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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Click here for information on the July 2015 Quarterly Average Sales Price (ASP)
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Click here for information on the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule.
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Clarification of Ordering and Certifying Documentation Maintenance Requirements for all providers who furnish, order or certify DMEPOS items, clinical laboratory services or imaging services are subject to these requirements and are individually responsible for maintaining records and providing them upon request.
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Endocrine-Specific Coding Courses Available
Twice the Value!
Attend one or both days at locations across the country.
Jul. 31: Salt Lake City, UT Oct. 19-20: Charlotte, NC SPACE IS LIMITED
Courses are open to all members and nonmembers and their staffs.
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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.
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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
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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News Alerts & Policy Updates
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Humana members will soon have the convenience of a digital member ID card.
This means that your patients with Humana coverage may present a digital member ID card on their smartphone, instead of a physical member ID card. Patients may also choose to print a paper version from their MyHumana ID Card Center or to fax a copy of the card to your office from their smartphone. Click here for more information and refer to these frequently asked questions and answers. Please alert your staff of this change.
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| New Medicare data available Increases transparency on hospital and physician utilization Data serves as a rich resource to clearer look into Parts A and B costs, services, and trends
As part of the Administration's efforts to promote better care, smarter spending, and healthier people, today CMS is posting the third annual release of the Medicare hospital utilization and payment data (both
inpatient and
outpatient) and the second annual release of the
physician and other supplier utilization and payment data. The announcement was made at the annual Health Datapalooza Conference in Washington, DC.
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When requesting documentation for post payment review, the Medicare Administrative Contractors (MACs), Comprehensive Error Rate Test (CERTs) Contractors and the Recovery Audit Contractrors (RACs) shall notify providers that the requested documents are to be submitted within
45 calendar days
of the request. Zone Program Integrity Contractors (ZPICs) shall notify providers that requested documents are to be submitted within
30 calendar days
of the request. Because there are no statutory provisions requiring that post payment review of the documentation be completed within a certain time frame, MACs, CERTs, and ZPICs have the discretion to grant extensions to providers who need more time to comply with the request.
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Clinical Laboratory Improvement Amendments (CLIA)
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Individualized Quality Control Plan (IQCP) for Clinical Laboratory Improvement Amendments (CLIA) non-waived testing. Click here to watch a video presentation to learn more about IQCP or email questions to: IQCP@cms.hhs.gov.
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New changes to Healthcare Common Procedure Coding System Billing staffs,
click here to learn about new CLIA-related changes for 2015.
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Physician Quality Reporting System (PQRS)
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The Physician Quality Reporting Programs Strategic Vision describes a long-term vision for CMS quality measurement for physicians, professionals, and public reporting programs, and how they can be optimized and aligned to support better decision-making from doctors, consumers, and every part of the healthcare system. These programs support incentives to providers, encourage improvements in care delivery, and deliver information to consumers.
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CMS is Accepting Suggestions for Potential PQRS Measures Each measure submitted for consideration must include all required supporting documentation. Documentation requirements and the submission timeline are posted on the Measures Management System Call for Measures web page. Questions about this Call for Measures or the required documentation may be submitted to C4M@wvmi.org.
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Electronic Health Records (EHR) News
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Visit the CMS eHealth Events page to access webinar presentations on the recently proposed rules for the EHR Incentive Programs. A new fast fact is now available on the Medicare Learning Network Educational Web Guides web page. This web page provides information on Evaluation and Management services; Guided Pathways that contain resources and topics of interest; lists of health care management products; and easy-to-understand billing and coding educational products. It is designed to provide educational and informational resources related to certain CMS initiatives. Please bookmark this page and check back often as a new fast fact is added each month.
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| Quarterly Update to the Correct Coding Initiative (CCI) Edits, Version 21.3, Effective October 1. National Correct Coding Initiative (NCCI) edits, Version 21.3, which will be effective October 1, 2015. Make sure that your billing staffs are aware of these changes. |
The Medicare Secondary Payer (MSP) Fact Sheet provides information on MSP provisions and includes information on MSP basics, common situations when Medicare may be first or second, conditional payments, coordination of benefits rules etc. Please share with your billing/coding staff.
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Click here for information and resources on submitting correct ICD-10 codes to Medicare.
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The 2016 ICD-10-CM files are now available, along with the General Equivalence Mappings (GEMs) on the 2016 ICD-10-CM and GEMs web page. The posted files contain the complete versions of both ICD-10-CM (diagnoses) which will be implemented on October 1. The 2016 Reimbursement Mappings will be available in August.
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| Use New Interactive Case Studies to Explore ICD-10 Concepts The Centers for Medicare & Medicaid Services (CMS) has released interactive case studies that can help you understand key ICD-10 documentation concepts. Available on the Road to 10 tool at cms.gov/ICD-10, the case studies present:
- Clinical scenarios
- Short quizzes on related coding concepts
- Documentation tips
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| ICD-10 is scheduled to take effect on October 1. All HIPAA- covered entities are affected by this change. In order to help you get ready, AACE has several resources available to physicians and/or staff. Click here for the Endocrine Toolkit for Success, which includes endocrine-specific crosswalks from ICD-9 to ICD-10. Click here for pre-recorded HIGH-LEVEL OVERVIEW webinars for physicians and/or staff. Click here to read about who and what are affected by ICD-10, consequences of poor preparation and things to keep in mind.
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Endocrine TRAC: Tips on Reimbursement & Coding
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CMS Fact Sheet on Chronic Care Management Services This fact sheet provides background on the newly payable chronic care management (CCM) service, identifies eligible providers and patients, and details the Medicare PFS billing requirements. Click here for a list of FAQs on Chronic Care Management Services. |
Click here for information on Incorrect Place-of-Service Coding Resulted in Potential Medicare Overpayments Costing Millions. Make sure you and your billing staff know and understand the place of service codes and definitions.
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Click here for the Revised and Clarified Place of Service (POS) Coding Instructions Podcast (ICN 909207) was released and is now available in downloadable format. This podcast, based on MLN Matters? article MM7631, is designed to provide education about revised and clarified national policy for POS code assignment. Please alert your billing staff.
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Educational Opportunities
Webinars, seminars, calls and classes
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Two Days, Two Courses, Twice the Value!
Endocrine-specific coding courses are available for you and your staff. San Francisco has been added as a live course location. Attend one or both days at locations across the country. Salt Lake City, UT, and Charlotte, NC.
Seating is limited -- don't delay.
Click here to register.
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Disclaimer:
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-9-CM and HCPCS codes change annually, you should reference the current CPT?, ICD-9-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 2013American 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 ? 2015. All Rights Reserved.
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