JOURNALThe Medical BusinessThe Monthly Newsletter for the Informed Health Care Professional

Brought to you by the Medical Management Institute | May 2013 | Issue 4 Volume 4

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Inside this IssueCMS News Updates

ICD-10 for Mental, Behavioral, & Neurological Disorders

A Compliance Program Can Protect Your Practice

EHRs Fall Short of Meeting Physician Needs

Audiology New & Revised HCPCS Codes

MMI Member Updates

The Art of Incident to Billing

Be Careful When Using New G Codes

Patience with Patients

Make a Great First Impression...Twice

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mmi news updates

iPad Mini Winner from the AAPC ConferenceCongratulations Deborah!The MMI Team had an amazing time hosting a booth at the AAPC Conference. We got to meet a ton of amazing new people, and even got to catch up with ARHCP & MMI members! We had hundreds of people sign up for our iPad mini

raffle, and we want to congratule Deborah again on winning it! Did you miss out

on the drawing? Visit our facebook page (www.facebook.com/MMIfan) to take part in our ongoing promotions and giveaways! Are you on twitter? Visit www.twitter.com/MMIclasses.

Certification Programs on a New SystemMedical Coding, Management, & AuditingRe-introduce yourself to our online certification programs, now hosted on a brand new learning system called LearnerNation! This new system was built with you the user in mind, complete with interactive tools including flash cards, practice quizzes, and embedded videos. MMI offers a medical coding training program, to prepare you for the CPC® or RMC, as well as a management training program, and the brand new auditing training program.

ICD-10-CM Certification ProgramOnline Program Coming SoonEffective October 1, 2014, the ICD-9-CM code sets used by medical coders and billers to report health care diagnoses and procedures will be replaced with ICD-10 codes. ICD-10 will be a radical change, requiring extensive planning and training.

That is why the amazing instruction team at the Medical Management Institute has put together a

fully customizable ICD-10-CM certification training program, completely online! This program even includes ‘Implementation Insurance,’ guaranteeing no additional charges for continuing education should ICD-10 not be implemented on October 1, 2014.

A complete training program is available for each of the following fields: Coder, Manager, Provider, Clinical Staff, Biller. Visit mmi-classes.com/collections/icd-10 for more details.

Hospital Coding Conference in Atlanta, GABecome a Registered Hospital Coder!

Please join us July 15-19 for our Hospital Coding Conference in Atlanta, GA, and become a Registered Hospital Coder (RHC)!

The first 3 days will cover Facility Coding (Inpatient & Outpatient), and the last two will cover Facility Billing. For more details, visit mmi-classes.com/collections/hospital-coding.

*Note: This conference will be recorded, so if you can’t make these dates you can purchase an online version and become certified upon passing the online exam!*

April showers bring May flowers...or in our case, classes! Our instruction team and staff worked very hard through the month of April; we attended and hosted a booth at the AAPC Conference in Orlando and met amazing new people, finished putting together a fully customizable and online ICD-10 training program, and finished uploading courses to our new learning platform. Please take advantage of the hardwork, and check out the new courses and programs- enjoy the flowers!

mmi news updates

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Obama Administration Simplifies, Significantly Shortens Application for Heatlh InsuranceApril 30, 2013The Centers for Medicare & Medicaid Services (CMS) today announced that the application for health coverage has been simplified and significantly shortened. The application for individuals without health insurance has been reduced from twenty-one to three pages, and the application for families is reduced by two-thirds. The consumer friendly forms are much shorter than industry standards for health insurance applications today.In addition, for the first time consumers will be able to fill out one simple application and see their entire range of health insurance options, including plans in the Health Insurance Marketplace, Medicaid, the Children’s Health Insurance Program (CHIP) and tax credits that will help pay for premiums.The applications released today, which can be submitted starting on October 1, can be found here:http://cciio.cms.gov/resources/other/index.html#hie“Consumers will have a simple, easy-to-understand way to apply for health coverage later this year,” said CMS Acting Administrator Marilyn Tavenner. “The application for individuals is now three pages, making it easier to use and significantly shorter than industry standards. This is another step complete as we get ready for a consumer-friendly marketplace that will be open for business later this year.”

“Navigator” Program will Help Consumers Understand New Coverage OptionsApril 09, 2013The Centers for Medicare & Medicaid Services (CMS) today announced the availability of new funding to support Navigators in Federally-facilitated and State Partnership Marketplaces. Navigators are individuals and entities that will provide unbiased information to consumers about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.“Navigators will be an important resource for the millions of Americans who are eligible to enroll in new coverage opportuni t ies through the Marketplace starting in October of 2013,” said CMS Acting Administrator Marilyn Tavenner. 

Help for Consumers Navigating the Health Insurance Marketplace Proposed by CMSApril 03, 2013The Centers for Medicare & Medicaid Services (CMS) released a proposed rule today outlining standards that Navigators in Federally-facilitated and State Partnership Marketplaces must meet, and clarifying earlier guidance about the Navigator program. Navigators are organizations that will provide unbiased information to consumers about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.“Navigators will be an important resource for consumers who want to learn about and apply for coverage in the new Marketplace,” said CMS Acting Administrator Marilyn Tavenner. Millions of Americans will be eligible for new coverage opportunities in 2014. For those who are not familiar with health insurance, have limited English literacy, or are living with disabilities, Navigators will serve an important role in ensuring people understand the health coverage options available to them. Navigators will provide accurate and impartial assistance to consumers shopping for coverage plans in the new Marketplace.

CMS Ensures Greater Value for People in Medicare Drug & Health Plans

April 01, 2013The Centers for Medicare & Medicaid Services (CMS) issued the 2014 rate announcement and final call letter for Medicare Advantage (MA) and prescription drug benefit (Part D) programs. The announcements set a stable path for Medicare Advantage and implement a number of policies designed to improve payment accuracy. Health care spending has been slowing across the nation, with Medicare spending per beneficiary growing at only 0.4 percent per capita in 2012. For the first time since inception of the Part D program, the deductible for the defined standard plan will be lower in 2014 than in previous years. Today’s guidance will give people in Medicare health and drug plans more value in the care they receive and greater protections against increasing costs.

cms news updates reprinted from cms.gov

cms news updates

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y definition, a mental disorder is a change in a person’s mood, behavior, or perception of things, often associated with distress and impaired functioning. Examples include

mood disorders (e.g. depression, psychotic and delusional conditions), disorders caused by substance abuse, as well as behavioral and personality disorders. The definition of mental, behavioral and neurodevelopmental disorders is important for investigation and, of course, health care and the insurance industry (particularly health insurance and pension insurance).

The following elements are especially important:

• Personal harm and suffering

• Abnormality (statistical, social, individual)

• Limitations or disabilities in what a person can perform

• Danger for others or the individual

In most instances more than one of these elements has to occur at the same time.

Over the past few years, ICD-9 chapter 5 has changed from “Mental Disorders” to "Mental, Behavioral and Neurodevelopmental Disorders." Additionally, the section title for categories 317–319 was revised from "Mental Retardation" to "Intellectual Disabilities." All this seemingly in efforts to keep up with the constant discovery of specific nuances of the brain and, of course, to make the transition to the ICD-10 a little more fluid.

Coding mental and behavioral disorders in ICD-9 proved to be challenging. So much so, that many coders are curious as to how much more challenging it will be with the increased specificity available in ICD-10. ICD-10-CM doesn’t only include far greater detail, but more categories and more codes to boot.

Codes for Mental and Behavioral Disorders (located in Chapter 5 in both ICD-9-CM and ICD-10-CM), include some conditions that are classified differently and the clinical terminology is also different. There is much greater detail in ICD-10-CM and more categories and codes as well.

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ICD-10 for Mental, Behavioral, & Neurodevelopment Disorders

icd-10 for mental, behavioral, & neurodevelopment disorders

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For example in ICD-10-CM, the codes for schizophrenia and delusional disorders include new categories—schizotypal disorder and undifferentiated schizophrenia. The organization of the categories is also different than in I-9, although the broad categories of disorders are similar, such as mental or behavioral disorders with an organic origin, psychotic and non-psychotic disorders, intellectual disabilities and personality disorders.

You will also see updated names and definitions of disorders in ICD-10-CM, which reflect more current clinical terminology and standardization of the terms used to diagnose mental, behavioral and substance use disorders. The American Psychiatric Association (APA; publishers of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV) and the Centers for Disease Control and Prevention (CDC) worked together to better align the DSM-V and the Mental Disorders classification in ICD-10-CM.

Commonly used terms such as “substance abuse” or “substance dependence” are separate conditions in ICD-10-CM, so “abuse” and “dependence” are not interchangeable as implied in the I-9. The term "disorder" is used in the classification rather than "disease" and "illness". The classification also includes a terminology note regarding clarifying that the word “disorder" describes a clinically recognizable set of symptoms or behavior associated, in most cases, with interference with personal function and distress.

Another notable difference in ICD-10 involves substance use, abuse and dependence. These disorders not only include updated terminology, they will also be classified and coded differently in ICD-10-CM. Alcohol dependence, drug dependence, and non-dependent abuse of drugs are classified to three different categories including more combination codes for alcohol and drug use and related conditions (e.g. hallucinations, withdrawal, etc.). The ICD-10-CM codes identify the withdrawal state, the effects (i.e. abuse and dependence) and the manifestations (alcohol abuse with alcohol-induced delirium). The substance involved is indicated in the second and third characters while the fourth and fifth characters specify the clinical state.

Other changes in ICD-10-CM involve sequencing instructions. In coding intellectual disability for example, the classification directs the user to code any associated physical or developmental disorder first rather than as additional codes.

However, one thing doesn’t seem like it will change, the need for thorough documentation of all psychiatric disorders. Mental and behavioral disorders require detailed information on the acuity and etiology of the disease as well as any associated manifestations or complications—whether you’re using ICD-9 or ICD-10.

Each chapter of ICD-10 begins with a listing of related code ranges (blocks).  Chapter 5 ICD-10 Blocks include:

• F01-F09 Mental disorders due to known physiological conditions;

• F10-F19 Mental and behavioral disorders due to psychoactive substance use;

• F20-F29 Schizophrenia, schizotypal and delusional, and other non-mood psychotic disorders;

• F30-F39 Mood [affective] disorders;

• F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders;

• F50-F59 Behavioral syndromes associated with physiological disturbances and physical factors;

• F60-F69 Disorders of adult personality and behavior; F70-F79 Mental retardation;

• F80-F89 Pervasive and specific developmental disorders;

• F90-F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence; and,

• F99 Unspecified mental disorder. 

As you can see, each block begins with the same alpha letter “F”.  There is no requirement for a 7th character extensor in chapter 5.

A number of codes have been significantly expanded in ICD-10

F10.182 – For example, “Alcohol abuse with alcohol-induced sleep disorder”. The block that covers schizophrenia, schizotypal states and delusional disorders (F20-F29) has been expanded by the introduction of new categories such as undifferentiated schizophrenia (F20.3), schizoaffective disorder, depressive type (F25.1), and schizotypal disorder (F21).

“October 1, 2014, is the deadline for implementation and use of ICD-10-CM and ICD-10-PCS.”

Guidelines for mental disordersNo specific coding guidelines were ever developed for mental disorders in ICD-9-CM but the guidelines for mental disorders diseases are also distinctly different ICD-10-CM. They are more detailed and provide for certain conditions classified in Chapter 5, like pain disorders with related psychological factors, mental and behavioral disorders due to psychoactive substance use and psychoactive substance use, abuse and dependence.

icd-10 for mental, behavioral, & neurodevelopment disorders

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Alcohol dependence is defined in the I-10 classification in a way that is similar to the DSM. Category F10.1- F10.99 describes alcohol abuse and dependence.  These categories require 5 or 6 characters to complete the code. There is no referencing back for a 5th digit (ICD-9 requirement), each code is complete.  Example: code F10.221 “Alcohol dependence with intoxication delirium.”

Bipolar disorder, category F31, includes manic-depressive illness, manic-depressive psychosis, and manic-depressive reaction.  Example: code F31.62 states “Bipolar disorder, current episode mixed, moderate.” Clinical documentation will require greater detail than physicians have been using for the past 30 years.  Training of both coders and providers will take time and should be factored into the ICD-10 transition budget for years 2013 and, likely, Q1-Q3 of 2014.

October 1, 2014, is the deadline for implementation and use of ICD-10-CM and ICD-10-PCS. For diagnosis coding purposes, the ICD-10 diagnosis codes will be used to assign codes to documented conditions for a specific patient encounter, in any place of service.  If you are assigning ICD-9 codes now, you will be assigning ICD-10 diagnosis codes on October 1, 2014. CPT and HCPCS codes will not change for physician billing.  It is recommended that clinicians should follow the general rule of recording as many diagnoses as are necessary to cover the clinical picture.

Chapter 5 (F01-F09) is comprised of a range of mental disorders grouped together on the basis of commonality between the demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction. The dysfunction may be primary, as in diseases, injuries, and insults that affect the brain directly and selectively; or secondary, as in systemic diseases and

disorders that attack the brain only as one of the multiple organs or systems of the body that are involved.

The takeaway here is: acquire the knowledge and understanding of ICD-10 codes used by your practice. Accomplish this by taking a proactive approach and keeping an open mind. 

You may assign codes from other ICD-10-CM chapters

It is highly likely that you will assign codes from other chapters based on medical record documentation. 

Let’s take chapter 19 for instance: it contains codes for injuries, poisoning, and adverse effects. Codes from chapter 19 (e.g. T40, T51), would be used in conjunction with the F10-F19 codes if a patient has an acute alcohol or drug poisoning, even if the patient has an alcohol or drug dependency.

Or, let’s take a code from the nervous system (G30.x). If the patient has documented dementia due to an underlying condition, the underlying condition (e.g. Alzheimer’s) is the first-listed code (G30.9). The dementia would be second-listed (F02.81).

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s the health care market gets more and more competitive, if done right, your docs will become overwhelmed with new patients that they will have to see. Well, what about your established patients? They certainly can’t fall to the wayside while in

search of a golden paycheck. Incident-to services is the perfect way for physicians to get reimbursement at 100% of Medicare’s Fee Schedule and maximum use of the ancillary staff. However, you must adhere to the rules.1. The patient must be established with an established

problem. NEW PROBLEMS in Established Patient Visits do not count as Incident-to

2. The visit must be completed with the same provider that it started with. A physician should not “pass” a patient off to ancillary staff and likewise. The physician can certainly come in to address the patient, but then the ancillary staff should come back to “close” the patient out.

3. Frequent subsequent visits. When scheduling patients for services incident to the physician, be sure the patient is scheduled with the actual physician when a new problem occurs as well as every third or fourth visit with an established problem so the physician can remain active in the continued care management.

4. Direct Supervision: When the patients see ancillary staff, the doc must be on property and readily available to assist if needed. The doc cannot be down the street grabbing a bite or at the hospital next door doing rounds. They must be on the premise!

Here are some FAQ regarding incident-to:

Q: We employ several nurse practitioners (NPs) that have received credentials from most of the major carriers. Sometimes, they act as nurses rather than as independent NPs when other ancillary clinical staff members are ill or on vacation. It is our understanding that once an NP has received credentials from an insurer, we no longer can bill his or her services "incident to." How should we bill for services when they assist us? When we bill services as though the NP performed the entire visit, we lose 15% of our reimbursement.

A: Incident-to care is care provided in the physician office or patient home incident to the care provided by the physician. The physician first must see the patient, and the care provided must be an integral part of the physician's documented treatment plan.Physician assistants (PAs) and NPs can bill their services as incident to the physician—that is, bill under the physician's provider number as if the physician had provided the service—as long as the services rendered to the patient are part of a documented treatment plan. Other requirements:

• The PA or NP must be an employee of the physician or the group that employs the physician. Leased or

contracted employees are permitted.• The doctor (or other employed physician of the same

tax ID group) must be in the office and immediately available when the services are provided.

• No new patients or established patients with new problems can be treated.

• Visits in the hospital or nursing home do not apply.• Unless the provider is a PA, NP, certified nurse

midwife, or clinical nurse specialist, the service can be billed only at the 99211 level.

• Services typically must be provided in the doctor's office and must be an expense to the doctor.

• The physician must initiate the plan of care and remain involved in the care.

If the ordering doctor is not in the office when the service is provided, the service must be billed under the number of the supervising physician, that is, the doctor who actually is in the office that day and is part of the same tax ID group.PAs and NPs also can bill under their own provider numbers after receiving payer credentials. Then they typically are reimbursed at 85% of the physician fee schedule.Services to new patients by the PA or NP should be billed with the provider number of the PA or NP. Also, visits for established patients for new problems should be billed under the provider number of the PA or NP. In neither of these cases should the bill be sent out as incident to the physician service using the physician's provider number.Incident-to services are allowed in the patient's home as well. Both the physician and the employee must be present in the patient's home for incident-to services to take place. This occurrence would be fairly rare for most practices.There is no incident-to service in a hospital setting (inpatient or outpatient).

Q: I am negotiating to join several managed care plans. They are asking for market data to support my assertion that their reimbursement levels are too low. Where can I obtain this information?

A: One place to obtain reimbursement information is the Medicare fee schedule for your locality (presuming the services you provide are covered by Medicare). Another source is the explanation of benefit forms from your other payers.Be aware, however, that the outliers may only want to obtain market data from you and still may be unwilling to negotiate. If that is the case, then you may be better off continuing nonparticipation with those insurers and telling patients the reason you chose not to participate. If you are not already doing so, you could offer those patients an incentive for out-of-pocket payment at the time of service. Doing so should be the policy in a small office.

FAQ: Compliments of Medical Economics

The Art of Incident to BillingEnsure your practice gets full credit when your nurses see patients

In honor of National Nurse Week (May 6-12, 2013)

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the art of incident to billing

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MS added two G-codes: G0456  and  G0457, for the use of disposable negative pressure wound therapy (NPWT) devices. When

reporting these codes, check coverage for NPWT. The coverage may extend to more than one kind of device, and you will have to document its use carefully.

The HCPCS codes G0456 and G0457, provides a payment mechanism for NPWT procedures furnished to beneficiaries through means unrelated to the DME benefit.

Spiracur Inc., a privately held medical device company focused on the development of innovative wound healing technologies states, "This is particularly important for patients who receive their wound care therapy in their doctor's offices or at a clinic, as it allows patients to be ambulatory instead of remaining in a home care setting.” CMS previously did not have a mechanism to adequately cover NPWT procedures in these settings.

The new codes are for clinical services using a mechanically-powered device, not durable medical equipment, including provision of c a r t r i d g e a n d d r e s s i n g ( s ) , t o p i c a l application(s), wound assessment, and instructions for ongoing care. Code G0456 applies to total wound(s) surface area less than or equal to 50 square centimeters, and code G0457 applies to total wound(s) surface area greater than 50 square centimeters.

Effective dates of service on and after January 1, 2013, will reimburse for deliveries of constant and controlled levels of negative pressure to facilitate the healing of the following types of open wounds:

• Stage III and IV pressure ulcer • Neuropathic (diabetic) ulcer

• Chronic (present for at least 30 days) ulcer of mixed etiology

• Venous or arterial insufficiency ulcer • Complications of a surgically created wound • Traumatic wound

Payors expect providers to utilize all accepted wound care standards. Accepted wound care standards include the following:

• Patient turning and positioning • Appropriate surface modalities to prevent

pressure wounds • Appropriate management of moisture and

incontinence • Consistent application of compression

garments and/or bandages • Leg elevation and ambulation • Appropriate topical wound treatments • Appropriate necrotic tissue debridement • N u t r i t i o n a l s t a t u s e v a l u a t i o n w i t h

appropriate intervention

The patient medical record maintained by the health care professional must include the following patient-specific information:

• Physician order for treatment • Documentation to substantiate standard

protocols have been met • Wound description including specific

measurements and condition • Patient-specific treatment plan

Would you like to chew on more detailed billing information for Negative Pressure Wound Therapy? Let us know.

Email info@mmiclasses.com

Coding Negative Pressure Wound Therapy?Be Careful When Using New G Codes

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coding negative pressure wound therapy

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ow Health Reform will change the way you pay taxes and shop for health care. Take a more sensitive approach to new patients that walk through your doors. The Supreme Court’s ruling on ACA (aka Obamacare) has many patients wondering how

they will be affected. Assure them, they will have plenty of time to adjust to the tax implications of the new law. Even though some changes went into effect in 2010 and 2011, major changes won’t be seen until 2013 and 2013. Overall, the revisions are to stretch over 10 years. Here is a timeline of nuances of the new law – past, present and future – with tax-related info:

2010• Donut Hole - $250 prescription drug rebate: This rebate

addresses the gap in drug coverage for people on Medicare. While the Medicare Part D gap will not be fully eliminated until 2020, this rebate is intended to help seniors pay drug costs until then.

• Revised adoption tax credit: The maximum credit increased from $12,150 to $13,170 per eligible child. The increase is retroactive to January 1, 2010, so if you adopted a child after that date, you may have been able to backtrack to claim this increased credit on your 2010 tax return.

• The tanning tax: (Remember this one?) The legislation imposes a 10% tax on individuals who use ultraviolet indoor tanning services. The tax was levied beginning July 1, 2010.

2011• Tax-free medical account limits: You are no longer able to

use your flexible spending account (FSA) to buy over the counter drugs like acetaminophen. Prescription drugs are still covered. 

• Fines for abuse of Health Savings Accounts (HSAs): Penalties for using your HSA to buy non-qualified products increase. They climbed from 10% to 15% to 20%, giving you added motivation not to purchase the iPad mini or those shoes you’ve had your eyes on with your HSA.

2013This is a big year for those who file taxes jointly with incomes over $250,000 and individual filers with incomes over $200,000. Now subject to two taxes:• Medicare tax on earned income: The tax will increase

from 1.45% to 2.35%, but only on income beyond the $200,000/$250,000 thresholds.

• Medicare tax on investment income: This new 3.8% tax

will be assessed on interest, dividends, capital gains, rent and royalty income. Investment income from retirement accounts is not subject to the tax.

Taxpayers at any income level may be subject to:

• Cap on flexible spending account (FSA) contributions: Previously, employers could set the limit on contributions to FSAs. Many opted for caps as high as $5,000. In 2013, a cap of $2,500 goes into effect. Anything above the cap becomes part of your taxable income. The cap will rise each year as the cost-of-living increases.

• New limits on medical deductions: Current law allows filers who itemize their deductions to deduct out-of-pocket medical expenses that exceed 7.5% of their income. In 2013, expenses must exceed 10% for filers under age 65. (If you’re over 65, the law goes into effect in 2016.)

2014The year 2014 is a watershed for the healthcare reform law. This is when the major changes to your healthcare plan will begin. At this time, all Americans will be required to maintain health insurance. (Exceptions include Native Americans, prisoners and illegal immigrants.)If you are not covered by an employer plan, or by Medicare or Medicaid, you’ll have to purchase your own coverage from a market exchange.The IRS is responsible for monitoring whether people comply with the new laws. They’ll do this by requiring you to report the value of your health plan on your tax return. If you don’t have coverage, a penalty will be assessed.

Here are the details:Something new on Form W-2: Starting in 2014, you’ll see a new number on your W-2 form. This is how employers will report the value of your health plan to the IRS. This key figure will determine whether you’re eligible for tax credits or liable for tax penalties.Health plans are not income: Even though the value of your plan is reported on your W-2, it’s not taxable. So you don’t need to report it as income on your tax return.Penalties for those without medical coverage: The penalty starts at $95 or 1% of income (whichever is greater) per person in 2014. It gradually rises until it hits 2.5% or $695 (whichever is greater) per person by 2016.Tax credits for low-income filers: If you can’t afford health insurance, you may be eligible for tax credits to help you pay the cost of coverage if you earn between 133% and 400% of the federal poverty level. Based on the current poverty level of $10,830 per year for singles and $22,050 per year for a family of four, assistance would be available for singles with income between $14,404 and $43,320 and families with income between $29,327 and $88,200.

More changes to come…These changes take taxpayers through the first four years of healthcare reform. More are coming down the road. Remember to check out turbotax.com and irs.gov periodically for the latest news on those that may affect your income taxes.

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Patience with PatientsJennifer Donovan | March 21, 2013

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he days of making a great first impression once are long gone. Nowadays, you make that impression twice and if they don’t match up, you stand the chance of losing total credibility and confidence.

Check out this two-part tip session on landing the job you’ve always wanted.

The first-first impression is generally a virtual one: 1. Your ResumeIt’s amazing how many perspective employers report how many resumes they receive with typos, in the incorrect format, and the classic mistake of inconsistent tense.

Here are seven (7) tips to making a great first virtual impression:

1. No fluff – Objectives are passé. Employers no longer want to hear how you are “seeking an entry-level

position in a face-paced work environment with the opportunity of advancement”. Be more specific. What are your skills and why would they be a perfect fit for the position you are applying for?

2. Position Appropriate – If you are applying for a billing/coding position, you can leave out the two years as a nail tech. Include only pertinent education and work experience. That’s right! You may need to have several different drafts of your resume to meet the job requirements of the position(s) you are applying for.

3. Simplicity – When resumes come through that are more than a page long, they’re generally skipped over or, at best, left for last. When too much information is given and an employer has to go through hundreds of resumes in response to their job post, the cleanest and most concise ones are reviewed first.

Career Services

Make a Great First Impression...Twice!

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make a great first impression...twice

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4. No time to be cute – Again, keep it clean, concise and professional. No flowery icons, cutesy fonts or smiley faces – these are generally first-class, one-way tickets to the trashcan.

5. Relevancy is key – include the six months of medical billing/coding classes and getting your certified coder credentials. Don’t get me wrong, other things can certainly come up in your interview, but may not be necessary on your resume.

6. Understand your qualifications – There are so many certifications that cover the same criteria and require similar testing to attain, but may not be listed as ‘accepted’ in the job post. Educate yourself. Know the difference between those listed and those that you hold. Understand what it took to get your credentials, what you were tested on and what it takes to maintain it. Many employers may only list credentials that other employers listed without even knowing what they are. Likewise, do not apply for a position in which you know you are not qualified for.

7. Know what Employers want to know –What can you do for them? What have you done before? How can you do it again for them and do it better? Remember, keep it pertinent.

NOTE: Not an English major? Use spell check and/or have one or two people proof your resumes before stashing them in your “resumes to send” folder.

The second- first impression: 2. The InterviewBravo! Your resume is a success and now you are on deck for your first interview. It’s time to bring it! This is the time when not only are your credentials being evaluated, so is your behavior, your body language, your attire and your speech. This may sound rough, but if your impression is negative, your qualifications may not matter. That’s the world we live in baby!

In efforts to attain employment, you must:

1. Think like an employer • Yes, you may be incredibly nervous, this interview

could mean the world to you, the job could make a huge difference for you and your family…but to the employer, interviews are tedious, time-consuming, and mentally exhausting. As such, the employer does not want to go through this process again and again so the goal is to find someone who will stay for a long time, who is easy to work with (no one wants to referee employee conflicts – a ref position is just not in the budget), and easy to train (who also remains trainable – the last thing an employer wants to hear from a new employee for the first couple of years is “I know…I know” only to see they are doing the task incorrectly)

2. Dress to Impress• We are in the day and age of virtual malls, remote

work and casual Friday gone array. Basically, there are many companies that permit casual

dress everyday, however, not during the interview process. This is when it’s perfectly acceptable to overdress, but not underdress.

• I remember one candidate whose resume blew all the others away, but when she came in for her face-to-face in a mini-skirt, halter top, “night make up” and platforms I had to inform her that she was not interviewing for any position we had. When she politely left the building her back tattoo let me know I made the right decision. The next day, she called to apologize, we rescheduled an interview and she is currently doing coding work for a successful family practice in Texas. I’m very proud of her - she’s grown up a lot!

• Don’t forget a firm handshake. No one likes a limp-wristed one; it screams “insecure!”

3. Highlight • You may be incredibly qualified for the position,

but maybe you lack direct experience. Highlight what you have accomplished. What some common accomplishments may say about you:

o You’ve been the “CEO” of your household for the past eighteen years. You’ve raised children and balanced meals, extra curricular events, family gatherings, etc.

Says: You are super organizedo You’ve earned a degree.

Says: You show the desire to improve

o You’ve taught pre-K, specializing in special needs children.

Says: You show patients, loyalty and perseverance.

• Look at all areas of your life to find strength.

4. Don’t mumble!• If your potential employer has to pull information

from you, you’re already making them work too hard, which in turn may make them not want to work with you at all. Speak clearly and concisely. If your interview is early in the morning (before you normally have a chance to get the marble out of your speaking voice), get up earlier make some phone calls (call your parents, pay your bills over the phone, etc.), go the newspaper stand and chat up the clerk, or the coffee shop vendor…whatever it takes to get your voice warmed up and ready for conversation.

5. Stay Positive!• We all have the tendency to be our own worst

critic. Don’t let one faux pas keep replaying itself over and over in your head to the theme from the Bates Motel. If the interview doesn’t land you the job, this is no time to kick yourself for a bad day. See each interview as a practice for the next…until you land the job that’s perfect for you and the employer.

make a great first impression...twice

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oday, with CMS’ 2013 $1 billion increase in program operations (which includes funds for many provisions in the Affordable Care Act [ACA]), even the smallest of practices

need some form of compliance plan. Your compliance plan is the groundwork of your practice; a compliance program is more like an implementation, execution, maintenance and monitoring art form (more on this later). With the government ’s budget increase for f raud investigations, the OIG has hired even more investigators and opened more offices across the country. The Department of Justice (DOJ) has also assigned more FBI agents to its enforcement effort, and there are significant increases in HIPAA for health care fraud as well. It would be irresponsible as professionals in this industry to ignore the fact that there is a dire need to increase protection of our practices – unless, of course, you are selling to a hospital, joining/forming an Accountable Care Organization (ACO), or you don’t plan to be in business for very much longer. For those who are targeted, penalties for violations of fraud include civil fines, criminal penalties, and exclusion from Medicare and Medicaid. Although the government originally focused on large health care organizations, they are certainly taking a closer look at physician practices now. There was even rumors that CMS will pay rewards of up to $1,000 to Medicare beneficiaries who, in the words of our source, report "health care scams and unscrupulous providers" to the government.There are many misinterpreted fears that coding and documentation errors could alone put

providers in cuffs, but the government continually states they "will not be punished for honest mistakes and we [CMS] will not make referrals to the OIG for occasional errors." Despite the government's reassurances, physicians remain a bit skeptical– imagine that? After all, who’s the judge of what's considered an "honest mistake" and what's fraud? Exactly. Contrary to popular belief, coding and documentation represent only one component of the entire compliance picture. The investigations also include physician self-referrals, kickbacks and fraudulent billing practices.

What is a compliance program?

To put it simply, it’s a series of internal controls and measures to ensure that you're following federal, state and local statutes and regulations governing the federally funded health care programs. A c o m p l i a n c e p r o g r a m m a y i n c l u d e t h e s e components:

• Legal reviews of contracts and operating procedures,

• Directives and training for employees,

• Monitoring and auditing mechanisms,

• Procedures for reporting violations of your plan or of government regulations

Implementing a compliance program can help prevent misconduct, and help detect and contain misconduct before it spirals into a bigger problem –

A Compliance Program Can Protect Your PracticeWhy you should have one and how to keep it currentJennifer Donovan | March 22, 2013

a compliance program can protect your practice

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e.g. OIG investigation or RAC Audit. Implementing a compliance program can also reduce the likelihood that an unhappy employee will resort to “whistle-blowing” because compliance programs include steps for employees to report problems internally. Additionally, having a compliance program in place is a factor in your favor if the government does target your practice. Your documented efforts to follow the law may help you avoid criminal prosecution and exclusion from the federal health care programs, and they provide an argument for lighter fines and penalties if you do make a mistake.

Do I need a compliance program?

Despite the potential benefits of compliance plans, the government doesn't require that health care organizations develop them, and some practices may decide that a formal program isn't necessary. Here are some questions to ask yourself as you make that decision:

Does the nature of your practice justify developing a compliance plan?

If you see few patients insured by federal health care programs and have few contractual relationships with other providers or ancillary centers, developing an extensive compliance plan may not be a good use of your resources. You may simply need to document your existing operations and controls.

Do your practice's policies and/or compensation systems promote aggressive coding and billing?

Is your practice part of a larger organization (such as an ACO or practice-management entity) that already implements a compliance program for all its practices?

Even if your practice doesn't need a full-on compliance plan, you may want to consider supporting your internal controls, by training your staff to follow them and documenting your effort. In addition to help avoid criminal action and civil monetary penalties, compliance programs can promote consistency, efficiency and accountability

-- regardless of whether the "organization" is a large multispecialty group or a two-doctor family practice.

A compliance program overview

Developing your program to comply with government regulations may seem as taxing as the regulations themselves do. In efforts to ease the overwhelming panic attacks, here are some helpful bullets to guide you when developing your plan, or reviewing and updating your existing one:

Remember:

Keep up-to-date with the government's enforcement priorities and make them your compliance program a priority; and conduct random audits of your claims, contracts, investments, and referral arrangements.

• How do you Market your practice;

• Build your Board: Appoint high-level personnel to lead your compliance effort;

• Develop written standards for complying with the law, and revise your existing policies and procedures as necessary;

• Train physicians and staff on the standards, policies and procedures and how to follow them;

• Monitor your operations (e.g. billing, referrals and marketing practices);

• Do background checks on physicians as well as other clinical and administrative staff. Be sure to verify information on resumes and applications;

• Set up procedures for staff to report suspicious conduct;

• Establish disciplinary standards and steps for violations of policies and procedures, and enforce those standards;

• Modify all policies and procedures as necessary when misconduct is discovered

a compliance program can protect your practice

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n honor of April being National Autism Month, here are changes to Current Procedural Terminology (CPT® Americn Medical Association) and Health Care

Common Procedure Coding System (HCPCS) Level II codes that were effective January 1, 2013. Comments from CMS have been included as commercial health plans may soon adopt Medicare’s coding rules.

New CPT Codes

New codes related to nerve conduction studies a n d i n t r a o p e r a t i v e n e u r o p h y s i o l o g i c monitoring has been added for 2013.

Nerve Conduction Studies

These new nerve conduction study codes replace two H-reflex codes (see Deleted Codes).• 95907: Nerve conduction studies; 1-2

studies• 95908: 3-4 studies• 95909: 5-6 studies

• 95910: 7-8 studies• 95911: 9-10 studies• 95912: 11-12 studies• 95913: 13 or more studies

The numerical ranges included in the descriptors refer to the number of nerve conduction studies performed. Tests must be performed with separate electrodes for stimulating, recording, and grounding on only those specific nerves needed for the diagnosis in question. Waveforms must be reviewed on site in real time with reports by the examiner and interpretation by the physician or other qualified health care professional. Each type of nerve conduction study is counted only once on the same nerve.

Intraoperative Neurophysiologic Monitoring (IONM)

These new IONM codes replace CPT 95920 (see Deleted Codes).

Audiology2013 New & Revised HCPCS Codes

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• 95940: Continuous intraoperative neuro-physiology monitoring in the o p e r a t i n g room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure)

• 95941: Continuous intraoperative neuro-physiology monitoring, from o u t s i d e t h e operating room (remote or nearby) or for monitoring of more than one case while in the operating room, p e r h o u r ( L i s t separately in addition to code for primary procedure) (See Medicare Note)

• G0453: Continuous intraoperative neuro-physiology monitoring, from o u t s i d e t h e operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes ( l i s t i n addition to primary procedure) (This is a Medicare-only code. See Medicare Note)

These CPT codes are add-on codes to be listed in addition to the primary surgical procedure. They describe ongoing neurophysiologic monitoring, testing, and data interpretation distinct from the performance of specific types of basel ine neurophysiologic s tudies performed during surgical procedures. Do not report these codes for automated monitoring devices that do not require continuous attendance by a professional qualified to interpret the testing and monitoring. Both 95940 and G0453 are billed in units of 15 minutes and should be listed in addition to the primary surgical procedure. Continuous and immediate communication directly with the operating room is also required, and the codes include the ongoing monitoring time distinct from the performance of baseline studies.

CMS Note:

95941 may not be used for Medicare beneficiaries because it allows a provider to remotely monitor several patients at the same time. Because the CMS allows a provider to monitor only one patient at a time, it created G0453, which covers continuous remote (outside the operating room) monitoring for one patient.

Deleted CPT Codes• 95920: Intraoperative neurophysiology

testing, per hour (see 95940- 1, G0453)

• 95934: H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle (see 95907-13)

• 95936:  record muscle other than gas-trocnemius/soleus muscle (see 95907-13)

New HCPCS Level II CodesNew codes related to frequency modulated (FM) and digitally modulated (DM) systems have been added for 2013.

• V5281: personal FM/DM system, monaural, (one receiver, transmitter and microphone)

• V5282: personal FM/DM system, binaural (two receivers, transmitter and microphone)

• V5283: personal FM/DM neck, loop induction receiver

• V5284: personal FM/DM, ear level receiver

• V5285: personal FM/DM, direct audio input receiver

• V5286: personal blue tooth FM/DM receiver

• V5287: personal FM/DM receiver, not otherwise specified

• V5288: personal FM/DM transmitter assistive listening device

• V5289: personal FM/DM adapter/boot coupling device for receiver, any type

• V5290: transmitter microphone, any type

CMS Note:

Although FM/DM systems are not a Medicare benefit, the codes will be instrumental for Medicaid and private insurance programs that supplement hearing aid and cochlear implants recipients, especially children, with the technology.

Revised HCPCS Level II CodesThe following code was revised to include assistive listening device supplies not otherwise specified

• V5267: hearing aid or assistive listening device/supplies/accessories, not otherwise specified

“...commercial health plans may soon adopt

Medicare’s coding rules.”

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ccording to a survey from the American College of Physicians ACP), physician satisfaction with their health records systems has steadily declined over the past

two years. On average, satisfaction has seen a 12% drop, while the number of “very dis. Furthermore, that post-EHR productivity is nowhere near what it was prior to implementation of the software systems.

On paper, electronic health records (EHRs) sound like such a great idea – streamlining physician documentation, patient health records and quality reporting so docs can devote more time to the practice of medicine. Turns out, that goal may be a ways off.

“Dissatisfaction is increasing regardless of practice type or EHR system,” Michael S. Barr, M.D., MBA, FACP, who leads ACP's Medical Practice, Professionalism & Quality division said in a statement. “These findings highlight the need for the meaningful use program and EHR manufacturers to focus on improving EHR features and usability to help reduce inefficient work flows, improve error rates and patient care, and for practices to recognize the importance of ongoing training at all stages of EHR adoption,” Barr concluded.

ACP and American EHR Health Partners studied survey data from 4,279 clinicians for the report, which was presented at the 2013 HIMSS Conference.

Here’s a small sampling of the results:

The biggest issues revolve around workflows, ease-of-use, and how the systems can improve care. Survey responses also indicated that it is becoming more difficult to return to pre-EHR implementation productivity. In 2012, 32 percent of the responders had not returned to normal productivity compared to 20 percent in 2010.The survey results comes a few weeks after EHRs, and the Meaningful Use program, were put under the spotlight with a highly controversial New York Times piece that suggested the EHR vendors were high on their piece of a $19 billion incentive pie. It can be argued that clinicians have minimal exposure to the EHR, often delegate HER tasks to nurses and administrators, and historically, don’t take kindly to change. We want to hear from you. Do you love or hate your EHR? Email info@mmiclasses.com

EHRs Fall Short of Meeting Clinician NeedsSurvey Results

A “Dissatisfaction is increasing regardless of practice type or EHR system.”Michael S. Barr, MD., MBA, FACP

EHRs fall short of meeting clinician needs

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The Medical Business Journal is brought to you by the Medical Management Institute

The Medical Business Journal is a monthly source of up-to-date information on all issues affecting the healthcare industry. Its content ranges from medical coding and billing to healthcare reform legislature and beyond. The MBJ is not affiliated in any way with the Department of Health and Human Services, Medicare, or the Centers for Medicare and Medicaid Services. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional services, and is not a substitute for individualized expert assistance. The CPT codes, descriptors, and modifiers are copyrighted by the American Medical Association. For more information, please call MMI at 866-892-2765.

Editor in ChiefCarleigh Benscoter

ContributorsKathy DysonJennifer Donovan

Layout & DesignCarleigh Benscoter

MBJ

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