Endonomics™ is an e-newsletter from the Socioeconomics & Member Advocacy Office of the American Association of Clinical Endocrinologists (AACE).
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Do you know the purpose of the CERT contractor?
The CERT contractor checks to see that providers are billing correctly and contractors are paying correctly. They select and review claims, assign improper payment categories, calculate improper payment rates and provide education to change behaviors.
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What is HPID?
It's a Health Plan Identifier and is a standard, unique health plan identifier required by HIPAA. All controlling health plans, except small plans, were required to obtain HPIDs by Nov. 5, 2014.
Click here for more information.
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Endonomics™ is distributed free to both AACE members and non-members. The goal is to provide the latest industry news to those who work in the business side of an endocrinology practice.
Be Part of the Network
To be added to the distribution list, email your name, title, name of practice/business, phone and fax, and preferred email to: Endonomics@aace.com.
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Visit AACE's
EmPower
for endocrine patient information.
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Dear Practice Support Subscriber,
Welcome to another edition of
Endonomics™ ,
an
e-newsletter for physicians, practice management specialists, office administrators, coders, billers, collectors and other endocrinology business office staff.
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 A Message From Dr. Felice Caldarella
AACE MACRA Task Force Chair
Join us Thursday, February 16 at 9 p.m. EST for an AACE WEBINAR on the Medicare Quality Payment Program (aka MACRA).
Due to increased demand, the AACE MACRA Task Force is hosting a third live webinar, as an AACE member benefit, to help you learn about the provisions of the Quality payment Program/MACRA implementation and how you can avoid a 4 percent Medicare payment penalty. This webinar will provide information on the final MACRA rule and guidance to help you transition and successfully participate this year in the Quality Payment Program. Use this link to register for the 90-minute webinar scheduled for this THURSDAY, FEBRUARY 16, at 9 p.m. ET.
Click here
to visit AACE's redesigned MACRA webpage.
Note:
AACE MACRA webinars will be archived and available for viewing on the AACE MACRA webpage.
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MACRA or Medicare Access and CHIP Reauthorization Act of 2015, which replaces the Sustainable Growth Rate (SGR) formula is designed to pay clinicians for the value and quality of care they provide. MIPS applies to Medicare Part B clinicians. CMS renamed the reimbursement program to the Quality Payment Program or QPP, which will reform Medicare Part B payments across two tracks: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).
Click here for more information on MACRA implementation, AACE activities resources, steps to prepare your practice and ideas for potential endocrine quality measure.
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Click here
to read AACE/ACE's position statement on patient access to necessary and appropriate medical care.
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Attention Members in:
AL, AZ, ID, MT, ND, OR, SD, UT, WA, WY, t
he Vitamin D Assay Testing LCD (local coverage policy), effective February 3, the CPT codes 82306 and 82653.
Click here to find a list of coding guideline including covered diagnosis, documentation requirements and frequency limitations.
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Attention Members in: NC, SC, VA, WV
NEW Edits to Detect Electronic Comparative Billing Report Billing Patterns These eCompare smart edits will assist in monitoring your specific billing patterns and can serve as a training aide providing detailed provider education for self-auditing purposes. The eCompare smart edits will include links to educational material and will instruct providers to log in to the eServices portal to view your personalized eCBR results. Please alert your staff of these edits.
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Members in NC, SC, VA, WV, KY & OH
The Medicare Administrative Contractors have reported an issue with the UNITS field on electronic claims that may affect any service reported with multiple units such as Diabetes Self-Management Training Services, Medical Nutritional Therapy Services, and drugs billed with units (i.e. testosterone, cosyntropin etc.). Please alert coding, billing and collections staff to ensure reimbursement is for the correct amount of units.
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Click here for information on prolonged services without direct face-to-face patient contact separately payable under the Physician Fee Schedule (Manual Update).
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REVISED ANNOUNCEMENT Regarding Renewal Applications for DEA Registration
Starting January 2017, DEA will no longer send its second renewal notification by mail. Instead, an electronic reminder to renew will be sent to the email address associated with the DEA registration. At this time, DEA will otherwise retain its current policy and procedures with respect to renewal and reinstatement of registration.
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AACE live coding courses meet the need of endocrinologists allowing you and your staff to focus on gaining valuable knowledge, skills and confidence with documentation, coding and billing. These courses provide opportunities to network with other physicians or staff and share best practices and/or challenges facing the endocrine office today.
- Self-Audit Workshop: Find Errors with Opportunities
- Bridge the Gaps in Coding & Collections for Endocrinology
Summer: Lake Tahoe area
Fall: Alexandria/Washington DC area
Winter: Orlando area
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Have you and/or your staff obtained the AACE-Certified Endocrine Coder designation? An AACE Certified Endocrine Coder (AACE-CEC) is an individual of high professional integrity who has passed a coding certification examination sponsored by AACE. Also, the designee has achieved a certain level of knowledge and expertise in coding of services, procedures and diagnoses for endocrine physician practices. An AACE-CEC is ethical, compliant, and always striving for knowledge.
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The
Quarterly Provider Update provides a listing of Agency regulations and meeting notices. Non-regulatory changes to the Medicare and Medicaid programs, consisting of manual instructions, are also included in this listing.
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Click here for a summary of policies for calendar year 2017 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Services List and CT Modifier Reduction List.
Click here for a revised Telehealth Services Fact Sheet from CMS.
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Fee-for-Service Data Collection System: Clinical Laboratory Fee Schedule Data Reporting Template This guide is intended to assist the laboratory community in meeting the new requirements under Section 1834A of the Social Security Act (the Act) for the Medicare Part B Clinical Laboratory Fee Schedule (CLFS). The Quick User Guide, which includes guidance for the Fee-for-Service Data Collection System (FFSDCS) CLFS data reporting template is included as an attachment in this article.
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Providers who would like additional information on avoiding improper payments for blood glucose self testing equipment and supplies for Medicare beneficiaries can refer to these resources:
- MLN Matters® Article SE1008 "Medicare Coverage of Blood Glucose Monitors and Testing Supplies," available at http://www.cms.gov/ Outreach-and-Education/ Medicare-Learning-NetworkMLN/MLNMattersArticles/ downloads/SE1008.pdf on the CMS website; and
- Click here for Local Medicare Coverage Determinations on the CMS website.
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January 2017 Average Sales Price Files Available
CMS posted the January 2017 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the
2017 ASP Drug Pricing Files
webpage. Please alert the appropriate staff.
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New Care Management webpage from CMS
Fact sheets, FAQs, Chronic Conditions & Data Warehouses on Advance Care Planning,
Chronic Care Management
, and Transitional Care Management Services.
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Understanding and Promoting the Value of Chronic Care Management Services Call
Tuesday, February 21 from 1:30- 3 p.m. ET
To register or for more information, visit
MLN Connects® Event Registration
. During this call, CMS experts discuss the benefits of providing Chronic Care Management (CCM) services and changes for CCM in the Physician Fee Schedule
final rule
. A new outreach and education campaign from the CMS Office of Minority Health increases awareness about the value of CCM, encourages adoption, and provides an opportunity for health care professionals to ask questions.
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Medicare Part B
Covers one influenza vaccination and its administration each influenza season for Medicare beneficiaries. Medicare may cover additional seasonal influenza vaccinations if medically necessary. For the 2016-2017 season, the CDC recommends use of the Inactivated Influenza Vaccine (IIV) or the Recombinant Influenza Vaccine (RIV). The nasal spray influenza vaccine (Live Attenuated Influenza Vaccine (LAIV)) should n
ot be used during 2016-2017.
For more information:
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Have you checked the exclusion lists?
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Office of Inspector General (OIG) Exclusion Authorities Watch a brief
video from the OIG and learn about the effects of exclusion authorities. Exclusion is when OIG prevents an individual or an entity from participating in the Medicare, Medicaid, or other Federal health care programs. No program payments will be made for items or services furnished, ordered, or prescribed by the excluded individual or entity. As a result, exclusion can impact your payments, even if you are not the party that is excluded.
This video is part of the OIG Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative. The video originally aired in 2011, but the information is current.
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* Fraud and abuse definitions
* Laws used to fight fraud and abuse
* Government partnerships engaged in fighting fraud and abuse
* Where to report suspected fraud and abuse
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- Monitoring Medicare Payments for clinical Diagnostic Lab Tests
- Medicare Payments for Transitional Care Management & Chronic Care Management
- Prolonged Services- Reasonableness of Services
- Drug Waste of Single-Use Vial Drugs
- Comparison of Average Sales Prices to Average Manufacturer Prices
- ACO:
- Beneficiary Assignment and Shared Savings Payments
- Savings, Quality and Promising Practices
- Use of EHRs to Support Care Coordination through ACOs
- Risk Adjustment Data: Sufficiency of Documentation Supporting Diagnosis
Please alert coding and billing staff in the event a request is sent for record review of these services, supplies or procedures.
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Watch a brief video on Compliance Program Basics
from the Office of the Inspector General (OIG) on the seven fundamental elements of an effective program. This video is part of the OIG Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative to prevent fraud, waste, and abuse. The video originally aired in 2012, but the information is current.
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Register now
for the MLN Connects® call scheduled for Tuesday, February 21, from 1:30 to 3:00 p.m. ET. "Understanding and Promoting the Value of Chronic Care Management Services."
To register or for more information, visit MLN Connects Event Registration.
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This interactive site helps clinicians understand and successfully participate in the program. This Application Program Interface (API), builds on that site by making it easier for other organizations to retrieve and maintain the Quality Payment Program's measures and enable them to build applications for clinicians and their practices. The API, available at qpp.cms.gov/education, will allow developers to write software using the information described on the Explore Measures section of QPP.cms.gov. Based on interviews with clinicians, CMS created the Explores Measures tool, which enables clinicians and practice managers to select measures that likely fit their practice, assemble them into a group, and print or save them for reference.
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ICD-10 Code Updates: Impact on Medicare Quality Programs o
n October 1, new ICD-10-CM and ICD-10-PCS code sets went into effect. As a result of the consolidated coding updates, a large number of new codes were added or removed. CMS examined the impact to quality measures and determined that these updates will impact our ability to process data reported on certain quality measures for the fourth quarter of CY 2016. Therefore, CMS will not apply the 2017 or 2018 PQRS payment adjustments, as applicable, to any eligible professional or group practice that fails to satisfactorily report for CY 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the fourth quarter of CY 2016.
Subscribe to the Quality Payment Program listserv from CMS-
visit the Quality Payment Program
portal and select "Subscribe to Email Updates" in the footer. The Education & Tools page includes program resources to help you learn more about eligibility and how to participate.
Click here to Access the Medicare Diabetes Prevention Program Model Expansion Callfrom November 2016.The call provided information on t
he CY 2017 Medicare Physician Fee Schedule (PFS)
final rule
including the expansion of the Medicare Diabetes Prevention Program (MDPP) Model set to begin on January 1, 2018. During the call, CMS experts provided a high-level overview of the finalized policies. The goal of the model expansion is to prevent the onset of type 2 diabetes among Medicare beneficiaries diagnosed with pre-diabetes through a structured behavioral change intervention. MDPP services will be furnished in community and health care settings by coaches that are trained community health workers or health professionals. The rule finalizes aspects of the expansion that will enable organizations new to Medicare to prepare their organizations for enrollment into Medicare as MDPP suppliers. Subsequent rulemaking in 2017 will propose additional policies. Visit the
MDPP
webpage for more information about the model.
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Members in NC, SC, VA, WV Your Medicare Administrative Contractor, Palmetto GBA will accept '8-body areas,' '8-organ systems' or 'complete single organ system examination' for a comprehensive examination when using the 95 Evaluation and Management Guidelines. Please alert the coding, billing and compliance departments.
E/M Tip:
Ancillary staff may only document: Review of systems (ROS), Past, family and social history (PFSH), and Vital signs. These three areas must be reviewed by the physician or non-physician practitioner (NPP) who must write a statement that it is reviewed and correct or add to it. Please share with appropriate staff.
For medical review purposes, Medicare requires that services provided/ordered be authenticated by the author. The method used shall be a handwritten or electronic signature. Stamped signatures are not acceptable. Providers who need additional information on the guidelines for using an electronic signature may reference CMS'
Medicare Program Integrity Manual
(PDF, 599 KB) (Pub. 100-08), Chapter 3, Sections 3.3.2.4.E-F.
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Q.
We are not currently taking any NEW Medicare patients. We do still have plenty of traditional Medicare patients who we see and bill Medicare. We have a patient asking to come see us and pay cash. I know she has traditional Medicare. She is trying to circumvent our no-new-Medicare rule. (We are taking new cash-pay patients.) I don't think we can allow her to become a cash pay patient since I know she has Medicare and we bill other patients under Medicare. Do you have an opinion?
A.
The patient is asking for a "private contract," which is illegal UNLESS the physician opts out of Medicare completely, meaning that he NEVER charges Medicare for ANY patient AND agrees not to for at last two years."
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Join AACE's free Practice Support Network and receive bimonthly editions of
Endonomics
™ -- A Practice Management newsletter for the business side of your office. Send your name, address, phone, fax and email address to:
endocoding@aace.com
and become part of the network today.
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for more information on
Endonomics
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All medical coding must be supported with documentation and medical necessity. **While this document represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will recognize and accept the coding and documentation recommendations. As CPT®, ICD-10-CM and HCPCS codes change annually, you should reference the current CPT®, ICD-10-CM and HCPCS manuals and follow the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information. This information is taken from publicly available sources. The American Association of Clinical Endocrinologists cannot guarantee reimbursement for services as an outcome of the information and/or data used and disclaims any responsibility for denial of reimbursement. This information is intended for informational purposes only and should not be deemed as legal advice, which should be obtained from competent local counsel. Current Procedural Terminology (CPT©) is copyright and trademark of the 2017 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT©. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
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