CMS / Provider News

CMS: Prove Your Exemption From the E-Prescribing Penalty With New G Codes

Even if you don’t have prescribing privileges, you can rest assured now as CMS will not cut your pay as a penalty for failing to comply with the new e-prescribing incentive program.

As you are probably aware, starting in 2012, you may be subject to a one percent payment adjustment on your Part B pay if you don’t successfully participate in e-prescribing this year. In 2013, that payment adjustment will go up to 1.5 percent, and in 2014 it will rise to two percent, CMS’s Daniel Green, MD noted on a Feb. 15 CMS-sponsored call.

“To earn an incentive in 2011, an eligible professional must e-prescribe 25 times during the year, ten of which must be in the first six months,” Green said. “If they are a successful e-prescriber during the calendar year, they not only would avoid the 2012 payment adjustment, they would get a one percent 2011 payment incentive, and they would be exempt from the 2013 payment adjustment,” he explained.

“Earning an incentive in 2011 does not necessarily exempt the eligible professional or group practice from a payment adjustment in 2012,” Green explained.

How to Avoid the Adjustment

CMS reps said that they’ve been flooded with calls about the 2012 payment adjustment, and described ways that you can avoid the adjustment if you qualify.

Not eligible to prescribe: If you are not a physician, nurse practitioner, or physician assistant between Jan. 1 and June 30, 2011, you can avoid the e-prescribing penalty. In addition, if you don’t have prescribing privileges at least once on a claim between Jan. 1 and June 30, 2011, you should append G8644 (Eligible professional does not have prescribing privileges) at least once before June 30 to ensure that your MAC knows you are not subject to the penalty, said CMS’s Michelle...

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March 27, 2011
CMS / Medicaid / Medicare / Provider News

Registration open for electronic health records incentives

On Jan. 3, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) opened the registration for the Medicare and Medicaid electronic health record (EHR) incentive programs. It was started in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas and broad participation is invited from eligible professionals and eligible hospitals who wish to participate.

In February, the registration will open in California, Missouri, and North Dakota and in other states during the spring and summer of 2011.

“With the start of registration, these landmark programs get underway, and patients, providers, and the nation can begin to enjoy the benefits of widespread adoption of electronic health records,” CMS Administrator Donald Berwick, MD was quoted as saying in the news release. “CMS has many resources available to help providers register and participate, and we look forward to working with eligible professionals and eligible hospitals to facilitate the process, beginning on January 3rd and going forward.”

“It’s time to get connected,” said David Blumenthal, MD, MPP, National Coordinator for Health Information Technology. “ONC and CMS have worked together over many months to prepare for the startup on January 3rd. ONC’s Certified HIT Product List includes more than 130 certified EHR systems or modules and is updated frequently. ONC also has hands-on assistance available across the country through 62 Regional Extension Centers. We look forward to continuing to work with CMS to assist eligible providers in 2011 and future years.”

The news release said that interested providers can acquaint themselves with the programs’ requirements by visiting CMS’ Official Web Site for the Medicare and Medicaid EHR Incentive Programs.

Eligible providers seeking to participate in the Medicaid programs must initiate registration at CMS’...

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January 4, 2011
Hot Coding Topics / Medicare / Provider News

Medicare Covers 99406, 99407

If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.

The change: In the past, you could collect for tobacco cessation counseling for a patient with a tobacco-related disease or with signs or symptoms of one. But on Aug. 25, CMS announced that “under new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare recognized practitioner who can work with them to help them stop using tobacco.”

“For too long, many tobacco users with Medicare coverage were denied access to evidencebased tobacco cessation counseling,” said Kathleen Sebelius, HHS secretary, in an Aug. 25 statement. “Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence.”

Count Attempts and Minutes

The new tobacco cessation counseling coverage expansion will apply to services under Medicare Part B and Part A. That means your physicians and coders should know how to correctly document and report the sessions.

“Medicare allows billing for two counseling attempts in a year, but each attempt can occur over multiple sessions, with four sessions per attempt,” explains Jennifer Swindle, CPC, CPC-E/M, CPC-FP, RHIT, CCP-P, director of coding and compliance for PivotHealth LLC in Brentwood, Tenn.

According to section 12 of chapter 32 of the Medicare Claims Processing Manual, “Claims for smoking and tobacco use cessation counseling services shall be submitted with an appropriate diagnosis code. Diagnosis codes should reflect: the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.”

Swindle says 305.1 (Tobacco use disorder) is one diagnosis supporting...

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December 13, 2010
Hot Coding Topics / Medicare / Provider News

Replace 90658 With a Q Code, After Jan. 1

Get ready to change your flu vaccine product code 90658 to one of four Q codes. For 2010, report 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) to signify that your physici...

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December 8, 2010
2011 Medicare Physician Fee Schedule / CPT 2011 / CPT and RBRVS Annual Symposium / Hot Coding Topics

Peds Win Per Component Vaccine Admin Codes, Lose Requested PE RVUs

Pediatricians who were thrilled with CPT 2011’s move to paying vaccines per component got a setback from Medicare’s rejection of the recommended RVUs for new vaccine administration codes 90460 and 90461.

The Relative Update Committe recommended that the 2011 Medicare Physician Fee Schedule and Resource Based Relative Value Scale assign 0.20 practice expense (PE) RVUs to 90460 and 0.16 PE RVUs to 90461. But CMS disagreed with the proposal. “We disagree with the recommendations and will maintain 0.17 RVUs for code 90460 and 0.15 RVUs for code 90461 since these codes would be billed on a per toxoid basis,” said Kenneth Simon, MD, MBA, Senior Medical Officer, Center for Medicare and AMA CPT Editorial Panel Member, in “Medicare Physician Payment Schedule 2011 Changes and Beyond” at the CPT® and RBRVS 2011 Annual Symposium on Nov. 10, 2010.

The increased PEs represent an increase in RVUs from the 2010 values for comparable codes 90465/90467 and 90466/90468. The RUC requested the increase in value due to increased time for patient education. Since the new codes are valued per component, CMS felt no increase was warranted.

CMS assigned RVUs to 90460 and 90461 by crosswalking them with the values of the noncounseling vaccine administration codes 90471 and 90472. This means that new code 90460 has the same RVUs as 90471, and each unit of 90461 has the same RVUs as 90472.

The work and total RVUs for the codes include:

<td width="203"
Code PE  RVU  RUC Proposed PE  RVU MPFS Accepted Total RVUs
90460 0.20 0.17 0.59
90461 0.16 0.15 0.3
90465

...

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November 29, 2010
2011 Medicare Physician Fee Schedule / Medicare / Provider News

CMS Slashes Conversion Factor for 2011, Establishes Preventive Visit Codes

Get ready for another year of nail-biting to find out if your Medicare payments will be slashed. “The calendar year 2011 Physician Fee Schedule conversion factor is $25.5217,” notes the 2011 Medicare Physician Fee Schedule Final Rule, printed in th...

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November 9, 2010
Medicare / modifier 76 / modifier 77 / modifier GD / Provider News

Medicare Medically Unlikely Edits MythBuster Stops Practice Pay Losses

Medically unlikely edits ignorance could be causing you medical coding claim  denials.

Ensure you’re not letting medically unlikely edits (MUEs) wreak havoc on your urology practice’s coding and reimbursement by uncovering the truth about four aspects of these edits.

Myth 1: MUE Edits Don’t Affect Your Practice

Some practices feel that they don’t need to worry about MUEs.

Reality: “They limit the frequency a CPT code can be used,” says Chandra L. Hines, business office manager at Capital Urological Associates in Raleigh, N.C. “With our specialty of urology, we need to become aware of the denials and not let every denial go because the insurance company said it was an MUE. We should all be aware of MUEs as they occur, and we cannot always control whether or not we will receive payment.”

The MUE list includes specific CPT or HCPCS codes, followed by the number of units that CMS will pay. CMS developed the MUEs to reduce paid claims error rates in the Medicare Program. The first edits were implemented in January 2007, although some of the edits themselves became public in October 2008.

Some MUEs deal with anatomical impossibilities while others edit automatically the number of units of service you can bill for a service in any 24-hour period. Still others limit codes according to CMS policy. For example, excision of a hydrocele, bilateral (55041) has a bilateral indicator of “2,” so you should never bill two or more units of this code. Additional edits focus on the nature of the equipment for testing, the study or procedure, or pathology specimen.

Anatomical example: The MUEs edit out and deny an erroneously coded claim for a circumcision (54161, Circumcision, surgical excision other than clamp, device or dorsal slit; older than 28 days of age) for a patient...

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October 15, 2010
CMS / Provider News

CPT 99406, 99407 Coverage Extended to All Smokers

CMS announcement is triumph for physicians who haven’t collected in the past. If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune. In the past, CMS only covered 99406-99407 (Smoking and tobacco us...

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August 31, 2010
CMS / Provider News

Medical Record Retention: How Long Should You Keep Patient Charts?

CMS says keep patient medical records for 6 years. Medical practices often hear conflicting advice regarding how long they must hang on to a patient’s medical records, but CMS intends to clear up any misinformation with new MLN Matters article SE1022...

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August 25, 2010