  One must code based on the services provided.

If a 2017 CPT book has not been procured by your office, we urge that it be obtained as soon as possible as it is an invaluable source of information.  One is unable to fully understand the codes unless the preface to a section is read.  The "Introduction" section of the CPT is so insightful.  Two sites to obtain the CPT book are from the American Medical Association (AMA)  at https://commerce.ama-assn.org/store/ or PMIC (a leading independent distributor of coding books at http://www.medicalcodingbooks.com/category/publishers-pmic.

Please do share this e-mail and attachment with your office staff.

Debra Farley
Billing Director
BILLPro Management Systems
12-13-16
 

CMS revised on 11-16-16 the article "Provider Enrollment Requirements for Writing Prescriptions for Medicare Part D Drugs."

The revision shows a phased approach to enforcement that will begin in the second calendar quarter of 2017 and end with full implementation and enforcement of the Part D prescriber enforcement requirement on January 1, 2019.

The article is available at

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1434.pdf

Debra Farley
Billing Director
BILLPro Management Systems
11-25-16

CGS Medicare just announced that the 2017 Medicare Physician Fee Schedule is now available in PDF. CSV, and searchable formats.  It is located at

http://cgsmedicare.com/partb/fees/index.html

    To search a specific code, select Option 1 and to view the entire physician fee schedule select Option 3.

Debra Farley
Billing Director
BILLPro Management Systems
11-14-16