Please see the CMS e-mail below and click on the link for the full NEW article titled "THERAPY  MODIFIER CONSISTENCY EDITS" which is self explanatory.

Debra Farley
Billing Director
BILLPro Management Systems
2-12-14


    From: CMS MLNMatters-L [mailto:MedlearnMatters-L@CMS.HHS.GOV]
    To: MLNMATTERS-L@LIST.NIH.GOV
    Sent: Tue, 11 Feb 2014 15:52:02 -0500
    Subject: New Article Posted to MLN Matters
       

    New:
       

    MM8556 – Therapy Modifier Consistency Edits

    http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8556.pdf

     

 Please scroll down for an e-mail received Friday from HBMA (Healthcare Billing and Management Association) which provides an update on the efforts of Congress "to repeal/replace the Sustainable Growth Rate (SGR) formula."

We shall keep you updated as we receive information.

Debra Farley
Billing Director
BILLPro Management Systems
2-10-14

        From: HBMA [mailto:info@hbma.org]
        To: debra@billpro.net
        Sent: Fri, 07 Feb 2014 16:24:29 -0500
        Subject: Lawmakers Make Progress on SGR Deal

        [

         
        February 6, 2014

        To: HBMA Membership
        From: HBMA GR Committee
        Re: SGR Reform/Replace initiative

        The HBMA Government Relations Committee has been closely monitoring Congressional efforts to repeal/replace the Sustainable Growth Rate (SGR) formula.

        On Thursday afternoon (2/6) the House Ways and Means Committee, House Energy and Commerce Committee, and Senate Finance Committee leadership introduced a bi-partisan/bi-cameral bill to repeal and replace the Medicare Sustainable Growth Rate (SGR) formula. The Congressional sponsors have provided a section-by-section summary for your review available at:  http://www.hbma.org/uploads/content_files/files/SGR%20Repeal%20and%20Medicare%20Provider%20Payment%20Modernization%20Act%20Section%20by%20Section.pdf

        In addition to formally repealing the SGR, the bill:

            Provides for annual automatic payment updates of 0.5% for five years (2014 – 2018)
            Discontinues automatic updates for five years, beginning in 2018
            Consolidates the three existing Medicare quality programs into a single value-based incentive the Merit-based Incentive
            Payment (MIP) Program
            Provides for increased Medicare payments based upon score on a (MIP), beginning in 2018
            Would resume annual automatic updates beginning in 2024. All providers would receive an update, but the amount of the automatic update would vary from .5% to 1%
            Provides incentives, such as a 5% bonus to providers who receive a significant portion of their revenue from an APM, for providers to switch to alternative payment models (APMs)
            Expands the availability of Medicare data to patients and certain qualified entities

        The bill does not include separate payment provisions known as “extenders.” (see below)
         
        While this framework agreement is encouraging, and represents significant progress on repealing and replacing the much maligned SGR formula, none of the sponsors of the legislation have formally provided any information on how they propose to pay for this fix. Although official estimates have not been finalized, preliminary estimates appear to put the cost of this proposal somewhere in the neighborhood of $120-$130 billion over 10 years.

        This means that before the bill can be voted upon, the sponsors must identify savings or new revenue of a comparable amount.

        Several Congressional offices expressed considerable disappointment that the so-called Extenders were not included in this proposal. They indicated that they intend to continue pushing House and Senate leaders to include the Extenders in the final package. They noted that because the budgetary offsets have not been finalized, an opportunity to include the Extenders is possible if they can find the money necessary to pay for the extensions. The Extenders not included in the agreement are:

            The Therapy Cap
            The work GPCI floor
            Ambulance add-ons
            The Medicare-dependent hospital (MDH) and low –volume hospital programs

        Congress has until March 31st to pass legislation to prevent a 24% reduction in Medicare physician fee-schedule payments from occurring. All of the so-called Extender initiatives are also slated to expire on March 31st unless Congress adopts legislation to “extend” those initiatives.
        Copyright 2014 HBMA. All Rights Reserved.

 CMS has extended "the deadline for eligible professions to attest to meaningful use for the Medicare EHR Incentive Program 2013 reporting year from" February 28, 2014 to March 31, 2014."   Please scroll down for the full e-mail.

Debra Farley
Billing Director
BILLPro Management Systems
2-10-14

        From: Centers for Medicare & Medicaid Services [mailto:cmslists@subscriptions.cms.hhs.gov]
        To: debra@billpro.net
        Sent: Fri, 07 Feb 2014 13:17:47 -0500
        Subject: CMS Allows Extended Attestation Period for the 2013 Reporting Year

         

        News Updates | February 7, 2014
         
           

        New EHR Attestation Deadline for Eligible Professionals:
        March 31, 2014

        CMS is extending the deadline for eligible professionals to attest to meaningful use for the Medicare EHR Incentive Program 2013 reporting year from 11:59 pm ET on February 28, 2014 to 11:59 pm ET March 31, 2014.

        In addition, CMS is offering assistance to eligible hospitals who may have experienced difficulty attesting to submit their attestation retroactively and avoid the 2015 payment adjustment.

        This extension will allow more time for providers to submit their meaningful use data and receive an incentive payment for the 2013 program year, as well as avoid the 2015 payment adjustment.

        This extension does not impact the deadlines for the Medicaid EHR Incentive Program or any other CMS program, including the electronic submission for the Physician Quality Reporting System EHR Incentive Program Pilot.

        How to attest?
        If you are an eligible professional, you may use the registration and attestation system to submit your attestation for meaningful use for the 2013 reporting year.  You must attest prior by 11:59 pm ET on March 31, 2014 to meet the new 2013 program deadline.

        If you are an eligible hospital, you may contact CMS for assistance submitting your attestation retroactively.  You must contact CMS by 11:59 pm on March 15, 2014 in order to participate for the 2013 program year.

        Resources
        If you are an eligible professional working on your attestation for the 2013 reporting period, there are resources available to help you with the registration and attestation process.

            Stage 1 Meaningful Use Calculator
            Registration and Attestation User Guides
            EHR Incentive Program Website

        The EHR Information Center is open to assist you with all of your registration and attestation system inquiries. Please call, 1-888-734-6433 (primary number) or 888-734-6563 (TTY number). The EHR Information Center is open Monday through Friday from 7:30 a.m. – 6:30 p.m. (Central Time), except federal holidays.

        Tips
        In addition, there are some simple steps you can take which will help to make the process easier for you:

            Ensure that your payment assignment and other relevant information is up to date in the Medicare payment system PECOS
            Make sure to include a valid email address in your EHR program registration
            Consider logging on to use the attestation system during non-peak hours such as evenings and weekends
            Log on to the registration and attestation system now and ensure that your information is up to date and begin entering your 2013 data
            If you experience attestation problems, call the EHR Incentive Program Help Desk and report the problem
            If your organization has more than 1,000 providers assigned to a proxy user, use the PECOS system to designate additional proxies to facilitate attestation.

        Eligible Hospital Instructions:

            Send the following information to EH2013Extension@Provider-Resources.com  no later than 11:59 PM EST on 3/15/2014:
                CCN
                Hospital Name
                Contact Person Name
                Contact Person Email
                Contact Person Phone
            Type “EH 2013 EXTENSION” in the subject line of the email note
            Each Hospital must be identified in a separate email

Please scroll down for an e-mail received from CMS (Centers for Medicare and Medicaid Services) titled "HHS strengthens patients' right to access lab test reports."  It is sent for your information.

Debra Farley
Billing Director
BILLPro Management Systems
2-7-14

    From: Centers for Medicare & Medicaid Services [mailto:cmslists@subscriptions.cms.hhs.gov]
    To: debra@billpro.net
    Sent: Mon, 03 Feb 2014 12:09:06 -0500
    Subject: HHS News: HHS strengthens patients’ right to access lab test reports
   

    HHS strengthens patients’ right to access lab test reports

     

    As part of an ongoing effort to empower patients to be informed partners with their health care providers, the Department of Health and Human Services (HHS) has taken action to give patients or a person designated by the patient a means of direct access to the patient’s completed laboratory test reports.

     

    “The right to access personal health information is a cornerstone of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule,” said Secretary Kathleen Sebelius. “Information like lab results can empower patients to track their health progress, make decisions with their health care professionals, and adhere to important treatment plans.”

     

    The final rule announced today amends the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations to allow laboratories to give a patient, or a person designated by the patient, his or her “personal representative,” access to the patient’s completed test reports on the patient’s or patient’s personal representative’s request. At the same time, the final rule eliminates the exception under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to an individual’s right to access his or her protected health information when it is held by a CLIA-certified or CLIA-exempt laboratory. While patients can continue to get access to their laboratory test reports from their doctors, these changes give patients a new option to obtain their test reports directly from the laboratory while maintaining strong protections for patients’ privacy.

     

    The final rule is issued jointly by three agencies within HHS: the Centers for Medicare & Medicaid Services (CMS), which is generally responsible for laboratory regulation under CLIA, the Centers for Disease Control and Prevention (CDC), which provides scientific and technical advice to CMS related to CLIA, and the Office for Civil Rights (OCR), which is responsible for enforcing the HIPAA Privacy Rule.

     

    Under the HIPAA Privacy Rule, patients, patient’s designees and patient’s personal representatives can see or be given a copy of the patient’s protected health information, including an electronic copy, with limited exceptions. In doing so, the patient or the personal representative may have to put their request in writing and pay for the cost of copying, mailing, or electronic media on which the information is provided, such as a CD or flash drive. In most cases, copies must be given to the patient within 30 days of his or her request.

     

    The final rule is available for review at: http://www.federalregister.gov.

     

Please see the attached article that appeared in the February 2014 edition of Anthem's publication, "Network Update."   Effective 1-1-2014 Anthem Medicare Advantage will no longer cover routine physicals -- it will continue to provide the Initial Preventive Physical Exam and Annual Wellness Visit, following traditional Medicare guidelines.

Debra Farley
Billing Director
BILLPro Management Systems
2-7-14

Please see the attachment to this post which is Anthem's updated DME (durable medical equipment) policy effective 3-1-14.

Debra Farley
Billing Director
BILLPro Management Systems
2-3-14

Please see the information below published by the Part B Insider 1-24-14 which is sef-explanatory.

Debra Farley
Billing Director
BILLPro Management Systems
1-31-14

Part B Insider (Multispecialty) Coding Alert
Print Friendly and PDF More Options
CPT® 2014: Check Is Not in the Mail for New Telephone/Internet Consult Codes
- Published on Fri, Jan 24, 2014

Sadly, the Final Rule does not include any RVUs for 99446-99449.

Each year when the new edition of CPT® is issued, Part B practices get very excited about the potential for payment from newly established codes. Although this does often come to fruition and you are able to collect for new services, practices can also be let down by low or no reimbursement assigned to new codes.

Now that the 2014 Medicare Physician Fee Schedule has been finalized, you can get to know how much reimbursement has been assigned to each code. In addition, some MACs have issued coverage decisions on how to collect for many of the new codes. Unfortunately, however, the hope that many practices had for the new interprofessional telephone/internet consult codes has turned to disappointment. Although some practices suspected that they wouldn’t see payment for these codes, CMS’s latest confirmation of that fact has left many practitioners disappointed.

When RVU Is Zero, You Won’t Collect

The new interprofessional telephone/internet consultation codes went into effect on Jan. 1, so you can technically start billing them if your provider meets the criteria for them and documents the time spent, since 99446-99449 are time-based codes. However, chances are strong that you won’t collect any reimbursement for these codes.

CMS did not assign any relative value units (RVUs) to this code set for 2014, and most Medicaid providers don’t reimburse for these services either. Some private payers might, but even they are quite restrictive in paying these codes.

For example, CareFirst, a Blue Cross Blue Shield provider, states in its Policies and Procedures, “CareFirst does not provide benefits for non-face-to-face services via telephone or internet; or effective 1/1/2014, interprofessional telephone/internet consultations (99446-99449). All of these services are considered ‘integral to/include in’ all other services, whether reported alone or in addition to other services or procedures.”

Therefore, check with your insurer before billing these codes, and if the representatives tell you that these services are payable, get the policies in writing.

 

On 1-29-14  CGS  Medicare announced a CMS special open door forum call to be held on Tues, 2-4-14 from 1-2 pm ET that will discuss  Hospital Inpatient Admission Order and Certification; 2 Midnight Benchmark for Inpatient Hospital Admissions. The target audience for this call includes hospitals, physicians and non-physician practitioners, case managers, medical and specialty societies, and other healthcare professionals.   Further below is the CGS announcement on  this call -- please click on the link provided in the announcement as it  provides many sites to click on (all in blue highlight) for additional information on the subjects to be presented.

Physicians should ONLY admit to inpatient status those patients who reasonably expect to require 2 midnights of medically necessary hospital care.  If the guidelines for the "2 Midnight" rule are not met, that care is then to be provided as outpatient/observation care.  If you provide inpatient/outpatient/observation care in a  hospital setting, it is extremely important that your professional claim be billed with the proper place of service (POS) and respective CPT code.  POS 21 denotes inpatient care and POS 22 denotes outpatient/observation care.  NOTE:  For a complete listing of POS codes and their definitions, please go to Section 10.5 after clicking on the following link.

      http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2679CP.pdf

At some point in the foreseeable future, Medicare will hold both Part A and Part B claims on one system.  If a Part A inpatient stay is denied by Medicare as not medically necessary and a claim submitted for your services is billed with a POS 21, your claim will also be denied.  It must not be assumed that all hospital care is on an inpatient basis!  It is the provider's responsibility to ensure his/her claims are billed correctly -- regarding hospital care, the claim must be submitted correctly as inpatient or outpatient/observation!

Special Open Door Forum: Final Rule CMS-1599-F — CMS will host a follow-up Special Open Door Forum (ODF) call to allow hospitals, practitioners, and other interested parties to ask questions on the physician order and physician certification, inpatient hospital admission and medical review criteria that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) final rule (CMS-1599-F). Additional information on the inpatient hospital admissions policy is available on the Inpatient Hospital Reviews web page. Additional information relating to the order and certification provisions is located on the Hospital Center web page. Feedback and questions on the two midnight provision for admission and medical review can be sent to IPPSAdmissions@cms.hhs.gov.  This topic was recently discussed, and training materials provided, during an MLN Connects™ National Provider Call on J anuary 14, 2014.  Read more...
http://www.cgsmedicare.com/ohb/pubs/news/2014/0114/cope24520.html

Debra Farley
Billing Director
BILLPro Management Systems, Inc
1-29-14

Please see the self-explanatory CMS e-mail below on the 2014 Annual Update to the Therapy Code Lists

Debra Farley
Billing Director
BillPro Management Systems
1-17-14

From: CMS MLNMatters-L <MedlearnMatters-L@CMS.HHS.GOV>
To: MLNMATTERS-L@LIST.NIH.GOV
Date: 01/15/2014 10:51 AM
Subject: New  Article Posted to MLN Matters (

 

New:
 

MM8482 – 2014 Annual Update to the Therapy Code Lists

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8482.pdf

 

Please see the self-explanatory CMS e-mail below on the 2014 Medicare Therapy Cap Values

Debra Farley
BillPro Management Systems
1-17-14

From: CMS MLNMatters-L <MedlearnMatters-L@CMS.HHS.GOV>
To: MLNMATTERS-L@LIST.NIH.GOV
Date: 01/15/2014 10:51 AM
Subject: New  Article Posted to MLN Matters

   

New:
 

MM8407 – Therapy Cap Values for Calendar Year (CY) 2014

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8407.pdf

 

Your attention is directed to the CGS Medicare e-mail below titled "Reporting Federally Mandated Visits (CPT Codes 99307-99310)."

Please click on the link for the full article.

Debra Farley
Billing Director
BILLPro Management Systems
1-16-14


    From: MedicareEmailList@cgsadmin.com
    To: debra@billpro.net
    Sent: Wed, 15 Jan 2014 16:30:52 -0500
    Subject: Ohio Part B News from CGS

    Ohio Part B News from CGS

    Reporting Federally Mandated Visits (CPT Codes 99307-99310) —CPT codes 99307-99310 (Subsequent Nursing Facility Care, per day) shall be used to report federally mandated physician visits and other medically necessary visits.

    The initial visit in a skilled nursing facility (SNF) and nursing facility (CPT 99304-99306) must be furnished by a physician except as otherwise permitted as specified in the Code of Federal Regulations (42 CFR 483.40(c)(4)). Qualified Non-Physician Practitioners (NPPs) may provide federally mandated visits (after the initial visit by the physician and as permitted under the Long Term Care Regulations). Read more...

    http://cgsmedicare.com/ohb/pubs/news/2014/0114/cope24339.html

Please scroll down for a CMS e-mail received yesterday and click on the link for the new article titled "Documentation Requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounter."

Debra Farley
Billing Director
BILLPro Management Systems
1-15-14

    From: CMS MLNMatters-L [mailto:MedlearnMatters-L@CMS.HHS.GOV]
    To: MLNMATTERS-L@LIST.NIH.GOV
    Sent: Mon, 13 Jan 2014 15:23:35 -0500
    Subject: New Article Posted to MLN Matters (SE1405)         

    New:

    SE1405 – Documentation Requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounter

    http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1405.pdf

     

     

Your attention is directed to the attachment to this post which is a CMS e-mail dated today titled "CMS Fact Sheet:  CMS Strategy to Combat Medicare Part D Prescription Drug Fraud and Abuse

Debra Farley
Billing Director
BILLPro Management Systems
1-7-14

Well, the Health Insurance Exchanges are upon us. 

Caresource, a known Medicaid Advantage Plan, has a new product called "Just4Me" and it is a Health Insurance Exchange Product.  THIS  IS NOT A MEDICAID PRODUCT.  Patients are responsible for deductibles, coinsurance or payments that apply to their coverage. 

The website for this product is https://www.caresource.com/providers/ohio/caresource-just4me/.

The electronic payer ID and claims mailing address for this product is the same as that of Caresource Medicaid, i.e., payer ID 31114,  claims mailing address

    Caresource
    Attn:  Claims Dept
    PO Box 8730
    Dayton, OH  45401-8730

We are calling this to your attention so you are aware of the new Health Insurance Exchange products and so they are not confused with other products such as Medicaid Advantage Plans.   For reporting purposes, in the billing system, new payers for each Health Insurance Exchange should be created along with a new payer class of "Exchanges" just to be used for exchange products.  Should you have any questions, please contact your account manager at BILLPro.

Please share this with your office/billing staff.

Debra Farley
Billing Director
BILLPro Management Systems
1-7-14

Ohio Medicare just published the 2014 Physician Fee Schedule.  It is now available in PDF and CSV  at

http://www.cgsmedicare.com/ohb/coverage/fees/fees.html

When you click on this link please follow the instructions below:

->  Scroll down  to "Option 3: Select a fee schedule"

->  "Select a year" of "2014"

->  "Select the fee schedule to display" of "Physician"

->  Click on "Display Results"


Just as an example, in 2013 Medicare allowed $70.65 for a participating physician for code 99213 in an office setting.  For 2014 the allowance is $70.61.

NOTE:  Preceding the actual fee schedule is the Ohio Part B 2014 Enrollment Package.  Please read this as it contains important information such as

-  The Health Insurance Marketplace

-  Information related to Medicare Prescription Drug (Part D) Coverage

-  Primary Care Incentives

-  Engaging Physicians in Quality

-  Incentives and Payment Adjustments for Quality Reporting

   NOTE:   "The Electronic Prescribing (eRx) Incentive Program, including any payment adjustments for unsuccessful e-prescribing
   or reporting , will end in 2014.  No reporting of electronic prescribing for this program is required in 2014."   The e-
   prescribe HCPCS code G8553 was deleted effective 1-1-2014.

-  Medicare and Medicaid EHR Incentive Programs

-  Revalidation

Debra Farley
Billing Director
BILLPro Management Systems
1-3-14