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J a n u a r y 2 0 1 2

Solo practitioners and physicians nearing retirement age wouldn’t have to adopt electronic health record (EHR) systems to avoid meaningful use penalties, if H.R. 1331 passes. Without the legislation, Electronic Health Records Improvement Act that was introduced March 21, physicians risk a 1% cut to Medicare payments in 2015. The legislation was referred to the House Committee on Energy and Commerce. Click here for additional information.

Speaking of EHRs, CGS, a Medicare Administrative Contractor, has

some useful tips regarding electronic medical records here. They also offer some guidance on amendments, corrections, and addenda in a medical record here.

Are you hoping for an incentive payment for participating in

the EHR program? If so, take a look at the EHR Incentive Program Audits Overview here.

M a y / J u n e 2 0 1 3

Click here to find

information on EHRs

such as:

which agencies certify

EHRs

which EHRs are

certified

obtain a list of

currently certified

EHRS

and more!

Take AACE’s EHR survey here and help other endocrinology offices with their common questions or concerns!

Expect to receive only 98% of your Medicare Part B PFS (physician fee schedule) amount for covered professional services in 2014 if you did not file 10 unique encounters before June 30, 2013.

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CMS is helping the health care industry deliver high quality, efficient health care through

its eHealth programs.

eHealth provides an integrated approach to simplify the adoption of electronic standards and health information technology.

Members of the listserv will receive information about eHealth, how CMS' programs work together, and how to participate. Subscribers will also hear about the latest program developments, the availability of new resources, and upcoming deadlines and milestones for the different eHealth programs.

C l i c k h e r e f o r m o r e

i n f o r m a t i o n .

Non-Physicians Acting as Scribes for Physicians CGS, a Medicare Administrative Contractor for CMS, provides information on non-physicians acting as scribes here.

Temporary Delay for Ordering & Referring Denial Edits These edits will check certain claims for an approved or validly

opted-out physician or nonphysician who is an eligible specialty type with a valid individual National Provider Identifier (NPI).The following are examples of claims that would be denied if this information were missing or incorrect. • Laboratories for ordered tests

• Imaging centers for ordered imaging procedures • Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and

Supplies (DMEPOS) for ordered DMEPOS CMS will advise us of the new implementation date in the near future. Informational messages will continue to be sent for those claims that would have been denied had the edits been in place. Click here for additional information.

Suppliers submitting claims for imaging services must identify the ordering or referring physician or practitioner. Please note that according to CMS, if billing globally, both

components will be impacted by the edits and the entire claim will deny if it doesn't meet the ordering and referring requirements. It is recommended that providers and suppliers bill the global claims separately to prevent

a denial for the professional component. Click here for more information under the category of “Claims, Pricer, and Code Updates.”

New HCPCS Code for Zometa and/or Reclast Medicare requires HCPCS code Q2051 (Injection, Zoledronic Acid, not

otherwise specified, 1mg) to be reported for Zometa and/or Reclast for claims with dates of service July 1, 2013 and forward. Codes J3487 and J3488 will no longer be payable for Medicare. Please see MLN Matters

®

MM8286 for the further details.

Please check with your commercial carriers to determine what HCPCS codes are required for reporting Zometa and/or Reclast injections. HCPCS codes J3487 and J3488 may or may not be used to report Zometa and/or Reclast injections to commercial carriers.

Medicare Physician Fee Schedule (MPFS): How the fees are calculated

CGS, a Medicare Administrative contractor provides a well written article on how the calculations are done. Click here for the full article.

88172 and 88177 Subject to CLIA Edits Effective January 1, 2013 and

require the facility to have a CLIA certificate. The implementation date

of this request is April 1, 2013. To see the complete Change Request

from CMS click here.

88172 [Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to

determine adequacy for diagnosis, first evaluation episode, each site] 88177 [Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to

determine adequacy for diagnosis, each separate additional evaluation episode, same site (list separately in addition to code for primary procedure

P a y m e n t A l e r t !

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General ICD-10 &

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Dates of Service: Is it ICD-9 or ICD-10? Visit the CMS ICD-10 website for the latest news and resources

and the ICD-10 continuing medical education modules developed by CMS in partnership with Medscape to help you prepare for the October 1, 2014, deadline.

Changes in the requirements for written orders regarding DME go into effect July 1. In order to be

reimbursed for certain DME (durable medical equipment), the physician, PA, NP, or CNS must have a face to face encounter with the patient 6 months prior to ordering items such as insulin pumps, home blood glucose monitors, etc. Click here for more information.

This fact sheet describes common CERT (Comprehensive Error

Rate Testing) errors related to glucose testing supplies

and provides a checklist of the documentation needed to support a claim submitted to Medicare for glucose testing supplies.

Effective July 1, 2013, Medicare will implement a national mail-order program for diabetic testing supplies.

Beneficiaries who have their diabetic testing supplies shipped or delivered to their homes must use a national mail order contracted supplier with Medicare. Click here for additional information.

The Office of Inspector General (OIG) offers

information on provider self-disclosure protocol. Click

here to find out:

Background info

Why disclosure is important

Benefits of disclosure

Eligibility criteria and guidance and more!

AACE members have access to an ICD-9 to ICD-10 Coding

Convention Comparison here

Click here for AACE membership Information

Pass the word!

New Medicare Administrative Contractor for Connecticut, Maine, Massachusetts, New Hampshire, New York, and

Rhode Island. Click here for the

implementation schedule!

AACE encourages

members to validate

that their provider

enrollment information

is current in PECOS

(Provider Enrollment

Chain and Ownership

System) in lieu of the

delay to ensure there

are no impacts/delays in

patient care.

Click here for

additional information

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Contact Endocoding@aace.com or 904-353-7878 for additional information. All courses, dates and locations are subject to

change. Cancellations must be received in writing to the AACE office 48 hours in advance of the course in order to receive a full

refund. No-shows or cancellations received after this time are not eligible for a refund. AACE reserves the right to cancel the course

with a minimum 48-hour notification. Participants will have the option to attend in an alternate course (if available) or request a

full refund.

Fundamentals and Advanced Endocrine Coding Register

T h i s a c t i v i t y h a s b e e n a p p r o v e d f o r A M A P R A C a t e g o r y 1 C r e d i t ( s ) ™

September 19-20 ● Las Vegas, NV Las Vegas Agenda December 5-6 ● Miami, FL Miami Agenda

Bridge the Gaps in Endocrine Coding Register

T h i s a c t i v i t y h a s b e e n a p p r o v e d f o r A M A P R A C a t e g o r y 1 C r e d i t ( s ) ™

July 22 ● Jacksonville, FL Jacksonville Agenda

August 15 ● Atlanta, GA Atlanta Agenda

Evaluation and Management (E/M) Documentation for Endocrinologists “What’s in your record?” Register

T h i s a c t i v i t y h a s b e e n a p p r o v e d f o r A M A P R A C a t e g o r y 1 C r e d i t ( s ) ™

July 23 ● Jacksonville, FL Jacksonville Agenda

August 16 ● Atlanta, GA Atlanta Agenda

Limited Seating

It is becoming a necessity for physicians and their staff to gain advanced knowledge and resources to maximize reimbursements, comply with federal and commercial guidelines, and stay compliant with the various state, federal, and commercial regulations. ICD-10-CM,

scheduled to be effective October 1, 2014, will bring greater challenges with additional training demands and more specific documentation requirements for physicians and other providers of service. CMS and third party payers are spending millions of dollars investigating physician billing practices and the federal government is recovering billions of dollars in healthcare fraud related settlements and judgments through the False Claims Act. A large percentage of these recovery efforts are due to miscoding of claims, misunderstanding of policies, rules and regulations. Physicians and medical practices are facing increased challenges on the business and financial end of the endocrine practice with healthcare reform, dwindling reimbursements, and increased audit requests. Attending one or more of AACE’s educational opportunities can help you keep up with the latest and greatest coding challenges and be prepared when the auditors show up at the door! All classes are designed to assist physicians, non-physicians, coders, billers, and collectors, practice managers, etc., in obtaining all allowable reimbursement and complying with federal and commercial guidelines.

Open to AACE members and non-members & their staff!

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All medical coding must be supported with documentation and medical necessity. **While this document represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will recognize and accept the coding and documentation recommendations. As CPT

®, ICD-9-CM and HCPCS codes change annually, you should reference the current CPT

®,

ICD-9-CM and HCPCS manuals and follow the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information. This information is taken from publicly available sources. The American Association of Clinical Endocrinologists cannot guarantee reimbursement for services as an outcome of the information and/or data used and disclaims any responsibility for denial of reimbursement. This information is intended for informational purposes only and should not be deemed as legal advice, which should be obtained from competent local counsel. Current Procedural Terminology (CPT

©) is copyright and

trademark of the 2012 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT

©. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions

apply to government use. 5

We want to hear from you!

Tell us what you think of Endonomics! Please take a few minutes to take this survey. Your feedback is very important to us as we strive to assist you with a profitable and compliant business office.

o Is Endonomics™ valuable and useful for your office?

o What other topics would you like to see offered in Endonomics™?

o Other comments…

AACE's Socioeconomics and Member Advocacy Department's goal is to reach out to the endocrinology business world and become the one- stop- shop, not only for endocrinology clinicians, but their support staff as well. Currently, Endonomics

™ is

currently a free newsletter for both members and non-members. Interested parties should send an e-mail to Endonomics@aace.com with their name, phone and fax numbers, location and preferred e-mail address to be added to our Practice Support Network database.

Coding TRAC

Tips on Reimbursement And Coding

Please submit comments or questions to Endocoding@aace.com.

What is the Medicare National Correct Coding Initiative (NCCI)?

The Medicare National Correct Coding Initiative (NCCI) (also

known as CCI) was implemented to promote national correct

coding methodologies and to control improper coding leading

to inappropriate payment. NCCI code pair edits are automated

prepayment edits that prevent improper payment when certain

codes are submitted together for Part B-covered services. In

addition to code pair edits, the NCCI includes a set of edits

known as Medically Unlikely Edits (MUEs). An MUE is a

maximum number of Units of Service (UOS) allowable under

most circumstances for a single Healthcare Common

Procedure Coding System/Current Procedural Terminology

(HCPCS/CPT) code billed by a provider on a date of service

for a single beneficiary.

For information about the Medicaid NCCI program, refer to The

National Correct Coding Initiative on Medicaid’s web page.

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