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A medical practice management newsletter for endocrinologists and support staff created by the Socioeconomics and Member Advocacy Department of the American Association of Clinical Endocrinologists (AACE). Interested parties should send an e-mail to [email protected] with their name, phone and fax numbers, location and preferred e-mail address to be added to our Practice Support Network database.
Citation preview
1
IMMEDIATE ACTION IS REQUIRED to avoid payment disruption If you enrolled for Electronic Funds Transfer (EFT) with Pinnacle Business Solutions Inc Cahaba Government Benefits Administrators or Trailblazer Health Enterprises look out for a letter from Novitas Solutions Inc requesting a CMS-588 EFT Authorization Agreement Please read this letter carefully for instructions for completing and returning the Agreement Failure to complete and submit the Agreement may result in a delay or interruption of your Medicare payments Additional information here Version 5010 Enforcement Discretion Period Ends June 30 2012 If you have not yet finalized your Version 5010 upgrade you should be working to complete this step as soon as possible This web page is dedicated to Version 5010 information which includes a fact sheet discussing steps that should be taken to be compliant by June 30 2012 Visit the ICD-10 website for the latest news and resources to help you prepare
EM SERVICES COMPARATIVE BILLING REPORT (CBR) WILL BE RELEASED On June 4 from CMS These reports are not available to anyone except the providers who receive them For more information please visit the CBR Services website at httpwwwsafeguard-servicesllccomcbrdefaultasp or call the SafeGuard Servicesrsquo Provider Help Desk CBR Support Team at 530-896-7080
CMS Requires a compliance plan AND annual fraud waste and abuse (FWA) training for organizations providing health prescription drug or administrative services to Medicare Advantage (MA) or Prescription Drug Plan (PDP) enrollees The compliance plan must incorporate measures to detect prevent and correct fraud waste and abuse Fraud an intentional act of deception misrepresentation or concealment in order to gain something of value Waste over-utilization of services (not caused by criminally negligent actions) and the misuse of resources Abuse excessive or improper use of services or actions that is inconsistent with acceptable business or medical practice
J a n u a r y 2 0 1 2 M a r c h 2 0 1 2
M a y 2 0 1 2
2
LCD (Local coverage Determinations) for Bone
Mass Measurements
Providers in Illinois Michigan Minnesota Wisconsin Iowa
Kansas Missouri and Nebraska should review their LCD (Local Coverage Determination) for
Bone Mass Measurements The LCD lists the specific
requirements for bone density exams Medicare will allow a
bone mass measurement every two years if at least 23 months
have passed Bone Mass Measurements may be allowed
more frequently if the requirements of LCD MS-004 are
documented
Documentation must state the name of the osteoporosis drug the patient is taking If the patient is on long-term glucocorticoid (steroid) therapy state the name the dosage and the duration of the drug
There is additional information about bone mass measurements for Illinois Michigan Minnesota and Wisconsin and for Iowa Kansas Missouri and Nebraska
1 2 3 4 5
1 Conducting internal monitoring and auditing 2 Implementing compliance and practice standards 3 Designating a compliance officer or contact 4 Conducting appropriate training and education 5 Responding appropriately to detected offenses and developing corrective
action 6 Developing open lines of communication and 7 Enforcing disciplinary standards through well-publicized
guidelines OIG has developed a list of four potential risk areas affecting physician practices
1 Coding and billing 2 Reasonable and necessary services 3 Documentation 4 Improper inducements kickbacks and self-referrals (Soliciting
offering or receiving a kickback bribe or rebate (for example paying for a referral of patients in exchange for the ordering of diagnostic tests and other services or medical equipment)
This list of risk areas is not exhaustive or all encompassing but a starting point for an internal review of potential vulnerabilities within the physician practice
Compliance Program Guidance for Third-Party Medical Billing Companies
Have you checked the exclusion lists Check the OIG and General Services Administration (GSA) exclusion lists for all new employees and at least once a year thereafter to validate employees and other entities that assist in the administration or delivery of services to Medicare beneficiaries are not on such lists
OIG List of Excluded IndividualsEntities (LEIE)
General Services Administration (GSA) database of excluded individualsentities
A $100000 settlement paid to US Department of HHS for posting appointments on an internet- based calendar that was publicly accessible
GUIDE TO PRIVACY AND SECURITY OF
HEALTH INFORMATION
Company penalized $35125544 for employing an individual who was excluded from Federal health care programs The OIG alleges that companies should know if employees are excluded from participating in Federal health care programs
According to the OIG (Office of Inspector General) an effective compliance program for individual and small group physicians contain seven components that provide a solid basis upon which a physician practice can create a voluntary compliance program The components are
3
All enrolled providers and suppliers must revalidate their enrollment information under new enrollment screening criteria through CMS This revalidation effort applies to those providers and suppliers enrolled prior to March 25 2011 New providers and suppliers that enrolled on or after March 25 2011 are not impacted Between now and March 23 2015 MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier Providers and suppliers must wait to submit the revalidation until their MAC asks them to do so
bull Contact Information for Medicare Enrollment Contractors bull Tips to Facilitate the Medicare Enrollment Process bull FAQs
Complete Signing Your Medicare Enrollment Application Electronically Internet-based PECOS (Provider Enrollment Chain and Ownership System) now allows providers to sign Medicare enrollment applications electronically You can save time and expedite review of your application by utilizing the electronic signature process This feature does not change who is required to sign the application Read more
What are Taxonomy Code Sets A hierarchical code set that consists of codes descriptions and definitions designed to categorize the type classification andor specialization of health care providers The codes are updated twice a year and effective April 1 and October 1 The code set is available from the Washington Publishing Company and maintained by the National Uniform Claim Committee The Code Set is a HIPAA standard and is the only code set used in HIPAA standard transactions to report the typeclassificationspecialization of a health care provider when such reporting is required
After determining your eligibility for the Electronic Health Record (EHR) Incentive Programs you should register as early as possible for the Medicare andor Medicaid program CMSrsquo EHR Information Center is open to assist the EHR provider community with registration and other program-related inquiries To reach the center call 1-888-734-6433 (primary number) or 888-734-6563 (TTY number) from 730 am ndash 630 pm (Central Time) Monday through Friday except federal holidays More information about the EHR Incentive Programs Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs
HHS FINALIZES NEW RULES TO CUT REGULATIONS FOR HOSPITALS AND HEALTH CARE PROVIDERS Among other changes the final rules will require that all eligible candidates including advanced practice registered nurses and physician assistants be reviewed by medical staff for potential appointment to the hospital medical staff and then be granted all of the privileges rights and responsibilities accorded to appointed medical staff members
Technical Component of Physician Pathology Services
Furnished to Hospital Patients No Longer Covered
by Medicare for Certain Pathologists and Independent
Labs (Part B)
This moratorium expires on June 30 2012 Therefore
pathologists and independent laboratories that provide the TC of physician pathology services furnished to hospital patients
may no longer bill for and receive Medicare payment for these services effective for
claims with dates of service on and after July 1 2012
MLN Mattersreg article MM5943 and MLN Mattersreg article MM5347
Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice Information from the Federation of State Medical Boards
GetReady5010org ndash
Free webinars amp resources
4
Coding and Practice Management Educational Opportunities for 2012
These courses are designed for physicians non-physician practitioners coders and billers
Bridge the Gaps in Endocrine Coding This activity has been approved for AMA PRA Category 1 CreditTM
Richmond VA Date June 12-13 Location Medical Society of VA
2924 Emerywood Parkway Suite 300 Richmond VA 23294-3746
Cost AACE members andor their staff $350 Non AACE members $400 Participants may take the AACE sponsored Certified Endocrine Coder Exam at no additional cost This is an open book exam with truefalse and multiple-choice questions
Atlanta GA Date July 19 Location The Commerce Club 191 Peachtree St NE 49th Floor Atlanta GA 30303 Cost AACE members andor their staff $300 Non AACE members $350 Space Provided by The Physicians Practice SOS Group wwwppsosgroupcom 4480 South Cobb Drive Suite H-236 Atlanta GA 30080-6989 Office 770-333-9405 Email infoppsosgroupcom
Fundamentals amp Advanced Endocrine Coding Course With AACE-sponsored Certified Endocrine Coder (AACE-CEC) Exam
This activity has been approved for AMA PRA Category 1 CreditTM
Gainesville FL Date June 29-30 Location University of Florida 1600 SW Archer Rd Academic Research Building
Room R4-265 Gainesville Florida Cost for both courses and CEC exam membersnon-membersstaff $550 2 0 S e a t s a v a i l a b l e
Philadelphia PA Date November 9-10 Location Embassy Suites
Philadelphia Airport 9000 Bartram Avenue Philadelphia PA 19153
Cost for both courses AACE members andor their staff $650 Non AACE members $725 Register by October 10 amp Save $100
NEW
Contact Vanessa Lankford at vlankfordaacecom or 904-353-7878 for additional information AACE reserves the right to cancel any course with a minimum 48-hour notification Participants will have the option to attend in an alternate course (if available) or request a full refund
5
Distance Learning and Total Access with PMIreg
Month by month - cancel at any time
$225 per month AACE members amp staff Registrants must use promotional code ldquoAACErdquo to receive discount $249 Non AACE members
bull Live weekly webinars where you can ask specific questions and get direct answers on a variety of current topics important to your practice
bull 24-hour access to TOTAL ACCESS Audio Library with almost 200 hours of pre-recorded training sessions and choose from 100+ topics
bull A fast way to bring both experienced and new staff up-to-speed on current issues bull Include your physician to learn about important coding billing compliance and operational updates bull Inexpensive convenient way to develop your own talent without leaving the office to attend training classes bull Use your offices speakerphone so that multiple staff can participate
Topics include ICD-10 Diagnosis Coding for Endocrinology (pre-recorded) Front Office Breach Mastering Medical Decision Making Translating Efficiencies to Profit (62112) HCPCS Modifiers (62812) EampM Documentation (scheduled for 7102012) Conducting ldquoPayer Proofrdquo EM Chart Audits (scheduled for 7112012) Top 5 Concerns of Medical Practice Managers (72612) Compliance is NOT an Option (scheduled for 822012)
PMI National Certifications via Webinar
Live Certification Webinars include 10 to12 90-minute learning sessions taught in a live Webinar format via your computer Interact ask questions and get answers real-time This option includes the full course manual shipped to the candidates address plus access to the streamed versions of the live sessions to review anytime Once the candidate is ready to take the exam heshe will arrange with PMI for an exam proctor to administer the test live in a nearby community Learn more
Certified Medical Insurance Specialist Certified Medical Coder Certified Medical Compliance Officer Certified Medical Office Manager Payment plans available Use promotional code AACE when registering For more information or to register call 800-259-5562 x242 AACE assumes no liability for the purchase(s) of these programs All purchases and communications are between the attendee and the company
wwwpmimdcom
6
Medical Decision Making Complexity of medical decision-making is the component for determining medical necessity for visits procedures and other services the patient obtains Three categories determine the level of medical complexity and two of the three categories must be met or exceeded to appropriately calculate medical decision-making
1 Number of Diagnoses andor Management Options 2 Amount andor Complexity of Data 3 Risk of Complications Morbidity andor Mortality
Number of Diagnosis andor Management Options can be Straightforward 0-1 diagnosis andor management options Low complexity 2 diagnosis andor management options Moderate complexity 3 diagnosis andor management options High Complexity 4 or more diagnosis andor management options
Documentation should indicate If problem is new worsened stable mildserious exacerbation and or life threatening Assessment clinical impression or diagnosis Initiation or changes in treatment Patient andor nursing instructions therapies and medications Referrals consult requests or advice sought
Amount andor Complexity of Data can be
Straightforward 0-1 items for the amount andor complexity of data Low complexity 2 items for the amount andor complexity of data Moderate complexity 3 items for the amount andor complexity of data High complexity 4 or more items for the amount andor complexity of data
Documentation should indicate
Clinical lab tests - orderedreviewedperformed Radiological tests - orderedreviewedperformed Medical tests - orderedreviewedperformed Test results discussed with performinginterpreting physician Obtainingreviewing old medical records Obtaining case history from another source Personal visualization of images or specimens
Risk of Complications Morbidity andor Mortality Can be
Minimalstraightforward Lowlow complexity Moderatemoderate complexity Highhigh complexity
Documentation should indicate Presenting problem(s) diagnostic procedure(s) ordered management options selected Comorbiditiesunderlying diseases or other factors that increase the complexity of medical decision making by
increasing the risk of complications morbidity andor mortality Surgical or invasive diagnostic procedures ordered planned or scheduled at time of EM visit Referral for or decision to perform a surgical or invasive diagnostic procedure on an urgent basis
An example of appropriate calculation of the MDM will be provided in the upcoming
edition of Endonomicstrade
7
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2011 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use
We want to hear
from you Tell us what you think of Endonomics Please take a few minutes to take this survey Your feedback is very important to us as we strive to assist you with a profitable and compliant business office
o Is Endonomicstrade valuable and useful for your office
o What other topics would you like to see offered in Endonomics
o Other commentshellip AACEs Socioeconomics and Member Advocacy Departments goal is to reach out to the endocrinology business world and become the one- stop- shop not only for endocrinology clinicians but their support staff as well Currently Endonomics is a free newsletter for both members and non-members Interested parties should send an e-mail to Endonomicsaacecom with their name phone and fax numbers location and preferred e-mail address to be added to our Practice Support Network database
Coding TRAC
Tips on Reimbursement And Coding bull New physician specialty codes for sleep medicine and sports medicine have
been established Effective Date April 1 2012 Implementation Date October 1 2012 Medicare specialty codes describe the specific or unique types of medical services that physicians and non-physician practitioners provide Although physicians self-designate their Medicare physician specialty on their Medicare enrollment applications (ie CMS-855I) non-physician practitioners are assigned their Medicare specialty code when they enroll The specialty code becomes associated with their submitted claims Medicare contractors also use specialty code data to develop claim-processing edits For additional information see MLN Mattersreg article MM7600
bull What is the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN) The PTAN is the number that Medicare assigns and consists of 5 to 10 characters comprised of numeric or alpha characters for Part B providers and 6 characters for Part A providers You may have heard it referred to as the Medicare provider number or PIN When accessing the Interactive Voice Response (IVR) or contacting your Provider Contact Center you will need the PTAN in addition to your NPI and the last five digits of the Tax Identification Number (TIN) Additional information can be found at MLN Mattersreg Number SE1216
bull HPSA bonus payments pertain only to physicians professional services Only the professional component will receive the bonus payment for services provided in an approved HPSA area containing both a professional and technical component Additional information on HPSA bonus payments is here
bull Technical component of physician pathology services furnished to hospital patients no longer covered by Medicare for certain pathologists and independent labs (Part B) as of June 30 2012 For background and policy information regarding payment to pathologists and independent laboratories for the TC of physician pathology services furnished to hospital patients refer to MLN Mattersreg article MM5943 and MLN Mattersreg article MM5347
bull FREE Educational Course Avoiding Medicare Fraud and Abuse A Roadmap for Physicians
2
LCD (Local coverage Determinations) for Bone
Mass Measurements
Providers in Illinois Michigan Minnesota Wisconsin Iowa
Kansas Missouri and Nebraska should review their LCD (Local Coverage Determination) for
Bone Mass Measurements The LCD lists the specific
requirements for bone density exams Medicare will allow a
bone mass measurement every two years if at least 23 months
have passed Bone Mass Measurements may be allowed
more frequently if the requirements of LCD MS-004 are
documented
Documentation must state the name of the osteoporosis drug the patient is taking If the patient is on long-term glucocorticoid (steroid) therapy state the name the dosage and the duration of the drug
There is additional information about bone mass measurements for Illinois Michigan Minnesota and Wisconsin and for Iowa Kansas Missouri and Nebraska
1 2 3 4 5
1 Conducting internal monitoring and auditing 2 Implementing compliance and practice standards 3 Designating a compliance officer or contact 4 Conducting appropriate training and education 5 Responding appropriately to detected offenses and developing corrective
action 6 Developing open lines of communication and 7 Enforcing disciplinary standards through well-publicized
guidelines OIG has developed a list of four potential risk areas affecting physician practices
1 Coding and billing 2 Reasonable and necessary services 3 Documentation 4 Improper inducements kickbacks and self-referrals (Soliciting
offering or receiving a kickback bribe or rebate (for example paying for a referral of patients in exchange for the ordering of diagnostic tests and other services or medical equipment)
This list of risk areas is not exhaustive or all encompassing but a starting point for an internal review of potential vulnerabilities within the physician practice
Compliance Program Guidance for Third-Party Medical Billing Companies
Have you checked the exclusion lists Check the OIG and General Services Administration (GSA) exclusion lists for all new employees and at least once a year thereafter to validate employees and other entities that assist in the administration or delivery of services to Medicare beneficiaries are not on such lists
OIG List of Excluded IndividualsEntities (LEIE)
General Services Administration (GSA) database of excluded individualsentities
A $100000 settlement paid to US Department of HHS for posting appointments on an internet- based calendar that was publicly accessible
GUIDE TO PRIVACY AND SECURITY OF
HEALTH INFORMATION
Company penalized $35125544 for employing an individual who was excluded from Federal health care programs The OIG alleges that companies should know if employees are excluded from participating in Federal health care programs
According to the OIG (Office of Inspector General) an effective compliance program for individual and small group physicians contain seven components that provide a solid basis upon which a physician practice can create a voluntary compliance program The components are
3
All enrolled providers and suppliers must revalidate their enrollment information under new enrollment screening criteria through CMS This revalidation effort applies to those providers and suppliers enrolled prior to March 25 2011 New providers and suppliers that enrolled on or after March 25 2011 are not impacted Between now and March 23 2015 MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier Providers and suppliers must wait to submit the revalidation until their MAC asks them to do so
bull Contact Information for Medicare Enrollment Contractors bull Tips to Facilitate the Medicare Enrollment Process bull FAQs
Complete Signing Your Medicare Enrollment Application Electronically Internet-based PECOS (Provider Enrollment Chain and Ownership System) now allows providers to sign Medicare enrollment applications electronically You can save time and expedite review of your application by utilizing the electronic signature process This feature does not change who is required to sign the application Read more
What are Taxonomy Code Sets A hierarchical code set that consists of codes descriptions and definitions designed to categorize the type classification andor specialization of health care providers The codes are updated twice a year and effective April 1 and October 1 The code set is available from the Washington Publishing Company and maintained by the National Uniform Claim Committee The Code Set is a HIPAA standard and is the only code set used in HIPAA standard transactions to report the typeclassificationspecialization of a health care provider when such reporting is required
After determining your eligibility for the Electronic Health Record (EHR) Incentive Programs you should register as early as possible for the Medicare andor Medicaid program CMSrsquo EHR Information Center is open to assist the EHR provider community with registration and other program-related inquiries To reach the center call 1-888-734-6433 (primary number) or 888-734-6563 (TTY number) from 730 am ndash 630 pm (Central Time) Monday through Friday except federal holidays More information about the EHR Incentive Programs Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs
HHS FINALIZES NEW RULES TO CUT REGULATIONS FOR HOSPITALS AND HEALTH CARE PROVIDERS Among other changes the final rules will require that all eligible candidates including advanced practice registered nurses and physician assistants be reviewed by medical staff for potential appointment to the hospital medical staff and then be granted all of the privileges rights and responsibilities accorded to appointed medical staff members
Technical Component of Physician Pathology Services
Furnished to Hospital Patients No Longer Covered
by Medicare for Certain Pathologists and Independent
Labs (Part B)
This moratorium expires on June 30 2012 Therefore
pathologists and independent laboratories that provide the TC of physician pathology services furnished to hospital patients
may no longer bill for and receive Medicare payment for these services effective for
claims with dates of service on and after July 1 2012
MLN Mattersreg article MM5943 and MLN Mattersreg article MM5347
Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice Information from the Federation of State Medical Boards
GetReady5010org ndash
Free webinars amp resources
4
Coding and Practice Management Educational Opportunities for 2012
These courses are designed for physicians non-physician practitioners coders and billers
Bridge the Gaps in Endocrine Coding This activity has been approved for AMA PRA Category 1 CreditTM
Richmond VA Date June 12-13 Location Medical Society of VA
2924 Emerywood Parkway Suite 300 Richmond VA 23294-3746
Cost AACE members andor their staff $350 Non AACE members $400 Participants may take the AACE sponsored Certified Endocrine Coder Exam at no additional cost This is an open book exam with truefalse and multiple-choice questions
Atlanta GA Date July 19 Location The Commerce Club 191 Peachtree St NE 49th Floor Atlanta GA 30303 Cost AACE members andor their staff $300 Non AACE members $350 Space Provided by The Physicians Practice SOS Group wwwppsosgroupcom 4480 South Cobb Drive Suite H-236 Atlanta GA 30080-6989 Office 770-333-9405 Email infoppsosgroupcom
Fundamentals amp Advanced Endocrine Coding Course With AACE-sponsored Certified Endocrine Coder (AACE-CEC) Exam
This activity has been approved for AMA PRA Category 1 CreditTM
Gainesville FL Date June 29-30 Location University of Florida 1600 SW Archer Rd Academic Research Building
Room R4-265 Gainesville Florida Cost for both courses and CEC exam membersnon-membersstaff $550 2 0 S e a t s a v a i l a b l e
Philadelphia PA Date November 9-10 Location Embassy Suites
Philadelphia Airport 9000 Bartram Avenue Philadelphia PA 19153
Cost for both courses AACE members andor their staff $650 Non AACE members $725 Register by October 10 amp Save $100
NEW
Contact Vanessa Lankford at vlankfordaacecom or 904-353-7878 for additional information AACE reserves the right to cancel any course with a minimum 48-hour notification Participants will have the option to attend in an alternate course (if available) or request a full refund
5
Distance Learning and Total Access with PMIreg
Month by month - cancel at any time
$225 per month AACE members amp staff Registrants must use promotional code ldquoAACErdquo to receive discount $249 Non AACE members
bull Live weekly webinars where you can ask specific questions and get direct answers on a variety of current topics important to your practice
bull 24-hour access to TOTAL ACCESS Audio Library with almost 200 hours of pre-recorded training sessions and choose from 100+ topics
bull A fast way to bring both experienced and new staff up-to-speed on current issues bull Include your physician to learn about important coding billing compliance and operational updates bull Inexpensive convenient way to develop your own talent without leaving the office to attend training classes bull Use your offices speakerphone so that multiple staff can participate
Topics include ICD-10 Diagnosis Coding for Endocrinology (pre-recorded) Front Office Breach Mastering Medical Decision Making Translating Efficiencies to Profit (62112) HCPCS Modifiers (62812) EampM Documentation (scheduled for 7102012) Conducting ldquoPayer Proofrdquo EM Chart Audits (scheduled for 7112012) Top 5 Concerns of Medical Practice Managers (72612) Compliance is NOT an Option (scheduled for 822012)
PMI National Certifications via Webinar
Live Certification Webinars include 10 to12 90-minute learning sessions taught in a live Webinar format via your computer Interact ask questions and get answers real-time This option includes the full course manual shipped to the candidates address plus access to the streamed versions of the live sessions to review anytime Once the candidate is ready to take the exam heshe will arrange with PMI for an exam proctor to administer the test live in a nearby community Learn more
Certified Medical Insurance Specialist Certified Medical Coder Certified Medical Compliance Officer Certified Medical Office Manager Payment plans available Use promotional code AACE when registering For more information or to register call 800-259-5562 x242 AACE assumes no liability for the purchase(s) of these programs All purchases and communications are between the attendee and the company
wwwpmimdcom
6
Medical Decision Making Complexity of medical decision-making is the component for determining medical necessity for visits procedures and other services the patient obtains Three categories determine the level of medical complexity and two of the three categories must be met or exceeded to appropriately calculate medical decision-making
1 Number of Diagnoses andor Management Options 2 Amount andor Complexity of Data 3 Risk of Complications Morbidity andor Mortality
Number of Diagnosis andor Management Options can be Straightforward 0-1 diagnosis andor management options Low complexity 2 diagnosis andor management options Moderate complexity 3 diagnosis andor management options High Complexity 4 or more diagnosis andor management options
Documentation should indicate If problem is new worsened stable mildserious exacerbation and or life threatening Assessment clinical impression or diagnosis Initiation or changes in treatment Patient andor nursing instructions therapies and medications Referrals consult requests or advice sought
Amount andor Complexity of Data can be
Straightforward 0-1 items for the amount andor complexity of data Low complexity 2 items for the amount andor complexity of data Moderate complexity 3 items for the amount andor complexity of data High complexity 4 or more items for the amount andor complexity of data
Documentation should indicate
Clinical lab tests - orderedreviewedperformed Radiological tests - orderedreviewedperformed Medical tests - orderedreviewedperformed Test results discussed with performinginterpreting physician Obtainingreviewing old medical records Obtaining case history from another source Personal visualization of images or specimens
Risk of Complications Morbidity andor Mortality Can be
Minimalstraightforward Lowlow complexity Moderatemoderate complexity Highhigh complexity
Documentation should indicate Presenting problem(s) diagnostic procedure(s) ordered management options selected Comorbiditiesunderlying diseases or other factors that increase the complexity of medical decision making by
increasing the risk of complications morbidity andor mortality Surgical or invasive diagnostic procedures ordered planned or scheduled at time of EM visit Referral for or decision to perform a surgical or invasive diagnostic procedure on an urgent basis
An example of appropriate calculation of the MDM will be provided in the upcoming
edition of Endonomicstrade
7
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2011 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use
We want to hear
from you Tell us what you think of Endonomics Please take a few minutes to take this survey Your feedback is very important to us as we strive to assist you with a profitable and compliant business office
o Is Endonomicstrade valuable and useful for your office
o What other topics would you like to see offered in Endonomics
o Other commentshellip AACEs Socioeconomics and Member Advocacy Departments goal is to reach out to the endocrinology business world and become the one- stop- shop not only for endocrinology clinicians but their support staff as well Currently Endonomics is a free newsletter for both members and non-members Interested parties should send an e-mail to Endonomicsaacecom with their name phone and fax numbers location and preferred e-mail address to be added to our Practice Support Network database
Coding TRAC
Tips on Reimbursement And Coding bull New physician specialty codes for sleep medicine and sports medicine have
been established Effective Date April 1 2012 Implementation Date October 1 2012 Medicare specialty codes describe the specific or unique types of medical services that physicians and non-physician practitioners provide Although physicians self-designate their Medicare physician specialty on their Medicare enrollment applications (ie CMS-855I) non-physician practitioners are assigned their Medicare specialty code when they enroll The specialty code becomes associated with their submitted claims Medicare contractors also use specialty code data to develop claim-processing edits For additional information see MLN Mattersreg article MM7600
bull What is the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN) The PTAN is the number that Medicare assigns and consists of 5 to 10 characters comprised of numeric or alpha characters for Part B providers and 6 characters for Part A providers You may have heard it referred to as the Medicare provider number or PIN When accessing the Interactive Voice Response (IVR) or contacting your Provider Contact Center you will need the PTAN in addition to your NPI and the last five digits of the Tax Identification Number (TIN) Additional information can be found at MLN Mattersreg Number SE1216
bull HPSA bonus payments pertain only to physicians professional services Only the professional component will receive the bonus payment for services provided in an approved HPSA area containing both a professional and technical component Additional information on HPSA bonus payments is here
bull Technical component of physician pathology services furnished to hospital patients no longer covered by Medicare for certain pathologists and independent labs (Part B) as of June 30 2012 For background and policy information regarding payment to pathologists and independent laboratories for the TC of physician pathology services furnished to hospital patients refer to MLN Mattersreg article MM5943 and MLN Mattersreg article MM5347
bull FREE Educational Course Avoiding Medicare Fraud and Abuse A Roadmap for Physicians
3
All enrolled providers and suppliers must revalidate their enrollment information under new enrollment screening criteria through CMS This revalidation effort applies to those providers and suppliers enrolled prior to March 25 2011 New providers and suppliers that enrolled on or after March 25 2011 are not impacted Between now and March 23 2015 MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier Providers and suppliers must wait to submit the revalidation until their MAC asks them to do so
bull Contact Information for Medicare Enrollment Contractors bull Tips to Facilitate the Medicare Enrollment Process bull FAQs
Complete Signing Your Medicare Enrollment Application Electronically Internet-based PECOS (Provider Enrollment Chain and Ownership System) now allows providers to sign Medicare enrollment applications electronically You can save time and expedite review of your application by utilizing the electronic signature process This feature does not change who is required to sign the application Read more
What are Taxonomy Code Sets A hierarchical code set that consists of codes descriptions and definitions designed to categorize the type classification andor specialization of health care providers The codes are updated twice a year and effective April 1 and October 1 The code set is available from the Washington Publishing Company and maintained by the National Uniform Claim Committee The Code Set is a HIPAA standard and is the only code set used in HIPAA standard transactions to report the typeclassificationspecialization of a health care provider when such reporting is required
After determining your eligibility for the Electronic Health Record (EHR) Incentive Programs you should register as early as possible for the Medicare andor Medicaid program CMSrsquo EHR Information Center is open to assist the EHR provider community with registration and other program-related inquiries To reach the center call 1-888-734-6433 (primary number) or 888-734-6563 (TTY number) from 730 am ndash 630 pm (Central Time) Monday through Friday except federal holidays More information about the EHR Incentive Programs Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs
HHS FINALIZES NEW RULES TO CUT REGULATIONS FOR HOSPITALS AND HEALTH CARE PROVIDERS Among other changes the final rules will require that all eligible candidates including advanced practice registered nurses and physician assistants be reviewed by medical staff for potential appointment to the hospital medical staff and then be granted all of the privileges rights and responsibilities accorded to appointed medical staff members
Technical Component of Physician Pathology Services
Furnished to Hospital Patients No Longer Covered
by Medicare for Certain Pathologists and Independent
Labs (Part B)
This moratorium expires on June 30 2012 Therefore
pathologists and independent laboratories that provide the TC of physician pathology services furnished to hospital patients
may no longer bill for and receive Medicare payment for these services effective for
claims with dates of service on and after July 1 2012
MLN Mattersreg article MM5943 and MLN Mattersreg article MM5347
Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice Information from the Federation of State Medical Boards
GetReady5010org ndash
Free webinars amp resources
4
Coding and Practice Management Educational Opportunities for 2012
These courses are designed for physicians non-physician practitioners coders and billers
Bridge the Gaps in Endocrine Coding This activity has been approved for AMA PRA Category 1 CreditTM
Richmond VA Date June 12-13 Location Medical Society of VA
2924 Emerywood Parkway Suite 300 Richmond VA 23294-3746
Cost AACE members andor their staff $350 Non AACE members $400 Participants may take the AACE sponsored Certified Endocrine Coder Exam at no additional cost This is an open book exam with truefalse and multiple-choice questions
Atlanta GA Date July 19 Location The Commerce Club 191 Peachtree St NE 49th Floor Atlanta GA 30303 Cost AACE members andor their staff $300 Non AACE members $350 Space Provided by The Physicians Practice SOS Group wwwppsosgroupcom 4480 South Cobb Drive Suite H-236 Atlanta GA 30080-6989 Office 770-333-9405 Email infoppsosgroupcom
Fundamentals amp Advanced Endocrine Coding Course With AACE-sponsored Certified Endocrine Coder (AACE-CEC) Exam
This activity has been approved for AMA PRA Category 1 CreditTM
Gainesville FL Date June 29-30 Location University of Florida 1600 SW Archer Rd Academic Research Building
Room R4-265 Gainesville Florida Cost for both courses and CEC exam membersnon-membersstaff $550 2 0 S e a t s a v a i l a b l e
Philadelphia PA Date November 9-10 Location Embassy Suites
Philadelphia Airport 9000 Bartram Avenue Philadelphia PA 19153
Cost for both courses AACE members andor their staff $650 Non AACE members $725 Register by October 10 amp Save $100
NEW
Contact Vanessa Lankford at vlankfordaacecom or 904-353-7878 for additional information AACE reserves the right to cancel any course with a minimum 48-hour notification Participants will have the option to attend in an alternate course (if available) or request a full refund
5
Distance Learning and Total Access with PMIreg
Month by month - cancel at any time
$225 per month AACE members amp staff Registrants must use promotional code ldquoAACErdquo to receive discount $249 Non AACE members
bull Live weekly webinars where you can ask specific questions and get direct answers on a variety of current topics important to your practice
bull 24-hour access to TOTAL ACCESS Audio Library with almost 200 hours of pre-recorded training sessions and choose from 100+ topics
bull A fast way to bring both experienced and new staff up-to-speed on current issues bull Include your physician to learn about important coding billing compliance and operational updates bull Inexpensive convenient way to develop your own talent without leaving the office to attend training classes bull Use your offices speakerphone so that multiple staff can participate
Topics include ICD-10 Diagnosis Coding for Endocrinology (pre-recorded) Front Office Breach Mastering Medical Decision Making Translating Efficiencies to Profit (62112) HCPCS Modifiers (62812) EampM Documentation (scheduled for 7102012) Conducting ldquoPayer Proofrdquo EM Chart Audits (scheduled for 7112012) Top 5 Concerns of Medical Practice Managers (72612) Compliance is NOT an Option (scheduled for 822012)
PMI National Certifications via Webinar
Live Certification Webinars include 10 to12 90-minute learning sessions taught in a live Webinar format via your computer Interact ask questions and get answers real-time This option includes the full course manual shipped to the candidates address plus access to the streamed versions of the live sessions to review anytime Once the candidate is ready to take the exam heshe will arrange with PMI for an exam proctor to administer the test live in a nearby community Learn more
Certified Medical Insurance Specialist Certified Medical Coder Certified Medical Compliance Officer Certified Medical Office Manager Payment plans available Use promotional code AACE when registering For more information or to register call 800-259-5562 x242 AACE assumes no liability for the purchase(s) of these programs All purchases and communications are between the attendee and the company
wwwpmimdcom
6
Medical Decision Making Complexity of medical decision-making is the component for determining medical necessity for visits procedures and other services the patient obtains Three categories determine the level of medical complexity and two of the three categories must be met or exceeded to appropriately calculate medical decision-making
1 Number of Diagnoses andor Management Options 2 Amount andor Complexity of Data 3 Risk of Complications Morbidity andor Mortality
Number of Diagnosis andor Management Options can be Straightforward 0-1 diagnosis andor management options Low complexity 2 diagnosis andor management options Moderate complexity 3 diagnosis andor management options High Complexity 4 or more diagnosis andor management options
Documentation should indicate If problem is new worsened stable mildserious exacerbation and or life threatening Assessment clinical impression or diagnosis Initiation or changes in treatment Patient andor nursing instructions therapies and medications Referrals consult requests or advice sought
Amount andor Complexity of Data can be
Straightforward 0-1 items for the amount andor complexity of data Low complexity 2 items for the amount andor complexity of data Moderate complexity 3 items for the amount andor complexity of data High complexity 4 or more items for the amount andor complexity of data
Documentation should indicate
Clinical lab tests - orderedreviewedperformed Radiological tests - orderedreviewedperformed Medical tests - orderedreviewedperformed Test results discussed with performinginterpreting physician Obtainingreviewing old medical records Obtaining case history from another source Personal visualization of images or specimens
Risk of Complications Morbidity andor Mortality Can be
Minimalstraightforward Lowlow complexity Moderatemoderate complexity Highhigh complexity
Documentation should indicate Presenting problem(s) diagnostic procedure(s) ordered management options selected Comorbiditiesunderlying diseases or other factors that increase the complexity of medical decision making by
increasing the risk of complications morbidity andor mortality Surgical or invasive diagnostic procedures ordered planned or scheduled at time of EM visit Referral for or decision to perform a surgical or invasive diagnostic procedure on an urgent basis
An example of appropriate calculation of the MDM will be provided in the upcoming
edition of Endonomicstrade
7
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2011 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use
We want to hear
from you Tell us what you think of Endonomics Please take a few minutes to take this survey Your feedback is very important to us as we strive to assist you with a profitable and compliant business office
o Is Endonomicstrade valuable and useful for your office
o What other topics would you like to see offered in Endonomics
o Other commentshellip AACEs Socioeconomics and Member Advocacy Departments goal is to reach out to the endocrinology business world and become the one- stop- shop not only for endocrinology clinicians but their support staff as well Currently Endonomics is a free newsletter for both members and non-members Interested parties should send an e-mail to Endonomicsaacecom with their name phone and fax numbers location and preferred e-mail address to be added to our Practice Support Network database
Coding TRAC
Tips on Reimbursement And Coding bull New physician specialty codes for sleep medicine and sports medicine have
been established Effective Date April 1 2012 Implementation Date October 1 2012 Medicare specialty codes describe the specific or unique types of medical services that physicians and non-physician practitioners provide Although physicians self-designate their Medicare physician specialty on their Medicare enrollment applications (ie CMS-855I) non-physician practitioners are assigned their Medicare specialty code when they enroll The specialty code becomes associated with their submitted claims Medicare contractors also use specialty code data to develop claim-processing edits For additional information see MLN Mattersreg article MM7600
bull What is the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN) The PTAN is the number that Medicare assigns and consists of 5 to 10 characters comprised of numeric or alpha characters for Part B providers and 6 characters for Part A providers You may have heard it referred to as the Medicare provider number or PIN When accessing the Interactive Voice Response (IVR) or contacting your Provider Contact Center you will need the PTAN in addition to your NPI and the last five digits of the Tax Identification Number (TIN) Additional information can be found at MLN Mattersreg Number SE1216
bull HPSA bonus payments pertain only to physicians professional services Only the professional component will receive the bonus payment for services provided in an approved HPSA area containing both a professional and technical component Additional information on HPSA bonus payments is here
bull Technical component of physician pathology services furnished to hospital patients no longer covered by Medicare for certain pathologists and independent labs (Part B) as of June 30 2012 For background and policy information regarding payment to pathologists and independent laboratories for the TC of physician pathology services furnished to hospital patients refer to MLN Mattersreg article MM5943 and MLN Mattersreg article MM5347
bull FREE Educational Course Avoiding Medicare Fraud and Abuse A Roadmap for Physicians
4
Coding and Practice Management Educational Opportunities for 2012
These courses are designed for physicians non-physician practitioners coders and billers
Bridge the Gaps in Endocrine Coding This activity has been approved for AMA PRA Category 1 CreditTM
Richmond VA Date June 12-13 Location Medical Society of VA
2924 Emerywood Parkway Suite 300 Richmond VA 23294-3746
Cost AACE members andor their staff $350 Non AACE members $400 Participants may take the AACE sponsored Certified Endocrine Coder Exam at no additional cost This is an open book exam with truefalse and multiple-choice questions
Atlanta GA Date July 19 Location The Commerce Club 191 Peachtree St NE 49th Floor Atlanta GA 30303 Cost AACE members andor their staff $300 Non AACE members $350 Space Provided by The Physicians Practice SOS Group wwwppsosgroupcom 4480 South Cobb Drive Suite H-236 Atlanta GA 30080-6989 Office 770-333-9405 Email infoppsosgroupcom
Fundamentals amp Advanced Endocrine Coding Course With AACE-sponsored Certified Endocrine Coder (AACE-CEC) Exam
This activity has been approved for AMA PRA Category 1 CreditTM
Gainesville FL Date June 29-30 Location University of Florida 1600 SW Archer Rd Academic Research Building
Room R4-265 Gainesville Florida Cost for both courses and CEC exam membersnon-membersstaff $550 2 0 S e a t s a v a i l a b l e
Philadelphia PA Date November 9-10 Location Embassy Suites
Philadelphia Airport 9000 Bartram Avenue Philadelphia PA 19153
Cost for both courses AACE members andor their staff $650 Non AACE members $725 Register by October 10 amp Save $100
NEW
Contact Vanessa Lankford at vlankfordaacecom or 904-353-7878 for additional information AACE reserves the right to cancel any course with a minimum 48-hour notification Participants will have the option to attend in an alternate course (if available) or request a full refund
5
Distance Learning and Total Access with PMIreg
Month by month - cancel at any time
$225 per month AACE members amp staff Registrants must use promotional code ldquoAACErdquo to receive discount $249 Non AACE members
bull Live weekly webinars where you can ask specific questions and get direct answers on a variety of current topics important to your practice
bull 24-hour access to TOTAL ACCESS Audio Library with almost 200 hours of pre-recorded training sessions and choose from 100+ topics
bull A fast way to bring both experienced and new staff up-to-speed on current issues bull Include your physician to learn about important coding billing compliance and operational updates bull Inexpensive convenient way to develop your own talent without leaving the office to attend training classes bull Use your offices speakerphone so that multiple staff can participate
Topics include ICD-10 Diagnosis Coding for Endocrinology (pre-recorded) Front Office Breach Mastering Medical Decision Making Translating Efficiencies to Profit (62112) HCPCS Modifiers (62812) EampM Documentation (scheduled for 7102012) Conducting ldquoPayer Proofrdquo EM Chart Audits (scheduled for 7112012) Top 5 Concerns of Medical Practice Managers (72612) Compliance is NOT an Option (scheduled for 822012)
PMI National Certifications via Webinar
Live Certification Webinars include 10 to12 90-minute learning sessions taught in a live Webinar format via your computer Interact ask questions and get answers real-time This option includes the full course manual shipped to the candidates address plus access to the streamed versions of the live sessions to review anytime Once the candidate is ready to take the exam heshe will arrange with PMI for an exam proctor to administer the test live in a nearby community Learn more
Certified Medical Insurance Specialist Certified Medical Coder Certified Medical Compliance Officer Certified Medical Office Manager Payment plans available Use promotional code AACE when registering For more information or to register call 800-259-5562 x242 AACE assumes no liability for the purchase(s) of these programs All purchases and communications are between the attendee and the company
wwwpmimdcom
6
Medical Decision Making Complexity of medical decision-making is the component for determining medical necessity for visits procedures and other services the patient obtains Three categories determine the level of medical complexity and two of the three categories must be met or exceeded to appropriately calculate medical decision-making
1 Number of Diagnoses andor Management Options 2 Amount andor Complexity of Data 3 Risk of Complications Morbidity andor Mortality
Number of Diagnosis andor Management Options can be Straightforward 0-1 diagnosis andor management options Low complexity 2 diagnosis andor management options Moderate complexity 3 diagnosis andor management options High Complexity 4 or more diagnosis andor management options
Documentation should indicate If problem is new worsened stable mildserious exacerbation and or life threatening Assessment clinical impression or diagnosis Initiation or changes in treatment Patient andor nursing instructions therapies and medications Referrals consult requests or advice sought
Amount andor Complexity of Data can be
Straightforward 0-1 items for the amount andor complexity of data Low complexity 2 items for the amount andor complexity of data Moderate complexity 3 items for the amount andor complexity of data High complexity 4 or more items for the amount andor complexity of data
Documentation should indicate
Clinical lab tests - orderedreviewedperformed Radiological tests - orderedreviewedperformed Medical tests - orderedreviewedperformed Test results discussed with performinginterpreting physician Obtainingreviewing old medical records Obtaining case history from another source Personal visualization of images or specimens
Risk of Complications Morbidity andor Mortality Can be
Minimalstraightforward Lowlow complexity Moderatemoderate complexity Highhigh complexity
Documentation should indicate Presenting problem(s) diagnostic procedure(s) ordered management options selected Comorbiditiesunderlying diseases or other factors that increase the complexity of medical decision making by
increasing the risk of complications morbidity andor mortality Surgical or invasive diagnostic procedures ordered planned or scheduled at time of EM visit Referral for or decision to perform a surgical or invasive diagnostic procedure on an urgent basis
An example of appropriate calculation of the MDM will be provided in the upcoming
edition of Endonomicstrade
7
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2011 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use
We want to hear
from you Tell us what you think of Endonomics Please take a few minutes to take this survey Your feedback is very important to us as we strive to assist you with a profitable and compliant business office
o Is Endonomicstrade valuable and useful for your office
o What other topics would you like to see offered in Endonomics
o Other commentshellip AACEs Socioeconomics and Member Advocacy Departments goal is to reach out to the endocrinology business world and become the one- stop- shop not only for endocrinology clinicians but their support staff as well Currently Endonomics is a free newsletter for both members and non-members Interested parties should send an e-mail to Endonomicsaacecom with their name phone and fax numbers location and preferred e-mail address to be added to our Practice Support Network database
Coding TRAC
Tips on Reimbursement And Coding bull New physician specialty codes for sleep medicine and sports medicine have
been established Effective Date April 1 2012 Implementation Date October 1 2012 Medicare specialty codes describe the specific or unique types of medical services that physicians and non-physician practitioners provide Although physicians self-designate their Medicare physician specialty on their Medicare enrollment applications (ie CMS-855I) non-physician practitioners are assigned their Medicare specialty code when they enroll The specialty code becomes associated with their submitted claims Medicare contractors also use specialty code data to develop claim-processing edits For additional information see MLN Mattersreg article MM7600
bull What is the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN) The PTAN is the number that Medicare assigns and consists of 5 to 10 characters comprised of numeric or alpha characters for Part B providers and 6 characters for Part A providers You may have heard it referred to as the Medicare provider number or PIN When accessing the Interactive Voice Response (IVR) or contacting your Provider Contact Center you will need the PTAN in addition to your NPI and the last five digits of the Tax Identification Number (TIN) Additional information can be found at MLN Mattersreg Number SE1216
bull HPSA bonus payments pertain only to physicians professional services Only the professional component will receive the bonus payment for services provided in an approved HPSA area containing both a professional and technical component Additional information on HPSA bonus payments is here
bull Technical component of physician pathology services furnished to hospital patients no longer covered by Medicare for certain pathologists and independent labs (Part B) as of June 30 2012 For background and policy information regarding payment to pathologists and independent laboratories for the TC of physician pathology services furnished to hospital patients refer to MLN Mattersreg article MM5943 and MLN Mattersreg article MM5347
bull FREE Educational Course Avoiding Medicare Fraud and Abuse A Roadmap for Physicians
5
Distance Learning and Total Access with PMIreg
Month by month - cancel at any time
$225 per month AACE members amp staff Registrants must use promotional code ldquoAACErdquo to receive discount $249 Non AACE members
bull Live weekly webinars where you can ask specific questions and get direct answers on a variety of current topics important to your practice
bull 24-hour access to TOTAL ACCESS Audio Library with almost 200 hours of pre-recorded training sessions and choose from 100+ topics
bull A fast way to bring both experienced and new staff up-to-speed on current issues bull Include your physician to learn about important coding billing compliance and operational updates bull Inexpensive convenient way to develop your own talent without leaving the office to attend training classes bull Use your offices speakerphone so that multiple staff can participate
Topics include ICD-10 Diagnosis Coding for Endocrinology (pre-recorded) Front Office Breach Mastering Medical Decision Making Translating Efficiencies to Profit (62112) HCPCS Modifiers (62812) EampM Documentation (scheduled for 7102012) Conducting ldquoPayer Proofrdquo EM Chart Audits (scheduled for 7112012) Top 5 Concerns of Medical Practice Managers (72612) Compliance is NOT an Option (scheduled for 822012)
PMI National Certifications via Webinar
Live Certification Webinars include 10 to12 90-minute learning sessions taught in a live Webinar format via your computer Interact ask questions and get answers real-time This option includes the full course manual shipped to the candidates address plus access to the streamed versions of the live sessions to review anytime Once the candidate is ready to take the exam heshe will arrange with PMI for an exam proctor to administer the test live in a nearby community Learn more
Certified Medical Insurance Specialist Certified Medical Coder Certified Medical Compliance Officer Certified Medical Office Manager Payment plans available Use promotional code AACE when registering For more information or to register call 800-259-5562 x242 AACE assumes no liability for the purchase(s) of these programs All purchases and communications are between the attendee and the company
wwwpmimdcom
6
Medical Decision Making Complexity of medical decision-making is the component for determining medical necessity for visits procedures and other services the patient obtains Three categories determine the level of medical complexity and two of the three categories must be met or exceeded to appropriately calculate medical decision-making
1 Number of Diagnoses andor Management Options 2 Amount andor Complexity of Data 3 Risk of Complications Morbidity andor Mortality
Number of Diagnosis andor Management Options can be Straightforward 0-1 diagnosis andor management options Low complexity 2 diagnosis andor management options Moderate complexity 3 diagnosis andor management options High Complexity 4 or more diagnosis andor management options
Documentation should indicate If problem is new worsened stable mildserious exacerbation and or life threatening Assessment clinical impression or diagnosis Initiation or changes in treatment Patient andor nursing instructions therapies and medications Referrals consult requests or advice sought
Amount andor Complexity of Data can be
Straightforward 0-1 items for the amount andor complexity of data Low complexity 2 items for the amount andor complexity of data Moderate complexity 3 items for the amount andor complexity of data High complexity 4 or more items for the amount andor complexity of data
Documentation should indicate
Clinical lab tests - orderedreviewedperformed Radiological tests - orderedreviewedperformed Medical tests - orderedreviewedperformed Test results discussed with performinginterpreting physician Obtainingreviewing old medical records Obtaining case history from another source Personal visualization of images or specimens
Risk of Complications Morbidity andor Mortality Can be
Minimalstraightforward Lowlow complexity Moderatemoderate complexity Highhigh complexity
Documentation should indicate Presenting problem(s) diagnostic procedure(s) ordered management options selected Comorbiditiesunderlying diseases or other factors that increase the complexity of medical decision making by
increasing the risk of complications morbidity andor mortality Surgical or invasive diagnostic procedures ordered planned or scheduled at time of EM visit Referral for or decision to perform a surgical or invasive diagnostic procedure on an urgent basis
An example of appropriate calculation of the MDM will be provided in the upcoming
edition of Endonomicstrade
7
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2011 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use
We want to hear
from you Tell us what you think of Endonomics Please take a few minutes to take this survey Your feedback is very important to us as we strive to assist you with a profitable and compliant business office
o Is Endonomicstrade valuable and useful for your office
o What other topics would you like to see offered in Endonomics
o Other commentshellip AACEs Socioeconomics and Member Advocacy Departments goal is to reach out to the endocrinology business world and become the one- stop- shop not only for endocrinology clinicians but their support staff as well Currently Endonomics is a free newsletter for both members and non-members Interested parties should send an e-mail to Endonomicsaacecom with their name phone and fax numbers location and preferred e-mail address to be added to our Practice Support Network database
Coding TRAC
Tips on Reimbursement And Coding bull New physician specialty codes for sleep medicine and sports medicine have
been established Effective Date April 1 2012 Implementation Date October 1 2012 Medicare specialty codes describe the specific or unique types of medical services that physicians and non-physician practitioners provide Although physicians self-designate their Medicare physician specialty on their Medicare enrollment applications (ie CMS-855I) non-physician practitioners are assigned their Medicare specialty code when they enroll The specialty code becomes associated with their submitted claims Medicare contractors also use specialty code data to develop claim-processing edits For additional information see MLN Mattersreg article MM7600
bull What is the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN) The PTAN is the number that Medicare assigns and consists of 5 to 10 characters comprised of numeric or alpha characters for Part B providers and 6 characters for Part A providers You may have heard it referred to as the Medicare provider number or PIN When accessing the Interactive Voice Response (IVR) or contacting your Provider Contact Center you will need the PTAN in addition to your NPI and the last five digits of the Tax Identification Number (TIN) Additional information can be found at MLN Mattersreg Number SE1216
bull HPSA bonus payments pertain only to physicians professional services Only the professional component will receive the bonus payment for services provided in an approved HPSA area containing both a professional and technical component Additional information on HPSA bonus payments is here
bull Technical component of physician pathology services furnished to hospital patients no longer covered by Medicare for certain pathologists and independent labs (Part B) as of June 30 2012 For background and policy information regarding payment to pathologists and independent laboratories for the TC of physician pathology services furnished to hospital patients refer to MLN Mattersreg article MM5943 and MLN Mattersreg article MM5347
bull FREE Educational Course Avoiding Medicare Fraud and Abuse A Roadmap for Physicians
6
Medical Decision Making Complexity of medical decision-making is the component for determining medical necessity for visits procedures and other services the patient obtains Three categories determine the level of medical complexity and two of the three categories must be met or exceeded to appropriately calculate medical decision-making
1 Number of Diagnoses andor Management Options 2 Amount andor Complexity of Data 3 Risk of Complications Morbidity andor Mortality
Number of Diagnosis andor Management Options can be Straightforward 0-1 diagnosis andor management options Low complexity 2 diagnosis andor management options Moderate complexity 3 diagnosis andor management options High Complexity 4 or more diagnosis andor management options
Documentation should indicate If problem is new worsened stable mildserious exacerbation and or life threatening Assessment clinical impression or diagnosis Initiation or changes in treatment Patient andor nursing instructions therapies and medications Referrals consult requests or advice sought
Amount andor Complexity of Data can be
Straightforward 0-1 items for the amount andor complexity of data Low complexity 2 items for the amount andor complexity of data Moderate complexity 3 items for the amount andor complexity of data High complexity 4 or more items for the amount andor complexity of data
Documentation should indicate
Clinical lab tests - orderedreviewedperformed Radiological tests - orderedreviewedperformed Medical tests - orderedreviewedperformed Test results discussed with performinginterpreting physician Obtainingreviewing old medical records Obtaining case history from another source Personal visualization of images or specimens
Risk of Complications Morbidity andor Mortality Can be
Minimalstraightforward Lowlow complexity Moderatemoderate complexity Highhigh complexity
Documentation should indicate Presenting problem(s) diagnostic procedure(s) ordered management options selected Comorbiditiesunderlying diseases or other factors that increase the complexity of medical decision making by
increasing the risk of complications morbidity andor mortality Surgical or invasive diagnostic procedures ordered planned or scheduled at time of EM visit Referral for or decision to perform a surgical or invasive diagnostic procedure on an urgent basis
An example of appropriate calculation of the MDM will be provided in the upcoming
edition of Endonomicstrade
7
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2011 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use
We want to hear
from you Tell us what you think of Endonomics Please take a few minutes to take this survey Your feedback is very important to us as we strive to assist you with a profitable and compliant business office
o Is Endonomicstrade valuable and useful for your office
o What other topics would you like to see offered in Endonomics
o Other commentshellip AACEs Socioeconomics and Member Advocacy Departments goal is to reach out to the endocrinology business world and become the one- stop- shop not only for endocrinology clinicians but their support staff as well Currently Endonomics is a free newsletter for both members and non-members Interested parties should send an e-mail to Endonomicsaacecom with their name phone and fax numbers location and preferred e-mail address to be added to our Practice Support Network database
Coding TRAC
Tips on Reimbursement And Coding bull New physician specialty codes for sleep medicine and sports medicine have
been established Effective Date April 1 2012 Implementation Date October 1 2012 Medicare specialty codes describe the specific or unique types of medical services that physicians and non-physician practitioners provide Although physicians self-designate their Medicare physician specialty on their Medicare enrollment applications (ie CMS-855I) non-physician practitioners are assigned their Medicare specialty code when they enroll The specialty code becomes associated with their submitted claims Medicare contractors also use specialty code data to develop claim-processing edits For additional information see MLN Mattersreg article MM7600
bull What is the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN) The PTAN is the number that Medicare assigns and consists of 5 to 10 characters comprised of numeric or alpha characters for Part B providers and 6 characters for Part A providers You may have heard it referred to as the Medicare provider number or PIN When accessing the Interactive Voice Response (IVR) or contacting your Provider Contact Center you will need the PTAN in addition to your NPI and the last five digits of the Tax Identification Number (TIN) Additional information can be found at MLN Mattersreg Number SE1216
bull HPSA bonus payments pertain only to physicians professional services Only the professional component will receive the bonus payment for services provided in an approved HPSA area containing both a professional and technical component Additional information on HPSA bonus payments is here
bull Technical component of physician pathology services furnished to hospital patients no longer covered by Medicare for certain pathologists and independent labs (Part B) as of June 30 2012 For background and policy information regarding payment to pathologists and independent laboratories for the TC of physician pathology services furnished to hospital patients refer to MLN Mattersreg article MM5943 and MLN Mattersreg article MM5347
bull FREE Educational Course Avoiding Medicare Fraud and Abuse A Roadmap for Physicians
7
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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) is copyright and trademark of the 2011 American Medical Association (AMA) All Rights Reserved No fee schedules basic units relative values or related listings are included in CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use
We want to hear
from you Tell us what you think of Endonomics Please take a few minutes to take this survey Your feedback is very important to us as we strive to assist you with a profitable and compliant business office
o Is Endonomicstrade valuable and useful for your office
o What other topics would you like to see offered in Endonomics
o Other commentshellip AACEs Socioeconomics and Member Advocacy Departments goal is to reach out to the endocrinology business world and become the one- stop- shop not only for endocrinology clinicians but their support staff as well Currently Endonomics is a free newsletter for both members and non-members Interested parties should send an e-mail to Endonomicsaacecom with their name phone and fax numbers location and preferred e-mail address to be added to our Practice Support Network database
Coding TRAC
Tips on Reimbursement And Coding bull New physician specialty codes for sleep medicine and sports medicine have
been established Effective Date April 1 2012 Implementation Date October 1 2012 Medicare specialty codes describe the specific or unique types of medical services that physicians and non-physician practitioners provide Although physicians self-designate their Medicare physician specialty on their Medicare enrollment applications (ie CMS-855I) non-physician practitioners are assigned their Medicare specialty code when they enroll The specialty code becomes associated with their submitted claims Medicare contractors also use specialty code data to develop claim-processing edits For additional information see MLN Mattersreg article MM7600
bull What is the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN) The PTAN is the number that Medicare assigns and consists of 5 to 10 characters comprised of numeric or alpha characters for Part B providers and 6 characters for Part A providers You may have heard it referred to as the Medicare provider number or PIN When accessing the Interactive Voice Response (IVR) or contacting your Provider Contact Center you will need the PTAN in addition to your NPI and the last five digits of the Tax Identification Number (TIN) Additional information can be found at MLN Mattersreg Number SE1216
bull HPSA bonus payments pertain only to physicians professional services Only the professional component will receive the bonus payment for services provided in an approved HPSA area containing both a professional and technical component Additional information on HPSA bonus payments is here
bull Technical component of physician pathology services furnished to hospital patients no longer covered by Medicare for certain pathologists and independent labs (Part B) as of June 30 2012 For background and policy information regarding payment to pathologists and independent laboratories for the TC of physician pathology services furnished to hospital patients refer to MLN Mattersreg article MM5943 and MLN Mattersreg article MM5347
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