1 NOA 3 rd Party Update 2012. 2 Resource For This Presentation NOA 3 rd Party Web Page found at NOA 3 rd Party Web Page found atHTTP://NEBRASKA.AOA.ORG/PREBUILT/NOA/INDEX.HTM

11

NOA 3NOA 3rdrd Party Update Party Update20122012

22

Resource For This Resource For This PresentationPresentation

NOA 3NOA 3rdrd Party Web Page found at Party Web Page found at

HTTP://HTTP://

NEBRASKA.AOA.ORG/NEBRASKA.AOA.ORG/

PREBUILT/PREBUILT/

NOA/NOA/

INDEX.HTMINDEX.HTM

http://nebraska.aoa.org/prebuilt/NOA/index.htm

33

44

55

66http://nebraska.aoa.org/prebuilt/NOA/index_Page353.htm

NOA 3rd Party Educational NOA 3rd Party Educational VideosVideos

77

88

2012 32012 3rdrd Party Update Party Update

HIPAA HIPAA (Privacy, EDI, Security)(Privacy, EDI, Security)

CMS Incentive Programs CMS Incentive Programs (EHR, eRx, PQRS)(EHR, eRx, PQRS)

CMS Quality Care – Pay For CMS Quality Care – Pay For PerformancePerformance

MedicaidMedicaid CodingCoding Office Procedures Office Procedures BCBSBCBS

99

HIPAA Privacy AuditsHIPAA Privacy Audits

For the first time, HIPAA Privacy audits are coming.

It is important that your staff annually review your HIPAA Privacy Manual and update personnel and other required information.

You should also review your HIPAA privacy policies during staff meetings at least twice a year.

1010


For the first time, HIPAA Privacy audits are coming.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

1111


http://nebraska.aoa.org/prebuilt/noa/HIPAA%20NOA%20Manual.PDF

1212


The OCR director reinforced that it is a consumer’s legal right to obtain a copy of their health information.

Visit the OCR website to obtain a copy of the memo and for videos, pamphlets, frequently asked questions, etc.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

1313

HIPAA EDI ICD-10HIPAA EDI ICD-10

ICD-10 codes provide more specific data to improve patient care & information exchange

ICD-10 used by rest of world for years. HHS has postponed the date by which

health care entities must comply with ICD-10 until October 2014

ICD-10 HHS education can be found at http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10/

1414

HIPAAHIPAA

HIPAA Security ReminderHIPAA Security Reminder– Action Action RequiredRequired

ManualManual

http://www.aoa.org/documents/AOA_HIPAA_Security_Regulation_Manual.pdf

1515


HIPAA HIPAA (Privacy, EDI)(Privacy, EDI)

CMS Incentive Programs CMS Incentive Programs (EHR, eRx, PQRS, (EHR, eRx, PQRS, MOC)MOC)



1616

All CMS Incentives 2011-All CMS Incentives 2011-20192019

http://nebraska.aoa.org/prebuilt/noa/2012-06-3RD-Party-Newsletter.pdf

1717

EHREHR

CMS recommends that all eligible professionals register as early as possible for EHR Incentive Programs.

If you do not resolve registration problems in time, you will not be able to attest and could potentially miss out on a payment year.

https://ehrincentives.cms.gov/hitech/login.action

1818

EHREHR

2012 is the last year you can earn the maximum incentive.

October 3rd is the Last Day for EPs to Begin their

90-Day Reporting Period for 2012

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

1919

EHREHR

CMS has posted a series of new videos about the Medicare EHR Incentive Programs to the CMS YouTube channel

http://www.youtube.com/user/CMSHHSgov.

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

http://www.cms.gov/EHRIncentivePrograms/

2020

EHREHR

The CMS EHR Incentive Program listserv provides timely information on program requirements and changes in the EHR Incentive Programs at https://www.cms.gov/EHRIncentivePrograms/65_CMS_EHR_Listserv.asp#opOfPage

2121

EHR - DocumentationEHR - Documentation

Do you take notes from a previous visit and “clone” them into the current visit?

If so, WPS reports that you may be the target of the Office of the Inspector General (OIG).

2222

EHR - DocumentationEHR - Documentation A “cloned” entry (e.g., HPI) can lead to an

erroneously high coding level, when a more abbreviated HPI would have been appropriate for the follow-up visit.

Regardless, WPS computers are looking for duplicate verbiage – between one patient’s multiple visits– between visits of multiple patients.

2323

Meaningful Use Stage 2: Meaningful Use Stage 2: TimelineTimeline

You start Stage 2 of Meaningful Use no sooner than 2014.You start Stage 2 of Meaningful Use no sooner than 2014. However, you must complete 2 years of Stage 1 before However, you must complete 2 years of Stage 1 before

starting Stage 2.starting Stage 2. In 2014, everone (stage 1 or 2) demonstrates for 90 days.In 2014, everone (stage 1 or 2) demonstrates for 90 days.

2424

CMS created Stage 1 vs. Stage 2 Comparison CMS created Stage 1 vs. Stage 2 Comparison Tables to help providers navigate the next Stage Tables to help providers navigate the next Stage of meaningful use.of meaningful use.

Providers will be able to see which measures are Providers will be able to see which measures are new, which ones are changing, and which ones new, which ones are changing, and which ones are being removedare being removed..

Example below…Example below…

Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure

Implement drug-drug and drug-allergy interaction checks

The EP has enabled this functionality for the entire EHR reporting period

No longer a separate objective for Stage 2

This measure is incorporated into the Stage 2 Clinical Decision Support measure

Generate and transmit permissible prescriptions electronically (eRx)

More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology

Generate and transmit permissible prescriptions electronically (eRx)

More than 50% of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology

Meaningful Use Stage 2: Meaningful Use Stage 2: ObjectivesObjectives

2525

Beginning in 2014, the reporting of Beginning in 2014, the reporting of clinical quality clinical quality measures (CQMs)measures (CQMs) will change for will change for allall providers, providers, those participating in Stage 1 or Stage 2.those participating in Stage 1 or Stage 2.

All providers must report on CQMs to All providers must report on CQMs to demonstrate meaningful usedemonstrate meaningful use..

All providers in their second year and beyond of All providers in their second year and beyond of demonstrating meaningful use must demonstrating meaningful use must electronicallyelectronically report CQM data to CMS.report CQM data to CMS.

Provider Before 2014 2014 and Beyond

EPs Complete 6 out of 44 CQMs3 core or 3 alternate core3 menuSelected CQMs must cover at least 3 of the National Quality Strategy (NQS) domains

Complete 9 out of 64 CQMsChoose at least 1 measure in 3 NQS domains Recommended core CQMs include:9 CQMs for the adult population9 CQMs for the pediatric populationPrioritize NQS domains

Meaningful Use Stage 2: CQMsMeaningful Use Stage 2: CQMs

2626http://www.cms.gov/EHRIncentivePrograms/Downloads/MU_Stage1_ReqSummary.pdf



2929

Not yet endorsed CQMsNot yet endorsed CQMs GLC screening for adultsGLC screening for adults Closing the referral loop (letter to referrer)Closing the referral loop (letter to referrer) Monitor for adverse drug event in chronic Rx med Monitor for adverse drug event in chronic Rx med

useruser

Meaningful Use Stage 2Meaningful Use Stage 2

3030

eRxeRx Optometrists can earn Medicare payment

bonuses for prescribing pharmaceuticals electronically;

However, they are NOT subject to Medicare payment reductions for failure to e-prescribe according to CMS.

Watch Remittance Advice for erroneous negative adjustments containing: – LE– Reason Code 237– Remark Code N545

3131

AOA: PQRSAOA: PQRS

Reporting Essentials:1. Utilize on Medicare patients2. Report with Quality Data Codes (QDCs)

that include CPT II and G codes3. May report with paper-based CMS 1500

claims4. May report with electronic 837-P claims

3232

AOA: PQRSAOA: PQRS

5. Must report QDC codes on the same claim as a CPT I code (charge as $0.01)

6. No penalty for more frequent reporting7. AOA recommends submitting QDC for all

reportable cases

3333

PQRSPQRS

Need to report on 3 PQRS measures 50% Need to report on 3 PQRS measures 50% of the time.of the time.

No need to report on more than three – No need to report on more than three – only raises chances of failure to meet the only raises chances of failure to meet the 50% threshold.50% threshold.

Dr. Quack’s PQRS Traffic Sheet should help Dr. Quack’s PQRS Traffic Sheet should help ease your reporting.ease your reporting.

3434http://nebraska.aoa.org/prebuilt/NOA/2011-12_3RD_Party_Newsletter.pdf

3535






3636

QRUR: Quality and Resource Use

Reports Medicare is moving to tie doctors’ pay to

quality and cost of care Value-based QRUR for MDs will begin in

2015, probably based on performance in 2013.

It will take effect for optometry in 2017, perhaps based on performance in 2015.

3737

QRUR: Quality and Resource Use

Reports The formula Medicare ultimately designs

to judge and pay doctors could become a valuable asset for private insurers

It may be a tool that will be somewhat bulletproof; physicians been part of the process of development

3838

CMS “Physician Compare”CMS “Physician Compare”

Information currently on the website Information currently on the website includes:includes:

Provider names, addresses, phone Provider names, addresses, phone numbers, specialties, clinical numbers, specialties, clinical training, and genders; training, and genders;

Whether provider write or speak Whether provider write or speak languages other than English; languages other than English;

http://www.medicare.gov/find-a-doctor/provider-search.aspx

3939

CMS “Physician Compare”CMS “Physician Compare”

Hospital affiliationHospital affiliation Whether provider accepts the Medicare-Whether provider accepts the Medicare-

approved amount as payment in full.approved amount as payment in full. Providers who participate in who participate in quality of quality of

patient care patient care programsprograms… … – PQRSPQRS– E-RxE-Rx

http://www.medicare.gov/find-a-doctor/provider-search.aspx

4040





MedicaidMedicaid CodingCoding Office ProceduresOffice Procedures BCBS BCBS

4141

MedicaidMedicaid

There is now Coverage of Unborn Children There is now Coverage of Unborn Children of Pregnant Women Not Otherwise Eligible of Pregnant Women Not Otherwise Eligible for Medicaidfor Medicaid

It is important to understand that this It is important to understand that this coverage is for the unborn child, not the coverage is for the unborn child, not the mother. mother.

Coverage of the mother is limited to only Coverage of the mother is limited to only those diagnoses that might have an effect those diagnoses that might have an effect on the pregnancy or the unborn child.on the pregnancy or the unborn child.

4242

MedicaidMedicaid

Only 180 Days to File a Medicaid Claim Only 180 Days to File a Medicaid Claim Starting in January 2013.Starting in January 2013.

This is instead of the current 12 month This is instead of the current 12 month time limit.time limit.

4343

Medicaid Medical HomeMedicaid Medical Home

Nebraska Medicaid is doing a pilot project Nebraska Medicaid is doing a pilot project on the Medicaid Medical Home concept a on the Medicaid Medical Home concept a clinic in clinic in KearneyKearney, and in , and in LexingtonLexington. .

Although the NE Medicaid medical home Although the NE Medicaid medical home physicians will not act as a true physicians will not act as a true “gatekeeper” (cannot limit access to “gatekeeper” (cannot limit access to providers), s/he will have significant providers), s/he will have significant influence if a referral is needed for eye influence if a referral is needed for eye care.care.

http://dhhs.ne.gov/medicaid/Pages/med_pilot_progress.aspx

4444

Medicaid Medical HomeMedicaid Medical Home

Thus, ODs must establish and maintain Thus, ODs must establish and maintain close relationships with PCPs to assure close relationships with PCPs to assure access to patients under the medical access to patients under the medical home concept. home concept.

Providing updates to the PCP via Providing updates to the PCP via correspondencecorrespondence, , copies of consultationscopies of consultations, , reports and test print-outsreports and test print-outs, plus , plus necessary necessary phone conversationsphone conversations, are ways to develop , are ways to develop such relationships. such relationships.

4545

Medicaid Patients Rate Medicaid Patients Rate DoctorsDoctors

A New Provider Rating and Review System A New Provider Rating and Review System (PRRS) Website has been launched, which (PRRS) Website has been launched, which allows consumers to monitor and evaluate allows consumers to monitor and evaluate the quality of provider services.the quality of provider services.

Although the ratings may not directly affect Although the ratings may not directly affect optometry at this time, they will likely optometry at this time, they will likely include all types of providers in the future. include all types of providers in the future.

The link to the Nebraska Medicaid Provider The link to the Nebraska Medicaid Provider Rating and Review System is available at Rating and Review System is available at https://https://prrs.ne.govprrs.ne.gov// Scroll to the bottom of the page.Scroll to the bottom of the page.

4646

Medicaid now using… Medicaid now using… National Correct Coding InitiativeNational Correct Coding Initiative

The National Correct Coding Initiative (NCCI) (also known as CCI) was implemented by CMS to control improper coding.

NCCI code pair edits are automated prepayment edits used when certain codes are submitted together for Part B-covered services.

You can find the NCCI edits for physicians, codes 90000-99999, in zip files at

https://www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp?intNumPerPage=all&submit=Go

4747

Medicaid now using… Medicaid now using… National Correct Coding InitiativeNational Correct Coding Initiative

NCCI edit examples:

Prevents payment for 92083 (fields) with 99211 (level 1 established E&M encounter)

Prevents payment for 92004 with 92002 (mutually exclusive exam codes)

Prevents payment for 92082 with 92083 (mutually exclusive fields codes)

4848

“How to Use the Searchable Medicare Physician Fee Schedule MLN Booklet”http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-

MLN/MLNProducts/Downloads/How-to-MPFS-Booklet-ICN901344.pdf

“How to Use the Medicare Coverage Database” http://www.cms.gov/Outreach-and-Education/Medicare-Learning-

Network-MLN/MLNProducts/downloads/MedicareCvrgeDatabase_ICN901346.pdf

“How to Use the National Correct Coding Initiative (NCCI) Tools“https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/How-To-Use-NCCI-Tools.pdf

National Correct Coding National Correct Coding InitiativeInitiativeResourcesResources

4949

Medicaid: Medically Unlikely Medicaid: Medically Unlikely EditsEdits

In addition to code pair edits, the NCCI includes a set of edits known as Medically Unlikely Edits (MUEs).

An MUE is a maximum number of Units of Service (UOS) allowable under most circumstances for a single HCPCS/CPT code billed by a provider on a date of service for a single beneficiary.

5050

Medically Unlikely EditsMedically Unlikely Edits

Examples of MUE maximum number of units:

92081 192082 192083 192100 192132 192133 192134 1

If NCCI or MUE would deny a code on a claim, the provider cannot utilize an AdvanceBeneficiary Notice (ABN) to seek payment from a Medicare patient.

5151






5252

Coding: Medicare CoverageCoding: Medicare Coverage

Medicare Now Covers Visual Evoked Potential code 95930. It was published on the WPS Optometry LCD on March 1st, 2012, and will be effective retroactively to April 1st, 2011.

Medicare Now Covers Tear Osmolarity Testing, CPT 83861, Effective 5/1/12.

5353

Coding: CPT on Therapeutic Coding: CPT on Therapeutic CLsCLs

CPT has created two new special CPT has created two new special ophthalmological codes for services for ophthalmological codes for services for reporting the use of therapeutic contact reporting the use of therapeutic contact lenses: lenses:

– 92071 – fitting of contact lens for 92071 – fitting of contact lens for treatment of ocular surface diseasetreatment of ocular surface disease

– 92072 – fitting of contact lens for 92072 – fitting of contact lens for management of keratoconus, initial management of keratoconus, initial fitting.fitting.

5454


These new codes replace the 92070, These new codes replace the 92070, "Fitting of contact lens for the treatment of "Fitting of contact lens for the treatment of disease, including supply of lens"disease, including supply of lens"

Both 92071 and 92072 are considered Both 92071 and 92072 are considered 'per lens‘ by CPT reported with RT or LT 'per lens‘ by CPT reported with RT or LT modifier to indicate which eye (WPS modifier to indicate which eye (WPS ‘bilateral’) ‘bilateral’)

Neither code includes the supply of the Neither code includes the supply of the contact lens.contact lens.

5555


Reimbursement for the CLs has been Reimbursement for the CLs has been problematic….. problematic…..

33rdrd Parties do not pay for 99070 (supply of Parties do not pay for 99070 (supply of materials)materials)

Some 3Some 3rdrd parties are paying for V-codes parties are paying for V-codes

Medicare BMedicare B does not pay for CL V-codesdoes not pay for CL V-codes

Medicare DMEMedicare DME does not pay for CLs except for does not pay for CLs except for aphakia.aphakia.

Other 3Other 3rdrd Parties are as confused as Medicare. Parties are as confused as Medicare.

5656

Coding: Medicare & Keratoconus Coding: Medicare & Keratoconus CLsCLs

The WPS Communiqué, our Medicare carrier’s quarterly newsletter, announced that CPT 92072, the fitting of contact lenses for keratoconus, is now considered inherently bilateral.

Therefore, reimbursement is for both eyes being fitted, and the use of a 50 modifier, or an RTLT modifier, is inappropriate.

If only one eye is fitted, then modifier 52 is called for, and the fitting fee should be adjusted down accordingly.

(A 52 modifier is appropriate whenever a bilateral procedure is performed on only one eye. Fee should be adjusted accordingly.)

5757

Coding: Glaucoma SeverityCoding: Glaucoma SeverityGlaucoma codes 365.10-365.65 must be Glaucoma codes 365.10-365.65 must be

reported with new codes 365.70-365.74 to reported with new codes 365.70-365.74 to provide information regarding the stage of provide information regarding the stage of the diseasethe disease. .

365.70 Unspecified365.70 Unspecified

365.71 Mild Stage365.71 Mild Stage**

365.72 Moderate Stage365.72 Moderate Stage**

365.73 Severe Stage365.73 Severe Stage**

365.74 Indeterminate365.74 Indeterminate

*specific definitions in CPT-2012*specific definitions in CPT-2012

5858

WPS: New Low Vision LCDWPS: New Low Vision LCD

From 2012 Winter Communique From 2012 Winter Communique http://www.wpsmedicare.com/j5macpartb/publications/comhttp://www.wpsmedicare.com/j5macpartb/publications/communique/archived/_files/2012-winter-cq.pdfmunique/archived/_files/2012-winter-cq.pdf

Low Vision Services LCD Low Vision Services LCD http://www.wpsmedicare.com/j5macpartb/policy/active/locahttp://www.wpsmedicare.com/j5macpartb/policy/active/local/l32007_ophth026.shtmll/l32007_ophth026.shtml

Low Vision Services Billing and Low Vision Services Billing and Coding instructions Coding instructions http://www.cms.gov/medicare-coverage-database/lcd_attachttp://www.cms.gov/medicare-coverage-database/lcd_attachments/32007_1/120811_00153_L32007_OPHTH026_CBG_0hments/32007_1/120811_00153_L32007_OPHTH026_CBG_010112.pdf10112.pdf

5959

NOC Code RequirementsNOC Code Requirements(not otherwise classified)(not otherwise classified)

The HIPAA Version 5010 implementation guide describes Non-Specific Procedure Codes as codes that may include, in their descriptor, terms such as:

Not Otherwise Classified (NOC);

Unlisted;

Unspecified;

Unclassified;

Other; Miscellaneous; Prescription Drug Generic; or Prescription Drug, Brand Name”.

More……….

6060

If a procedure code containing any of these descriptor terms is billed, a corresponding description of that procedure is required;

Otherwise, the claim is not HIPAA compliant, and thus cannot be reimbursed.

NOC Code RequirementsNOC Code Requirements

6161

Electronic Claim NarrativesElectronic Claim Narratives

When narratives are submitted on electronic claims to provide additional information related to the service line,

they should be entered at the line level, the 2400 loop in the NTE segment (not the 2400 loop, SV101-7 segment.)

There is a limit of 80 characters. Claims that require a narrative will be

denied as a return/reject if the narrative is not listed in this segment.

6262





MedicaidMedicaid CodingCoding Office ProceduresOffice Procedures BCBSBCBS

6363

DocumentationDocumentation

WPS Medicare audits have noticed the provider failed to document a face-to-face encounter with the patient.

A face-to-face encounter with the patient must occur and be documented in the medical record in order to bill an E/M service.

Upon medical review, Medicare will reduce or deny these services if there is no documentation for a face-to-face service.

6464

From the AOA: Cash From the AOA: Cash Discount?Discount?

You must charge all patients your usual and You must charge all patients your usual and customary fees, including private pay customary fees, including private pay patients. patients.

The FTC indicates that it analyzes how much The FTC indicates that it analyzes how much overhead is really being saved. If savings are overhead is really being saved. If savings are unrealistic, the discount is phony.unrealistic, the discount is phony.

The FTC has generally indicated that it views The FTC has generally indicated that it views any routine discount in excess of 25% not a any routine discount in excess of 25% not a genuine discount, but a reflection of the true genuine discount, but a reflection of the true price. price.

6565

The Federal Trade Commission engages in The Federal Trade Commission engages in elaborate and highly sophisticated elaborate and highly sophisticated analysis to assess such situations. analysis to assess such situations.

It should be noted that It should be noted that waivers of waivers of insurance co-paymentsinsurance co-payments or out-of-plan or out-of-plan charges is almost charges is almost always viewed as fraudalways viewed as fraud. .

From the AOA: Cash From the AOA: Cash Discount?Discount?

6666

ABN must be dated 3/2011ABN must be dated 3/2011

The latest version of the ABN (The latest version of the ABN (with the with the release date of 3/2011 printed in the lower release date of 3/2011 printed in the lower left hand cornerleft hand corner) is now available for ) is now available for immediate use and can be accessed via immediate use and can be accessed via the link below. the link below.

All ABNs with the release date of 3/2008 All ABNs with the release date of 3/2008 that are issued on or after January 1, 2012 that are issued on or after January 1, 2012 will be considered invalid.will be considered invalid.

http://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html

6767

Do Not Email PHIDo Not Email PHI

You should never include any protected health care information (PHI), such as a beneficiary Medicare number, in an e-mail sent to WPS Medicare.

You can submit this information safely through CSNAP's secure messaging feature.

You can sign up for C-SNAP at https://www.medicareinfo.com/apps/cms/home.do.

6868

PECOS UpgradePECOS UpgradeProvider Enrollment, Chain, and Ownership System

Providers and staff using internet-based PECOS will now see the following improvements:

Electronic Signature – You now have the ability to digitally sign and certify the application.

Access to More Information – Now you can see if a request for revalidation has been sent by your MAC.

Multiple Views of Your Information – Switch between Topic View and Fast Track View

Learn more about PECOS at https://PECOS.CMS.hhs.gov

6969

Medicare GLC ScreeningsMedicare GLC Screenings

Medicare provides coverage of an annual glaucoma screening GO-117 for beneficiaries in at least one of the following high-risk groups:– Individuals with diabetes mellitus– Individuals with a family history of glaucoma– African-Americans age 50 and older– Hispanic-Americans age 65 and older

The diagnosis code is V80.1 Payment in Nebraska: $47.65 for G0117

7070

Medicare GLC ScreeningsMedicare GLC Screenings

The patient’s appointment should have been made for a glaucoma screening. A glaucoma screening cannot be billed in addition to another examination code.

Medicare’s coverage of glaucoma screening includes – a dilated eye examination– an intraocular pressure (IOP) measurement and – a direct ophthalmoscopy examination or a slit-

lamp biomicroscopic examination.

7171

Medicare Billing CertificateMedicare Billing Certificate CMS has launched new Medicare Billing

Certificate Programs for Part B providers. To participate in the program, visit http://

www.CMS.gov/MLNproducts and select the "Web-Based Training Modules" link under the heading "Related Links Inside CMS."

This education includes required web-based training courses and readings and a list of helpful resources.

Upon successful completion of this Program you will receive a CMS certificate in Medicare billing.

7272

AOA: Medicare Audits Additional Medicare medical pre-payment Additional Medicare medical pre-payment

reviews may be coming to our area soon. reviews may be coming to our area soon. A prepayment reviewed claim will not be A prepayment reviewed claim will not be

processed until the physician responds to processed until the physician responds to the request to send records to the carrier.the request to send records to the carrier.

The 13 services announced are:The 13 services announced are:

CPT code CPT code 92235 92235

CPT code CPT code 92004 92004

CPT code CPT code 9201492014

CPT code CPT code 9201292012

CPT code 92020CPT code 92285CPT code 76514CPT code 92015

CPT code 92083CPT code 92250CPT code 92002CPT code 92226 CPT code 92225

7373

AOA: OIG Compliance AOA: OIG Compliance ProgramProgram

The Office of the Inspector General’s The Office of the Inspector General’s Voluntary Program for Medical Records Voluntary Program for Medical Records Compliance can be very helpful in Compliance can be very helpful in lessening concerns about audits by lessening concerns about audits by Medicare or other insurers.Medicare or other insurers.

Source: AOA NewsSource: AOA News

http://viewer.zmags.com/publication/ed02913d#/ed02913d/34http://viewer.zmags.com/publication/ed02913d#/ed02913d/34

7474

Requests for Record ReviewRequests for Record Review

For practice utilizes an electronic health record, verify all portions of the medical record are visible prior to printing and submitting the components to Medicare, e.g.,– physician orders, – physician signature,– test results, etc.

This can avoid the need for additional requests or claim denials for the missing documentation.

7575

Medicare Re-enrollmentMedicare Re-enrollment

Through 03/23/15, WPS and Noridian will send out notices on a regular basis to begin the revalidation process for each provider and supplier.

There are recent upgrades to PECOS; Once signed up, it makes your interactions with Medicare much simpler. http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/InternetbasedPECOS.html

A copy of your IRS form CP 575 may be required by the Medicare contractor to verify the provider or supplier’s legal business name and EIN.

7676

Manditory Education Manditory Education ResourcesResources

You are legally responsible for knowing the information disseminated in the WPS E-news listserv.

https://corp-ws.wpsic.com/apps/commercial/unauth/medicareListservUserWelcomeLoadAction.do

You are legally responsible for knowing the information disseminated in the Noridian E-news listserv.

https://naslists.noridian.com/list/subscribe.html?mContainer=2&mOwner=G30392x2n39372t36

7777






7878

BCBS BCBS

Nebraska BCBS providers recently Nebraska BCBS providers recently received correspondence from BCBS received correspondence from BCBS and Davis Vision announcing that, and Davis Vision announcing that, beginning in 2013, routine vision beginning in 2013, routine vision services through Davis Vision will be services through Davis Vision will be made available to Blue Cross and made available to Blue Cross and Blue Shield of Nebraska. Blue Shield of Nebraska.

7979

BCBS BCBS

It is our understanding that It is our understanding that Becoming a Davis provider is encouraged Becoming a Davis provider is encouraged

but not required by BCBSbut not required by BCBS Davis Vision has its own ophthalmic Davis Vision has its own ophthalmic

laboratories for use by its providers, and laboratories for use by its providers, and Davis supplies a large display of Davis Davis supplies a large display of Davis

Vision frames.Vision frames. As stated repeatedly in the past, Dr. Quack As stated repeatedly in the past, Dr. Quack

recommends completely understanding recommends completely understanding any provider agreement prior to enrolling any provider agreement prior to enrolling with a 3rd party with a 3rd party

8080

Coding: BCBS 50 ModifierCoding: BCBS 50 Modifier

As a reminder, BCBSNE requires two line As a reminder, BCBSNE requires two line charges when reporting bilateral surgery.charges when reporting bilateral surgery.

The first side should be submitted The first side should be submitted unmodified and with a charge for the first unmodified and with a charge for the first side. side.

The second side should be submitted with The second side should be submitted with modifier -50 and a charge for the second modifier -50 and a charge for the second line.line.

8181

Resource For This Resource For This PresentationPresentation

NOA 3NOA 3rdrd Party Web Page found at Party Web Page found at

HTTP://HTTP://

NEBRASKA.AOA.ORG/NEBRASKA.AOA.ORG/

PREBUILT/PREBUILT/

NOA/NOA/

INDEX.HTMINDEX.HTM

http://nebraska.aoa.org/prebuilt/NOA/index.htm

Documents

1 NOA 3 rd Party Update 2012. 2 Resource For This Presentation NOA 3 rd Party Web Page found at NOA 3 rd Party Web Page found atHTTP://NEBRASKA.AOA.ORG/PREBUILT/NOA/INDEX.HTM