Medical Business Journal Volume 2, Issue 11 Nov-Dec 2011

13 5010 Upgrade Postponed. Grace period granted. Warning: This does not delay implementation! What does that mean? Answers to your questions inside.

30 Top 5 Best (and Worst) States to Practice. We consider cost-of-living rates, tax burden data, malpractice climate numbers, and physician-density statistics. We’ve even included job opportunities that have been submitted this month.

21 Member Exclusive 2012 CPT Summary. What’s in store for 2012.

The Monthly Newsletter for the Informed Healthcare Professional

Brought to you by The Medical Management Institute

Issue 11 Volume 2 November - December 2011 www.mbjonline.com

15 2012 Medicare Physician Fee Schedule: The Final Rule Summary

Jan 18. Meaningful Use AttestationIs the incentive worth the process?

Feb 1. Implementing and Optimizing an ACO (Accountable Care Organization)Can your providers benefit as a working part of an ACO?

Feb 15. PQRS ReportingLearn all there is to know about quality reporting and how it can increase your revenue while build-ing quality patient care.

Feb 29. Implementing a new EHRHelp lessen patient suffering due to medical errors and the inability of ana-lysts to assess quality. How to get the most out of your new EHR.

Mar 14. Next steps: ICD-10Where are we now? With a year and a half to go- how prepared are you?

For more details visit www.mmiclasses.com

Winter Quarter at MMIThis quarter we focus on avenues that providers can take to increase their revenue while building their practice for the future. These classes will help you understand the incentive options out there and give you a glimpse into the future of the industry.

Be Productive this Winter SeasonAre you prepared for ACO and ICD-10?

www.mbjonline.com - Medical Business Journal 3

Features Contents

Brought to you by

The Medical Management Institute

The Medical Business JournalC o n t e n t s

6 A Year of Coding. The former MBJ editor gives us insight on his first year in the industry.

12 Patients/Patience. The patient’s point of view from the waiting room.

30 Top 5 Best (and Worst) States to Practice. Available jobs in the healthcare industry are included.

13 Version 5010 Upgrade. Doesn’t let practices off the hook.

15 2012 Medicare Physician Fee Schedule. The final rule summary.

18 Revenue Cycle Management. How to cut costs.

Inside Every Issue CMS News Updates.............................................7 The Podium: Making the Most of the

Election Year....................................................28

Health Nut: Sugar vs. Fat..................................17

Letter from the Editor.........................................4

5 CertificationCrossing

36 PLUS: MBJ Key Terms Puzzle.Test your healthcare knowledge

with a fun game!

20 ICD-10 Panic Kicks In. AMA promises to try to push back ICD-10

implementation date.

27 Accountable Care Organizations. Health information

technology is a must.

MembersOnly!

21 CPT Summary at a Glance. Available to MMI and ARHCP members only.

Coding Corner...................................................33

4 www.mbjonline.com - Medical Business Journal

Letter from the Editor

Dear Readers,

I don’t need to tell you how much the business of medicine has changed over the past few years, let alone the past few decades. You’ve lived through it- and because you still read publications such as The Medical

Business Journal, you’re still as excited about the industry and its future as you were when you started in the business.

So how did you do it? I would wager that you stayed on top of specialty and regulatory changes, as well as broad legislative topics, while educating yourself about how they affected you and your practice along the way. You likely adapted your business practices as you better understood what these changes meant to you, and your providers too, right?

Looking back, it can be said that a lack of education and certification requirements contributed to the industry’s darker days. That’s why I say make education and certification your New Year’s resolution. MMI is moving to a new platform that will make eLearning easier and more fun than ever before! Use your MMI gift card for yourself or pass it on to a friend to enroll in one of our comprehensive certification prep programs.

Between coding changes, bundling issues, hospital ventures, insurance changes, the holidays and the family...hang in there. 2012 is right around the corner and the MBJ will be here to keep you informed of all the changes, offer tips to make life easier and help promote your business through ads and contributions from our dearest friends, you!

Ultimately, the main effect of change isn’t necessarily the changes themselves, rather, it is how people react and adapt.

Happy Holidays to All!!!

Sincerely,JenEditor-in-Chief, Medical Business Journal

PS. I would like to personally invite you to “Like” us on our facebook page at www.facebook.com/MMIfan. Here you will find upcoming events, classes, and helpful resources to keep you informed and up-to-date in the healthcare industry.

Medical Business Journal Issue 11, Volume 2, November-December 2011

Editor-in-Chief: Jennifer Donovan, RMC, CPC, RMM

Managing Editor: Jennifer Donovan

Copy Editor: Rob Hassett, RMCJulia Scott, RMC

Contributors: Jennifer DonovanRuby Ramos, RMC, RMM

Maria AlboCarleigh Thomson

Rob Hassett

Layout and Design Carleigh Thomson

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: (770) 709.6928.

Legend of Acronyms in Issue 11.2

ACO – Accountable Care OrganizationNCQA – National Committee for Quality AssuranceHHS/DHHS – [Dept of] Health and Human ServicesOIG – Office of Inspector GeneralCIA – Corporate Integrity AggreementDME – Durable Medical EquipmentSNF – Skilled Nursing FacilityPOV – Point of ViewPCP – Primary Care ProviderCMS – Centers for Medicare and Medicaid ServicesHFCS – High Fructose Corn SyrupGI – Glycemic IndexRMC – Registered Medical CoderACA/PPACA – [Patient Protection and] Affordable Care Act

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This segment will act as a bulletin board; a place where you can go to find out about professional development, industry news, continuing edu-cation, announcements, upcoming events, and tools for success. This is the MBJ’s effort at keeping you updated and informed in the industry.

K e e p i n g y o u u p d a t e d i n t h e i n d u s t r y n e w s

Certification Crossing

Certification Crossing is a new segment by MBJ.

To make MMI’s eLearning experi-ence more user-friendly, the Insti-tute has joined forces with a cutting edge programming company. In ad-dition to instructor support, students have access to a system that al-lows them to learn in their own way. Set to launch in early 2012 so stay tuned. Are you already in an MMI class? No worries – you will receive access to the new platform to com-plete your studies in addition to your existing login so you can compare your work!

The Association of Registered Health Care Professionals is pleased to an-nounce the new Registered Medical Au-ditor exam will launch May 2012. This new RMA exam will be administered in beta format with no immediate scoring. This addresses an immediate need in the field, and will help move profession-als in the industry forward to achieve goals of RAC audits, ARRA, HITECH and other important initiatives with the ultimate goal of improving the quality of healthcare as a business.

All ARHCP coding exams will become ICD-10 compliant in March 2013. Stay tuned for more information on ICD-10 exam updates throughout 2012.

Maintain your certification with Con-tinuing Education Units from MMI! January 18th marks the first day of the Winter Quarter Classes. This quarter we will cover Meaningful Use, Nego-tiating Contracts with Payors, Imple-menting and/or Optimizing an ACO, and more!

www.facebook.com/MMIfanSwing by our Facebook page to keep in-formed of upcoming events and classes, helpful resources, or just to join in on the conversation. And if you “Like” us by March 1, 2012...we will put your name into a drawing for a chance to win a free iPad 2!! (Be sure to comment on our wall to let us know that you “Liked” us.)

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One journalist’s experience in the industry

Upon entering the world of medical coding, one is immediately impressed with how confusing it is. ICD-9, HIPAA, CPT, HCPCS, DRG, CMS, HHS… well these are just a random assort-ment of letters to an outsider. So, as a journalist with no medical experience whatsoever, I started the summer of 2010 just trying to make sense of all the acronyms.

Once I got far into the list to reach CMS, or the Centers for Medicare and Medicaid Services, it was like opening up Pandora’s box. Like most Ameri-cans outside of the healthcare indus-try, I had no idea how deep it went. My advice to anyone who wants to get into medical coding (or anyone simply paying a physician’s bill) is to start here.CMS is the belly of the beast. Even if you don’t accept Medicare or Medic-aid patients, CMS still has a direct ef-fect on your billing practices. Think of CMS as the largest private insurer in the country. When they set their rates, most private in-

surers follow suit. Codes are often changed based on recommendations by CMS. The transition from ICD-9 to ICD-10 is their brainchild, and the move to electronic health records (EHRs) is heavily influenced by the in-centives being offered. I would recom-mend that any forward-thinking coder check the CMS website every day for updates, because it isn’t always easy to tell where healthcare will be six months from now.

The actual logistics of medical coding are very simple—on the surface. You have a number for the diagnosis; let’s say a broken arm. Then you have a number for the treatment, or setting and casting the arm. Then you have one more number for the supplies used. On paper this may seem as sim-ple as 1, 2, 3. But within this simplicity are so many variables that a success-ful coder really has to do their home-work. For example, take the concept of a global period. Certain procedures will include supplies. Some proce-dures are bundled into payments that will pay one rate for a variety of proce-dures to treat the same condition. You need a good education in the fun-damental principles of coding. I took a two-week crash course to prepare my-self for the Registered Medical Coder

(RMC) exam and a knowledgeable in-structor is crucial. There is a process to coding, a process which is much more important than the specifics. You need to know how to get from documentation to reimbursement a lot more than you need to know how

to set a broken arm. Yes, terminology is important, but that is really the lan-guage and not the conversation.

The RMC exam is hard, but passing it is a feeling like nothing in the world. It’s a validation that, yes, you can do this job. As much as it tells employers that you are worth your salt, it allows you to stop worrying for a minute and realize that you are actually getting the hang of this. Of course the edu-cation doesn’t stop there. Once you can actually code like a professional, you have to learn how healthcare is changing.

The Patient Protection and Afford-able Care Act (PPACA) is changing the very foundation of healthcare… if it isn’t repealed. The ICD-10 is requir-ing doctors and coders to relearn en-tire workflows. Even the current ICD-9 is always evolving, adding new codes and deleting older ones. The only way to keep up is constant education. A career in medical coding also requires a career as a full-time student.

Despite all the hard work required in the industry, opportunities abound. If you think of a doctor as being in the business of healing, coders are in the business of getting that doctor paid for healing. A single coder is often the first, and only, line of defense prevent-ing an audit at a small practice. With-out coders, the healthcare industry would collapse under the weight of its own financial complexity. It is a career that one should take great pride in. It’s a tough job, but someone has to do it… and make an honest living while they’re at it.

Though I’m not sure what I will be do-ing, I commend each and every one of you for your dedication to the industry and wish you all great success as I move forward on to new pastures.

Sincerely,Christopher Myers, RMCFormer Editor-In-Chief, MBJ

Christopher Meyers, RMC

“The RMC exam is hard, but passing it is a feeling like

nothing in the world.”

A Year of Coding

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8 BERWICK RESIGNS. Is Tavenner up for the challenge?

8 HCPCS 2012. What’s in store for Level II Codes?

9 INCREASED MEDICARE COVERAGE FOR OBESITY SCREENING AND

COUNSELING.

9 HHS INCREASES GRANTS FOR AFFORDABLE INSURANCE

EXCHANGES.

10 OVER $5 BILLION RECOVERED IN 2011. Semiannual report to

Congress.

11 NEW AND IMPROVED CMS WEBSITE.


Berwick ResignsIs Tavenner up for the challenge?

Back in April 2010, President Obama nominated Dr. Donald Berwick, a pe-diatrician, to head the Centers for Medicare and Medicaid (CMS). Last July, after a Republican opposition and during a congressional recess, Obama appointed Berwick, giving him the job through the end of the year and the current session. Over the past 17 months, Berwick was said to have be-come a symbol of all that Republicans dislike in President Obama’s health-care policies. Though his temporary recess appointment was due to expire at the end of the year, effective Dec. 2, 2011, Dr. Donald Berwick resigned from the position. The Senate sees this as a confirmation that the next Obama nomination will not get appointed.

Dr. Berwick is a long-time advocate of patient safety. He is a respected mem-ber of the healthcare community and has had support from medical, trade, labor, and consumer organizations ranging from ACP, AARP, Wal-Mart, Consumer Union, and the AHA. Dur-ing the Berwick era, he oversaw the beginning of the EHR Incentive pro-

gram (currently 138,000 registered EPs and EH’s, paid over $527M in incentive payments) and helped im-plement a number of key provisions in the Affordable Care Act (ACA) per-taining to the Medicare and Medicaid programs. In October, CMS issued final regulations for accountable care

organizations (ACO), which are pro-vider consortiums designed to better coordinate care received by Medicare patients, all while improving medical outcomes and lower costs. ACOs will receive a share of any money they save the Medicare trust fund. It has been said in a Medscape article, that “Unfortunately, he’s [Berwick] been a scapegoat for Republicans who are mad about the ACA”.

Dr. Berwick steps down maintaining firm beliefs of the agency’s three aims: improving the experience of care, im-proving citizens’ health, and reduc-ing the per capita costs of healthcare. Who’s up now?

President Obama has nominated Berwick’s principal deputy, Marilyn Tavenner, RN, MHA to replace him. Ms. Tavenner is the Principal Deputy Administrator and Chief Operating Of-ficer for CMS. She is an RN with 35 years of health care experience and was a hospital CEU and senior level management for Hospital Corporations of America after 20 years of nursing. In times of declining state revenues and a struggling economy, Tavenner helped reduce Medicaid costs in intel-ligent ways such as program improve-ments, focusing on preventative care and creative use of technology.

Ms. Tavenner was also the secretary of the Virginia Department of Health and Human Resources under former Virginia Governor Tim Kaine. Ranking Republican on the finance Committee Senator Orrin Hatch has already stat-ed that “Republicans on the Finance Committee look forward to examining her record and gaining an understand-ing of her views on Medicare and Med-icaid and the president’s health law.” Only time will tell whether Tavenner is appointed, and what difference she can make.

“Tavenner helped reduce Medicaid costs

in intelligent ways”

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HCPCS 2012What’s in store for level II codes

More than 430 codes have been touched for 2012. Among them: • 285 added; one new modifier• 48 revised• 75 deleted

18 added, 8 deleted throughout 2011 that will not appear in your printed book or eBook of choice (depending solely, of course, on your book’s pub-lisher)

What about that new modifier? Modi-fier PD Diagnostic or related non di-agnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days has been added to help hospital identify those certain services that fall within the Medicare “3-day Payment Window”. The 3-day window policy requires a hospital to combine the charges and appropriate codes for any outpatient diagnostic and “re-lated” non-diagnostic services(other than ambulance and maintenance re-nal dialysis) provided within the 3-day period immediately preceding an inpa-tient admission.

Many codes have been deleted throughout the HCPCS II, especially in the C and Q sections. Among them: •C9272 is replaced by J0897 Injection, demosumab, 1mg•Q2040 is replaced by J0588 Injection, incobotulinumtoxin A, 1 unit•Q2042 is replaced by J1725 Injection, hydroxyprogesterone caproate, 1mg

Among the near 300 added codes, there are a few C codes including C9287 for the lymphoma drug brentux-imab vedotin and C9366 for the mem-brane/skin-allograft EpiFix. Nearly a dozen new drug/supply Q codes come for 2012 including Q0162 for the antin-


ausea drug ondansertron; Q2043 for sipuleucel-T, (therapeutic vaccine for prostate cancer); and 9 new Q codes to accompany the highly revised skin substitute section of the CPT for the associated supply of choice such as Alloskin and Talymed.

Additionally a series of E codes have been added to describe a variety of accessories for manual and power wheelchairs; 4 new K codes for home suction pumps and supplies for wound healing; and revised G codes for tele-health consultations that apply to both inpatient and emergency department services. Along with these G code re-visions, this sections contains the larg-est amount of changes for 2012. Over 200 additions to report quality indica-tors for Physician Quality Reporting System (PQRS).

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Increased Medicare Coverage

for Obesity Screening and

CounselingMore obesity coverage could lead

Medicare beneficiaries to less serious health problems.

On November 29, 2011, the Centers for Medicare & Medicaid Services (CMS) announced it was increasing coverage for treatments to reduce obesity. CMS Administrator Donald M. Berwick, M.D., said “Obesity is a chal-lenge faced by Americans of all ages, and prevention is crucial for the man-agement and elimination of obesity in our country.”

Based on the data, this added cover-age is going to assist a great deal of people nation-wide. More than 30% of people with Medicare coverage are thought to be obese. Although this is clearly an increase in coverage, the move might actually relieve some of the burden on Medicare providers in the long run. Obesity is linked to many serious chronic diseases, resulting in

Medicare beneficiaries who need ex-tensive and serious medical care down the road. By adding obesity screening and counseling as a preventive ser-vice, CMS could end up saving many Medicare beneficiaries from these complex and expensive treatments. Hopefully, simple face-to-face consul-tations with a healthcare professional can help some Medicare beneficiaries to make health-conscious decisions that stunt the growth of diseases like cardiovascular disease and diabetes.

Not only will this mean more people are covered for preventive obesity care generally, but statistics show that this program has the potential to ben-efit racial and ethnic minorities. Many diseases tied to obesity have been proven to disproportionately affect mi-nority populations; preventive care to combat obesity could be an effective answer to this problem.

Here’s how the additional coverage works: Medicare beneficiaries who screen positive for obesity at a BMI of 30 or higher are covered for a coun-seling visit each week for a month, bi-

“More than 30% of people with Medicare

coverage are thought to be obese”

weekly visits for the next five months, and then monthly visits for the next six (as long as the beneficiary has lost at least 6.6 pounds in the first six months of treatment).

HHS Increases Grants for Afford-

able Insurance Exchanges

State-created exchanges are receiv-ing funding so that they are ready

to be up and running by 2014.

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On November 29, 2011, the Depart-ment of Health and Human Services (HHS) awarded grants to 13 states to assist them in creating Affordable In-surance Exchanges.

These Exchanges are state-created, one-stop shopping for families and small businesses to find health insur-ance coverage at an affordable price. The theory is that several different com-panies are all in one spot trying to get people to sign up for coverage, leading to a decrease in price based on the in-crease in competition. Another hope is that the Exchanges require insurers to provide customers with easy-to-under-stand information about their services. This way, potential customers really understand the difference between insurers and are able to make an in-formed decision about their coverage. The Congressional Budget Office has estimated that the Exchanges will re-duce premiums by 7 to 10%.

In addition to providing funding of al-most $220 million, HHS has provided information on their website states


can use to determine the best way to build and implement their particu-lar Exchange. More information has been added recently because January marks the beginning of state legisla-tive sessions, where representatives will be able to debate the idea of their state Exchange and how to get it up and running. HHS didn’t just give this money away; states applied for these grants, so it’s clear that the idea of set-ting up these Exchanges with the help of government funding seems like a good idea to most states across the country. In fact, 49 states and the Dis-trict of Columbia have received some type of planning grant for Affordable Insurance Exchanges. Rhode Island even received the first ever “Level Two” grant, given to states that have developed their Exchange more fully. These Level Two grants also provide funding over several years, where the Level One grants are just for a year.

The important date to pay attention to here is 2014 – this is when the Af-fordable Care Act, which gave HHS the authority to administer grants for states to create and fully develop their Affordable Insurance Exchanges, goes into effect. If Congress, HHS, and CMS are right, this will be a good year for the individual and small busi-ness healthcare consumer to get a fair deal on health insurance coverage.

Semiannual report to Congress by OIG

Over $5 Billion Recovered in 2011

The efforts to protect the well-being of our healthcare system seem to be paying off. Let’s take a look back: In 2010, the government collected an astonishing $4 Billion through its

healthcare fraud prevention and en-forcement efforts. Back in January, the Department of Health and Human Services (HHS) issued a statement saying: “This is the highest annual amount ever recovered from people who attempted to defraud seniors and taxpayers.”

When those statistics came out in ear-ly 2011, they struck fear in the hearts and minds of those with any intention to defraud the system. The numbers seemed pretty hard to beat – being that, according to CNN Money, that was the largest sum ever recovered in a single year. Well, the Health Care Fraud Preven-tion & Enforce-ment Action Team (HEAT) didn’t dissipate in 2011. In its S e m i a n n u a l Report to Con-gress, the OIG a n n o u n c e d expected re-coveries of approximately $5.2 billion in audit and investigative receivables. This includes exclusions of 2,662 indi-viduals and entities from participation in federal health care programs, 723 criminal actions against individuals and entities that engaged in crimes against HHS programs, and 382 civil actions, which included false claims as well as unjust-enrichment lawsuits filed in federal district courts, civil monetary penalties settlements, and administrative recoveries related to provider self-disclosure matters.

The OIG tips their hat to the special efforts of HEAT in coordinating law enforcement operations among fed-eral, state, and local law enforcement entities; overseeing prescription drug investigations and reviews; and Medi-

“The OIG announced expected recoveries of

approximately $5.2 billion in audit and investigative

receivables.”

care Part A & Part B reviews and en-forcement actions – which include, but are not limited to, skilled nursing facilities (SNF) billing, oncology ser-vices, and durable medical equipment (DME). HHS and the Justice Depart-ment jointly created HEAT back in 2009 with the original intent to pre-vent waste, fraud and abuse in CMS programs. They are certainly bringing their A-game.

Corporate Integrity Agreements (CIAs) have also received special mention by the OIG. An instance was given where Church Street Health Management was penalized $230,000 because of

n o n - c o m p l i -ance with re-q u i r e m e n t s of its CIA with OIG by fail-ing to imple-ment training, develop and distribute poli-cies and proce-dures, submit an independent review organi-zation (IRO) re-

port, and provide notice of government investigations.

Inspector General Daniel Levinson ex-pressed confidence that technology “has tremendous potential to enhance [the OIG’s] program integrity capabili-ties, citing tools such as data mining, predictive analytics, trend evaluation, and modeling” to better target over-sight for HHS programs.

Sources:[HHS Increases Grants: http://cciio.cms.gov/programs/exchanges/index.html, http://www.healthcare.gov/news/fact-sheets/2011/05/exchanges05232011a.html, http://www.hhs.gov/news press/2011pres/11/20111129a.html] [Medicare Coverage for Obesity: millionhearts.hhs.gov]

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If you’ve been reading the MBJ for any amount of time, you may remember a series called “Navigating a Sea of In-formation”, where former MBJ Editor, Christopher Myers, provided a com-pass and map of various government websites and resources. This effort was to help readers navigate through the labyrinth to find the useful informa-tion that lies within. This was such a hot topic because so many people had such a difficult time weeding through the chaos. Well CMS has taken some of that feedback from users to devel-op their new and improved site! Other than the overall look and feel, some improvements are:

•A significantly improved search en-gine•Indepth ACA Info•Real-time updates regarding impor-tant CMS developments and initia-tives.•Content has been moved around for easier finding

If you’ve been working with the CMS site for years and thought you final-ly figured it out, only to see they’ve changed it all – don’t worry. CMS will be launching an archived version soon so you can still access the same in-formation without cluttering their new look.

New and Improved CMS Website

Additionally, CMS has launched a brand new site Medicaid.gov, and Healthcare.gov will remain the pri-mary site for consumer info. CMS states this is their first step only and they believe it will be well received by patients, partners, providers and staff, states and all others who utilize this site.

If you haven’t already, check out the new look at www.CMS.gov. Feed-back is encouraged at cmsideas.user-voice.com/forums.

Screenshot of new CMS Website.

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Patient’s POV- “From the Waiting Room”

You may remember a classic Seinfeld episode where George was charged for canceling his doctor’s appoint-ment. He was, of course, livid…as his character often was. Later on in the same episode, the same doctor has to cancel her appointment with George due to a personal emergency. Well, George smirked and decided to try to charge his doctor for the same thing that he was charged for (ah…good ol’ cheap George). Well, if you think about it, most viewers understood where George was coming from…whether they were on the doc’s side or not. In this world, if you miss an appointment, you are subject to a no-show fee if within a certain window of the sched-uled time. Well, if your patient has al-ready signed in, they’re already in the window. So, what makes the doctor’s office so different?

Understandably, there are reasons that can throw a doctor’s entire day off, including: the unpredictable nature of healthcare to patients misrepre-senting the reason for their visit, to pa-tients adding complaints, arriving late, to those just unprepared for their visit. Some patients are sicker than they think or need hospitalization. These doctors aren’t chatting by the water cooler and sipping Mai Thais. None-theless, what does that mean for the waiting patient?

Earlier in the year, a freelance writer who waited over four hours in 1969 has been all over CNN explaining her process of shopping for her doc-tor, scheduling only the first appoint-ment of the day or first after lunch and billing her doctor for excessive wait-times (with full up-front disclosure, of course). Cherie Kerr, now 67, says: “Now it’s funny. They’ll always give me a time when they know I’ll be the first ap-pointment.”What we need to re-member is this is a competitive business. We have to keep pa-tients happy. They are not customers, this isn’t Wal-Mart, but they are pay-ing consumers, whether through a private payer and co-pay, heath savings fund, or out-of-pocket. Some offices are keeping track of patient wait times with an egg timer and compensating those who wait too long with gift cards or fra-grant lotions; it’s an issue of mutual respect. Some try to avoid gift-giving by calling/texting their patients if they are running late. As a rule of thumb, a patient waits for approximately 10-20 minutes, rifling through old magazines or staring at a looping screen, before going stir crazy…and if they have any sort of pain, watch out! You’re lucky if

they wait 5 minutes without screaming at every person on your staff whether they need an insurance card or would like to move seats.

Though there is a shortage of primary care physicians, there is still a need to keep as tight and honest a sched-ule as possible and, if the doctor is running behind, let the patient know. In addition to the PCP shortage, also consider the lowered reimbursement and perpetually rising overhead; you’ll see the number of patients increases daily. Time is the crux of the matter, but if we can’t get a repairman or ca-ble guy to hold a 4-hour window, how

can we expect our doctors to? If a doctor spends 2 hours con-

sulting a patient on a newly revealed terminal illness diagnosis, what are they supposed to do, call “times up”? We’ve got to be fair. If patients bill doctors for wait times,

does that mean the doc-tor should bill the patient

who caused the wait in the first place? Or charge for filling out forms that insurance com-

panies don’t pay for? Or after-hours advice? What if one day that patient is you? Recent research shows PCPs spend 50% of their time performing work that is not reimbursable by the insurance company as they only pay for face-to-face visits.

Patients can help by becoming more involved in their own healthcare and as a result can come prepared for their schedule appointment within a realis-tic time frame.

Patients/Patience

Providers are being billed for patient wait time. What can you do to keep patients patient?

This spot highlights the most talked-about trends from the patient’s point of view. We also include some helpful information for your patients to understand how we run the business of medicine. This is the MBJ’s first attempt to build the bridge between patient and providers.

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Patients/Patience is a new segment by MBJ.

Doctor caring for patient.

K e e p i n g p a t i e n t s h a p p y b y

u n d e r s t a n d i n g t h e i r p o i n t o f v i e w


Just as suspected, the Centers for Medicare and Medicaid Services (CMS) Office of E-Health Standards and Services (OESS) announced that a grace period will be granted for its ASC X12 Version 5010 standards compliance enforce-ment, set for Jan. 1, 2012. Warning: This does not delay implementation! Providers are strongly encouraged to con-tinue to prepare for this deadline. Only in the event that implementation cannot be met, a 90-day discretion period for all HIPAA covered entities is available. CMS says it will initiate enforcement on office-based physicians, health in-surance plans and claims clearinghouses starting March 31, 2012. Although enforcement penalties may be delayed, failure to use 5010 may still mean no reimbursement.

The decision was based on industry feedback from orga-nizations and their trading partners who aren’t ready to fi-nalize system upgrades to 5010 standards. According to a Medical Group Management Association (MGMA) mem-bers’ survey, only 35% had begun internal testing. Mod-ernHealthcare.com states the same survey indicated that about 1 in 5 practices (approx. 22%) hadn’t even scheduled internal testing with their vendors. These results prompted MGMA to ask CMS to “immediately issue a comprehensive contingency plan” to allow health plans to continue process-ing non-compliant healthcare claims.

Robert Tennant, senior policy advisor with the Medical Group Management Association (MGMA) said the news is a great start. “As you know, MGMA has been calling on CMS to issue a comprehensive contingency plan to avoid a potentially significant cash flow disruption on Jan 1,” Ten-nant told Physicians Practice via e-mail. “This message that enforcement would be delayed 90 days was a step in the right direction. However, we remain concerned that critical provider trading partners, including practice management system vendors and health plans, will not be ready by the compliance date.”

MGMA is urging CMS to vigorously monitor each stake-holder group for their readiness to conduct compliant 5010 transactions, said Tennant. “We continue to be concerned about the ability of health plans to accept a 5010 claim that might not have all the content, but enough content to adju-dicate a claim.” He further noted that “CMS has to look seri-ously about allowing 4010 claims for a considerable length of time. We strongly encourage the government to monitor the industry. If things don’t improve, they’ll have to look seriously about augmenting the decision they made today.”

Are you ready?Only 2 months away from the Version 5010 standard up-grade - for those who have waited until the last minute, well, here we are. Version 5010 is a mandatory and integral step toward successful ICD-10 implementation. It is required when electronically conducting certain administrative trans-actions, including claims, remittance, eligibility and claims status requests and responses. This 5010 upgrade is from the 4010/40101A, which cannot accommodate the use of the ICD-10 code set.

What actions do you take to test now?

Providers: Submit claims properly. Providers should begin submit-ting as many claims as possible prior to the January 1st deadline. A low backlog of claims will reduce the financial stress on your office and assist with cash flow after the tran-sition.

Test your Version 5010 standards. Providers can test their systems through CMS’s Medicare Fee for Service pro-gram, which is already accepting test and production claims in Version 5010 as it prepares for the transition’s GO LIVE date.

Check partner readiness. Keep in mind the upgrade af-fects both providers and vendors so it is very important that you are aware of your vendors’ transition status.

Here’s why:

If your vendor is behind schedule, encourage them to take action immediately so they can be prepared to handle your claims once Version 5010 officially goes into effect. Even if you are ready to transition, if your vendor isn’t, you will be unable to complete your transition. If your vendor is on track to implement, use them as a benchmark to compare your own level of readiness. Payers’ services can be utilized sim-ilarly. They can be consulted to help develop your timeline. You should check now with your payers to see what plans they have in place to handle incoming claims and whether temporary alternatives (e.g., direct data entry) will be avail-able. It is imperative to make optimal communication efforts between providers, plans, clearinghouses, trading partners and vendors.

Version 5010 Upgrade Postponed

Doesn’t Let Practices Off the Hook


Version 510 Upgrade Postponed

Clearinghouses:

Clearinghouses can be helpful to those who have fallen be-hind on their Version 5010 implementation plan. They can take your 4010 codes and translate them to 5010, which allows you to submit Version 4010 to payers even after the transition. A clearinghouse may only be a temporary solu-tion, but a huge help to consider for your transition.

Credit:

This close to the effective date, if you foresee a delay in your ability to submit Version 5010 claims, you may want to consider establishing a line of credit with your financial insti-tution to help with any cash flow interruptions. Remember, the enforcement date is delayed, but your reimbursement flow may still be interrupted.

Particularly with regard to small payers and some small Medicaid carriers, this means that physician groups and hospitals might have to continue to file some claims in the

5010 format and some in the current 4010 format, unless clearinghouses can translate the claims back to 4010.

The CMS urged all practices to continue working with ven-dors and partners to become compliant with the new HIPAA standards and to run tests that will determine their readi-ness to accept the new standards beginning Jan. 1, 2012.

Additionally, respondents in a recent MGMA survey esti-mated that converting to HIPAA 5010 could set them back $16,575, and 45.2 percent of practices said that they had not yet started the implementation of software upgrades necessary for HIPAA 5010, even though 53.4 percent said that they were fully aware of the upcoming mandates.

CMS’s OESS said that it will continue to accept complaints associated with Version 5010 during the 90-day period be-ginning Jan. 1, 2012. If requested, those subject to com-plaints must provide “evidence of either compliance or a good faith effort to become compliant with the new HIPAA standards during the 90-day period.”Z


The Final Rule SummaryCMS posted the full Medicare Physi-cian Fee Schedule (PFS). The provi-sions of the rule will be effective Janu-ary 1, 2012 unless stated otherwise. Comments on those issues subject to comment are due by January 3, 2012.

Conversion Factor

CMS has calculated the 2012 conver-sion factor (CF) to be $24.6712. That ‘s a 27.4% cut in the current conver-sion factor of $33.9764 ,which expires on Dec. 31, 2011.

The CF must be viewed as a work in progress, because Congress has acted every year since 2003 to stop the cuts proposed by the notoriously flawed sustainable growth rate (SGR) formula.

Why so flawed?The conversion factor represents a 27.4% reduction in the fee schedule. Congress has voted to stop this cut every year for nearly the last decade. Therefore, while we expect them to do so again, the critical factor is that the reduction will be placed UNLESS Congress acts on this between now and Jan. 1 (sound familiar – we’ve heard the same song and dance for, you guessed it, almost 10 years).

CMS states in the Final Rule Summary, they expect a 2012 CF identical to the 2011 CF. The President’s budget calls for an ex-tension of the 2011 CF through Dec. 31, 2013, however legislation must go through the motions to enact this pro-posal or to maintain the current CF.

Is your specialty at risk…again?Across the board, E/M services will

see increases of approximately 1%. Gastroenterological procedures are viewed to remain the same, but the to-tal impact of the changes in the rule, on average, will vary depending on the mix of services provided. The change in the weights assigned to physician work, physician expense (PE) and professional liability insurance (PLI) components, and other changes in the proposed rule, come in to play.

What the RUC?CMS directed the AMA’s RUC (Rela-tive Value Committee) review of rela-tive values assigned to various cat-egories of services. In the proposed rule, CMS stated the RUC should re-view the physician work and practice expense values for all the E/M codes along with a number of high volume/high expenditure services which had not been reviewed [by RUC] in the last 6 years. Originally CMS requested a reexamination of E/M codes, but they dropped the request after the major-ity of commenters indicated it was not likely to be productive since the codes were recently reviewed. Additionally, commenters urged CMS to recognize some of the non face-to-face services provided by primary care and other physicians who provide care to chron-ically ill patients such as telephone calls and team conferences. CMS re-sponded it will continue to explore the valuation of E/M services and other re-finements to the physician fee sched-ule (PFS).

Multiple Procedure Payment Reductions

Currently a 50% multiple procedure payment reduction (MPPR) is applied to the technical component (TC) of ad-

vanced imaging, provided in the same session. This policy is based on the assumption that there are efficiencies in labor, supplies and equipment when more than one imaging procedure is performed. The policy was extended to the PE or therapy services (PT, speech and occupational therapy). A 20% reduction is applied to the PE of the second additional therapy code re-ported for the same day.

CMS proposed to apply a 50% reduc-tion to the professional component (PC = modifier 26) of multiple ad-vanced imaging services (MRI, PET, CT, etc) performed in the same ses-sion based on the rational that there are efficiencies when multiple images are interpreted as well. The Final rule, CMS decided to proceed with this change buy has reduced the MPPR adjustment to a 25% reduction.

The CMS is still considering more op-tions discussed in the proposed rule to extend the application of the MPPR in the future to include applying the MPPR to the TC for all imaging codes, not just advanced imaging (including radiology, audiology, cardiology, neu-rology, etc)

Geographic Practice Expense Index

The GPCI (GPCI – pronounced like ‘gypsy’) is a CMS calculated adjust-ment that applies to both the work and practice expense related value units for each code to reflect differences in labor, rent and other cost elements. GPCI changes are still being finalized including how it is applied to payment for physician services.

A technical change to how the GPCI applies to office rents, purchased ser-

2012 Medicare Physician Fee Schedule


vices and employee compensation.Implementation of a provision of the ACA establishing a PE index of 1.0 in several so-called frontier states – Montana, Wyoming, North Dakota, South Dakota and Nevada. A PE in-dex of 1.0 would be equivalent to the national average. The actual GPCI in these states would be less than 1.0 so this change raises payments in these states.

Elimination of the statutory floor on the GPCI the authority for which expired to protect lower cost and rural areas.

If the GPCI changes at a rate of +/- 1% tor 2%), removing the floor in some ar-eas will lead to substantial reductions in payment.

Annual Wellness Visit

CMS covers annual wellness visits for beneficiaries as mandated by the ACA. The law also covers a person-al prevention plan, which includes a health risk assessment (HRA). CMS increased the payment for AWV to reflect the additional time required to administer health risk assessment. They’ve adopted the following criteria for HRA:

•Collects self-reported information about the beneficiary.•Can be administered independently by the beneficiary or administered by a health professional prior to or as part of the AWV encounter•Takes into account the communica-tion needs of under-served popula-tions, persons with limited English proficiency, and persons with health literacy needs, •Takes no more than 20 minutes to complete•Addresses, at a minimum, demo-

graphic data, including but not limited to age, gender, race and ethnicity; self-assessment of health status, frail-ty, and physical functioning, psycho-social risks, including but not limited to depression/life satisfaction, stress, an-ger, loneliness/social isolation, pain, or fatigue; behavioral risks, including but no limited to tobacco use, physical activity, nutrition and oral health, al-cohol consumption, sexual practices, motor vehicle safety (seat belt use), and home safety and activities of daily living (ADLs), including but not limited to dressing, feeding, toileting, groom-ing, physical ambulation (including balance/risk of falls), and bathing

2012 Physician Quality Reporting System (PQRS)

CMS proposes to redefine a group practice for the reporting option as 25 or more eligible professionals (EPs). CMS also proposes to reduce the number of options for 6-month regis-try-based measures reporting.

Since implementation, in the formerly known as PQRI program, PQRS has continually evolved due to statutory up-dates enacted by Congress. CY 2012 can bring bonus payments of 0.5% of total allowed charges for services pro-vided during the reporting period. An additional 0.5% is available for those participating in a maintenance of certi-fication (MOC) program as well. MOC is required for board certification by recognized physician specialty organi-zations.

EPs who choose not to participate in satisfactorily submission of quality data, will be assessed penalties be-ginning 2015. Initial penalties will be 1.5% and rise to 2.0 in CY 2016.

2012 Medicare Physician Fee Schedule

eRx Program

The eRx program is moving to the pen-alty phase. Participation is required in CY 2012 to avoid a 1.5% payment re-duction in 2013.

The incentive payment is based on the total allowed charges for services under Medicare Part B - for 2012 it is 1.0% and 0.5% in 2013.

For EPs who do not participate or are not successful in participating will re-ceive reduced Medicare payments equal to: -1% in 2012, -1.5% in 2013, and -2.0% in 2014. To avoid these penalties eRS measures must be re-ported 25 times between 1/1/2011 and 12/31/2011 or 10 times between 1/1/2013 and 6/30/2013. Group prac-tices of 25-99 must report 625 times and group practices of 100 or more must report 2500 or more times be-tween 1/1/2012 and 6/30/2012.

Medicare EHR Incentive Program

CMS will now allow EPs participating in the Medicare EHR Incentive Pro-gram to report clinical quality mea-sures (CQMs) in 2012 by attesting to the CQMs utilizing CMS certified EHRs or by participating in the volun-tary PQRS-Medicare EHR Incentive Pilot. For individuals participating in the pilot, measures can be submitted through a PQRS EHR data submis-sion vendor or from a certified PQRS EHR via a web portal. CMS has ap-proved 44 EHR Incentive Program measures, to date.Z


2012 Medicare Physician Fee Schedule S m a l l b i t s o f i n f o r m a t i o n t h a t m a y a f f e c t

y o u r h e a l t h i n a b i g w a y

Sugar vs. Fat: What’s worse?

Have you ever noticed when you read nutrition labels that foods are either high in fat and low in sugar, or low in fat and high in sugar? Unless, of course, you fancy the fat-free food diet lines – those generally score zero across the board…taste included.

Statistics: Sugar: (Class: Carbohydrate). Calo-ries: 4 calories per gram (approx. 1 tsp). In nature: Fruits, grains and oth-er plants. Synthetic: Candy, soda and quick-foods.

Fat: (Class: Fat). Calories: 9 calories per gram. In nature: Nuts, Meat, and Dairy. Synthetic: French, fries, potato chips, and many other forms

It all depends on the source. Sugar: Foods such as yogurt, supple-ment bars, fruits, the sugar may be de-rived from natural resources – in yo-gurt, even the milk it contains is also a source of sugar. When reading la-bels, also be aware of added sugars. Though labels don’t list “bad” sugar versus ”good” sugar, you can still break the code from the ingredients list. Food labels always list ingre-dients in the order of greatest weight contained within the product. You can ascertain most of the sugars are from natural fruits if they’re listed first or second. Natural sugars like honey have a much lower glycemic index (GI) than artificial variations. Synthetic sugars increase the GI number, which causes the sug-ar to rush into the system and affect the body like a drug by exaggerating hormonal responses, especially insu-lin. You may be familiar with insulin – when the body has trouble producing it, its known as the disease diabetes. Type II diabetes is fastest growing dis-ease in the world.

Fat: When it comes to fat, you can use a similar method when reading labels. If the main source of fat is from animal products (e.g., dairy, meat, and poul-try) then you want to choose a low-fat option because all of these fats derived from animals are high in saturated fat. You want to limit saturated fats in order to maintain good heart health. However, fats from healthy sources such as plants (nuts, oils, seeds) are good for you as long as you keep an eye on the overall calorie count. Keep in mind that fat from coconut oil or palm oil is also high in saturated fats and should be limited or avoided. As previously mentioned, fat is dense. It’s a double-edged sword – lots of calories for its size, but it’s an essential nutrient that helps us feel satiated, or full. This is the very rea-son why our body craves it when we’re hungry – and the more of it we eat, the more our bodies want it. And since our bodies don’t need much of it, it makes it really easy to overeat. When we eat more food than our bodies can put to good use, our body stores it in adipose tissue (i.e., fat tissue), but its not re-ally fat as in the kind we eat, we get adipose tissue from too much protein, sugar, carbohydrates, and alcohol.

Think about it: most “delicacies” are laden with fat. As a soci-ety, we’ve found ways to con-sume just the bad parts of fat – like butter, margarine, and lard – which are completely

unnecessary for survival! Ever hear the saying “Some eat to

live; I live to eat” – maybe its time to find a happy balance. Life’s about bal-ance no matter which side your bread is buttered.

All things considered, sugar is more dangerous. The FDA has required that trans fats be listed on the side of every food label while sugar, sugar alcohol, artificial sweeteners,

and glucose syrups can be labeled with less stringent regulation. Many fats such as nuts, olives, seeds, avocados and fish are essential for optimal health and nothing in sugar is needed for human survival. A product

that contains 100% sugar, can still be marketed as 100% fat-

free when in fact sugar alters the body’s PH levels which makes an all-sugar food worse than a no-fat food. Fat has been linked to polycystic

ovarian syndrome (PCOS) and fibromyalgia, but excessive sugar

leads to insulin resistance problems. Sugar, in its cheapest and lowest quality form comes in high fructose corn syrup (HFCS) and is now found in items that aren’t even sweet – such as salad dressings and peanut butter. Though HFCS has the same amount of calories as regular sugar, HFCS can only be broken down by the liver, whereas natural sugars can be absorbed anywhere in the body. In the 80’s and 90’s we were trained to fear fat; “fat makes you fat” they said; fat-free food products popped up everywhere…remember Olestra? However, this is a new day and age. Due to heavy lobbying, effective marketing, deregulation, and public misconception, sugar is by far the more dangerous of the two. Education and motivation are your two best lines of defense.

New Rules to Follow1. Read your ingredients labels; not to be confused with the nutrition part of the label. If the first two ingredients are not whole and/or natural sources, pass . (e.g., whole wheat, organic = good; enriched, synthetic, high fruc-tose = bad)

2. Fill up on fruits and veggies before you eat your meal. This will help you refrain from overeating and provide a nice base of roughage for digestion.Z


1st tip: Re-negotiate your inventory contracts.

This will allow you to review what you are ordering, how often you are ordering the item, and how much you are spending for it. Once you have that information you must call your ac-count manager and re-negotiate a lower rate. This method has been very successful in many of my practices. You will be surprised what you can get from companies you never thought would have a discount program.

2nd tip: Avoid late fees and interest fees.

Paying late fees can be very costly to a practice. Some man-agers don’t realize how costly it can be until the end of the year figures and then you realize that it adds up. Another thing that will decrease expenses is to avoid charging on your business credit card because you accumulate interest fees. Instead of using the credit card go for the no interest payment plans. There are many companies that have this option.

Dealing with Rising Operational Costs in the Medical OfficeRuby Ramos of “Complete Reimbursement Solutions, LLC” has two tips on how to deal with

rising operational costs

Ruby Ramos, RMC, RMM, is the Administra-tor for Allied Surgical Group and James Street Ambulatory Surgical Suite in Morristown, NJ. Ruby has been in the field for 15 years and is a member of the Association of Registered Health Care Professionals (ARHCP) and the American Medical Billing Association (AMBA). Her prac-tice specialty is general surgery/oncology. [email protected]

Revenue Cycle Management H o w t o c u t c o s t s

Checking the inventory.

Z

AMA Pushes Back on Implementation DateAt its semi-annual policy-making meeting, the AMA states that one of its goals is “to work vigorously to stop implementation” of the International Classification of Diseases 10th Revi-sion family of diagnostic and proce-dural codes. An interesting stand from a once mighty organization that has done nothing but continuously shrink for the last decade to a membership representing less than 20% of practic-ing physicians. The AMA explained, citing a 2008 case study, that the av-erage three physician practice will spend nearly $83K to transition and implement ICD-10; these costs sky-rocket to more than $285,000 for a 10-physician group. So should they be spending additional money on efforts that will do nothing to help them imple-ment and become compliant? AMA

claims it is a massive and expensive undertaking that will bring little benefit to physicians, and will only be a dis-ruption to the implementation of EHRs and demonstration of meaningful use.

In an Oct. 26 statement released by the Medical Group Management As-sociation (MGMA), only 4.5 percent of study respondents rated their 5010 implementation status as complete while 40 percent said that their im-plementation status is less than one-quarter complete.

OESS made the decision to push back the Version 5010 enforcement period after industry feedback revealed that with only about 45 days remaining before the Jan. 1, 2012 deadline hits, many practices have not and likely

would not reach compliance.

Version 5010 will provide a greater functionality to healthcare claims and is also a prerequisite to transitioning to the ICD-10-CM and ICD-10-PCS code set, which will become manda-tory Oct. 1, 2013. Shortly after survey results were released, the American Medical Association (AMA) House of Delegates voted to try and halt ICD-10 code implementation, due to the significant burdens that will be placed on practices. It was estimated that a 10-physician practice could be forced to fork over $285,195 to complete the implementation phase of the ICD-10 code set. “ICD-10 does nothing to im-prove care of patients”, said one Mo-bile, Alabama delegate.

ICD-10 Panic Kicks In

Z


More than 500 changes come with the upcoming New Year. This includes minor additions to the Evaluation and Man-agement Services Guidelines which are intended to bring forth clarity to the “three-year rule” (HCPCS II includes a new modifier to help as well; more on pages 8 & 9). The three-year rule applies to, you guessed it, new patient vs. established. The guideline changes emphasize that a new patient is one who “has not received any professional ser-vices from the physician or another physician of the exact same specialty or subspecialty who belongs to the same group practice, within the past three-years”. The CPT 2012 further defines professional services to mean “any face-to-face services rendered by a physician and reported by a specific CPT code, or codes.” To visualize a patient’s status, the CPT 2012 brings back the Design Tree, which did not change for 2011, but was not included in the year’s book.

At-a-Glance Peek

For MBJ readers only, we bring you an at-a-glance peek on page 24-26, to show what 2012 brings -- effective Jan. 1st If you haven’t purchased your book yet, please see page 32 for purchasing information.

CPT Modifiers Two new modifiers are added to Appendix A, but don’t be alarmed if you won’t see them listed on the inside cover. We can only imagine that this is the AMA’s effort to bring CPT users to the full definitions as to break the habit of quick-find procedures that steer you away from proper modifier usage. This is just one journalist’s opinion, of course.

Modifier 33 Though not brand new, this is the first appear-ance in the book. The modifier was created in 2011 to denote the service is a covered annual wellness visit. By covered, they mean this modifier is appended when report-ing a preventative service “in accordance with a US Pre-ventative Services Task Force A or B rating in effect” and “other preventative services identified in [legislative or regu-latory] preventative services mandate”. For example, Medi-care’s IPPE (G0402) and annual wellness visit (G0438 and G0439). Modifier 33 is not intended to be applied for sep-arately reported services that are specifically identified as preventative (e.g. screening colonoscopy, G0105 or G0121; screening mammography, 77057), instead the modifier PT Colorectoal screening test converted to diagnostic test or another procedure to the diagnostic colonoscopy code to indicate the procedure started off as a preventative service.

(For a more detailed description, see the April 2011 issue of the MBJ – New Preventative Services Modifier)

Modifier 92 Alternative Laboratory Platform Testing Though it may not look new, this modifier is used when:• Lab tests are performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable, analytical chamber; • The test does not require permanent dedicated space; • The test is designed for carry or transport to the vicinity of the patient for immediate testing at that particular site. Medicare payors will use modifier 92 to indicate point-or-service HIV testing (86701-86703 and 87389) only. CMS transmitsl 2277, modifier 92 went into effect on Oct. 1, 2011 for this reason. Being that modifier 92 was introduced in 2008, CMS will allow you to apply it retroactively to claims filed on or since Jan. 1, 2008.

Category I Most CPT 2012 changes will be found in this sec-tion of the CPT. That’s over 200 new codes, over 180 dele-tions and more than 130 revisions. Zero changes occurred in only the Anesthesia (00100-01999) and Urinary System (50010-53899) sections.

Evaluation and Management Initial Observation Care codes 99218, 99219 and 99220 include additions of “reference times”. The 99220 descriptor now specifies, “Physicians typically spend 70 minutes at the bedside and on the pa-tient’s hospital floor or unit.” This language clarification al-lows providers to report the initial observation care codes using time as the key component when counseling, or coor-dination of care dominates the encounter.

Prolonged Services 99354-99335 (office or outpatient) and 99356-99357 (inpatient or observation) were given instruc-tions for physicians or other qualified health care profes-sional to indicate these add-on services specify total face-to-face time with the patient, and non face-to-face services on the patient’s floor or hospital/nursing facility unit during the same session. Time does not have to be continuous, but only one prolonged service code may be reported per day. Prolonged services without direct patient contact (99358-99359) also received guidelines in 2012 to highlight that these add-ons may be provided on another date, but the initial must have been face-to-face, though time need not be referenced.Additional guidelines also precede the Inpatient Neonatal and Pediatric Critical Care (99468-99476) and Initial and

CPT 2012 Summary

Preview for ARHCP Members and MMI Alumni Only


clude radiological supervision and interpretation. More in-structions have been added to the “Cardiac Assist” subsec-tion to clarify the replacement of ventricular assist device pump (33981-33983).

Digestive Few changes sprinkle this section. Of them, sev-eral parentheticals to clarify proper code selection. Three new codes were added (49082-49084) which describe ab-dominal parcentesis to replace deleted codes 49080 and 49081.

Reproductive Systems Codes in the Male and Female sec-tions remain untouched, but parentheticals have been added throughout these sections including instructions to see the Integumentary section regarding non-biodegradable contra-ception implants and removal with subsequent insertion.

Nervous System New code range 64633-64636 replace de-leted range 64622-64627 for destruction of paravertebral facet joint by neurolytic agent. The new range specifies lo-cation and the number of joints injected. Additionally, par-entheticals and instructions have been added and codes throughout received revisions to clarify intent or application of the code.

Eye/Ocular Adnexa and Auditory Only three minor changes for 2012 in these two sections : • An added parenthetical for proper use of 65280 and 65285; • Fitting of contact lens for treatment of disease; and • Deleted code 69802

Radiology There is lots of anxiety about this section for 2012. Though there are many changes, the most significant are:New codes to report intra-operative radiation treatment de-livery (77424, 77425); Intra-operative radiation treatment management (77469); New instructions for radiation man-agement is now reported in units of five fractions or treat-ment sessions, regardless of the actual time period in which the service is furnished; Atherectomy codes (75992-75996) have been deleted and replaced with directions to utilize Category III codes. For example, in 2012, instead of us-ing 75995 for Transluminal peripheral atheretomy, open or percutaneous, including radiological supervision and inter-pretation; visceral artery (except renal), each vessel, report Category III code 0235T.

Path/Lab Lots of green text in Path and Lab! 2012 brings a brand new section for molecular pathology (Mo-Path). Along with two full pages of instructions and over five pages

CPT 2012 Summary

Continuing Intensive Care Services (99477-99480) codes to emphasize what these services include and how the codes should be applied.

Integumentary One of the highlights of the AMA symposium this year was this section on the changes regarding the skin replacement/skin substitute codes. You will see many codes in range 15300-15431 are gone and replaced by a smaller list of simpler codes. Rationale behind this being that no matter the choice for supply of the graft, the procedure to apply is the same. Among these simpler codes is 15271 ap-plication of skin substitute 25 sq cm or less wound surface are and +15272…each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure). The skin substitute supply may be re-ported separately, of course. To describe biologic implant for soft tissue reinforcement, the CPT created add-on code 15777 Implantation of biologic implant (eg acellular dermal matrix) for soft tissue reinforcement (eg, breast, trunk). (List separately in addition to code for primary procedure). Keep an eye on this section as many other code descriptors re-ceived minor revisions.

Musculoskeletal Many code descriptors received revisions in this section as well either to clarify the intent of the ser-vice or through added parentheticals to draw attention to bundled services. For example: Below range 22520-22522, note the parenthetical which indicates bone biopsy as in in-cluded service when performed. Two new codes (22633 and 22634) join us for arthrodesis via combined posterior and posterlateral technique with posterior interbody tech-nique as well as a new manipulation code (26341) for Du-puytren’s contracture.

Respiratory All “removal of lung” codes in range 32440-32491 have been revised. There are six new codes for tho-racotomy (32096-32098, with biopsy; and 32505-+32507, with wedge resection), and a brand new category of a doz-en codes (32601-32674) has been established for VATS (video-assisted thoracic surgery. Additionally, close to a full page of instructions under “Lungs and Pleura” and paren-theticals throughout this section have been added.

Cardiovascular For those of you with the AMA’s Professional CPT, you will see lots of green in this section. Additional pages of instructions for code application as well as a quick reference chart to help with code selection for insertion, im-plantation and removal of a pulse generator and the com-ponents involved. Nearly 20 codes have been revised, nine have been added, including combo codes to report renal catheterization and angiography (36251-36254) which in-

of new codes – Tier 1 (81200-81383), Tier 2 (81400-81408). Mo-Path procedures involve analysis of nucleic acid to de-tect variants in genes that may be indicative of germline or somatic conditions, or to test for histocompatibility anti-gents. The specific gene that is analyzed is the basis for the code reported. Parenthetical notes have been added for HIV-1 and HIV-2 testing code 86703 (single result) for clari-fication of code selection for alternative testing. Example, HIV-1 antigen(s) with HIV-1 and HIV-2 antibodies (87389), and notes regarding when to apply modifier 92 with 86701-86703 and 87389. Codes 88312, 88313 and +88314 have been revised, and parentheticals added regarding special stain tests.

Medicine Immunization codes receive descriptor revisions and added instructions to clarify usage by vaccine compo-nent, rather than per injection. Codes 91010 and +91013 replace 91011 and 91012 for Esophageal motility studies. Code 92070 has been deleted and replaced by two new codes, 92071 and 92072, for contact lens fitting to treat dis-ease. Instructions fill a full page regarding sleep medicine testing and new codes have been added as well to report needle electromyography, per extremity. Hydration codes also received additional instructions to clarify the meanings of “initial ,” “subsequent, “ and “concurrent” infusions.

Category II & III Codes Over 50 codes have been added to these two areas of the CPT 2012. Many parentheticals throughout Category I direct readers to these codes for prop-er reporting. Among these changes are:Self-care education provided to patient (4450F); Referred to an outpatient cardiac rehabilitation program (4500F); In-tramuscular autologous bone marrow cell therapy (0263T-0265T); Percutaneous laminotomy/laminectomy (0274T, 0275T); And many, many more! Category II codes are a set of codes for supplemental tracking that can be used for per-formance measurements (PQRS codes). Category III codes describe emerging technologies, and also allow for track-ing and collection of specific data. If available, Category III codes are to be used before an unlisted Category I code.

An at-a-glance listing of CPT 2012 changes can be found on the following pages.

The Medical Management Institute will be covering specific information regarding 2012 changes in Specialty Updates Classes throughout their Winter 2012 Quarter Sessions. To be added to the list for your choice of specialty, contact the Institute today!

CPT 2012 Summary

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2012 Anatomy 101 CourseAt The Medical Management Institute

Learn the BasicsLearn the basics of Human Anatomy for medical coders

Enroll NowEnroll for this course online (www.mmiclasses.com) or over the phone (866-892-2765)

For more details visit www.mmiclasses.com


2012 CPT Updates and Changes [At-A-Glance]

www.mbjonline.com - Medical Business Journal 25www.mbjonline.com - Medical Business Journal 25

2012 CPT Updates and Changes


2012 CPT Updates and Changes

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Health Information Technology is a Must

The National Committee for Quality Assurance (NCQA) re-cently launched an accreditation program for accountable care organizations (ACOs). NCQA now emphasizes health IT in its requirements for accreditation.

If you speak to any hard-core EHR incentive or even mean-ingful use advocates, you will get two things: the defined difference between EHR and EMR and proud mention and promotion of ACOs. Its hard to think forward to an ACO without thinking about how it will work and what will make it run smoother…and that is optimal health IT.

NCQA sees this point and under the “care management” section of the seven domains in the accreditation program, they require ACOs to show that such an “organization col-lects, integrates and uses data from various sources for care management, performance reporting and identifying patients for population health programs.”. Additionally, an organization must also “provide resources to patients and practitioners to support care management activities.”

Another domain of criteria, “care coordination and transi-tions,” requires that as an ACO, an “organization facilitates timely exchange of information between providers, patients and their caregivers to promote safe transitions.”

NCQA also accredits health plans and recognizes patient-centered medical homes, is providing three accreditation levels for ACOs.

Level 1: Recognizes organizations that are in the process of forming ACOs.

Level 2: Designates organizations with the best chance of achieving the “triple aim” of lowering costs, improving qual-ity, and enhancing the patient experience

Level 3: After achieving level 2, ACOs must also show strong performance or improvement on the triple aim goal and then they may receive Level 3 accreditation.

Group practices, physician networks, hospital/provider part-nerships, hospitals and their employed or contracted pro-viders, publicly governed entities, and health plan-provider partnerships all can form ACOs that are eligible for NCQA accreditation. Among the first to commit to the ACO effort are the Billings Clinic in Montana and Health Partners in Minneapolis.

Accountable Care Organizations

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H o w t h e h e a l t h c a r e i n d u s t r y a n d

p o l i t i c a l g o v e r n m e n t m e s h

Making the Most of the Election YearAs the holiday season approaches it is easy to forget that January will kick off the politically charged 2012, deter-

mining the future direction of healthcare in the United States.

As Republicans and Democrats fight it out, implementa-tion of the healthcare bill is currently being challenged by a number of states. The outcome of this debate will lead to a policy that can directly impact our practices and guidelines in the healthcare industry. As healthcare administrators, we have a responsibility to inform our political leaders by not only showing up on election day, but by taking the time to communicate directly with elected officials to discuss the potential impact of this legislation.

Find your Local Congressmen You can use the websites www.sentate.gov or www.house.gov to find your local congressman. Research their web-sites and find out which legislators may be interested in your outlook. Congressmen want to please their constitu-ents, especially during an election year, so you are likely to get a response to your efforts if you contact representatives in your district. Once you have determined who to contact regarding your problem, you must reach out to your elected officials and make your concerns known. Letters are typi-cally the preferred method of communication with legisla-

tures and offer a great opportunity to present your problem in a clear and concise matter.

Write an Effective LetterListed below are some general tips from Congress.org on how to write and effective letter:http://www.congress.org/congressorg/issues/basics/

• Your purpose for writing should be stated in the first paragraph of the letter. If your letter pertains to a specific piece of legislation, identify it accordingly. e.g., House bill: H. R. ____, Senate bill: S.____.• Be courteous, to the point, and include key informa-tion, using examples to support your position.• Address only one issue in each letter; and, if pos-sible, keep the letter to one page.

Also, when addressing your letter, it is customary to refer to Senators and Representatives as “The Honorable” followed by their full name. For the Salutation, you would use “Dear Senator” or “Dear Representative” depending on the situa-

The Podium


tion. It is important to use proper headings and salutations even when sending emails to enhance your creditability as a citizen. Speaking of email - while electronic mail is gain-ing in popularity, it is important to note that correspondence by email do not have the same impact as a traditional let-ter and it can be very difficult to convey tone. It is always a good idea to start with a traditional letter for maximum impact when reaching out to an elected official.

Meet with an Elected OfficialIf your letter generates enough interest, you may be able to arrange for a face-to-face meeting with your elected official. This is a unique opportunity to offer insights on how the healthcare bill might affect the way you do your job in the future. Regardless of whether you support the legislation or not, it is important as professionals that we assert our con-cerns to Congress so they can make informed decisions. If you have the opportunity to meet a local Congressman, remember these tips:

Before the meeting: In addition to your background research, make sure that you know the correct names, spellings, and pronunciations of all officials and staff members that you will be interacting with. When you schedule your meeting, request the least amount of time necessary to go over your entire issue. Make sure you are dressed appropriately for meeting with an elected official. It is best to avoid clothing with any tears, tank tops and open toe shoes (e.g., flip-flops) when initially meet-ing with a government official. Do not bring any gifts to the meeting—it puts elected officials in an uncomfortable situ-ation and is generally frowned upon in government. Keep your group small—bring only essential members who are important for getting the message across.

At the meeting: Keep your presentation as brief as possible and discuss only the following: the problem you want to solve, possible solutions and reasons why the official should support your proposal. Be ready to answer any questions about your is-sue with factual information. It is critical that you stay cur-rent on any late-breaking developments affecting your is-sue. You may want to take the time to type up your main talking points so if you run out of time the official can review them at a later date. You should practice your talking points prior to the meeting, especially if you are going as part of a group. Be respectful of the official’s time and recognize non-verbal cues that the meeting has ended. Avoid temptation to ask for additional items or photographs.

After the meeting: Always follow up any face-to-face meeting with a handwrit-ten thank you note. This gives you an opportunity to reiterate your key points and provide your contact information. Keep in brief and regular contact via email with the decision mak-er’s staff and acknowledge any action that has taken place on behalf of your issue. With certain exceptions, sweeping changes to public policy are just not possible. However, it is important to acknowledge little milestones along the way to keep up morale and reach your ultimate goal. [The above list of tips on meeting a local Congressman was adopted from Mark Block, Director of external relations for Newsweek.---(Graham, 2010, 137-139).]

As healthcare employees, we have a responsibility to inform our policy makers how the laws they pass affect us! It is easy to get caught up in the routine of our everyday lives and forget how important we are to our government system. So as the holidays wind down, please remember to become informed about the current legislation and take the time to express your view on how we can better perform our services. We are a valuable resource for lawmakers and they ultimately want to know what their constituents think (especially during an election year) so take the opportunity to weigh in on this important issue!

“It is important to acknowledge little milestones

along the way to keep up morale and reach our

ultimate goal.”

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Sources:[Graham, Bob. (2010). America The Owner’s Manual: Making Govern-ment Work for You. Washington: CQ Press.][Mark Block, Director of external relations for Newsweek.---(Graham, 2010, 137-139).]

[This piece was based on the original work of Maria J. Albo as published in the The Basics of American Government (2011). Alexander, Ross and Carl D. Cavalli, eds. North Georgia Press: Dahlonega, GA.]

The Podium


Whether you are looking to relocate or are just curious, this guide will enlighten you on the best and worst states to practice in regards to cost-of-living rates, tax burden data, malpractice climate numbers, and physician-density

statistics along with some job opportunities that have been submitted this month.

The Top 5 Best States to Practice (In no particular order): Alabama: Cost of Living Index (92.74), Tax Burden per Capita ($2,967), Medical Board Disciplinary Actions per 1,000 Physicians (2.69), Physicians per 100,000 Resi-dents (218.2)

Idaho:C-O-L Index (93.04), Tax Burden per Capita ($3,276), Medical Board Disciplinary Actions (2.72), Physi-cians per 100,000 Residents (168.8)

Mississippi: C-O-L Index (9267), Tax Burden per Capita ($2,678), Medical Board Disciplinary Actions (2.62),

Physicians per 100,000 Residents (177.9)

South Dakota: C-O-L Index (98.53), Tax Burden per Capita ($3,042), Medical Board Disciplinary Actions (2.6), Physicians per 100,000 Residents (219.1)

Texas: C-O-L Index (91.04), Tax Burden per Capita ($3,197), Medical Board Disciplinary Actions (2.61), Physi-cians per 100,000 Residents (214.2)

Top Five Best (and Worst) States to Practice


The Top 5 Worst States to Practice (In no particular order): Connecticut: C-O-L Index (130.22), Tax Burden per Capita ($7,256), Medical Board Disciplinary Actions (1.69), Physicians per 100,000 Residents (376.4)

DC: C-O-L Index (139.92), Tax Burden per Capita ($6,076), Medical Board Disciplinary Actions (2.57), Physi-cians per 100,000 Residents (807.2)

Maryland: C-O-L Index (124.81), Tax Burden per Capita ($5,218), Medical Board Disciplinary Actions (2.11),

Physicians per 100,000 Residents (421.4)

New Jersey: C-O-L Index (128.47), Tax Burden per Capita ($6,751), Medical Board Disciplinary Actions (2.28), Physicians per 100,000 Residents (316.3)

New York: C-O-L Index (128.29), Tax Burden per Capita ($6,157), Medical Board Disciplinary Actions (3.03), Physicians per 100,000 Residents (395.9)

Healthcare Professionals

Birmingham, ALFull-time Position: Office Medical Assistant II A Company: Children’s Health SystemTo Apply: Visit www.chsys.org

Hauser, IDPart-time/Full-time Position: Day shift CoderCompany: Northern Idaho Advanced Care HospitalTo Apply: Visit www.niach.ernesthealth.com

Tupelo, MSFull-time Position: Coding SupervisorCompany: North MS Medical CenterTo Apply: Visit www.nmhs.net/tupelo

Yankton, SDPart-Time Position: Human Services DispatcherCompany: South Dakota Bureau of PersonnelTo Apply: Visit www.bop.sd.gov

Denison, TXFull-Time Position: Inpatient and Outpatient Medical CoderCompany: Supplemental Health CareTo Apply: Visit www.supplementalhealth care.com

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Sources: [States to practice: http://www.physicianspractice.com/best-states-to-practice] [Job Listings:http://csjobbank.jobamatic.com/a/jobs/find-jobs/q-medical+coder]

2012 Book Deals

CPT® 2012 Professional Edition*Publisher: AMAISBN#: 978-1-60359-568-1

Correctly interpreting and reporting medical procedures and services begins with CPT® 2012 Professional Edi-tion. Straight from the American Medical Association (AMA), this is the only CPT codebook with the official CPT coding rules and guidelines developed by the CPT Editorial Panel. Covers hundreds of code, guideline and text changes.

CPT is a registered trademark of the American Medical Association.

ICD-9

With almost 300 code changes, 2012 is definitely not a limited update year!Remain a step ahead with a resource that’s designed to enhance performance in your daily work. Now enhanced

with a new, bolder font to improve readability, 2012 ICD-9-CM for Physicians, Volumes 1 & 2 code books con-tinue to provide accurate and comprehensive coverage for diagnosis coding and reimbursement. Loaded with innovative features and content to address regulatory changes and coding challenges, Experts study industry changes and trends while seeking feedback from coding professionals to ensure your code book provides accu-rate and up-to-date information in an easy-to-use, intui-tive format.

HCPCS II

Accurately report supplies and services for physician, hospital outpatient, and ASC settings with the HCPCS Level II. Use this comprehensive reference for the HCPCS code set that focuses on management of reim-bursement. This user-friendly book will guide any coder confidently through current modifiers, code changes, ad-ditions and deletions with information as dictated by the Centers for Medicare and Medicaid Services (CMS).

Pick TWO or THREE of your 2012 Coding Books for ONE low price!

Order online at mmiclasses.com under the “Books” tab

[ ]3 Pack ($229)2 Pack ($169)


Y o u ’ v e g o t Q u e s t i o n s , W e ’ v e G o t A n s w e r s

Coding Corner

The Editor-in-Chief sits down to answer some of your tough coding questions.

Q: We have a bariatric surgeon that does the gastric band adjustment and we bill CPT S2083. Insurance companies are now denying and taking back money if they had paid so we started using 43999 (unlisted code) and put that it was for gastric band adjustment. Blue Cross Federal called us today stating S2083 no longer exists and they will not pay for 43999. The representative told us that there are codes but would not tell us what they were. Can you help shed some light on the subject?

A: Of course, the contract with the payor may come into play here, but generally there are three types of surgical procedures that are distinguished as follows:

1. Vertical banded Gastroplasty (CPT 43842) and other forms of Gastroplasty (43843) - procedures designed to restrict food intake by limiting gastric volume. A 15-ml gastric reservoir is created by one of several stapling techniques. The small gastric reservoir empties through a narrow channel on the lesser curvature of the stomach to the residual stomach. The channel is reinforced with a prosthetic material to ensure a channel circumference of 4.5 to 5 cm. This operation is attractive because it preserves gastroduodenal continuity and avoids the potential for micronutrient deficiencies.

2. Gastric Bypass (CPT 43846, 43847) and Laparoscopic Gastric Bypass (CPT 43644 and 43645) - procedures that also limit the gastric reservoir capacity by the creation of a 15 ml stapled gastric pouch. However, the stapled pouch is connected by a 10-mm anastamosis to a 40-cm Roux-en-Y jejunal limb, thus bypassing the distal stomach,

duodenum, and very proximal jejunum. This procedure combines gastric restriction with emptying of semisolid gastric contents into the jejunum, which seems to exert further additional limitation of food intake.

3. Laparoscopic placement of an adjustable gastric band (Lap-Band), (CPT 43770) which is a silicone implant in the shape of a ring, with an adjustable balloon. The band is placed just below the esophago-gastric junction, and the balloon is connected to a reservoir under the skin. The degree of gastric restriction can be adjusted by accessing the reservoir through the skin and adding or removing saline (CPT 90772 or HCPCS S2083)

I believe the third bullet is what you are looking for. Remember, when it comes to insurance representatives, its not that they refuse to help with coding just to upset you. Liability-wise, they are not permitted to give coding advice or give any indication that can lead to payment. Useful information can be found in your contract with that particular payor.


Q: Should present-on-admission (POA) queries stay in the record and become a part of the permanent medical record?

A: I believe all queries should become a permanent part of the record. I think when they are incorporated as part of the record they provide a logical rationale for how certain diagnoses begin to appear in the record. Let’s say a specialist places a query for specificity and subsequently the physician documents a more specific diagnosis. You will have to raise this topic with management and compliance staff to see what works best in your facility. One facility made the POA query form a permanent part of the record and used only in the following circumstances:

• A provider already documented the diagnosis at least once • The query only asked if the condition was POA

• The query did not seek to obtain an initial documentation of a diagnosis

Before making your queries a permanent part of the record you will have to consider:

• Is the wording “compliant”?• Is it “non-leading”?• Will your queries be audited on a routine basis for compliance and how will that be tracked?• Do you have detailed written query policies and procedures and if not do you have a plan to develop them?

Q: My doctor wants to start billing 99406 for tobacco cessation counseling. Can this be billed in addition to the regular E/M visit? If so, I’m assuming a modifier would need to be applied; would that be 25? Also, I tried to find an allowable for that code and if I am doing this correctly I came up with $14.46 as maximum charge from the Medicare website.

Q: If a patient has regular Medicare, how often can they have a visual fields threshold 92083 performed, and it get covered?

A: Regarding CPT 92083, I didn’t find any firm restrictions for submitting this code, but it appears to be on an annual basis unless the situation dictates otherwise (generally determined by supporting documentation upon request).

A: Yes, you would report 99406 (3-10 mins of counseling) with modifier 25 if another distinct encounter occurred during the same visit -- be sure your Doc documents time since this is a time-based code. The reimbursement is pretty low, but your doc can report it up to 8 times/year per patient.

Coding Corner


RMC: Can a laboratory report surgical pathology codes 88302-88309, 88311-88399 and 89049-89240 with modifier 76 for repeat procedures? We are set up to currently deny. We have told them [lab] we expect to see modifier 91, which they are not accepting. I have been searching the Internet and not finding consistent answers. I cannot find an answer on the CMS website either.

MBJ: Modifier 76 is for a repeat procedure (generally used by providers who perform clinical care) and modifier 91 is for a repeat clinical dx lab test (this is what a lab should use as it is specific to lab tests). It sounds like you understand the difference, it’s just getting the

lab to understand it is the problem. You may want to forward them the full definition of each of the modifiers to support the recommendation. If you have a contract with them that outlines the use of the modifier, that may clear things up for them too.

RMC: You and I are on the same page here. The lab is stating the surgical pathology procedure codes are “procedures” and therefore should be payable with modifier 76. They are telling us that modifier 91 is incorrect for these types of procedure codes. I have explained this multiple times for the different labs, but they continue to argue.

MBJ: According to the College of American Pathologists (CAP), they state in memorandum A-99-41, the following:

“Modifier -76 is used to indicate that a procedure or service was repeated in a separate operative session on the same day by the same physician.”

The -76 modifier indicates that an initial procedure code has not been mistakenly reported twice and therefore would not be appropriate to report multiple surgical pathology specimens.

Furthermore, I found many insurance companies will auto-deny with a 76 or 77 modifier as they are deemed inappropriate for path codes.

Outcome from RMC: Just wanted to give you an update on this topic. After much discussion here, it was decided that we would not allow the modifier 76 on surgical pathology codes. The documentation you sent to me helped tremendously!

Coding Corner

Send us your Q’s via email ([email protected]), phone (866-892-2765), or our

facebook page (www.facebook.com/MMIfan). We love to give you A’s!

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Coding Conversation


Word Bank

ACOARHCPAUDIT

BERWICKCHANGES

CIACMS

COUNSELINGEHRERX

GRACEPERIODHEALTHNUT

HITHITECH

IMPLEMENTATIONMGMAMMI

MPFSNCQA

OBSERVATIONOIG

PODIUMPQRSRAC

REVENUESCREENING

TECHNOLOGY

After you find all of the words, the message will reveal itself through the letters that are left.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 2 0 1 2 !

MBJ Key Terms PuzzleP r i n t o u t t h i s p u z z l e t o h a v e a l i t t l e f u n w h i l e t e s t i n g y o u r M B J k n o w l e d g e . ( W e d i d t h e f i r s t o n e f o r y o u ! )

Brought to you by The Medical Management Institute

Documents

Medical Business Journal Volume 2, Issue 11 Nov-Dec 2011