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Ohio Medicare DMEPOS / General Medicare DMEPOS Information / Revised LCD "Orthopedic Footwear" effective 1-1-14
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on: Mar 14, 2014, 02:59:54 am
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Please scroll down for the Jurisdiction B e-mail announcing the LCD/Policy Article Revision to "Orthopedic Footwear" Debra Farley Billing Director BILLPro Management Systems 3-14-14 From: Jurisdiction B DME MAC [mailto:dmemaclistserve@anthem.com] To: debra@billpro.net Sent: Thu, 13 Mar 2014 15:30:56 -0500 Subject: LCD and Policy Article Revisions Summary for March 13, 2014 LCD and Policy Article Revision Summary for March 13, 2014 Outlined below are the principal changes to DME MAC Local Coverage Determinations (LCD) and a Policy Article (PA) that has been revised and posted. Please review the entire LCD and each related PA for complete information. Orthopedic Footwear LCD Revision Effective Date: 01/01/2014 HCPCS CODES AND MODIFIERS: Revised: L3100 and L3170 narrative description access the LCD under "Quick Links" then click on "Medical Policy Center" available at: http://www.ngsmedicare.com/ngs/portal/ngsmedicare/dme%20mpc%20-%20active/!ut/p/a1/vVTbUtswEP0V9SFv9Wh9jx8zNGQIJBRCIPELI0vrIMaWje2k0K-v7DQtk5vJ9OInyXtWu3v27NKQzmio2EouWCUzxZL6HnqPMLa_9M5dB2DiunDRh1t_NPEtcEwNmNeA4eRsDRgFABc9b3I-GIB9PbbW_hvzwAZLm6fT_v21BYN7hz7QkIZcVXn1ROdqUaYoJGcF8kxVqKoOvPvXAZ6tsGALJAIrLFKpmjw7sEYkJM8Syd8I155YdECkSNKcE4MwXskV1rFy7S6wlAvV3LgUdO4JKwgiAEeYETjoMwEmi_2gG6HnunG8qfLA14OtKvs3moSbgTm563-1ulO7haVzv42lFpbdE_13EzzRfwfQopKmyy06WQOOUHz0hTqHo4Ca5OM5uBvAgTqu2wBdm841Uf5Bok2bTn6rDgN0BARoeIHJDccC34jsQBhC-AHEjtWNA5cOPyAtqxidjRa1tKsnQ6o4o7Mkq8dh_7gQpsRmUlhRSZ4gKXAlS20rSblMU1a8kTgriD7wJ2Lan4kFZqMC-fzyEvb0xNbj-VrRWevI5stIR2oCl9qE38pNUH39J2kO25T0Hyn7qYcDgrm03uuhdQsNP7CMT2_Qn-7U_WzuwLYnY2uFuO-ZANvnHtdMOHbEAhuY4wXoouMhakOMO1Oxb2HtSep5WchSV9W0NCJNjozr_uV5IrFunlqy5DFlUhGpBL7-DcmvH9WH06Pn6TTtPseX-rvybvu3_Xg8NsLozf5-9et0F6cP3bL36Qftk3xw/dl5/d5/L2dBISEvZ0FBIS9nQSEh/ |
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257
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Ohio Medicare (including managed care) / General Medicare Information / CMS CHANGE REQUEST 8425: 'RELATED' CLAIMS SET TO DENY
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on: Mar 12, 2014, 04:11:42 am
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Below is an article published on 3-10-14 in the publication "Part B Insider" which is extremely important reading. Please be sure to read the complete CMS Change Request by clicking on the link provided at the end of the article. Part B Insider (Multispecialty) Coding Alert [Print Friendly and PDF] [More Options] CMS SET TO DENY 'RELATED' CLAIMS - Published on Mon, Mar 10, 2014 CMS set to deny ‘related’ claims. Financial implications for your denials may get much steeper, thanks to a new CMS directive on related claims. Medicare contractors that have denied a claim under medical review “have the discretion to deny other related claims submitted before or after the claim in question,” CMS instructs in CR 8425, issued Feb. 5. “If documentation associated with one claim can be used to validate another claim, those claims may be considered ‘related,’” CMS says. “The MAC, Recovery Auditor, and ZPIC are not required to request additional documentation for the related claims before issuing a denial for the related claims,” CMS adds. CMS offers the following example of what could constitute a “related” claim, according to the transmittal: “A diagnostic test claim and associated documentation is reviewed and determined to be not reasonable and necessary and therefore the professional component can be determined to be not reasonable and necessary.” Translation: If a separate physician orders an x-ray and your radiologist performs an interpretation, but the claim is later found to be not reasonable and necessary, you could be forced to return the reimbursement your radiologist collected for his modifier 26 (Professional component) services. To read the complete change request, visit www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R505PI.pdf. Debra Farley Billing Director BILLPro Management Systems 3-12-14 |
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258
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Prepare for ICD 10 / ICD-10 CODING / Addt'1 Tools for ICD-10 implementation: UHC, ICD10data.com, Optum...
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on: Mar 07, 2014, 05:30:08 am
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Three additional tools are available to assist with ICD-10 implementation: United Healthcare Please visit their site at: https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=6fa2600ae29fb210VgnVCM1000002f10b10a____ Amongst other subjects, please scroll down and under "Tools" there is a link for "UnitedHealthcare Code Lookup Tool." This enables one to map an ICD-9 code to an ICD-10 code and vice versa. ICD10data.com This is yet another site enabling the mapping of an ICD-9 code to an ICD-10 code and vice versa. http://www.icd10data.com / CAUTION RELATING TO MAPPING SITES: As we know with ICD-9, coding to the highest level of specificity should be a priority. However, come ICD-10, payers may modify the terms of their contracts and may require reporting the code with the highest specificity. This may lead to altering their payment schedules and reimburse differently for higher vs lesser specificity codes. Unless the provider documents a diagnosis/condition as unspecified, stay away from unspecified codes. Please remember any translation program from ICD-9 to ICD-10 is to be used as a tool -- this does not in any way negate the necessity for purchasing and using an ICD-10 book. The translation program can assist in guidance on where to locate the "general" diagnosis, but then one must go to the ICD-10 book to determine the definitive code for that condition/diagnosis for any other codes related to that condition. Also, any "converted" code provided from the ICD10 data.com site is followed by "converts approximately to" which is further evidence that one must reference the ICD-10 code book. OptumCoding They have developed "ICD-10-CM Fast Finder Sheets" and there is one for each specialty. The description of the sheets is "Each specialty ICD-10 CM Fast Finder is a double-sided, laminated sheet containing approximately 300 ICD-10 CM codes with shortened descriptions based on actual frequencies for that specialty. They are fast, convenient and reliable." Please visit: https://www.optumcoding.com/Category/100308/100306/Debra Farley Billing Director BILLPro Management Systems 3-7-14 |
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261
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CPT/HCPCS/ICD-9 / CPT updates / Is there a specific code for writing a prescription?
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on: Mar 05, 2014, 04:38:35 am
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Below is an article published on 2-28-14 from the publication "Part B Insider" titled "Is there a specific code for writing a prescription?"
Debra Farley
Billing Director
BILLPro Management Systems
3-5-14
Question 3: Is there a code specific to writing a prescription?
Answer: No. CPT® includes writing prescriptions as part of an E/M service, and the service is essentially just part of the cost of seeing patients, much like office supplies. There is no specific code that payers will reimburse for writing a prescription, and if you try to report the unlisted E/M code (99499) for writing prescriptions, you could be putting yourself at a compliance risk since you didn’t perform an actual E/M service.
Note: If you review the Table of Risk in the 95 or 97 E/M Documentation Guidelines, you’ll see “Prescription drug management” designated as “Moderate” level of risk under “Management Options Selected.” This is how prescription drug management can influence your E/M level.
Best practice is for the provider to include documentation that shows actual management of the prescription. For example, if the oncologist is renewing an anti-emetic, the plan of care may state that the patient has been tolerating the current dosage well, so the physician is renewing the prescription. Or the physician may state that she’s choosing a specific drug because it is safer in combination with the patient’s diabetes medication.
Tip: ICD-9-CM includes V68.1 (Issue of repeat prescriptions). But you should not report V68.1 with an E/M code if the only reason the patient comes in is to pick up a prescription. In other words, without an actual evaluation and management service, you should not bill an E/M code. (ICD-10-CM has a similar code: Z76.0, Encounter for issue of repeat prescription.)
Remember: Care using certain prescriptions for certain medical conditions may have reportable Physician Quality Reporting System (PQRS) codes. While reporting the codes is informational in nature, and does not draw direct reimbursement, a physician who participates in PQRS may receive annual incentive payments if qualifications are met. Specialty practices have several quality measures the physician can capture, particularly if the administrative staff has developed a well-organized reporting system.
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Ohio Medicare (including managed care) / General Medicare Information / SummaCare Medicare Vaccine Cov'g--recommends prev. vaccines be administered..
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on: Mar 04, 2014, 02:14:07 pm
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Subject: SummaCare Medicare Vaccine Coverage - Summa recommends that all preventive vaccines be administered at a participating pharmacy convenient to the patient
CLIENTS:
Please see the article below which is copied from a recent SummaCare e-Newsletter.
SummaCare Medicare Vaccine Coverage
Did you know that most preventive vaccines are covered under Medicare Part D prescription drug coverage, while only a few are covered under Medicare’s Part B medical coverage?
To minimize patients' out-of-pocket costs and confusion, SummaCare recommends that patients get their preventive vaccines at a participating pharmacy.
Vaccines that are covered under the Part B medical benefit include influenza, pneumococcal and Hepatitis B, if the patient is intermediate or high risk. Part B also covers vaccines that are necessary to treat an injury or illness. For example, if a patient needs a tetanus vaccination related to an accidental puncture wound, it would be covered under Part B. However, if the Medicare beneficiary simply needed a booster shot of their tetanus vaccine, unrelated to injury or illness, it would be covered under Part D. For all preventive vaccines, please provide the patient with the appropriate prescription to take to a local participating pharmacy for administration.
If Part D vaccines are administered in your office and submitted to SummaCare, the claim will be denied as the patient's responsibility. If this happens, you will have to provide the patient with a bill, including the NDC code and units administered, to submit to MedImpact (the Part D Carrier).
In this situation, the patient will then have to:
Submit the bill to MedImpact, SummaCare’s PBM, to be processed under their Part D benefit.
Upon receipt of reimbursement, forward that payment to your office.
These claims will be paid at usual and customary rates, with the member responsible for the difference. These unnecessary steps often lead to patient dissatisfaction and additional telephone calls and complaints. We recommend that all preventive vaccines be administered at a participating pharmacy convenient to the patient.
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Debra Farley
Billing Director
BILLPro Management Systems
3-4-14
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263
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Prepare for ICD 10 / Are you ready / BREAKING News: ICD-10 deadline won't be delayed, Tavenner tells HIMSS
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on: Feb 28, 2014, 01:18:17 pm
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Your attention is directed to the article below appearing on the "Modern Healthcare" website yesterday which, again, sets in stone the 10-1-14 ICD-10 implementation date. Also contained in this article is information on Stage 2 EHR meaningful-use.
BREAKING: ICD-10 deadline won't be delayed, Tavenner tells HIMSS
By Joseph Conn
Posted: February 27, 2014 - 12:01 am ET
Tags: ICD-10, Marilyn Tavenner, Meaningful Use
Providers, payers and claims clearinghouses can look for no relief from the looming, Oct. 1 compliance deadline for the nationwide conversion to the ICD-10 family of diagnostic and procedural codes, the head of the CMS said Thursday. But some case-by-case exemptions will be made for providers having a tough time meeting their Stage 2 meaningful-use targets, she said.
“There are no more delays and the system will go live on Oct. 1,” Marilyn Tavenner said during her keynote address at the Healthcare Information and Management Systems Society convention in Orlando, Fla., Thursday. “Let's face it guys, we've delayed this several times and it's time to move on.”
Similarly, there will be no rollback of compliance dates for Stage 2, Tavenner said, despite considerable pressure being applied to the agency to further delay compliance dates and add flexibility to its “all or nothing” requirements to meet meaningful-use measures.
For eligible hospitals, the starting date for Stage 2 was Oct. 1, 2013. Those hospitals have only two starting dates left in the program, which operates on a fiscal year, to commence 90 consecutive days of meeting the meaningful-use criteria: April 1 and July 1, 2014.
Physicians and other eligible professionals, whose EHR incentive programs operate on the calendar year, have a bit more time and three dates—the first days of April, July and October—to start their 90-day clocks.
Regarding Stage 2 of the electronic health-record incentive payment program, which requires providers to electronically exchange healthcare records with others, Tavenner explained that “interoperability is a key step to everything going forward,” particularly CMS' value-based payment programs.
CMS has been sensitive to providers' concerns, Tavenner said, pointing out that the Stage 2 and Stage 3 start dates each had previously been pushed back a year. “Now is the time for us to start moving forward,” she said.
But, she acknowledged that some providers and health IT vendors may have legitimate issues, such as the late delivery of tested and certified software, or EHR vendors going out of business, that might preclude them from achieving timely compliance with Stage 2.
In those instances, Tavenner said, the CMS is willing, on a case-by-case basis, to entertain applications for “hardship exemptions.” Even with the exemptions, she said, CMS expects all Stage 2 providers to fully meet all Stage 2 criteria by 2015 while still encouraging everyone else eligible to meet them this year.
Debra Farley
Billing Director
BILLPro Management Systems
2-28-14
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265
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Ohio Medicare (including managed care) / General Medicare Information / Bundled, Inactive and Non-Payable Codes for 2014:Medicare Physician Fee Schedule
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on: Feb 21, 2014, 03:47:06 am
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Your attention is directed to the CGS e-mail below which is self-explanatory. Please click on the link provided for the document Debra Farley Billing Director BILLPro Management Systems 2-21-14 --------------------------------------------------------------------------------------------------------------------- From: MedicareEmailList@cgsadmin.comTo: debra@billpro.netDate: 02/20/2014 03:59 PM Subject: Ohio Part B News from CGS Ohio Part B News from CGS Bundled, Inactive, and Non-Payable Codes for 2014: Medicare Physician Fee Schedule Database — The Centers for Medicare & Medicaid Services (CMS) designates the status of HCPCS and CPT codes in the Medicare Physician Fee Schedule Database (MPFSDB). The status of codes may be updated periodically throughout the year and when the calendar year changes. Codes designated as Status A are active codes, are separately payable under the Medicare Physician Fee Schedule (assuming any existing coverage criteria are met), and have associated Relative Value Units (RVUs) and payment amounts. The list of Status A codes is extensive, and these codes are not listed in this article. http://www.cgsmedicare.com/pdf/J15_FeeSchedules2014.pdf |
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268
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Ohio Medicare (including managed care) / Therapy / Functional Reporting for Outpt Therapy Services: Reminders
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on: Feb 17, 2014, 05:14:24 am
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Your attention is directed to the CGS e-mail below. Please click on the link provided for the full article on "Functional Reporting for Outpatient Therapy Services: Reminders." Debra Farley Billing Director BILLPro Management Systems 2-17-14 From: MedicareEmailList@cgsadmin.comTo: debra@billpro.netDate: 02/14/2014 04:20 PM Subject: Ohio Part B News from CGS Ohio Part B News from CGS Functional Reporting for Outpatient Therapy Services: Reminders — Functional data reporting and collection requirements were implemented as of July 1, 2013, for outpatient therapy service claims with dates of service on or after January 1, 2013. This means that new HCPCS codes and modifiers describing functional limitations and severity for patients are required for outpatient therapy services, including physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) services. This system is designed to collect data on beneficiary function during the course of therapy services in order to better understand beneficiary conditions, outcomes, and expenditures. Read more... http://www.cgsmedicare.com/parta/pubs/news/2014/0214/cope24750.html |
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270
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Ohio Medicare (including managed care) / General Medicare Information / CMS: 2-midnight Benchmark: Discussion of Hospital Inpt Admission Order...
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on: Feb 13, 2014, 04:10:00 am
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On August 2, 2013, CMS issued a final rule, CMS-1599-F (available at http://www.gpo.gov/fdsys/pkg/FR-2013-08-19/pdf/2013-18956.pdfupdating FY 2014 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS). The final rule, commonly known as the “2-Midnight Rule,” modifies and clarifies the longstanding policy on Medicare Administrative Contractor review of inpatient hospital and critical access hospital (CAH) admissions for payment purposes. Under this final rule, surgical procedures, diagnostic tests and other treatments (in addition to services designated as inpatient-only), are generally appropriate for inpatient hospital admission and payment under Medicare Part A when the physician expects the beneficiary to require a stay that crosses at least two midnights and admits the beneficiary to the hospital based upon that expectation. This policy responds to both hospital calls for more guidance about when a beneficiary is appropriately treated—and paid by Medicare—as an inpatient and beneficiaries' concerns about increasingly long stays as outpatients due to hospital uncertainties about payment. CMS has released additional clarification (go to http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/IP-Certification-and-Order-01-30-14.pdfon the provisions of the final rule regarding the physician order and physician certification of hospital inpatient services. Additional information on the 2-Midnight Rule can be found on the Inpatient Hospital Reviews web page at http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.htmlShould you not have participated in the 2-27-14 CMS National Provider Call on the this subject, below is the link to the slide presentation. http://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/022714-2-Midnight-Rule-presentation.pdfDebra Farley Billing Director BILLPro Management Systems 2-28-14 |
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