November 2010

Medicare MLN Matters Article #MM7133 - Counseling to Stop Tobacco Use

The Medicare Learning Network® (MLN) has released MLN Matters Article #MM7133 to inform providers that the Centers for Medicare & Medicaid Services (CMS) will cover counseling services to prevent tobacco use for outpatient and hospitalized beneficiaries. Effective for claims with dates of service on and after August 25, 2010, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries 1) who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease; 2) who are competent and alert at the time that counseling is provided; and 3) whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner. This article is available on the CMS website at http://www.cms.gov/MLNMattersArticles/downloads/MM7133.pdf. Code 99406 (3-10 minutes) currently pays $14.61. Code 99407 (> 10 minutes) currently pays $27.92. Effective 1/1/2011 new “G” codes have been created which will waive the Medicare deductible and co-insurance. Let Rich know if you plan to use the new codes.

Medicare ALLOWABLE FEES

Each year CPB prepares a table with the Medicare Allowable Amounts for your commonly used office CPT codes. If you would like to receive this again in 2011, please notify Rich by December 10th.

Medicare FEE SCHEDULE

As you know, the Fall elections are just a few days away and Congress still has not passed a long term fix to the Medicare Fee Schedule. The following is HBMA’s (our professional association) Washington representative’s thoughts on the subject as published in early October:

“It appears likely that the House and Senate will conclude whatever business they can agree upon by the end of this week. Although there is still a lot of haggling going on, I do not anticipate anything major occurring prior to their adjournment. Most likely they'll conclude a short-term Continuing Resolution that will allow the government to operate into mid-December and then go home to run for re-election.

Several issues will be carried over to an expected "Lame Duck" session. No official start date for that session but it could "start" as early as the week after the election but it is more likely that serious discussions won't start until after Thanksgiving. This does not bode well for an SGR fix before the November 30th deadline.

Issues for discussion during the lame duck include - funding the government for the remainder of the Fiscal Year, dealing with the Tax Cut/Extenders, fixing the SGR and some defense related matters.

For billing companies and their clients, the most significant issue will be the pending SGR cuts. My conversations with Congressional staff indicate that they still believe that the Congress will move to prevent those cuts from occurring but nothing is certain. I have encountered some staff who are very pessimistic about the prospects for even a short-term fix in late November.

Lame Duck sessions are notoriously unproductive regardless of whose reign they occur under. Given the likelihood that the GOP will gain strength, they will not be in a mood to do anything of substance while the chamber is under Democratic control. Further, should Democrats - legitimately or not - blame their losses on the physician community - they will be in no mood to help physicians.

Not a formula that lends itself to an optimistic outlook but we still need to keep pushing.”

2009 eRx Incentive Program Feebdack reports

On October 25th, Highmark announced that the incentive payments for the 2009 Physician Quality Reporting Initiative (PQRI) for eligible professionals who met the criteria for successful reporting. Carriers and Medicare Administrative Contractors (MACs) will begin processing and distributing 2009 PQRI incentive payments on October 25, 2010and is scheduled to be completed by November 12, 2010.

The 2009 eRx feedback reports will be available on the Physician and Other Health Care Professionals Quality Reporting Portal at http://www.qualitynet.org/pqri on the internet, starting the second week of November. TIN-level reports on the Portal require an Individuals Authorized Access to CMS Computer Services (IACS) account. Participants may also contact their Carrier or MAC to request individual NPI-level reports via an alternate feedback report fulfillment process, please visit http://www.cms.gov/MLNMattersArticles/downloads/SE0922.pdf on the CMS website.

Who to Contact for Questions?

If you have questions about the status of your eRx incentive payment (during the distribution timeframe), please contact your Provider Contact Center. The Contact Center Directory is available at http://www.cms.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip on the CMS website.

Feel free to contact the QualityNet Help Desk with any of the following:

· Physician Quality Reporting Initiative (PQRI) Portal password issues
· PQRI/eRx feedback report availability and access
· PQRI-IACS registration questions
· PQRI-IACS login issues

The QualityNet Help Desk is available Monday through Friday from 7:00 a.m. – 7:00 p.m. CST at 1-866-288-8912 or via qnetsupport@sdps.org on the internet. The QualityNet Help Desk is also available to assist with PQRI and eRx measure-specific questions.

October 2010

HUMANA CHANGES

On August 6th Humana announced they will be making a number of changes in billing and payment policies and procedures effective November 6, 2010. The most notable that we saw pertains to our PCP’s: Humana will include E&M services with the removal of impacted cerumen (69210). It is not clear from their letter whether they will allow modifiers to show when the 69210 was separate and distinct from E&M services.

HIghmark Medicare – 99204 & 99205 prepayment review

On September 20, Highmark Medicare announced that all 99204 & 99205 CPT codes will undergo prepayment review:

A recent widespread post payment audit performed by Highmark Medicare Services’ Medical Review Department revealed that 73% of new patient office or outpatient visits, procedure codes 99204 and 99205, were billed incorrectly. While the number one error was incorrectly coding the level of service, other issues were identified. The issues included:

· The lack of an accepted form of provider signature,
· The documentation did not support incident to guidelines as there was no evidence of the physician initiating the plan of care, and
· No documentation was received to support the services billed.

In order to bill a new patient office or outpatient visit, the patient must not have received any professional service from any physician in the group of the same specialty within the last three years.

As a result of these review findings, a prepayment edit will be implemented on procedure codes 99204 and 99205 for physicians and non-physician practitioners (NPP) of all specialties.

You can read the full article:
https://www.highmarkmedicareservices.com/bulletins/partb/news09202010.html

If you are asked for any medical records, you are welcome to ask us to review them for anything non-clinical. We strongly urge you not to respond without making sure that the signature is in an acceptable format. There are legitimate ways to make it acceptable. Be sure to respond within the required time frame and please notify us (faxing the letter is fine) so we know why payment is being delayed.

It is important that your medical records substantiate your services to avoid being placed on prepayment review for other services as well. Failure to respond at all may lead Medicare to review even more charges or cease paying entirely.

If you have any questions, please contact me.

September 2010

CMB APPOINTMENT SYSTEM

Several office-based clients are now using our appointment system and enjoying the numerous benefits it offers. And it is free! Setup takes only a few minutes (which we do) and simply requires a computer and high-speed internet.

The system also offers an add-on auto-dialer option that works off the appointment system to remind your patients they have an appointment – thus cutting down on Missed appointments. After making the calls, it creates a report that lists who was called, what the status of the call was (appointment confirmed, no answer, busy, etc.), etc.

We also have 2 clients using the new digital pen technology which sends your charges to us within minutes or hours of treating the patients! This requires a color laser printer to print the specially engineered charge form. This is real “cutting-edge” technology!

If you are interested in the appointment system and/or the digital pen, please feel free to call.

ElectRonic PATIENT STATMENTS

Patient statements are moving into the 21st century! Patients can now access their monthly statement online via a secure hyperlink - much like many other bills. Providers that have this service, report a 20% - 30% increase in patient payments in addition to lower statement costs due to zero postage. To do so, we need to begin capturing the email addresses so patients can be notified via email. That saves postage (and trees!) and provides more timely payment. Patients without an email address can continue to receive paper statements. If the email bounces or is not opened within X days (7, for example), the statement software will recycle and print a paper statement. Clients using our free Appointment System can enter the email address in the first Demographics screen. Other clients can simply add it to any Charge form for us to enter – but please be sure it is written clearly.

EMR’s

In our continuing series to provide information, some additional considerations to ensure vendors meet the “meaningful use” criteria:

• If you look at an EMR program that does not have the CCHIT 2011 (yep, 2011) certification, we suggest you ask them to provide you a written guarantee that they will receive 2011 certification by December 31, 2010. Otherwise, you could be losing out on the initial Medicare payments. The top EHR vendors are all providing written guarantees including penalties if they do not meet 2011 through 2015 certification by the posted certification date.
• You can start with an EMR as late as 2012 and still receive the full Medicare Incentive bonus. See graph below.
• A Physician gets 75% of Medicare Allowable Charges up to the maximum each year (see chart below) if they have a certified EHR and can meet 15 of the 25 quality Meaningful Use criteria. For example, annual payments are calculated based on Medicare processed allowable charges for Year 1:

$40,000 x 75% = $37,500 = Max of $18,000
$24,000 x 75% = $18,000 = Max of $18,000
$20,000 x 75% = $15,000 = Max of $15,000

eRx & PQRI PAYMENTS

Per CMS, the 2009 eRx incentive payments will be distributed first, from late September through late October, and the 2009 PQRI incentive payments will be distributed from late October through mid-November.
The 2010 incentive payments will be distributed sometime in the fall of 2011.

MED RISK UPDATE

Effective 8/18/10, Med Risk asks that providers start using their new fax numbers. To fax New patient (PIF) or Submit Initial Evaluations and Rx’s: 877-389-7197 or 877-805-4173.