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The following 21 pages contain links to articles previously published in the NOA 3rd Party Newsletter. Only current articles relevant as of September 2017 are included. Also included are links to Internet websites currently important to the practice of optometry.
The Index can be searched in a variety of ways, the most efficient of which is to use the CONTROL-F Find Function on your computer. Simply hold down the CTRL (or COMMAND) key, then press the F key. A box will appear where you can enter the term of interest to you. Also, found below, is a alphabetical index, plus quick links to general topics of interest.
#A BC D E FGH IJKL M N OP QR ST UVWYZ
• CPT SERVICE and PROCEDURE CODES
• CPT MODIFIERS
• DME POST-OP GLASSES/CLS
• EDUCATIONAL VIDEOS ON 3RD PARTY TOPICS BY DR. QUACK
• HIPAA
• ICD-10 DIAGOSIS CODES
• MEDICARE
• MEDICAID
Updated March 2019
The following 20 pages contain links to articles previously published in the NOA 3rd
Party Newsletter. Only current articles that were relevant as of September 2017 are
included. Also included are links to Internet websites currently important to the practice
of optometry.
The Index can be searched in a variety of ways, the most efficient of which is to use the
CONTROL-F Find Function on your computer. Simply hold down the CTRL (or
COMMAND) key, then press the F key. A box will appear where you can enter the term of
interest to you. Also, found below, is a alphabetical index, plus quick links to general
topics of interest.
#A BC DD EE FGH IJKL MM NN OP QR ST UVWYZ
• CPT SERVICE and PROCEDURE CODES
• CPT MODIFIERS
• DME POST-OP GLASSES/CLS
• EDUCATIONAL VIDEOS ON 3RD PARTY TOPICS BY DR. QUACK
• HIPAA
• ICD-10 DIAGOSIS CODES
• MEDICARE (4 pages)
• MEDICAID (2 pages)
#
92004 and 92014 Comprehensive Exam Requirements [01-11] [05-17]
92000 vs. 99000 Exam Codes— Dr. Quack Video; Eyecor [01-15] [05-17]
92000 Coding Score sheet by Dr. Quack: Pp. 11-12 of [07-16] [05-17]
92014 vs. 99214 [03-15] [05-17]
92072 Fitting CL for Keratoconus [07-12]
99211 Coding Errors [06-11]
99213 vs. 99214 Coding errors [12-10]
92225 Extended ophthalmoscopy & Medicaid [03-04]
92227—92228 [02-11]
99000 coding Score sheet by Dr. Quack found on last 2 pages of [05-10]
99211 Coding Errors [03-09]
9930X E&M Nursing Home Coding Score Sheet by Dr. Quack {12-12]
A
ABN —–see Advanced Beneficiary Notice
ACA (Affordable Care Act) [03-13] [05-13]
Pediatric Vision Essential Benefit [03-13]
Rethink Eyecare [01-14]
Verifying Marketplace Coverage [02-14]
Accountable Care Organizations ACOs [11-11] [08-14]
ACOs and PHOs [06-13] [08-13] [01-14] [09-15]
ACOs in Nebraska in 2015 [06-15]
Advanced Beneficiary Notice (ABN) Update [06-17] [09-17] [11-17]
CMS Instruction Booklet Link
CMS ABN Educational Pamphlet
Non-covered items do not require ABN [11-15]
Option 2 completion instructions [12-15]
Patient refuses to sign? [04-13]
Tutorial, Interactive, by CMS [01-16]
Use by non-DME Supplier [02-18]
After-Hours billing [02-17]
Alcohol & Drug Abuse Assistance [01-12]
America Academy of Ophthalmology (AAO)
American Optometric Association (AOA)
Anti-Trust Guidelines from AOA [10-13] [11-13]
Board Certification [12-15]
Coding: AOA Resources [08-10] Coding Today [03-18]
EHR Registry “MORE” [05-16] [01-18]
American Society of Cataract & Refractive Surgeons (ASCRS)
Anti-markup (purchased service), Billing of CMS Manual System [05-09]
Anti-Trust Guidelines from AOA [11-15] AOA List of Do’s/Don’ts
A-Scans [10-10]
Audits: Preparing for audits - from AOA [10-14] RETURN TO PG.1.
B
Beneficiary Authorization to file a claim [01-10]
Bilateral vs. Unilateral [07-17]
Blue Cross Blue Shield of Nebraska Home Page Provider Manual [10-17]
50 Modifier [12-11]
Contact Lens Discounts [03-16]
CPT Coding [10-17]
Davis Vision [09-12]
Discount Plan Page 47 in BCBSNE Provider Manual [04-17]
Documentation [08-17] Records Request [10-17]
Fee schedule available via NaviNet [07-17]
HEDIS [02-16]
Medicare Advantage Plans [04-17]
Microfluidic analysis 83861 coding [03-18]
Provider Policy Manual
Post-Op Policy Change [11-16] Page 126 in Provider Manual
Reimbursement for V-codes [04-13]
Vision Therapy coding [11-06]
C
Cash Discounts vs. Insurance Fraud [10-03] [11-17]
CEDI — see DME electronic claims
CERT Comprehensive Claims Error Rate Testing [01-12]
Chief Complaint [1997 E&M Guidelines]
Child Abuse Nebraska Law [05-16]
CL — see Contact Lens
CMS
[CMS Homepage]
CMS Online Manual System
CMS Form Downloads
CMS-1500 Claim Forms Fact Sheet
Qualifying to file paper claims [02-09]
Box 29 [06-07] [04-12]
Box 32 and POS [09-08]
Reconsideration Request form download
Redetermination Request form download
Coding
Coding for maximum profit [08-05]
Coding Fraud [06-02] [08-05] [11-17]
Coding Videos by NOA [04-15]
“Coding Today” AOA Resource —- see under AOA
Co-management—see Post-op care
Common Electronic Data Interchange — CEDI — see DME MAC electronic claims
RETURN TO PG.1.
Compliance
AOA HIPAA Security Compliance Manual (2013 Revision)
Consolidated Billing (Medicare B and DME) [07-11] [10-11]
Consultation and Referral Coding Denied by Medicare [01-10]
Contact lenses
Bandage CL: AOA coding recommendation [07-12]
Contact Lens Rule (FTC final rule, 10 pages) [FTC Contact Lens Rule] [05-16] [04-18]
Contact Lens Rx Release
Document Expiration Date [09-17]
[FTC Contact Lens Rule] [04-18]
[Nebraska Mail Order CL Act] [12-14]
Required Release [12-15] [11-17]
Cosmetic [09-10]
Document Expiration Date [12-16]
Fairness to Contact Lens Consumers Act (FTC final decision, 118 pages) [Federal Register]
Reporting Violations to...[01-05]
Federal Contact Lens Rule (FTC final rule, 10 pages) [FTC Contact Lens Rule] Complying with [05-16] [04-18]
Medicaid CL Rules — see Medicaid: Vision Services Manual
Medicare and CLs — see DME MAC Contact Lenses
[Nebraska Optometry Rules/Regs] [12-16] Controlled Substances Number — Nebraska’s Discontinued [10-01]
Co-pay waiving [03-13] Affect on practice [10-17]
Correct Coding Initiative See under Medicare: ~ Correct Coding Initiative
CPT Codes Used by Optometry
92004 and 92014 Comprehensive Exam Requirements [01-11]
92000 vs. 99000 Exam Codes— Dr. Quack Video; Eyecor [01-15]
92000 Coding Score sheet by Dr. Quack: Pp. 11-12 of [07-16]
92014 vs. 99214 [03-15]
92072 Fitting CL for Keratoconus [07-12]
99213 vs. 99214 Coding errors [12-10]
92225 Extended ophthalmoscopy & Medicaid [03-04]
92227—92228 [02-11]
99000 coding Score sheet by Dr. Quack found on last 2 pages of [05-10]
99211 Coding Errors [03-09]
9930X E&M Nursing Home Coding Score Sheet by Dr. Quack {12-12]
Credentialing – Aperture Routine Vision Credentialing [04-16] [08-16] QQQ video [11-16]
C-SNAP —– see Medicare C-SNAP
RETURN TO PG.1.
D
Date of service [1997 E&M Guidelines]
DEA Controlled Substances Number [07-09]
Nebraska’s Discontinued [10-01]
Required for some Medicaid MCOs [10-16]
Deceased Patients: coding for services [02-04]
Delegation, Supervision, and Coding: Nebraska: [06-06] Medicare [11-06]
-Diabetes
Communicating with PCP [09-05] [02-17] [05-17] [11-17]
Diabetic eye exams [10-11] [06-17]
Diabetic Reporting Forms [09-05] [02-17] [05-17]
Diagnostic and treatment program [1997 E&M Guidelines Adobe Find]
Discounts—-see Fees
Discrimination – Patient [08-16] [11-16] [12-16]
DME MAC (formerly DMERC) [Noridian DME MAC Home Page] Bill DME or Medicare B? [04-17] [02-18]
DME MAC Accreditation no longer required for ODs: [05-09]
DME MAC ABN On demand education [09-13] Use by non-DME supplier [02-18]
DME MAC Contact Lenses LCD and Policy Article on “Refractive Lenses”
CL coding [09-16]
Frequent Replacement [11-09]
DME MAC CEDI —see DME MAC electronic claims
DME Deactivation with none-use [07-09]
DME MAC Documentation Requirements [07-12] [04-17] [08-17]
Date of Service [07-15]
Glasses Rx Requirements [08-14]
Save for 7 years [07-15]
DME Education on Demand [06-16] [12-17]
DME MAC Electronic Claims (CEDI) [10-11] [02-13]
CEDI Password [03-15]
CEDI ID suspended after 60 day inactivity [10-14]
Narratives [01-12]
DME Enrollment fee [01-14]
DME MAC Eye Prosthesis Coding DME LCD Page
DME MAC Fee Schedule
DME LCD and Policy Article
DME Modifiers [04-16] ( see also under Modifiers)
DME Office Inspections [12-17]
DME MAC non-supplier [02-12]
DME MAC Participating vs. Non-participating educational video [01-16]
DME MAC Proof of Delivery [05-12] [03-15]
DME continued on next page…. RETURN TO PG.1.
DME Continued….
DME MAC Post-Op Coding —- CMS-1500 Completion Suggestions by Dr. Quack [03-15] [05-17]
DME MAC Refractive Lenses LCD and Policy Article
DME MAC Reopenings and Redeterminations
DME MAC (DMEPOS) Supplier Manual Copy to every DME patient [07-12]
DME MAC Surety Bonds [10-09] AOA explanation [11-09] Update [05-10]
DME MAC Transitions lenses [02-05]
Documentation, adequate record [09-17] [11-17]
Diagnostic Services
Signature Unsigned orders [04-11] [04-18]
[1997 E&M Documentation Guidelines]
Extended time [03-15] [02-18]
Chronic conditions [11-13]
Coding errors: 99213 vs. 99214 [12-10]
HPI must be done by doctor [05-12]
New vs. Estab [07-13]
Ophthalmology [01-11];
Repeated Billing of same E&M Codes [09-12]
EHR Documentation [01-12]
Lid Surgery (Browlift Blepharoplasty) documentation [07-15] [03-17]
WPS Education [04-12] [06-12] 3
Driver’s Vision Requirements Motorist’s Vision Requirements for Nebraska
E
E-Prescribing Incentive program ended 2013; Part of meaningful use
E & M Wall Chart
The following nine 8 1/2 x 11 graphic pages make up a 3 page by 3 page wall chart that explains the relationships between History, Examination, and Decision Making in determining the final E&M level of service. Miniature examples at right.
*** Code Chart 1 - History
*** Code Chart 2 - History Score
*** Code Chart 3 - New Pt Score
*** Code Chart 4 - Examination
*** Code Chart 5 - Examination Score
*** Code Chart 6 - Established Pt Score
*** Code Chart 7 - Decision Making
*** Code Chart 8 - Decision Making Score
*** Code Chart 9 - Dr. Quack’s Directions
RETURN TO PG.1.
EDI—
See DME MAC Electronic claims
See Medicare Electronic claims
Educational Videos by Dr. Quack
VIDEO 1: Should I become a 3rd
party provider?
VIDEO 2: Steps to become A 3rd
party provider
VIDEO 3: Filing claims---background information
VIDEO 4: Filing claims using the 92000 ophthalmology codes
VIDEO 5: Filing claims using the 99000 Evaluation and Management codes
VIDEO 6: The 92000 vs. 99000 codes---which to use?
VIDEO 7: Using modifiers when filing claims---how and why
VIDEO 8: Filing claims as a Medicare Supplier (cataract post-op claims)
VIDEO 9: 3rd
Party Resources Available
VIDEO 10: Evaluating 3rd
parties---deciding whether to enroll as a provider
Electronic claims — Look under EDI, also DME MAC electronic claims
Electronic Health Records (EHR)
Audits [11-14]
Broadband Access Exclusions [03-16]
Changing/switching Vendors Advice [10-15] [11-15]
Clinical Decision Support Interventions [03-16]
Clinical Quality Measures (CQM)
CPOE Electronic Order Entry [04-16] [08-17]
FAQs [11-12]
Hardship exemptions [03-16]
HIPAA EHR assessment tool [11-14]
Integrity EHR integrity required [11-16]
Lab Tests core measure [04-15]
Meaningful Use 2015-17 [01-16] [03-16]
CPOE [01-15] [01-16]
Medicaid EHR Incentive: ODs do not qualify [09-11]
Multiple Locations—practicing in.. [05-14]
Objectives, Measures and Resources for 2016 [05-16]
Patient electronic access
Public health objectives stage 1 and 2 [04-16]
Nebraska Syndromic Surveillance [04-16]
Protected Health Information Core Objective Attestation
Record Format: Cloned records [11-12] Templates/checkboxes [06-13]
Registration Verification [01-13]
Registry by AOA “MORE” see under AOA: Registry MORE
Security Risk Analysis [01-14]
RETURN TO PG.1.
Encrypting you medical records [03-13]
Enrollment---Questions to ask before enrolling in a plan [04-16]
Epilation Coding [03-09]
Equity Laws from HHS [06-16]
eRx—-see E prescribing
Extended ophthalmoscopy 92225 —- Medicaid requirements [03-04]
F
Fees, Charges, and Payments
See under Medicaid or Medicare for fee schedules
Discounts for cash vs. Insurance Fraud [03-12] [11-17]
Fingerprinting for enrollment [12-16]
Foreign body and rust ring coding [06-17]
Forms — See under CMS Forms
Frames
Medicare— see under DME MAC: LCD and Policy Article
Medicaid — see under Medicaid Online Services: Vision Care Handbook
V-codes—- see under HCPCS codes
Fraud and Abuse Definition [12-17] CMS Booklet [02-18]
Fundus Photos
[2008 Medicare LCD-retired]
“Baseline?” [01-11]
To follow GLC and AMD [03-17]
Orders for [03-10]
Scanning laser fundus photos [01-15]
G
Glaucoma
Billing during cataract global period [08-12] [04-18] [04-18]
Screenings for Medicare patients [02-04] [07-06]
SCODI and Fields on same day [03-16]
Stages of, and coding [03-12]
H
HCC Coding Heirarchical Categorical Coding [02-17]
HCPCS Codes HCPCS II V-codes
Level II: Overview
Hierarchical Conditional Coding (HCC) [09-17]
RETURN TO PG.1.
HIPAA Summary [04-17]
HIPAA Regulations
• Combined Text of all HIPAA Rules (Updated March 2013)
• HIPAA Omnibus Final Rule (Issued January 2013)
• HIPAA Breach Notification Rule (Issued August 2009) Basics [03-18]
• HIPAA Security Rule Summary (Compliance was required as of April 20, 2005) Basics [03-18]
• HIPAA Privacy Rule Summary (Compliance was required as of April 14, 2003)
Templates and Forms
• Notice of Privacy Practices (AOA) (HIPAA Model NPPs)
• HHS Sample Business Associate Agreement
• File a HIPAA Complaint
• Security Risk Assessment Tool
AOA HIPAA Security Compliance Manual (Most recent 2013 Revision) AOA Resources [12-17]
Index of Previous HIPAA Articles and other Resources
Audits: Privacy and Security [04-16] [08-16] [12-16] Documentation [03-17]
Fake Audit Warning [06-17]
Business Associate [10-13] Security [06-16]
Breach reporting [11-16]
Cloud guidelines [11-16]
Compliance Program Fundamentals [06-17]
Cyber Insurance coverage [06-14] Checklist [07-17]
Cyber attacks likely [08-16]
Disclosure to Family, friends, and others involved in patient’s care [11-17]
Discrimination not allowed [08-16]
Documentation [03-17]
EDI Requirements [10-15]
EHR risk assessment tool
Electronic claims requirements [10-14]
Encryption [10-16]
FTC requirements that supplement HIPAA [11-16] [10-17]
Notice of Privacy Practices
Acknowledgement of receipt [10-14]
Notification Rules (breach of privacy or security) [09-15]
NOA Nebraska HIPAA Recommendations [03-14]
PASSWORD security & password checker [09-16] [10-16]
Phishing Scam [12-16]
Privacy Fact sheet [01-14] [07-14] [01-18]
Privacy practices in front office [11-14]
Ransomware Resources [06-17]
Release of Rx [05-15]
HIPAA continued….
RETURN TO PG.1.
HIPAA continued...
Release of records – [03-14] [01-18]
Patient’s rights [02-16] [04-16]
Can you charge for records [04-16]
If money is owed [04-16]
Risk Assessment Tool [01-14] [04-14] [11-15] [08-17] Risks with Copiers [11-13]
Sign-In Sheets [04-16]
Simplification Tools [06-17]
Text messaging [01-17]
Used Instrument containing PHI—Sale of [12-17]
When away from office [01-18]
History of Present Illness (HPI) [1997 E&M Guidelines]
Hospice Patient Coding [03-09]
Hydrocodone — Level II narcotics unavailable to ODs in Nebraska [10-14]
I
ICD-10-CM 2019 NOA ICD-10 TABLE for ODs
External Cause Coding (V,W,X,Y codes) should be avoided [02-16] [12-17]
Laterality [02-16]
Post-op Codes [11-15]
“Incident to” physician services, billing —–see under Medicare
Insulin and non-insulin medications [01-17]
Insurance Plan Contract evaluation —
AOA Tips [02-11]
VIDEO Evaluating 3rd
parties---deciding whether to enroll as a provider
Interpreter Translation Requirements and Resources for Hearing and Speech Impaired, Limited English Language Proficiency [05-15] [12-16]
[Google translation] [03-17]
HHS Language Assistance Site
Medicaid interpretation/translation resources [03-17]
IPA [02-15]
J-K
L
LASIK:
Prudent Referrals [FDA Website]
FDA Warning on Marketing [10-11]
LCDs — Local Coverage Determinations: see Medicare LCDs
Licensure Laws [Optometry Law & other Licensure Laws]
RETURN TO PG.1.
M
Malpractice claims Common Reasons for [07-16] Definition [08-16] Insurance FAQs [03-18]
MEDICAID Web Page (Nebraska Medicaid Home Page)
Bulletins (on bottom of webpage)
Changes in address, practice: reporting [11-16] [03-17]
Condition Codes for replacing frames/lenses [07-05]
Co-pay [02-13] with EyeMed [09-16]
Credentialing and re-credentialing QQQ Video [11-16]
Discounts must be disclosed [04-10]
Dual eligible Medicare + Medicaid [12-17]
Co-insurance & deductible Balance Billing Not Allowed [04-17] [07-17]
Meaningful Use Credit [03-17]
Electronic Claims [01-12] [05-12]
Electronic Funds Transfer [02-09]
EHR Medicaid Incentive Program Not Available in NE [09-13]
Eligibility confirmation [01-17]
Email secure communication
Employee background check [04-09]
Enrollment Page for State Medicaid Providers
Enroll with state before enrolling with MCOs [12-15]
Managed Care Enrollment Contacts [06-16]
Re-enrollment - Revalidation required [10-16] [12-16]
Fee Schedule
“Routine” Medicaid exams paid at intermediate level [08-14] [04-17]
Fingerprinting [01-17]
Heritage Health reorganization …see under Managed Care below
ICD-10 Unspecified codes denied [01-14] [12-17]
Managed Care—
Medicaid Managed Care changes in 2017 “Heritage Health”
Heritage Health Managed Care System [01-16] [04-16] [07-16] [08-16] [12-16] [02-17] [12-17]
Contact Information for 3 MCOs [06-17]
Dual Eligible Claims [06-17] [07-17] [12-17]
Enrollment [08-16]
Fee Schedule—not required to follow state fee schedule [03-18]
March Vision replaces Superior Vision under UHC Community [10-18]
Quick Reference Guide
Refraction under UHC Community Plan [02-18]
Retroactive Enrollment [08-16]
MEDICAID continued on following page….
MED
ICA
ID
RETURN TO PG.1.
MEDICAID continued from previous page...
OBSOLETE: Outdated Medicaid Managed Care Information kept for historical reference only
Billing [06-13] [08-13]
Differences in the four MCO’s Vision Policies [07-14]
Differences in reimbursement [06-15]
Eastern Counties [07-10]
Western 83 Counties [02-12] [04-12]
Contact Info [07-12]
Refraction with Medical Exam [10-12]
Frame limits [11-12] Medical Home [10-12]
Mother of unborn child — see Medicaid pregnancy related service
Medicaid Visual Care Provider Handbook
Billing Instructions
Bulletins—-Bottom of page
Payment Rules
Vision Care Fee Schedule
Vision Care Rules
NCCI and MUE edits [07-16] [07-17]
Overpayments [06-10]
Polycarbonate lenses for children [10-16]
MCO’s different polycarb Policies [07-14]
Preferred Drug List—2019 (for EYE Rx, see under Ophthalmics Section)
Preferred OTC Drug List—2019
Nebraska Total Care (Envolve)
United Health Care (March Vision)
WellCare (Avesis)
Pregnancy related services see under Unborn Child
Private insurance, with.. [03-15]
Prescription pads—-Tamper-resistant required [01-08]
RAC (Recovery Audit Contractor) [02-12]
Retroactive enrollment [08-16]
Rating Providers [06-12]
Scratch Coat [08-03]
Site Visits Required in Nebraska [03-16]
Translation resources [03-17]
Unborn Child Recipient —
Medicaid Pregnancy Related Services
Unborn child of undocumented residents –LB-599 [07-12] [08-12]
V-codes HCPCS II V-codes
MED
ICA
ID
RETURN TO PG.1.
MEDICARE
Wisconsin Physician Services GHA Home Page (our Medicare B Contractor)
Advantage—-Medicare Advantage (MA) Plans
AOA Advice on MA [06-15]
[CMS Overview] of MA
[Medicare info for Nebraskans] (Nebraska Dept. of Insurance MA Resources)
Deemed to be an MA Provider [05-13]
Fraud Waste Abuse training required for MA providers? [09-09] [07-14]
Training not needed? [09-14] [10-14] [11-17]
Anti-markup pricing (formerly called purchased diagnostic services) [05-09]
Appeals — [WPS Website]
ASETT Administrative Simplification Enforcement & Testing Electronic compliance [04-18]
Audits [06-12] [08-12] [11-17]
Balance Billing Illegal [04-17] [07-17]
Billing Instructions Section
Cards– Medicare ID Card Replacement [10-17] [11-17] [12-17] [01-18] [03-18] [04-18]
CERT Error Rate Testing
Common Ophth. Code Errors [01-11]
CCI —– see Medicare Correct Coding Initiative (CCI) Edits
Changes in address, practice, ownership: reporting [11-16] [06-17]
Claims—
CMS Internet Only Claims Processing Manual
837P Electronic and CMS-1500 paper claim use and limitations Crossover issues [01-18]
Claim Forms [11-17]
CLIA Laboratory testing [04-09]
Communiqués [Medicare B Website]
Comparing Providers --- see Medicare: Physician Compare
Comparative Billing Reports [12-15]
Compliance Program Video by CMS [12-16]
Consultation codes not accepted [01-10]
Correct Coding Initiative (CCI or NCCI) [Codes not billed same day] [07-16] [07-17]
C-SNAP Secure Network Access Portal [11-14] Replaced [10-17] [11-17] [02-18]
Credentialing and re-credentialing QQQ video [11-16]
[Crossover disposition codes]
“D” Medicare D (drug benefit)
Delegation to Employees and TC modifier [11-06] (see also Medicare: Incident to)
Directory of Medicare Providers (MEDPARD) [04-16]
Documentation — see under “D” Documentation
Dual eligible Medicare + Medicaid [04-15] [04-16] [06-17]
Balance Billing Not Allowed [04-17] [07-17]
Meaningful Use Credit [03-17]
MEDICARE continued on following page...
MED
ICA
RE
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MEDICARE (continued)
Education [WPS Medicare B] Required Education [08-15] [10-16]
E-newsletter required [07-16] [04-17]
E-prescribing — see under E-prescribing
EIDM replaces IACS [07-15] [07-16]
Electronic Claims required [04-13]
Electronic Funds Transfer [12-16]
Enrollment (also see PECOS) [Medicare B] [08-16] Paper [07-11]
Assistance [11-14]
Deceased Provider disenrollment [03-16]
Disenrollment from group [04-14]
email [06-11]
Fees [04-11] [01-14]
Re-enrollment (Revalidation) [05-16] [04-17] [06-17]
False Claims Act [08-09]
Family members billing of [07-17]
Fee limits for non-participating providers —-see Medicare Limiting Charge
Fee Schedule Medicare B Fee Schedule (Look under “YYYY Physician Fee Schedule”)
Forms CMS Forms
Fraud Waste and Abuse training [07-14] not required? [09-14] [10-14]
Glaucoma Screenings [Medicare Preventative Services]
Global Surgery [CMS Fact Sheet] [04-18]
Hospice patient coding [03-09]
HPSA (health professional shortage area) [CMS] 2018 [01-18]
TC and 26 Modifiers [06-12]
“Incident-to” a physician services [CMS Internet Only Manual 60.1—60.3] [WPS] [CMS Bulletin]
Interpretation and Report [04-14]
Laboratory testing—-see Medicare CLIA
LCD — Local Coverage Determinations [Policy Overview] [WPS LCDs] [11-17] [Retired LCDs]
MCD Medicare Coverage Database [06-17]
Listserv WPS Listserv signup Required [07-16]
Limiting Charge [Defined in MPFS Article] [03-11] [Fee table listing 2017 limiting charges]
Local coverage determinations —– see Medicare: LCDs
Low Vision Assistants/Specialists [CMS Manual pg 203]
Locum Tenens (substitute provider) [CMS Manual] [12-12] [04-14] [04-16] [04-17]
MACRA 2105 fee reimbursement law [05-15]
Manuals (CMS) [CMS Internet Only Manual List] [09-08]
Medical Necessity [12-12] MEDICARE continued on following page...
MED
ICA
RE
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MEDICARE (continued)
MIPS quality payment system [05-16] [06-16] [07-16] [10-16] [10-17] [01-18] [02-18]
AOA List of MIPS Quality Measures [04-17] [08-17]
New Data Submission System [02-18]
Participation status [06-17] [01-18] [02-18]
Participate if exempt? [06-17] 2018 MIPS Newsletter Without EHR? [04-18]
RESOURCES [07-17] [08-17] [10-17] 2018 MIPS Newsletter [01-18]
TABLE [02-17] 2018 MIPS Newsletter
Modifiers [Table of Medicare Modifiers]
Pricing Modifiers must be place first
MPFSDB Medicare Physician Fee Schedule Database
[CMS Search Page]
How to use search page
Resources Available [07-12]
Status Indicators (see pg. 21+) Quack List
Unilateral vs. Bilateral [07-17]
MSP Medicare Secondary Payer—-see Secondary Payer below under Medicare
MUE —Medically Unlikely Edits (limits # of units billed same day) [07-16] [07-17]
Multi-Factor Authentication Portal Requirements MFA (formerly C-SNAP) [10-17] [02-18]
Multi Procedure Payment Reduction (MPPR) [01-13]
National Coverage Determinations (NCDs) [01-16]
NCCI —– see Medicare Correct Coding Initiative (CCI) Edits
NOC Codes [02-12] [03-12]
Non-covered items booklet
Detailed Explanation of Non-Coverage
Notice of Medicare Non-Coverage
Non-face-to-face time billing [01-17] Now Payable [04-17]
Non-Participation provider limitations [02-10]
Nursing home coding Coding Scoresheet [05-11] [06-11] [07-11] 92000 rejected [12-12]
Open Payments – see Medicare - Sunshine Act
“Opting Out” as Medicare Provider
Ordering or Referring Providers [05-13] [12-13]
Overpayments
Paper Claims — see CMS-1500
Qualifying for filing Paper [04-13]
Participating Provider Directory [MEDPARD]
Patient Identifier Number change from SSN [06-17] [07-17] [08-17]
Patient Satisfaction [07-15]
PC Ace software [06-17] [11-17]
PECOS [08-16] revalidation [07-16]
Physician Compare including ODs [08-17] [11-17] [12-17] [01-18] [04-18]
PIN and PTAN —–see Medicare PTAN
Post-op coding and rules —– See under Post-op coding MEDICARE continued on following page...
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MEDICARE (continued)
[Preventative Services]
Prolonged Services codes [04-17]
PTAN [06-12] [12-13]
Purchased Diagnostic Services —- see Medicare Anti-markup pricing
QRUR Quality and Resource Use Reports Value based payment modifier [10-16] To Obtain
Reason and Remark Codes [CMS Reason Remark Codes]
Reciprocal billing & Locum Tenens (substitute doctor) [WPS Provider Education] [CMS Manual]
Recovery Audit Contractor for Nebraska (WPS RAC)
Re-enrollment —- see Medicare Enrollment
Reference Guide for New Physicians and Suppliers [Guide on CMS]
Referring Physician and Supplier Lookup
Refraction requires GY modifier [11-15]
Relatives—cannot bill for [07-13]
Refunds (voluntary) See Medicare -- overpayments
Remit Easy Print (MREP) Software [CMS] [08-17] [11-17]
Remittance Advice [CMS Understanding Remttance Advice][08-16]
Reopenings See Medicare -- Appeals
S-Codes not accepted by Medicare [List of Approved HCPCS codes]
Secondary Payer [CMS Explanation] [Office Questionnaire] [02-13]
Scribes, use of [08-17]
Self-service from WPS to explain claim rejection [12-17] [01-18]
Signature —requirements [CMS Manual] [06-16] [08-17] [04-18]
scribes [08-17]
signature on file errors [05-15] [06-16] [04-18]
Smoking Cessation [03-17]
Social Security Medicare Beneficiary Number Removal [06-17] [07-17] [08-17]
Standing Orders [02-13] [01-14] [WPS]
Substitute doctor —– see Medicare: Reciprocal billing & Locum Tenens
Summary Notice (to patients from Medicare)
Sunshine Act (Open Payments) [08-16]
Supervision Requirements [03-03] [06-06]
Surgery billed multiple times in a day [04-09]
Taxonomy codes [CMS]
Training On Demand [08-17]
[TriCare] [02-18]
Unilateral vs. Bilateral [07-17]
see Medicare: QRUR
Vision Services [08-17]
Wisconsin Physician Services NE Medicare B Carrier
Required e-News Required Communique’
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M Continued…
Meibomian Gland Dysfunction [06-16]
Missed Appointments –charging for [08-07]
Modifiers
—Medicare [WPS Table of Medicare Modifiers]
More than four modifiers? [12-11]
24 Modifier: E&M not related to Post-op Care [11-03] [WPS] [02-16]
25 Modifier: How to File a Service Along With a Procedure [WPS] [02-16] [02-18]
26 and TC Modifiers [WPS] [03-13]
50 - 52 Modifiers [WPS] Also see under Medicare—MPFSDB
54-55 Modifers [WPS] [07-08] [05-11]
59 When you can use [WPS] and {WPS}
Addition of 59XE, 59XS, 59XP, or 59XU modifiers [02-15]
76 [WPS] [01-15]
AQ Modifier [WPS]
EY Modifier [CMS] DME table [04-16]
GA Modifier [WPS] DME table [04-16]
GW Modifier [CMS] Ancillary testing [01-17]
GY Modifier [WPS] DME table [04-16]
GZ Modifier [WPS]
KX Modifier DME table [WPS] [04-16]
RT vs LT [02-15]
Motorist’s Vision Requirements for Nebraska
N
National Coverage Determinations (NCDs) [01-16]
National Provider Identifier [08-09] [06-12]
Nebraska Department of Revenue [Sales Tax exemptions] [Use browser to search page for exemption
Nebraska Licensure Laws [Optometry Law & other Licensure Laws]
NeHII View of Patient Records [03-17]
New Licensee Information [06-16] [05-17]
NPI See National Provider Identifier
NPPES see all NPI articles
Nursing home coding Coding Scoresheet [05-11] [06-11] [07-11] [09-17] 2000 rejected [12-12]
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O
OCT (optical coherence tomography) - scanning laser, HRT GDx, SCODI, etc
[WPS LCD SCODI] …..
CME and OCT Coding [05-16]
Coventry Prior Authorization required [02-11]
Glaucoma: SCODI and Fields on same day [03-16]
Glaucoma 92133 & 92134 same day [08-17]
Optic Nerve and Macula same day? [08-15]
Plaquenil Patients [02-16] ICD-10 Diagnosis Coding [05-16]
Place of Service change [07-16]
“Ruling out” a disorder with OCT [10-17]
OD Therapeutic Certification Proof [08-12]
Optometry Practice Act (Licensure Law) in Nebraska [Optometry Law & other Licensure Laws]
Optometry Rules and Regulations — [Rules and Regulations]
Education Requirement for Renewal [10-12]
Therapeutic Certification Proof [08-12]
Optomap [12-05] [08-10]
OSHA Standards in your office [11-13]
P
Paper Claims—– see under Medicare and also see CMS-1500
PC-ACE software (electronic claims) [WPS]
Plaquenil and Visual Fields [04-12] [05-16] Plaquenil and OCT [02-16]
Place of service [Medicare and Medicaid] [WPS POS Page] [09-08] [02-11] Reimbursement [11-12] [07-16]
Polycarbonate Lenses — for Medicaid children —- See under Medicaid: Polycarbonate lenses
POS —–see place of service
Post-cataract surgery glasses—– see under DME
Post Op Care
Billing during Global period [11-13] [04-18]
Ancillary testing during post-op period [10-14]
Claim directions for Post-op co-management services and for DME glasses claims [03-15]
E&M Coding Errors [06-09]
Examination with 24 modifier [04-07]
Modifiers 24 vs. 79 during post-op [12-14]
Refraction charges [02-01] [o4-07]
Related disorder billing [11-07]
YAG post-op coding [05-09] [01-11] [11-17]
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OBSOLETE: PQRS has been replaced by MIPS as of January 2017. The following PQRS information is mostly obsolete, and remains in the index for historical reference only.
PQRS Physician Quality Reporting Initiative [01-12] [02-12] [09-12] [01-16] [04-16] [06-16] [01-17]
8p modifier [07-16]
Education [08-13] [04-16] [07-16] Videos [06-15]
EIDM Account setup [08-15] [07-16] [08-16]
Feedback reports [08-14] [11-14]
Group reporting [05-15]
Payment adjustments [12-14] [11-16] AOA help [12-16] [01-17] CMS Reconsidering 2016 Penalty [07-17]
Payment [11-12] {12-12] [02-13]
Payments for previous years [10-14]
PQRS Office Traffic Sheet-2016 [Special Issue]
PQRS comparing providers [01-12]
CMS Web-based PQRS Measure Search Tool [02-16]
AOA PQRS Educational Resources [02-16]
PQRS evolving into MIPS [05-16] [06-16]
Feedback on 2015 PQRS [08-16] [10-16] [07-17]
Reporting via EHR [04-14] vs GPRO and Registry [07-15]
eRx reporting discontinued [02-14]
Practice guidelines—See Practice Guidelines at AOA webs site
Prescription Pads—tamper free [03-08] [04-08]
Prescription release
Expired Rx [07-08]
NE Board of Opty Guidelines [12-16] [09-17]
Primary Reason for Visit [1997 E&M Guidelines Adobe Find]
Professional Courtesy—–when is it legal [05-03]
Provider Agreements with Insurers [11-10]
Punctal Plug Coding [12-09] [11-10] [02-15]
post-op period [10-15]
Purchased services (anti-markup), Billing of CMS Manual System [05-09]
Q
R
Reciprocal Billing and Locum Tenens — see under Medicare
Records—-purchasing another doctor’s [07-10]
Records Retention [06-14] DME [10-12] Deceased/Inactive [08-16]
Records: Release of Medical Records & Patient Information
[Nebraska Law] (see also HIPAA Privacy)
Release required even when money is owed [10-15] [01-17]
Recoupment by Medicare
Red FlagS Rule—FTC’s ODs Generally Exempt [03-13]
Referrals—Legal limitations on [01-04] [06-07] See also “anti-markup purchased services”
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Refraction - charge separately [04-04]
Post-op Charge [02-01]
Refractive Lenses & DME—- see under DME-refractive lenses
Release of a CL Rx (FTC)—See contact lenses
Release of prescription — see prescription release
Remark Codes —see under Medicare Remark codes
Remittance Advice—see Medicare
Rent, Rental payments [OIG Fraud Alert]
Retinal Photos – see Fundus Photos
Routine vs. Medical billing [11-13]
Rust Removal [06-17]
Rx Pads—–tamper free: see prescription pads
S
S-Codes
AOA Comments: [08-11] [01-13]
Medicare does not accept [06-05]
Quack comments: [03-05]
Sales Tax
Low Vision Aids—–sales tax on [01-04]
Nebraska Department of Revenue [Sales Tax exemptions -Search]
SCODI—see OCT Optical Coherence Tomography
Scratch-coat: Medicaid vs. DME [08-03]
Self-referral: See Stark II & Stark III on Self Referral
Signature requirements [03-10] [05-10] [06-16]
Social Security Electronic Signature [04-12]
Standards of Care See Practice Guidelines at AOA webs site
Standing Orders [01-14]
Stark II & Stark III [01-01] [11-07]
Substitute providers {12-12] [04-14] [04-16] [04-17]—–see also Medicare “Locum Tenens” or Medicare “Incident to”
Supervision Requirements Medicare [03-03] Nebraska Regs [06-06]
T
Taxonomy Codes [01-09] [CMS]
Tear Osmolarity [06-12]
Therapeutic Certification Proof [08-12]
Therapeutic CLs —- see under Bandage CLs
Third Party Payers — Evaluating (AOA) [09-08] NOA Video
Treatment: Diagnostic and treatment program [1997 E&M Guidelines Adobe Find]
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U
Unilateral vs. bilateral: see Bilateral vs. Unilateral
V
V-Codes...HCPCS II V-codes
Vacation coverage of ODs See under: Substitute Providers
VEP Visual Electrophysiology Testing [07-17]
Videos— Educational Videos by Dr Quack —see under Education
Vision Therapy Coding AOA recommendations [09-15]
Visual Fields [Medicare LCDs]
Lid Surgery Blepharoplasty LCD
OCT and VF [06-16]
One Eye [08-17]
Plaquenil [11-07] [05-16]
Place of Service change [07-16]
VSP
Contact Information in Nebraska (John Bateman OD) [10-17]
CL coverage [11-11]
VSP and health diagnosis [01-10] [02-12]
Minimum Purchase postponed [08-16]
W
Workers Comp Reimbursement [Nebraska Statute] [01-18] correction [02-18]
Z
Zip Codes —– 9 digit zip codes required for some areas of Nebraska [06-08]
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