AAPC Coder ~ FREE TRIAL

The best online code lookup tools, see 112213 News Blast: AAPC Coder Free Trial

-OR- visit AAPC via: http://www.aapc.com/code/index.aspx

WINTER/END OF YEAR 2013

2013 Holiday Schedule

MEDTRON’s office will be closed:

Wednesday, December 25th, 2013 for Christmas! Statements received after noon on

Monday, December 23rd will be mailed on Thursday, December 26th

Wednesday, January 1st, 2013 for New Years! Statements received after noon on

Monday, December 30th will be mailed on Thursday, January 2nd

2013 CALENDAR YEAR-END CLOSING MEDDATA and Timeshare Clients: This will automatically be done for your practice when we run your December Month-End.

DO NOT RUN YOUR ‘END OF YEAR’ (EOY) BEFORE YOUR ‘END OF MONTH’ (EOM)!!

For assistance, contact Software Support: by double clicking support@medtronsoftware.com from MEDPM or MEDEHR Sign-On screens.

iSeries Clients: If your ‘Fiscal Year’ ends on December 31st, DON’T FORGET to run the YEAR-END CLOSING procedure IMMEDIATELY AFTER closing the month of December.

The Year-End process will back-up the files and only produce reports you specified in Setup & Support (option #2), Practice Control (option #1), Closing Reports Criteria, Year End Reports (option #6). NOTE: Your Year-End totals are reflected on December’s Month-End reports under “Year-To-Date”.

INSTRUCTIONS TO COMPLETE YEAR-END: 1. Procure a sufficient number of tapes. (You will need one set for the Month-End and a second set for the Year-End.) If any new tapes will be used, they must first be initialized. 2. From the MEDPM Master Menu:

- Select Option #8 Closing and Backup Menu - Select Option #3 Month-End Closing to perform the regular month-end Once completed, you will receive a screen indicating that it is time to close the year, and will have the option to run

the Year-End without having to select option #5 Year-End Closing from the Closing & Backup menu.

If you encounter any problems contact Software Support immediately at (985) 234-0599. DO NOT attempt to rerun.

2013 Holiday Schedule

MEDTRON’s office will be operating on After Hours Protocol on

Tuesday, December 24th, 2013 for Christmas!

A News Blast will be posted the week of December 16th, 2013 with more details.

**************************************

MEDDATA/MEDTRON Staff Wish You A Joyous

Holiday Season

What do you think of MEDTRON’s NEW AND IMPROVED WEBSITE? www.medtronsoftware.com

We want to hear your opinion! email: support@medtronsoftware.com

In this issue… ICD-10 is Almost Here - Be Prepared ............................ pg 2 MEDTRON ICD-10 Implementation Update ................... pg 3 2014 Updates ................................................................ pg 3 CMS Finalizes Physician Payment Rates for 2014 ........... pg 4 Part B Provider Inpatient Admission Order/Cert Req .... pg 5 Ordering and Referring Provider Update ..................... pg 5 ACA Provider Fee Schedule Updates ............................ pg 6 Premium Payment Grace Period for ACA ...................... pg 6 Revised 1500 Claim Form Usage Transition ................. pg 7 News Blast Review ........................................................ pg 7 HIPAA Security and Compliance ................................... pg 8

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ICD-10 IS ALMOST HERE – BE PREPARED

ICD-10 or a clinical modification of ICD-10 is the classification system currently being used by the majority of the world. The United States is the only industrialized nation not using an ICD-10-based classification system. The transition to ICD-10 for the United States is scheduled for October 1, 2014. Practices/providers should get started now preparing for this huge transition!

What is ICD-10: ICD-10-CM was developed and is maintained by National Center for Health Statistics (NCHS) under authorization by the World Health Organization (WHO). It is a clinical modification of the WHO’s ICD-10, which consists of a diagnostics classification system. ICD-10-CM includes the level of detail needed for morbidity classification and diagnostics specificity in the United States. It also provides code titles and language that compliment accepted clinical practice in the US. The system consists of more than 68,000 diagnosis codes.

ICD-10-PCS was developed and is maintained by Centers for Medicare and Medicaid Services (CMS) to capture procedure codes. This procedure coding system is much more detailed and specific than the short volume of procedure code included in ICD-9-CM. The system consists of 87,000 procedure codes. ICD-10-PCS is not required for professional billing. Together ICD-10-CM and ICD-10-PCS have the potential to reveal more about quality of care, so that data can be used in a more meaningful way to better track the outcomes of care. ICD-10-CM/PCS incorporate greater specificity and clinical detail to provide information for clinical decision making and outcomes research. What are the major differences between ICD-9 and ICD-10: ICD-9-CM ICD-10-CM 3-5 characters 3-7 characters First character is numeric or alpha (E or V) First character is alpha Characters 2-5 are numeric Characters 2-7 are alpha or numeric Always at least 3 characters Always at least 3 characters Use of decimal after 3 characters Use of decimal after 3 characters What you can do now to get prepared: Practices should gather and organize information to identify what systems and processes need to be addressed in the ICD-10-CM transition. Providers should focus on understanding how ICD-10-CM is different from ICD-9-CM and complete training courses offered by various organizations: http://apps.who.int/classifications/apps/icd/icd10training/ http://www.aapc.com/icd-10/training.aspx http://www.ahima.org/education/onlineed/Programs/ICD10 Resources: American Health Information Management Association (AHIMA): http://www.ahima.org/icd10/ World Health Organization (WHO): http://www.who.int/classifications/icd/en/ American Association of Professional Coders (AAPC): http://www.aapc.com/icd-10/ CMS: http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html YouTube Video: “ICD-10, The Provider Perspective” Contact Software Support for assistance or any questions via:

Email: From MEDPM or MEDEHR Sign On screens, double click on ‘support@medtronsoftware.com’ -OR-

Phone: (985) 234-0599 (local) or (800) 978-0599 (toll free) -OR-

Fax: (985) 234-0609

Happy Holidays From the MEDTRON/MEDDATA Staff Members

2014 UPDATES Update your Charge Master for the new 2014 fee schedules (allowables) published by Medicare, Medicaid

and any of your managed care relationships. Update your system to new 2014 CPT codes effective January 1, 2014 and 2013 ICD-9 codes effective

October 1, 2013, if any. See AAPC Coder Free Trial Offer on page 1 Reminder – there is no grace period. After new fee schedules (allowables) are loaded, run an Allowable vs. Charge Comparison Report and

update any standard prices in your Charge Master to insure that all charge amounts are higher than published allowables.

Implement the scanning of your patients’ insurance cards and driver’s licenses into MEDPM. Utilize Online Eligibility via MEDPM.

NOTE: Medicare returns patients’ address, Part C, i.e., Medicare Advantage replacement coverage information and/or Medicare Secondary Payer (MSP) status as applicable and preventive code use. LA Medicaid returns patient’s policy #, Bayou Health Plan (BHP), Take Charge information and Primary Insurance/Third Party Liability (TPL) codes as applicable.

Update your system for Medical Necessity, National Correct Coding Initiative (NCC/NCCI) edits, National Provider Identifiers (NPI), Medigap (MGP), Global Surgical Periods (GSP), Relative Value Units (RVU), and the new Charge Master Indicators, i.e., modifiers, frequency, status, and sex. NOTE: All clients who requested the Medigap update; please review your Medicare EOBs carefully for payments

with Remark MA18: ‘FORWARDED TO PT INSURER’. When received, update the associated Insurance Company Master’s Medigap field to ‘Y’.

Call the MEDTRON Implementation Department at 985-893-2550 to order systematic updates.

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MEDTRON ICD-10 IMPLEMENTATION UPDATE

MEDTRON (MSI) has begun the programming effort for ICD-10 implementation. Completion of programming and claim testing with carriers will occur between March - June 2014. Testing will be done directly with Blue Cross, Novitas (LA/MS Medicare), Molina (LA Medicaid), ACS (MS Medicaid) and Emdeon Clearinghouse for all other electronic claims. Important Novitas notes: Claims with ‘Span dates’ will have to be split and submitted separately for September and October 2014

dates of service. Local Coverage Determinations (LCDs) are expected to be published by April 10, 2014. MEDTRON will install the ICD-10 version of MEDPM for client use before the end of Summer 2014, well in advance of the October 1, 2014 deadline. The programming, any installation instructions, and implementation instructions will be provided with the release, which are included in the MEDTRON Software Support Agreement.

More information on MEDTRON Software’s ICD-10 Readiness and Implementation will be published via News Blasts. Visit www.medtronsoftware.com often to keep updated!

CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) HOT TOPICS

CMS Finalizes Physician Payment Rates for 2014 Final Rule Focuses on Improved Care Coordination

On November 27, CMS finalized payment rates and policies for 2014, including a major proposal to support care management outside the routine office interaction as well as other policies to promote high quality care and efficiency in Medicare. CMS’s care coordination policy is a milestone, and demonstrates Medicare’s recognition of the importance of care that occurs outside of a face-to-face visit for a wide range of beneficiaries beginning in 2015. The final rule sets payment rates for physicians and non-physician practitioners paid under the Medicare Physician Fee Schedule for 2014 and addresses the policies included in the proposed rule issued in July. CMS projects that total payments under the fee schedule in 2014 will be approximately $87 billion.

As part of CMS’s continuing effort to recognize the critical role primary care plays in providing care to beneficiaries with multiple chronic conditions, beginning in 2015, the agency is establishing separate payments for managing a patient’s care outside of a face-to-face visit for practices equipped to provide these services.

Are you using Transition Care Management (TCM) codes (99495-99496)? See 031413 News Blast: Educational Series: Transition Care Management (TCM)

The 2014 payment rates increase payments for many medical specialties with some of the greatest increases going to providers of mental health services including psychiatry, clinical psychologists and clinical social workers.

CMS is finalizing a process to adjust payment rates for test codes on the Clinical Laboratory Fee Schedule (CLFS) based on technological changes. Currently, the payment rates for test codes on the CLFS do not change once they have been set (except for changes due to inflation and other statutory adjustments). This review process will enable CMS to pay more accurately for laboratory tests on the CLFS.

The final rule also includes several provisions regarding physician quality programs and the Physician Value-Based Payment Modifier (Value Modifier). As CMS continues to phase-in the Physician Value-Based Payment Modifier, for 2016 CMS is finalizing its proposals to apply the Physician Value Modifier to groups of physicians with 10 or more eligible professionals, and to apply upward and downward payment adjustments based on performance to groups of physicians with 100 or more eligible professionals. However, only upward adjustments based on performance (not downward adjustments) will be applied to groups of physicians with between 10 and 99 eligible professionals. CMS also is finalizing several related proposals to the Physician Quality Reporting System (PQRS) for 2014, including a new option for individual eligible professionals to report quality measures through qualified clinical data registries. In 2014, quality measures will be aligned across quality reporting programs so that physicians and other eligible professionals may report a measure once to receive credit in all quality reporting programs in which that measure is used. Additionally, CMS is better aligning PQRS measures with the National Quality Strategy and meaningful use requirements, and transitioning away from process measures in favor of performance and outcome measures. Finally, certain data collected in 2012 for groups reporting certain PQRS measures under the Group Practice Reporting Option (GPRO) will be publicly reported on the CMS Physician Compare website in 2014. “Aligning measures across quality programs focuses providers on the most important measures and makes it easier to participate in programs like PQRS, which are designed to emphasize quality for Medicare beneficiaries,” said Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer. Full text of this excerpted CMS press release (issued November 27).

Final Rule Fact Sheet: Final Policy and Payment Changes to the Medicare Physician Fee Schedule for CY 2014 Fact Sheet: Changes for CY 2014 Physician Quality Programs and the Value-Based Payment Modifier Physician Fee Schedule Physician Value-Based Payment Modifier PQRS

Source: CMS eNews, 11/29/2013

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Part B Provider Inpatient Admission Order and Certification Requirements (Click title for CMS publication released on September 05/2013)

One of the most significant aspects of the 2014 IPPS Final Rule was effective October 1, 2013. The CMS publication “clarifies” CMS coverage/payment criteria for Part A inpatient hospital claims, by creating requirements for the attending physician orders and certifications and by establishing new guidelines to justify and document the medical necessity of inpatient hospital admissions under Part A. As a condition of payment under Part A, physicians must document the medical necessity of an admission, which

must include: a certification with an admission order, the reason for the inpatient services, the estimated time the patient will stay in the hospital (2-midnight minimum), and plans for post-hospital care

The preamble to the regulation says that admission orders must include the word “inpatient” — either admit “as an inpatient,” “for inpatient services,” “to inpatient” or similar language. Physicians shouldn’t use specific destinations, such as “Admit to ICU” or “Admit to 4C.”

The 2-midnight stay and its certification don’t mean hospitals are home free in terms of medical necessity. The certification is a prerequisite for a 2-midnight stay, but the documentation must support the medical necessity of the admission/length of stay.

There is an advantage to the certification requirement, i.e., it will drive a lot more clinical documentation education toward physicians. Physicians use the chart as a communication tool, but Medicare views it as a billing tool. CMS wants it in a format and at a level of detail that is clear to a layperson.

CMS Resources: Reviewing Hospital Claims for Admission FINAL available via: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/Downloads/ReviewingHospitalClaimsforAdmissionFINAL.pdf

Selecting Hospital Claims for Patient Status Reviews: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/Downloads/SelectingHospitalClaimsforAdmissionsonorafterOctober1st2013forReviewForWebPostingCLEAN.pdf

Frequently Asked Questions: 2 Midnight Inpatient Admission: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/Downloads/2MidnightInpatientAdmissionGuidanceandPatientStatusReviewsforA-.pdf MSI Software Support can share the CMS Compliance slides upon request:

Email: support@medtronsoftware.com

Ordering and Referring Provider Update

Per CMS’s instructions, contractors will turn on Phase 2 denial edits on January 6, 2014. The edits will check the following claims for a valid individual National Provider Identifier (NPI) and deny the claim when this information is invalid: Claims from clinical laboratories for ordered tests; Claims from imaging centers for ordered imaging procedures; Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for ordered

DMEPOS; and Claims from Part A Home Health Agencies (HHAs).

For more information refer to: MLN Matters article #SE1305 available via:

http://www.medtronsoftware.com/pdf/SE1305_Ordering_Referring_Provider_Update CMS Ordering and Referring Information website:

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/MedicareOrderingandReferring.html

04302013 NEWS BLAST: Ordering/Referring Provider Edits 04102013 NEWS BLAST: Ordering/Referring Provider Must Be Properly Enrolled in Medicare

Page 6 End of Year 2013

PREMIUM PAYMENT GRACE PERIOD FOR ACA EXCHANGE ENROLLEES

The Affordable Care Act (ACA) Health Insurance Exchange is now open and individuals who enroll with eligibility for the Pre-mium Tax Credit will be granted a 90-day grace period to pay their monthly premium. Federal regulations prohibit carriers participating in the exchange from cancelling an insured’s coverage for non-payment within 90 days of the premium due date. Claims received within the first 30 days of the lapse are to be paid by the carrier; however, a hold can be placed on any claims received within the last 60 days which can result in provider’s exposure, i.e., to not be paid.

According to 45 C.F.R. §156.270(d): “Grace period for recipients of advance payments of the premium tax credit. A Qualified Health Plan (QHP) issuer must provide a grace period of three consecutive months if an enrollee receiving advance payments of the premium tax credit has previously paid at least one full month’s premium during the benefit year. During the grace period, the QH issuer must:

1. Pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period;

2. Notify Health & Human Services (HHS) of such non-payment; and, 3. Notify providers of the possibility of denied claims when an enrollee is in the second and third months of the grace period.”

If the insured fails to pay within 90 days, coverage will be terminated and claims placed on hold will not be paid by the carrier. The physician will be responsible for collecting payment in full directly from the patient; a burden the physician should not have to bear as he/she should be able to make an informed decision about providing potentially uncovered services.

Currently, the Centers for Medicare and Medicaid Services (CMS) recommends carriers “notify all potentially affected providers as soon as practicable when an enrollee enters the grace period”. The phrase “as soon as practicable” leaves much room for interpretation. When is it practicable? Notification after services are rendered and the enrollee’s coverage has been terminated is not practicable.

In an effort to prevent physicians from bearing further burden, CMS has been requested by Medical Group Management Association (MGMA) to require participating carriers to notify providers of an enrollees grace period status as part of the insurance eligibility verification process. Carriers should have this information available for providers by at least day 15 of the 90-day period. Should a carrier not provide accurate and timely information, the carrier should be held financially responsible for any services rendered during the last 60 days of the grace period for an enrollee whose coverage is terminated.

Sources: Medical Group Management Association: http://www.mgma.com/WorkArea/DownloadAsset.aspx?id=1374940

AFFORDABLE CARE ACT (ACA) PROVIDER FEE SCHEDULE IMPACT

On November 1, 2012 the Centers for Medicare & Medicaid Services (CMS) released the final rule for the 2013 Medicare Physician Fee Schedule (MPFS). The final MPFS rule took effect on January 1, 2013, however not all policies were immediately implemented and some continue to be updated and/or enhanced.

The final rule (http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1590-FC.html):

implemented the Affordable Care Act’s (ACA) requirement that Medicaid pay physicians practicing in family medicine, general internal medicine, pediatric medicine, and related subspecialists at Medicare levels in calendar years 2013 and 2014. See the MEDDATA created Medicaid Traditional/ACA Fee Schedule Comparison Chart.

finalized changes to the Physician Quality Reporting System (PQRS) and Electronic Prescribing (e-prescribing) Incentive Programs, including new e-prescribing hardship exemptions for those participating in the Meaningful Use Electronic Health Records (EHR) Incentive Program. If not yet reporting, see 2013 PQRS Memo and 12/03/12 News Blast: Deadlines & Updates to CMS Quality Reporting Programs, EHR, PQRS, eRX.

allowed for Certified Registered Nurse Anesthetists (CRNAs) to be paid by Medicare for providing all services that they are permitted to furnish under state law. This change allows Medicare to pay CRNAs for services to the full extent of their state scope of practice. The rule also allows Medicare to pay for portable x-rays ordered by nurse practitioners, physician assistants and other non-physician practitioners.

Prepaid Bayou Health Plans (BHP) are delayed in their handling of the retro payment of the enhanced ACA fee schedule. Most should be addressed in the last quarter of 2013; watch for each plans newsletter and/or website for more information.

Review the 092613 News Blast: Updates to the 2013 Medicare, Medicaid and ACA Provider Fee Schedules to review the changes specific to Medicare, Medicaid and instructions for correcting APRN/NP and PA (NPP) previously paid at lower rate claims.

REVISED 1500 CLAIM FORM USAGE TRANSITION BEGINS JANUARY 2014

The National Uniform Claim Committee (NUCC) has announced the approval of the timeline for transitioning to the 02-12 version (bottom right corner) of the 1500 Health Insurance Claim Form (1500 Claim Form). The updated form accommodates reporting needs for ICD-10 and supports the requirements in the Accredited Standards Committee X12 (ASCX12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3. The transition timeline aligns with Medicare’s timeline for implementation.

The NUCC’s approved timeline is: January 6, 2014 – payers may start obtaining and processing paper claims submitted on the revised

1500 Claim Form (version 02-12). January 6 thru March 31, 2014 – dual use period in which payers continue to obtain and process paper

claims on the old 1500 Claim Form (version 08/05). April 1, 2014 – payers obtain and process paper claims submitted only on the revised 1500 Claim Form

(version 02-12) (per ‘Use new Form’ field, via Practice Control, Insurance Criteria section)

MEDTRON will test use and carrier acceptance with MEDDATA in January/February 2014. MEDTRON will implement changes for Timeshare (TMS) and iSeries clients for availability in March 2014.

Review 120413 News Blast: Revised 1500 Claim Form Usage Transition Begins January 2014. For more information, visit NUCC’s website at www.nucc.org. A sample of the updated form with revisions is available via: http://www.health-forms.com/w1500CHANGE.PDF

Sources: Doctors Management, November 22, 2013 Newsflash (email publication) National Uniform Claim Committee, www.nucc.org Health Forms & Systems, www.Health-Forms.com

More information will be published via News Blasts; visit www.medtronsoftware.com often to keep updated! Contact Software Support for assistance or any questions via email: support@medtronsoftware.com.

Page 7 End of Year 2013

NEWS BLAST REVIEW

The 112513 News Blast: 2014 Support File Updates for ICD-9 and CPT Codes Access News Blast for individual specialty changes/updates.

REMINDER: Not only must support files be updated via MEDPM, but Charge tickets must be reviewed and reconciled to confirm all diagnosis and/or transaction codes (key codes) using specific CPT codes are still accurate.

MEDEHR Clients: 112513 News Blast: MEDEHR Yearly Template Support Updates for ICD-9 and CPT Updates.

Access News Blast for individual specialty changes/updates. REMINDER: Not only must support files be confirmed/updated via MEDPM and MEDEHR, but

encounter templates must be reviewed to confirm all linked diagnosis and/or transaction codes (key codes) using specific CPT codes are still accurate.

The 120613 News Blast: Blue Cross Blue Shield of LA: Network Reminders and Changes (originally published 08/12/2013).

Updated information includes: Properly Filing Office of Group Benefits (OGB) Claims New look for member ID cards in 2014 Valuable Resources

MEDTRON suggests assigning a specific staff member to monitor and distribute information posted on the MEDTRON website to the appropriate practice staff for review.

Visit http://www.medtronsoftware.com/ for a complete list of News Blasts and Resources!

HIPAA SECURITY AND COMPLIANCE CLEARING CACHE

Privacy is a top priority! With the explosive use of handheld devices, all users must actively protect the PHI the practice has been entrusted with by patients. Here are a few “common sense” ideas to help keep PHI safe. NEVER share your password with anyone. Keep your PC, Laptop, and phone locked with code/password when not actively in use.

“When in doubt, lock it out”. KNOW where your devices are at all times. Never leave devices

unattended or share with others.

Clean out your recycle bin/trash and empty your cache

regularly. Do NOT store / save passwords on a publicly used device.

Cache is a collection of duplicated data stored elsewhere on a computer. If a website is experiencing trouble such as slow upload or faulty results, the cache may need to be cleared on the device.

To Clear Cache in Firefox: From Firefox, select Firefox, select Options,

select Options again. From Advanced tab, select Network tab. User will need to clear the cache in two places:

Cached Web Content – click ‘Clear Now’ Offline Web Content and User Data – click ‘Clear Now’

Click ‘Ok’.

To Clear Cache in Internet Explorer: From Internet Explorer, select Tools, Select Internet Options From General tab, Browsing History section, click ‘Delete’ Check all available options, click ‘Delete’ Click ‘Ok’. NOTE: To comply with Compliance rules,

users should not store passwords in Internet browsers.

Contact Technical Support for

assistance via email: tech@medtronsoftware.com

Page 8 End of Year 2013