From: Jurisdiction B DME MAC <dmemaclistserve@anthem.com>
To: debra@billpro.net
Date: 08/07/2014 03:30 PM
Subject: Written Order Prior to Delivery – Corrections to Document

      

Written Order Prior to Delivery - Corrections to Document

Joint DME MAC Article

Written order prior to delivery (WOPD) is a long-standing statutory requirement for certain items of durable medical equipment (DME). The list of items subject to WOPD was expanded by the Affordable Care Act Section 6407. Medicare policy stipulates that a WOPD that is missing an element is not "curable" by a provider (i.e., a provider cannot make corrections to a WOPD) except as outlined below.

    I.  If errors in the WOPD are found prior to delivery, the supplier has two options:

        A. The WOPD may be properly amended following the guidance in the Medicare Program Integrity Manual (Internet-Only Manual, Publication 100-08), Chapter 3, Section 3.3.2.5; or,

        B. A new WOPD may be created and sent to the physician for signature and date.

   
   [All-About-NGS_RBoxBG]
   
   

    II.     If errors in the WOPD are found after delivery of the item, the supplier has two options:

        A. If the error is discovered prior to claim submission, the original supplier may recover the delivered item(s), obtain a compliant, complete  WOPD and then may redeliver the item(s) to the beneficiary; or,

        B. If the error is discovered after submitting a claim, the original supplier can recover their items and a new supplier must complete the transaction after complying with all requirements.

Because WOPD is a statutory requirement, claims denied because of a defective WOPD result in a beneficiary liability determination. Suppliers are strongly encouraged to review their WOPD documentation carefully prior to delivery to ensure that all the requirement elements are present on the document.

Related Content

    Centers for Medicare & Medicaid Services Internet-Only Manual Publication 100-08, Medicare Program Integrity Manual,  Chapter 3

From: Jurisdiction B DME MAC <dmemaclistserve@anthem.com>
To: debra@billpro.net
Date: 08/07/2014 03:30 PM
Subject: Proof of Delivery - Requirements for Signature and Date

      

Proof of Delivery – Requirements for Signature and Date

Joint DME MAC Article

Auto-filling the date of delivery on delivery documentation or Proof of Delivery (POD) is a common business practice for many Durable medical equipment prosthetics, orthotics, and supplies (DMEPOS) suppliers. Upon delivery, the Medicare beneficiary or designee is required to review the POD and must provide his or her signature, which signifies knowledge, approval and acceptance of the delivery. The Medicare Program Integrity Manual Chapter 4, Section 4.26.1 “Proof of Delivery and Delivery Methods” does not state who may enter the date of delivery, but indicates that the date of signature must be the date in which the item was actually delivered. According to the PIM “….the date of signature on the delivery slip must be the date that the DMEPOS item was received by the beneficiary or designee…..” If the delivery documentation is signed by the beneficiary’s designee, the PIM also recommends noting the relationship of the designee to the beneficiary on the document.

   
Based on these instructions, the POD delivery date element is not required to be personally filled in by the beneficiary/designee. The date of delivery may be entered by the beneficiary, designee or the supplier. The date entered must be the actual date of delivery.

In the event that the supplier's delivery documents have both a supplier entered date and the beneficiary or designee signature date on the POD document, the beneficiary/designee entered date is considered to be the delivery date and thus the date of service.

Related Content

    Centers for Medicare & Medicaid Services Internet-Only Manual Publication 100-08, Medicare Program Integrity Manual,  Chapter 4

Please see the CMS article below titled " Partial Code Freeze Prior to ICD-10 Implementation."

    Debra Farley
    Billing Director
    BILLPro Management Systems, Inc.
    debra@billpro.net
    440-854-0205
    OR 1-800-736-0587 ext 0205
    FAX 440-516-3783

        From: CMS MLNMatters-L [mailto:MedlearnMatters-L@CMS.HHS.GOV]
        To: MLNMATTERS-L@LIST.NIH.GOV
        Sent: Mon, 04 Aug 2014 06:36:03 -0500
        Subject: Revised Article Posted to MLN Matters          

                 
        Revised:
             

        SE1240 – Partial Code Freeze Prior to ICD-10 Implementation

        http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1240.pdf

         

Please scroll down and click on the link provided for a new CMS article titled "Clarification of the Confined to the Home Definition in Chapter 15, Covered Medical and Other Health Services, of the Medicare Benefit Policy Manual."

Debra Farley
Billing Director
BILLPro Management Systems
8-6-14

    From: CMS MLNMatters-L [mailto:MedlearnMatters-L@CMS.HHS.GOV]
    To: MLNMATTERS-L@LIST.NIH.GOV
    Sent: Wed, 06 Aug 2014 06:19:45 -0500
    Subject: New Article Posted to MLN Matters

         

    New:

    MM8818 – Clarification of the Confined to the Home Definition in Chapter 15, Covered Medical and Other Health Services, of the Medicare Benefit Policy Manual

    http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8818.pdf

     

Please see the CGS e-mail below for a revised 7-31-14 article on ICD-10 Testing Approach for ICD-10

Debra Farley
Billing Director
BILLPro Management Systems
8-5-14

MedicareEmailList@cgsadmin.com
To: debra@billpro.net
Date: 08/04/2014 03:55 PM
Subject: Kentucky and Ohio Part B News from CGS

Kentucky and Ohio Part B News from CGS

Revised: Medicare Fee-For-Service (FFS) International Classification of Diseases, 10th Edition (ICD-10) Testing Approach — This article was revised on July 31, 2014, to show the new ICD-10 implementation date of October 1, 2015. In addition, the portions of the article that discuss ICD-10 acknowledgement testing and end-to-end testing are updated as a result of the new implementation date. Read more...

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1409.pdf

Please scroll down for the CMS e-mail received yesterday titled "Deadline for ICD-10 allows health care industry ample time to prepare for change."   The new deadline is October 1, 2015!

If you haven't already, we suggest singing up for CMS ICD-10 Industry Email Updates at http://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD-10_Industry_Email_Updates.html

BILLPRO REMINDERS:

A) As we have previously published when the implementation date was set for 10-1-2014, please ensure your practice has enough
    of a monetary cushion should there be major problems when ICD-10 is implemented which could severely impede cash flow.  If
    you do not have a line of credit with a banking institution or you believe it may not be in a sufficient amount, take steps to seek
    same.  Some payers may not permit both ICD-9 and ICD-10 codes on the same claim while others will request that they be
    submitted on the same claim when dates of service span the compliance date.   This could result in a slower cash flow until it is
    determined how carriers want claims submitted!     

B)  The responsibility for ICD-10 education must be the sole responsibility of our clients as this is a MAJOR overhaul!  BILLPro's
     responsibility is education of its employees.  Will we keep you up-to-date on ICD-10?   Yes, as we are provided information.

C)  If you (or members of your office) do not have access to the MESSAGE BOARD, please contact Wendy Erbskorn at BILLPro at
     440-854-0213, 1-800-736-0587 ext 0213 or by e-mail at wxb@billpro.net.  This site holds  vast amounts of information including
     ICD-10 information.
 

Debra Farley
Billing Director
BILLPro Management Systems
8-1-14

    From: Centers for Medicare & Medicaid Services [mailto:cmslists@subscriptions.cms.hhs.gov]
    To: debra@billpro.net
    Sent: Thu, 31 Jul 2014 17:19:51 -0500
    Subject: CMS NEWS: Deadline for ICD-10 allows health care industry ample time to prepare for change
     

    FOR IMMEDIATE RELEASE                                     Contact: CMS Media Relations

    July 31, 2014                                                         (202) 690-6145 or press@cms.hhs.gov

     

    Deadline for ICD-10 allows health care industry ample time to prepare for change

    Deadline set for October 1, 2015

    The U.S. Department of Health and Human Services (HHS) issued a rule today finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.

    The ICD-10 codes on a claim are used to classify diagnoses and procedures on claims submitted to Medicare and private insurance payers. By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patient’s care across providers and over time. ICD-10 improves quality measurement and reporting, facilitates the detection and prevention of fraud, waste, and abuse, and leads to greater accuracy of reimbursement for medical services. The code set’s granularity will improve data capture and analytics of public health surveillance and reporting, national quality reporting, research and data analysis, and provide detailed data to enhance health care delivery. Health care providers and specialty groups in the United States provided extensive input into the development of ICD-10, which includes more detailed codes for the conditions they treat and reflects advances in medicine and medical technology.

    “ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” said Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid Services (CMS). “For patients under the care of multiple providers, ICD-10 can help promote care coordination.”

    Using ICD-10, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM. Moreover, the level of detail that is provided for by ICD-10 means researchers and public health officials can better track diseases and health outcomes. ICD-10 reflects improved diagnosis of chronic illness and identifies underlying causes, complications of disease, and conditions that contribute to the complexity of a disease. Additionally, ICD-10 captures the severity and stage of diseases such as chronic kidney disease, diabetes, and asthma.

    The previous revision, ICD-9-CM, contains outdated, obsolete terms that are inconsistent with current medical practice, new technology and preventive services.

    ICD-10 represents a significant change that impacts the entire health care community. As such, much of the industry has already invested resources toward the implementation of ICD-10. CMS has implemented a comprehensive testing approach, including end-to-end testing in 2015, to help ensure providers are ready. While many providers, including physicians, hospitals, and health plans, have completed the necessary system changes to transition to ICD-10, the time offered by Congress and this rule ensure all providers are ready.

    For additional information about ICD-10, please visit: http://www.cms.gov/ICD10



     

CMS held a National Provider Call on 7-24-14 to present "2015 Medicare PFS Proposals for PQRS, Value Modifier, EHR Incentive Program, and the Physician Compare Website."   The description and agenda are detailed below.

Description
    This MLN Connects™ National Provider Call provides an overview of the 2015 Physician Fee Schedule (PFS) Proposed Rule. This presentation will cover potential program updates to the Physician Quality Reporting System (PQRS). The topics covered include changes to reporting mechanisms, individual measures, measures groups for inclusion in 2015, criteria for satisfactorily reporting for incentive, criteria for avoiding future payment adjustments, requirements for Medicare incentive program alignment, and satisfactory participation under the qualified clinical data registry option.

    The presentation also provides an overview of the proposals for the value-based payment modifier, including how CMS proposes to continue to phase in and expand application of the value-based payment modifier in 2017 based on performance in 2015. The presentation also describes how the value-based payment modifier is aligned with the reporting requirements under the PQRS. This presentation further provides updates to Physician Compare and the Electronic Health Record (EHR) Incentive Program.

 Agenda
    •    Proposed changes to PQRS individual reporting requirements and PQRS Group Practice Reporting Option (GPRO)
    •    Proposed updates to Physician Compare and the EHR Incentive Program
    •    Review of the proposed value-based payment modifier policies under the 2015 proposed rule
    •    Plan for the future of the PQRS GPRO
    •    Where to call for help

    To access the slide presentation and announcements,  located  under  "Call Materials," please visit:

    http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2014-07-24-Quality-Rpt.html?DLPage=1&DLSort=0&DLSortDir=descending

     
 Debra Farley
 Billing Director
BILLPro Management Systems
7-30-14
   

Please scroll down to a recent CGS Medicare e-mail publishing an article titled "Clinical Laboratory Improvement Amendments (CLIA): Requirements."  Please click on the link for the full article.

Debra Farley
Billing Director
BILLPro Management Systems
7-22-14
    From: MedicareEmailList@cgsadmin.com
    To: debra@billpro.net
    Sent: Mon, 14 Jul 2014 16:30:59 -0500
    Subject: Kentucky and Ohio Part B News from CGS

    Kentucky and Ohio Part B News from CGS

    Clinical Laboratory Improvement Amendments (CLIA): Requirements — Under the Clinical Laboratory Improvement Amendments (CLIA) legislation, Medicare requires entities that perform clinical laboratory testing to be certified by the Secretary of the Department of Health and Human Services (DHHS). This includes laboratory testing performed in physician offices as well as by independent clinical laboratories. CLIA certificates are issued through designated state agencies. Read more...

    http://www.cgsmedicare.com/partb/pubs/news/2014/0714/cope26261.html

Please see the attachment to this post which is an article published in June 2013 by Aetna titled "Certain Medicare Advantage plans cover annual physicals."

Debra Farley
Billing Director
BILLPro Management Systems
7-16-14

Attached are 2 articles from Anthem:

-   "Routine Physical Exam are Covered in 2014"

-  "2014 Ohio Medicare Advantage Plan Changes" -- see pages 6 and 7 regarding the AWV

Debra Farley
Billing Director
BILLPro Management Systems
7-16-14

Providing the Annual Wellness Visit (AWV) booklet is no longer available from CMS.   Information on the elements of the AWV are located at:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf

Coding, coverage and payment information is located at

https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS_QuickReferenceChart_1.pdf

Debra Farley
Billing Director
BILLPro Management Systems
7-16-14

Please scroll down for the "QUARTERLY PROVIDER UPDATE NOTIFICATION" from the Jurisdiction B DME MAC contractor for Ohio.  To access the information, go to

http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index.html

>  under "Quarterly Provider Updates" at the left, click on the 2nd heading "Mid-Quarter instructions."

>  under "Downloads" click on the first item, "July 2014 Mid-Quarter Instructions." 

> click on the blue highlighted "Transmittal 528. Medicare Program Integrity"

Therein lies the "Proof of Delivery" policy effective 8-5-2014.



Debra Farley
Billing Director
BILLPro Management Systems
7-16-14



    From: Jurisdiction B DME MAC [mailto:dmemaclistserve@anthem.com]
    To: debra@billpro.net
    Sent: Tue, 15 Jul 2014 15:30:49 -0500
    Subject: Quarterly Provider Update Notification


          
    Quarterly Provider Update Notification
     
    The Centers for Medicare & Medicaid Services Quarterly Provider Update provides a listing of Agency regulations and major policy notices. Non-regulatory changes to the Medicare and Medicaid programs, consisting of manual instructions, are also included in this listing. You can view the latest CMS quarterly provider update , on the CMS website at

 http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index.html

Please scroll down for a CGS e-mail dated 7-15-14 and click on the link provided for a letter from CGS to physicians addressing "amendments, corrections and delayed entries with electronic health records."


Debra Farley
Billing Director
BILLPro Management Systems
7-16-14


    From: MedicareEmailList@cgsadmin.com
    To: debra@billpro.net
    Sent: Tue, 15 Jul 2014 16:32:51 -0500
    Subject: Kentucky and Ohio Part B News from CGS

    Kentucky and Ohio Part B News from CGS

    Dear Physician - Electronic Health Records and Addenda

    http://cgsmedicare.com/jc/mr/pdf/DearPhysician_EHRA.pdf

The e-mail below is self-explanatory.

Debra Farley
Billing Director
BILLPro Management Systems
7-16-14

From: Centers for Medicare & Medicaid Services <cmslists@subscriptions.cms.hhs.gov>
To: debra@billpro.net
Date: 07/15/2014 02:09 PM
Subject: Spotlight On: Summary of Cares]
   

News Updates | July 15, 2014
 
   

Learn More about Summary of Care Meaningful Use Requirements in Stage 2

If you are an eligible provider participating in the EHR Incentive Programs, you will have the option of reporting the Summary of Care menu objective in Stage 1, but will be required to meet the core objective in Stage 2.

The intent of the objective is to demonstrate that a provider has the full capability to use their certified EHR technology to successfully transmit a summary of care document to a different EHR vendor in a live setting.

Meeting Stage 2 Summary of Care Requirements
To count toward the objective, the transition or referral must take place between providers with different billing identities such as a different National Provider Identifier (NPI) or hospital CMS Certification Number (CCN).

If the receiving provider already has access to the certified EHR technology (CEHRT) of the initiating provider of the transition or referral, simply accessing the patient’s health information does not count toward meeting this objective.

However, if the initiating provider also sends a summary of care document, this transition can be included in the denominator and the numerator as long as it is counted consistently across the organization and across both measures if:

    For Measure 1, a summary of care document is also provided by any means
    For Measure 2, a summary of care document is provided using the same technical standards used if the receiving provider did not have access to the CEHRT

What to Include for Measure 1
Include the transitions of care in which a summary of care document was provided to the recipient of the transition or referral by any means.

What to Include for Measure 2
Include the transitions of care in which a summary of care document was transmitted electronically using a CEHRT to the recipient, or via exchange facilitated by an organization that is an eHealth Exchange participant.

What to Include for Measure 3
A single summary of care document sent to a provider using a different EHR and EHR Vendor or a test with the CMS and ONC Randomizer test system would meet the measure.

Measure 3 requires sending one record to someone on a different vendor system one time. If that happens in the course of fulfilling Measure 2, there is no need to do a test. The test EHR only exists for providers who never send to someone on a completely different vendor than their own.

Providers that use the same CEHRT and share a network for which their organization either has operational control of or license to use can conduct one test for the successful electronic exchange of a summary of care document with either a different EHR technology or the CMS designated test EHR that covers all providers in the organization.

For More Information
For more information about the Summary of Care requirements, review the following materials:

    Stage 1 Summary of Care spec sheets for eligible professionals and eligible hospitals
    Stage 2 Summary of Care spec sheets for eligible professionals and eligible hospitals
    Provider User Guide for the NIST EHR Randomizer Tool

   

Debra Farley
Billing Director
BILLPro Management Systems
7-16-14
    From: MedicareEmailList@cgsadmin.com
    To: debra@billpro.net
    Sent: Tue, 15 Jul 2014 16:32:51 -0500
    Subject: Kentucky and Ohio Part B News from CGS

    Kentucky and Ohio Part B News from CGS5.pdf

    Task Force Scenario: Documenting Therapy and Rehabilitation Services — The CERT A/B MAC Outreach & Education Task Force, a partnership of all A/B Medicare Administrative Contractors, created this guide to educate providers on common documentation errors for outpatient rehabilitation therapy services. These widespread errors contribute to Medicare's national payment error rate, as measured by the Comprehensive Error Rate Testing (CERT) program. Read more...

    http://cgsmedicare.com/articles/cope26285.html