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.
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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
Magazine's
website
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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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Get in the Know. . .
Please alert your coding, billing and collection staff.
Effective January 1, CPT® codes 76536 and 76942 cannot be billed together at the same patient encounter unless performed at separate anatomic sites.
CMS will add a new procedure to procedure (PTP) edit to the National Correct Coding Initiative (NCCI) that will affect Medicare reimbursement if a physician performs guidance for needle placement (CPT® code 76942) and a diagnostic head and neck ultrasound (CPT® code 76536) at the same patient encounter. The new edit was put into place because CMS indicated that evaluation of a patient's anatomic region and guidance for a needle placement procedure in that anatomic region by the same radiologic modality at the same patient encounter are not separately reportable services.
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Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
- MACRA makes three important changes to how Medicare pays those who give care to Medicare beneficiaries. These changes include:
- Ending the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers' services.
- Making a new framework for rewarding health care providers for giving better care not more just more care.
- Combining our existing quality reporting programs into one new system.
Click here
for information on MACRA's new goals for value-based payments.
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Physician Quality Reporting System
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Since 2015, the PQRS program will apply a negative payment adjustment to individual EPs and PQRS group practices who do not satisfactorily report data on quality measures for Medicare Part B Physician Fee Schedule (MPFS) covered professional services in 2013.
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The new Physician Quality Reporting System (PQRS) Web-Based Measure Search Tool is available to easily identify claims and registry measures that may be applicable and help find measures that meet satisfactory reporting requirements for the 2016 PQRS program year. Click on a measure to view the individual claims and registry measure specifications. Search measure-related keywords, and others such as: Measure Number, Reporting Methods, National Quality Strategy (NQS) Domain, Cost-Cutting Measures and Measure Steward.
Click here for the one-stop shop for the most current resources to support electronic clinical quality improvements. Learn about eCQI resources and connect with the community of professionals who are dedicated to CQI for better health.
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Click here for the one-stop shop for the most current resources to support electronic clinical quality improvements. Learn about eCQI resources and connect with the community of professionals who are dedicated to CQI for better health.
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Click here to download the new Preventive Service Poster.
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Avoiding Deactivation
If an owner, partner, managing employee, director, officer, authorized/delegated official, etc., has died, a CMS-855B should be submitted as a change request removing the deceased individual from the supplier's enrollment record. If a replacement for the deceased individual has been made, all pertinent information for the replacement should be included with the change request. It is important that this information be submitted as soon as possible. If the contractor is notified by Social Security of a date of death for an owner, partner, managing employee, director, officer, authorized/delegated official, etc., and has not been notified to remove or replace the deceased individual, a request for this information will be sent to the organization. If no response is received within 90 days from the date of the request, the organization's billing privileges may be deactivated. To avoid deactivation, please submit the CMS-855 change information as soon as possible.
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Click here
for "Incident to" guidelines from Medicare.
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Click here
for Provider Enrollment, Chain and Ownership System (PECOS) fact sheet and information.
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ICD-10 Post-Implementation: Coding Basics Revisited MLN Connects® Video
In this Centers for Medicare & Medicaid Services (CMS) ICD-10 video
,
Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) discuss the unique characteristics and features of the ICD-10 coding system. Topics include:
- What is a valid code
- Guidelines for coding and reporting
- Coding process and examples: 7th character, unspecified codes, external cause codes, laterality
- How to submit coding questions
- Resources for coders
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Click on the YouTube video below for
helpful pointers to avoid duplicate professional claims. This is the second in a series of Medicare Compliance videos.
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Click here for i
nformation on the new waived CLIA Tests that include 83036QW-Hemoglobin: glycosylated (AIC). Please alert your coding, billing and collection staffs.
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Click here provider compliance tips for diabetic test strips.
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Practice Management/HIPAA/Compliance
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Click here to read if you are complying with documentation requirements for lab services.
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Click here to read if you are complying with medical documentation.
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- General compliance guidelines
- The claims submission process
- Initiatives and incentives
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Register to attend the AMA/MGMA "Collaborate in practice" conference March 20-22
The AMA and MGMA are collaborating on a new conference called "Collaborate in Practice" to be held March 20-22 at the iconic Broadmoor Hotel, in Colorado Springs, CO. The conference emphasizes successful, practical approaches to achieving the quadruple aim.
The event includes impressive speakers like Sen. Bill Bradley, Lyle Berkowitz, MD, Stephen Beeson, MD, William Faber, MD, and others. Click here for more details. A
MA members receive a $200 discount with promo code CIPAMA16.
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CEU and AMA PRA Category 1 Credits
Drug Diversion: Schemes, Auditing, and Referrals Web-Based Training course
is available here. Learn about:
* Impact of drug diversion on Medicare Part D
* Common drug diversion fraud schemes
* Sources of information used to support audits
* Data analysis tips and techniques relative to drug diversion schemes
* Techniques for effective on-site and desk auditing
* How to report results of audits and make strong referrals
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Click here for UnitedHealthcare's Network Bulletin -- February.
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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.
Click here
for more information on
Endonomics
™ and see the latest editions.
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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 2016 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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Copyright © 2016. All Rights Reserved.
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