Don’t Lose Out on the EHR Incentive Dollars: Enrollment in PECOS Required!
The Medicare Electronic Health Record (EHR) Incentive Program is only available to “eligible” professionals and hospitals. The final rule will soon be published and CMS is planning to use the Provider Enrollment, Chain and Ownership System (PECOS) to verify Medicare enrollment. While this may seem like a no-brainer, you may or may not have an enrollment record in PECOS. Use the checklist below to avoid a last minute scramble that could impact your incentive payment.
ComplyTrack Risk Assessment Questions Updated!
We would like to notify you of changes that have been made to the ComplyTrack Risk Assessment questions in the Comprehensive Library for the Provider Baseline. As part of the Quarterly Review Process, the following Risk Assessments were reviewed this quarter:
OPR Coverage – Is this What we Expected?
On May 7, Medicare finally released the transmittals which summarize the basic rules for documentation, coding and billing of outpatient pulmonary rehabilitation (OPR) services. Multiple updates to the Medicare manuals were provided via two CMS transmittals – 124 (CR 6823) and 1966 (CR 6823) which describe the national coverage guidelines for OPR.
Medical Decision Making – Breaking It Down. Part 1 of 3: Number of Diagnosis & Management Options
Medical Decision Making (MDM) is one of the three “key components” of determining the level of an evaluation and management (E/M) service. It is probably the most difficult component of an E/M service to review. MDM is where the providers thought process is quantified and most often the primary role in determining the correct level of service or E/M code.
Category III Codes Available for Facet Joint Injections Using Ultrasound Guidance
In CPT 2010, the AMA implemented new codes for facet joint injections. The CPT editorial panel clarified that facet joint injections require the use of imaging guidance and included the guidance in the code description. The new codes of 64490 to 64492 for cervical or thoracic facet joints and 64493 to 64495 for lumbar or sacral facet joint injections include fluoroscopy or CT guidance. They also clarified that if imaging is not used, codes 20550 to 20553 are to be used for these injections.
Billing for Drug Waste: A Look at the New Modifier – JW
The reporting of new modifier –JW, which specifies the portion of a single dose vial (SDV) or single use package that was not administered to the patient, and which goes into effect July 30, 2010, is optional at this time.
Medicare guidelines state to report the drug amount administered on one line, and on a separate line you may report the amount of drug NOT administered (wasted) with modifier –JW appended to the associated HCPCS code.
Pub. 100-22? CMS Issues a New Manual
On June 11, 2010, CMS issued a transmittal containing the first two chapters of a new Manual. The Manual is Pub. 100-22 and is titled "Medicare Quality Reporting Incentive Programs". The Manual addresses the Physician Quality Reporting Initiative (PQRI) and E-Prescribing (eRx) Medicare Quality Reporting Incentive Programs. The Manual does not establish new requirements for the PQRI and eRx programs. It simply manualizes existing requirements to the programs.
FTC Red Flags Enforcement Delayed Again
In accordance with a request from Congress, the FTC has delayed enforcement of the Red Flags Rule until December 31, 2010. This enforcement extension is necessary in order for lawmakers to finalize the scope of those impacted by the Rule. Should legislation determining the scope of affected entities be passed before the new deadline, the Rules will go into immediate effect.
Understanding Complex Physician Fee Schedule Changes in 2010
The Physician Fee schedule has had numerous and confusing updates this year, so I thought a quick note to customers about how we can help would be in order. Key issues include:
- The January 2010 RVU file had multiple updates and corrections.
- The April 2010 RVU file was not published by CMS.
- The Affordable Care Act created RETROACTIVE payment changes to the some RVUs and the conversion factor back to 01/01/2010.
- The payment rates for July 2010 are still in flux.
New Advance Beneficiary Notice Modifiers Effective April 2010
On April 5, 2010, CMS revised the Advance Beneficiary Notice of Noncoverage (ABN) modifiers. The purpose of the new modifiers is to differentiate between voluntary and mandatory use of the liability notice.
The new modifiers are:
-GA –Waiver of Liability Statement Issued as Required by Payer Policy
-GX – Notice of Liability Issued, Voluntary under Payer Policy
Self-Administration of Drugs or Biologicals and Recovery Audit Contractors (RAC)
CMS recently released Transmittal 123 (Change Request 6950) on April 30, 2010 on Determining Self-Administration of Drugs or Biologicals which took effect on April 30, 2010. Transmittal 123 provided contractors with updates to manual language related to the determination of self-administration of drugs and biologicals, to allow for other routes of administration besides injections to be considered as not usually self-administered based on some new drugs that were approved by the Food and Drug Administration.
CMS Issues Clarification on PR (Pulmonary Rehabilitation) Guidelines
As part of the initial implementation of the PR program January 1, 2010, CMS recently issued Transmittal 124 (May 7th 2010) within the Medicare Benefit Policy Manual clarifying medical necessity along with program specifications and supervision requirements. As many of the new preventative services offered by CMS, the goal of the program is patient awareness and education to facilitate more aggressive self care.
Summary of April IOCE Changes
The Integrated Outpatient Code Editor Summary of Data Changes document, published quarterly by CMS, is exceedingly valuable for hospital chargemaster maintenance. It is concise and lists all coding changes by their effective date. It is an essential for quarterly chargemaster updates.
The IOCE Summary of Data Changes document provides all quarterly changes related to:
APC CHANGES
HCPCS "S" Codes: What are they?
I recently completed a consulting project for a client that required researching commercial payer coverage policies for a specific procedure. What I found was that, in addition to a list of relevant CPT codes for the particular service I was researching, there was a host of HCPCS “S” codes that were included in some of the coverage policies. It occurred to me that these are not codes you come across every day, so I took the opportunity to refresh my understanding of these codes. I’ll share with you what I learned.
Inpatient Rule Making for 2011 Begins - EBook Available
CMS published the 2011 Inpatient Prospective Payment System Proposed Rule on May 4, 2010. This year's proposals include changes to the MS-DRG payment rates for 2011, clarification on provider aggreements and supplier approvals, new COPs (Hospital Conditions of Participation) for Rehabilitation and Respiratory care services, and accreditation requirements for Inpatient Psychiatric services for individuals under the Age of 21.
This year's rule is 472 pages, with additional data and files not included in the rule (published instead on the CMS website).
Key RAC Resources
Have you noticed one of the newest features in the MediRegs Coding Suite of products? Under Special Searches on the right hand side tool bar is now a direct link to RAC Issues. Key RAC Resources may be found here, including a direct link to CMS’s RAC information, Region A and B’s index of issues (Mediregs is attempting to secure permission from Regions C and D to post the issues listed on their respective websites), and a summary of RAC issues.
Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements
On May 5, 2010, CMS issued an interim final rule implementing provisions of the Patient Protection and Affordable Care Act (PPACA). The rule implements the provision which requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the programs.
ICD-10: Leading the way......
Questions, questions, some answers, but more questions as I reflect on the 2010 ICD-10 AHIMA Summit that I attended earlier this week. One of the big questions is are YOU ready for this big change in healthcare and have you started to PREPARE? ICD-10 will affect all aspects in healthcare (payers, providers, vendors, clearinghouses, third party administrators, independent laboratories, employers, and researchers) to name a few.
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