JOURNALThe Medical BusinessThe Monthly Newsletter for the Informed Health Care Professional

Brought to you by the Medical Management Institute | August 2013 | Issue 7 Volume 4

mmiclasses.com

Inside this IssueCMS News Updates

CPT® 2014 Expected Code Changes

MMI News Updates

ICD-10 Training Exclusive MBJ Discount

Test Your Knowledge: Crossword Puzzle

Best Practices for Billing and Collections

National Immunization

Awareness Month

FAQ for the Pediatric Immunization Administration Codes

Shipment of First Lots of 2013-2014 Seasonal Influenza Vaccine in US

What You Should Know for Flu Season

2

M M I N e w s u p d a t e s

Recognizing National Immunization Awareness Month (NIAM)Completely Online with Instructor Support Each year in August, National Immunization Awareness Month (NIAM) provides an opportunity to highlight the need for improving national immunization coverage levels. Activities focus on encouraging all people to protect their health by being immunized against infectious diseases. In 2013, the National Public Health Information Coalition is coordinating NIAM activities.

In honor of NIAM, we have compiled some related articles in this issue. Enjoy, and please let us know what you think!

Looking for a Job?Check out the MMI Job BoardThe Medical Management Institute is proud to host a MMI job board! Visit www.mmiclasses.com and click on the “Job Board” tab to check out all of the latest postings. You can search by keyword (medical coding, remote, contract, etc) and by location.

Looking to place a job posting for your company? Post it on our job board for 30 days for only $25! We will post your listing on Facebook and Twitter as well, free of charge.

Have you “Liked” MMI Yet?Facebook.com/MMIFanIf you haven’t “Liked” MMI yet on Facebook, then you are really missing out some great promotions, informative articles, exclusive CEU opportunities, and helpful resources. In our latest Facebook promotion, we gave away the “ICD-10 Overview & Implementation” online course, worth 2 AAPC/ARHCP/PAHCOM CEUs to Lori Bettencourt- all for “Liking” and sharing our page! Visit facebook.com/mmifan today, and get social with us!

Are you more of a “tweeter”? Follow us on twitter.com/mmiclasses for the same great deals and resources.

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

That is why the amazing instruction team at the Medical Management Institute has put together a fully customizable ICD-10 certification training program, completely online! There are 5 training paths available: Coder, Manager, Provider, Clinical Staff, and Biller. These programs include ‘Implementation Insurance,’ guaranteeing no additional charges for continuing education should ICD-10 not be implemented on October 1, 2014.

• The ICD-10 Coder Certification Path is $1,299 and includes the following online modules:

• ICD-10 Implementation Planning• ICD-10 Documentation Requirements• Advanced Anatomy & Physiology• Basic Coding for ICD-10• Specialty Coding for ICD-10• Final Online Certification Exam

Visit mmi-classes.com/collections/icd-10 for more details, and contact us for discounted group rates!

HIPAA Training For Your OfficeAre You In Compliance? $29.99 CourseHIPAA Privacy Rules require the adoption of specific practice policies to address patient privacy issues. In addition, the Security Rules require you to conduct a risk assessment and have written policies on handling protected patient information. In addition, both rules require annual and ongoing training efforts for all physicians and staff.

This 30 minute video offers real world examples and provides flash cards to aid in preparing for the final exam. Your employees can access it through any web browser.Enroll online for the “HIPAA Privacy & Security” course today by clicking here. [Group discounts are available upon request]

MMI news updates

mmiclasses.com | info@mmiclasses.com | 866-892-2765

facebook.com/MMIfan | twitter.com/MMIclasses

3

CMS Finalizes Fiscal Year 2014 Payment and Policy Changes for Medicare Skilled Nursing FacilitiesJuly 31, 2013On July 31, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1446-F] outlining fiscal year (FY) 2014 Medicare payment rates for skilled nursing facilities (SNFs). The major provisions of the final rule are summarized below. Changes to payment rates under the SNF Prospective Payment System (PPS) for FY 2014• Based on the changes contained within this final

rule, CMS estimates that aggregate payments to SNFs will increase by $470 million, or 1.3 percent, for FY 2014 relative to payments in FY 2013. This estimated increase is attributable to the 2.3 percent market basket increase, reduced by the 0.5 percentage point forecast error correction (explained below) and further reduced by the 0.5 percentage point multifactor productivity adjustment required by law.

Revise and rebase the market basket• The Medicare statute requires CMS to establish a

SNF market basket index that reflects changes over time in the prices of an appropriate mix of goods and services included in covered SNF services. CMS has developed a SNF market basket index that encompasses the most commonly used cost categories for SNF routine services, ancillary services, and capital-related expenses.

Reporting of distinct therapy days• To ensure accuracy in case-mix assignment and

payment, CMS is adding an item to the Minimum Data Set (MDS) to record the number of distinct calendar days of therapy provided by all the rehabilitation disciplines to a beneficiary over the seven-day look-back period.

Forecast error correction• A forecast error correction is applied when the

difference between the actual and projected market basket percentage change for a given year (the most recent available FY for which there is

final data) exceeds the 0.5 percentage point threshold.

Medicare Drug Premiums Remain Stable for Four Years in a RowJuly 30, 2013This news comes as seniors and people with disabilities continue to save money on out of pocket drug costs. Yesterday, HHS announced that more than 6.6 million people with Medicare have saved over $7 billion on prescription drugs as a result of the Affordable Care Act, an average of $1객 per beneficiary. The Affordable Care Act closes the donut hole over time.

On Eve of Medicare Anniversary, Over 6.6 Million Seniors Save over $7 Billion on DrugsJuly 29, 2013On the eve of the 48th anniversary of the signing of Medicare and Medicaid into law, new information released today by the Department of Health and Human Services (HHS) shows a strong Medicare program. Over 6.6 million people with Medicare have saved over $7 billion on prescription drugs as a result of the Affordable Care Act. These savings average $1객 per beneficiary in drug costs while a beneficiary is in the donut hole coverage gap that the law closes over time.  

CMS Imposes First Affordable Care Act Enrollment Moratoria to Combat FraudJuly 26, 2013Building on strong anti-fraud efforts already underway, Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner today announced temporary moratoria on the enrollment of new home health provider and ambulance supplier enrollments in Medicare, Medicaid and the Children s Health Insurance Program (CHIP) in three fraud hot spot areas of the country. The goal of the temporary moratoria is to fight fraud and safeguard taxpayer dollars, while ensuring patient access to care. 

CMS News Updates

CMS news updates

www.cms.gov

Centers for Medicare & Medicaid Services

4

ollections should not be thought of as something that only happens on the backend of the billing process. It should start by properly conveying your policies and

expectations in advance to both patients and staff. Here are some tips you can implement in your practice to improve your patient collections at little or no cost.

Office Visits - Front Desk Responsibilities1. Patients need to understand and acknowledge in writing that they are personally responsible for any charges not covered by insurance. They should be required to sign your financial policy at every visit, not just the first visit in order to remind them of their obligations. This should reduce the number of patients who have the attitude that their insurance made a mistake and it's therefore not their problem.

2. Of course you always want to collect co-pays at the time of visit, but what does your staff do when a patient says they didn't bring any form of payment? Turning the patient away is costly both in terms of a wasted appointment slot as well as the potential loss of that patient's future revenue. Instead, train your staff to introduce themselves by first name to make a connection and then hand the patient a pre-addressed envelope to remit funds when they get home. For example, "My name is Karen and I've written my name on this envelope along with our address. As soon as you get home today, please put your check in this envelope and mail it back to my attention as I will be keeping an eye out for it."

What To Include and Not Include On Your Statements

3. Is your phone # on your bills? This may seem obvious, but some bills do not show a phone # and that delays payment by making it more difficult for a patient to call if they want to set up a payment plan or ask a question about their bill. Now they have to take the time to look up your phone # and they may put that off until later.

4. Is there a due date on your bill or do you just show the date the bill was generated? Many bills

do not show a specific due date which implies that payment is due whenever the patient feels like paying.

5. Are penalties specified for violating terms? Is there any consequence to paying late? Why not include a late charge in order to give your bill priority over other bills which don't incur penalties? A flat late fee is much easier to manage than a percentage of balance.

6. Do you show aging boxes on your statements? The use of aging boxes on statements which show 30, 60, 90, etc balances conveys exactly the opposite of what you want. It shows that you expect your patients' balances to age and you've even made a provision for that right on your statements when you really want to convey an expectation of getting paid as soon as the bill is received. Aging boxes also train patients to only pay the portion of the balance that is the oldest rather than paying off the balance in full.

7. The use of colored paper for late reminders is helpful in getting patients' attention as they stand out among the pile of white paper in a patient's stack of bills.

Establishing Internal Collections Policies8. Just like other aspects of your employee handbook, your collections policies should be in writing. This makes it easier when training new employees and demonstrates the importance placed on collections. Include performance benchmarks ($ collected or # calls made during a specific time period or establish a maximum % of AR over 60 days). Review and update your collections policy as needed while keeping it clear and simple. Determine how returned mail should be handled.

C

Best Practices For Billing and CollectionsDavid Wiener, “Mr Cash Flow”

Best Practices For Billing and Collections

“There is no law that says you have to warn a patient that you’re going to send them to collections

before you do”

5Best Practices For Billing and Collections

9. Define "past-due" and include the next steps for handling a past-due account. How many written contacts will be sent? How many phone calls will be made? When will this follow up occur and at what intervals? Evidence shows it is best to vary the form of follow up at regular intervals of 7-14 days.

A recommended process would be 2 mailed bills + 1 phone call + 1 warning letter and this should all occur within 90 days or less. If a patient has been asked to pay 4x in 90 days and you've gotten no response, they're sending you a message and need to be in the hands of a third party agency because continued first party efforts at that point will not generate a good ROI.

Making Collections Calls10. Be careful when leaving voice messages so as not to "advertise" a debt owed to your practice when your message might be heard by others in the household. Ensure that your staff is fully compliant with all Federal, State and Local Regulations regarding first party collections and telephone calls, or utilize a service to make these calls for you who is compliant.

11. Try to make a connection with the debtor by speaking clearly and enthusiastically. And stay firm by using phrases such as "It's my policy that...."

12. Make the call with the mental attitude that you will get payment in full on one call, not that you're going through a list and making calls just to get it over with. Your mental attitude affects what comes out of your mouth, so expect success!

13. If a patient says they don't have enough money to pay their balance, ask, "How much are you short?" rather than, "How much can you pay?" This small change in language conveys an expectation that the majority of the funds are available and that you'll be working out a payment plan for the smaller remaining balance.

14. Never make "idle threats". It is a violation of collections laws to threaten to send a patient to collections unless using a collection agency is a normal practice for you.

15. Train your collector to take good notes so that if they have subsequent conversations with the patient, you can refer back to their notes and

if that staff member leaves, it will be a good starting point for someone else to pick up their work.

Avoid Costly ViolationsUse only an employee or a licensed 3rd party agency/attorney to collect for you, never an unlicensed 3rd party. Only use 3rd parties who are committed to full compliance to all Federal, State and Local regulations regarding both first and third party collections. Only use a 3rd party who provides you with a “hold harmless”” agreement as a matter of course.

Do not share information about a balance due with parties other than the debtor or their spouse. For example, if you call the debtor's office and someone else answers the phone, do not leave a message about a balance due, only a message to return your call.

Prior to discussing any patient A/R information with anyone outside your practice, make sure that you have a HIPAA Business Associate Agreement signed and on file with the individual or agency.

Collection MythsAll of these items are things to consider when establishing your practice's individual collection policy, but they are not legal requirements.

• There is no law that says you have to warn a patient that you're going to send them to collections before you do.• There is no law that says you have to wait a certain

number of days before sending a patient to collections.• There is no law that says that if a patient is paying

$5/month that you can't send them to collections.

David Wiener, known as “Mr Cash Flow” is a speaker,

educator, and consultant working with medical and dental

practices across the United States, helping make their

practices more efficient and profitable. His blog, Mr Cash

Flow’s Tips and Tricks provides practical solutions for practice

optimization. It can be found at http://mrcashflowblog.com. To receive a free, personalized A/R

strategy session via phone, contact him at 888-780-1333

6

I heard that the pediatric immunization administration (IA) codes (90465–90468) were deleted starting in 2011. Is that true?

Yes, that is true. Starting January 1, 2011, codes 90465, 90466, 90467, and 90468 were deleted from the Current Procedural Terminology (CPT®) nomenclature.

Were codes 90471–90474 deleted as well?

No, codes 90471–90474 were not deleted or revised in any way.

Were codes 90465–90468 replaced? If so, what are the replacement code numbers and descriptors?

Yes, codes 90465–90468 were replaced with codes 90460 and 90461.

90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component

+90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (List separately in addition to code for primary procedure.)

Code 90460 is reported once for the first component of each vaccine or toxoid administered by any route. The reporting of code 90460 includes counseling for the first vaccine component. Code 90461 is additionally reported for the counseling associated with each additional component of any combination vaccine or toxoid.

The + symbol next to code 90461 indicates that it is an add-on code, just like 90466 was an add-on code to 90465 and 90468 was an add-on code to 90467. An add-on code (ie, 90461) can only be reported in conjunction with the primary code (in this case, 90460).

How does CPT define a vaccine component?

A component refers to all antigens in a vaccine that prevent disease(s) caused by one organism. Multivalent antigens or multiple serotypes of antigens against a single organism are considered a single component of vaccines. Combination vaccines are those vaccines that contain multiple vaccine components. Conjugates or adjuvants contained in vaccines are not considered to be component parts of the vaccine as defined above.

How many components are in the common pediatric vaccines and which pediatric IA codes would I report with each?

Please see the following chart: (A-1)

We administer Prevnar 13 to our patients. Do we repor t t h i s vacc i ne t o have 13 components?

No, because the antigens contained in the Prevnar 13 vaccine only prevent disease caused by one organism (ie, pneumococcus).

If a vaccine provides protection against multiple diseases but is not available in the United States as single component individual products, can I still report codes 90460–90461?

Yes, the CPT definition of component is not dependent on the availability of the product as single components. The commercial availability of vaccine products is a dynamic process that may vary throughout the year, making this a difficult indicator to use.

How are the pediatric IA codes (90460–90461) different from the former pediatric IA codes (90465–90468)?

Please see chart: (A-2)

FAQ for the Pediatric Immunization Administration Codes

In Honor of National Immunization Awareness Month From the American Academy of Pediatrics

FAQ for the Pediatric Immunization Administration Codes

7FAQ for the Pediatric Immunization Administration Codes

The IA codes specify that the counseling must be performed by a physician or “other qualified health care professional.” What determines who qualifies as an “other qualified health care professional”?

This guideline was revised and clarified in the 2012 CPT manual. A "physician or other qualified healthcare professional" is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from "clinical staff." A clinical staff member is a person who works under the supervision of a physician or other qualified healthcare professional and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specific services.

To report CPT codes 90460–90461, the physician or the qualified health care professional who is reporting the service must perform face-to-face counseling (and so document that the counseling was personally performed).

Will there ever be an occasion, given the guidelines for reporting pediatric IA codes (90460–90461), for which we would need to report 90471–90474?

Yes, if you see older patients (ie, those 19 years and older), there is no counseling performed on the patient, or the health care professional counseling does not meet the new CPT definition for an other qualified health care professional, such as clinical staff (eg, LPNs, RNs).

Click here to be directed to the American Academy of Pediatrics to review the

entire FAQs for the Pediatric Immunization Administration Codes in full.

A-1

A-2

8

Of the proposed 31 new procedure codes for CY2014 that directly pertain to radiology, 26 codes are the result of bundling requests from the Relative Value Scale Update Committee’s (RUC) Relativity Assessment Workgroup (RAW).

Code pairs identified as being performed together 75 percent of the time or more and therefore considered by the CPT Editorial Panel for bundling in 2014, included abscess drainage, breast biopsy, embolization and intravascular stent procedures. In addition, the radiation oncology therapeutic radiology simulation-aided field setting code was captured in the Harvard-based codes with utilization greater than 30,000 screen.

Look for the  Economics & Health Policy News section of the ACR website for an impact analysis of the 2014 code changes to be posted  this summer. Radiology practices are advised to review how the following procedures are coded currently and to anticipate how the bundled changes will impact their practices.

Abscess DrainageThe abscess drainage codes 49021, 49041 and 49061 were identified as codes reported together with imaging guidance 75 percent or more of the time. Therefore, the RAW requested that the abscess drainage codes and guidance code 75989 be bundled. The ACR and other specialty societies

submitted a code proposal to develop a more cogent structure of the percutaneous abscess drainage codes and improve this family of codes. A new code also was recommended that describes a soft-tissue fluid collection drainage by catheter using imaging guidance.

Breast BiopsyNew bundled codes will be created to describe breast biopsy procedures that include imaging guidance as well as placement of one or more localization device(s) and imaging of the specimen when performed. Codes 77031, 77032, 76098, 19103, 19290 and 19295 were caught in the 75-percent screen. New codes also will be created to report the placement of clips and other breast localization devices without biopsy or during aspiration procedures.

EmbolizationAlso caught in the 75-percent screen was the surgical embolization code 37204, which is billed in conjunction with the radiological supervision and interpretation (RS&I) codes 75894 (Transcatheter therapy, embolization, any m e t h o d , r a d i o l o g i c a l s u p e r v i s i o n a n d interpretation) and 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis).

New codes and introductory guidelines will be provided  for reporting bundled embolization and occlusion procedures. Deletion of the existing s u r g i c a l c o d e s 3 7 2 0 4 a n d 3 7 2 1 0 w a s recommended, as these services would be reportable with one of the new family of embolization codes.

Intravascular StentThe endovascular revascularization procedures were identified by the RAW during the RUC five-year review process in 2008 as potentially misvalued via a high-volume growth screen. The RAW requested codes 37205-37208 be revised at that time. However, the RAW agreed to defer review as requested by the ACR and other specialty societies because it would be difficult to describe a typical patient and a typical clinical scenario given the revision of the lower extremity revascularization codes in 2010. In April 2010, code 37205 was identified as a potentially

CPT® 2014 Expected Code ChangesFrom the American College of Radiology

CPT® 2014 Expected Code Changes

9

misvalued service by the 75-percent screen. The specialty societies again were encouraged to create new codes that bundle 37205-37208 with RS&I code 75960.

Look for new codes to describe intravascular stent revascularization (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial or coronary), which will include RS&I, and angioplasty within the same vessel when performed.

Harvard-Based Codes with Utilization Greater Than 30,000CPT code 77280, Therapeutic radiology simulation-aided field setting; simple, was captured by the Harvard valued-utilization over 30,000 screen. The RUC requested that ASTRO survey the entire family of simulation codes (77280, 77285, 77290, 77295). However, ASTRO reviewed the process of care associated with these codes and determined this family of codes should be referred to CPT for revision.

Look for three changes to occur in conjunction with radiation oncology procedures: (1) revision to the family of simulation codes; (2) creation of a new respiratory motion management simulation code; and (3) revision and reassignment of CPT code 77295.

The new simulation codes recommended address the significant changes that have taken place in the process of care for physician and staff and the nature of the equipment utilized.

An add-on code to report respiratory motion management simulation; clinical treatment planning introductory guidelines to clarify the reporting of this service; and the definitions for simple, intermediate and complex treatment planning have been revised to reflect current clinical practice.

Code 77295, Therapeutic radiology simulation-aided field setting; 3-dimensional, represents the work of physics and dosimetry planning and is incorrectly named as “simulation.” The work of 77295 is quite different from the existing and proposed revised simulation codes. Editorial revision to the descriptor and possible renumbering of 77295 as part of the restructuring of simulation codes was recommended.

Category III CodesCerebral perfusion analysis using computed tomography (0042T)

The ACR and the American Society of Neuroradiology requested the extension of Category III code 0042T, Cerebral perfusion analysis using computed tomography with

contrast administration, including post-p r o c e s s i n g o f p a r a m e t r i c m a p s w i t h determination of cerebral blood flow, cerebral blood volume, and mean transit time, which had been scheduled to sunset in 2014. This code extension was requested in order to continue to track the utility and increasing number of cerebral perfusion studies. CT perfusion remains a work in progress with respect to uniformity of application and integration, such as vendor specific issues, agreement on stroke protocols and dose-related concerns.

Renal DenervationA new Category III code will be created to describe percutaneous renal denervation (PRD) from a transcatheter approach. PRD is an endovascular catheter-based procedure using radiofrequency energy to ablate the nerves in the vascular wall of the renal artery(ies), and has shown promise in treating patients with hypertension resistant to drug therapy.

Myocardial InnervationA Category III code was requested to describe the utilization of gamma-scintigraphy in the a s s e s s m e n t o f m y o c a r d i a l s y m p a t h e t i c innervations to track and differentiate studies of infarct from flow. Currently, providers are using an unlisted procedure code, either CPT code 78499, Unlisted cardiovascular procedure, diagnostic nuclear medicine, or CPT code 78999, Unlisted miscellaneous procedure, diagnostic nuclear medicine.

The September/October 2013 issue of the ACR Radiology Coding Source will publish a listing of the new 2014 code descriptors and numbers. In addition, the AMA will provide an early release of a downloadable version of the CPT code book from the AMA Bookstore. The CMS-approved values for codes, however, will not be known until the Medicare Physician Fee Schedule Final Rule is published in the Federal Register.

Note: The AMA posts a Summary of Panel Actions that are available for public viewing. While this summary lists the code changes proposed and the actions taken by the panel, the AMA cautions that these actions are a reflection of the discussions at the most recent panel meeting. Future panel actions may impact these items. Codes are not assigned, nor exact wording finalized, until just prior to publication. Release of this more specific CPT® codeset information is timed with the release of the entire set of coding changes in the CPT publication.

Click here to read the whole article from the American College of Radiology (acr.org).

CPT® 2014 Expected Code Changes

10

SWIFTWATER, Pa., July 25, 2013 /PRNewswire/ -- Sanofi Pasteur, the vaccines division of Sanofi (EURONEXT: SAN and NYSE: SNY), announced today that the first lots of Fluzone®(Influenza Virus Vaccine) for the 2013-2014 season have been released by the U.S. Food and Drug Administration (FDA) for U.S. distribution and were shipped July 24. This shipment represents the first of more than 60 million doses of seasonal influenza vaccine the company plans to deliver to U.S. health care providers this fall. Influenza vaccine is anticipated to be available to the public from local health care providers and pharmacies in August.

"Although influenza disease typically peaks in the U.S. during the winter, the virus can circulate at any time of year, and in fact, last year, reports of increased levels of influenza disease began in the fall," said David P. Greenberg, M.D., Vice President, U.S. Scientific and Medical Affairs. "Annual immunization of more than 130 million people in a few months is a huge undertaking for health care providers each year, and that is why as the largest producer of influenza vaccine in the U.S., our goal is to deliver a reliable supply of influenza vaccine to support health care providers in planning their fall clinics."

New for 2013-2014

For the 2013-2014 season, two new influenza virus strains have been included in the trivalent seasonal influenza vaccine. There is a new A(H3N2) antigen and a new influenza B antigen. The A(H1N1) component of the vaccine is unchanged since the 2009 pandemic. Last season, influenza A(H3N2) disease predominated in the U.S., and it was particularly severe in older adults.

The 2013-2014 influenza season will be the first in which quadrivalent influenza vaccines will be available in the U.S. Until this year, seasonal influenza vaccines included only one B strain. Fluzone Quadrivalent vaccine includes two A strains and two B strains to help protect against influenza disease. Epidemics of influenza B occur every two to four years in all age groups. Influenza B is a common cause of influenza-related morbidity and mortality in children and has been associated with pneumonia and other respiratory illnesses, nervous system disease, muscle pain and inflammation, and other complications. In recent years, up to 44 percent of influenza-associated deaths in children and adolescents 18 years of age and younger were due to influenza B.

In addition to the strain changes in the 2013-2014 vaccine and the availability of quadrivalent vaccines, Sanofi Pasteur is pleased to announce that no presentations of Fluzone vaccine contain natural rubber latex.

This season, Sanofi Pasteur will provide the following influenza vaccine options in its Fluzone vaccine family to help address the unique immunization needs of children, adolescents, and younger and older adults:

• Fluzone vaccine, upon which health care providers have relied for more than 40 years, is approved for use in people six months of age and older. Fluzone vaccine will be provided in a 0.25mL pediatric dose for children six months through 35 months of age and a 0.5mL dose for children 35 months of age and older and adults. Fluzone vaccine also will be available in a 5 mL multi-dose vial for immunization of people six months of age and older, adolescents, and adults. Fluzone vaccine is the only influenza vaccine licensed by the FDA for children as young as 6 months of age. 

• Fluzone Quadrivalent vaccine, which helps protect against four influenza strains, is the newest addition to Sanofi Pasteur's Fluzone family of influenza vaccines, having been licensed by the FDA in June 2013. Like Sanofi Pasteur's Fluzone vaccine, Fluzone Quadrivalent vaccine is licensed for use in children six months of age and older, adolescents, and adults.

• Fluzone High-Dose vaccine, which was introduced in 2010 for adults 65 years of age and older, will be widely available this season. Adults 65 years of age and older are at greater risk for influenza and its complications because the immune system weakens with age. Older adults often do not produce as much antibody following immunization as do younger people. Fluzone High-Dose vaccine is specifically formulated to elicit stronger influenza antibody responses in adults 65 years of age and older.

• Fluzone Intradermal vaccine, which was introduced in 2011, also will be widely available for the 2013-2014 season. Fluzone Intradermal vaccine features an ultra-fine needle that is 90 percent shorter than the typical needle used for intramuscular injection of influenza vaccine. Fluzone Intradermal vaccine is anticipated to be an attractive immunization option for adults 18 through 64 years of age, an age group that has among the lowest rates of immunization.

Sanofi Pasteur Announces Shipment of First Lots of 2013-2014 Seasonal Influenza Vaccine in US

Pasteur Press Release | July 25, 2013

Sanofi Pasteur Announces Shipment of First Lots

11

"With these influenza vaccine options, our goal is to help improve the immunization experience for patients and their health care providers, thus helping to improve immunization rates," said Dr. Greenberg. "We are pleased to offer many different influenza vaccines to meet the specific needs of every patient six months of age and older."

Due to extended shipping time and earlier incidence of disease, the first doses of Fluzone vaccine were shipped to Alaska and Hawaii and to the Centers for Disease Control and Prevention (CDC) for use in the Vaccines for Children program. Direct shipments to health care providers and distributors will be ongoing through October, with health care providers who have placed reservations with Sanofi Pasteur receiving initial shipments by the end of August to support fall immunization campaigns.

Sanofi Pasteur is still accepting orders for most presentations of Fluzone vaccines. Health care providers wishing to reserve vaccine can do so by visiting www.vaccineshoppe.com or by calling 1-800-VACCINE (1-800-822-2463). Members of the public seeking a specific vaccine option, such as Fluzone High-Dose vaccine, Fluzone Intradermal vaccine, or Fluzone Quadrivalent vaccine, can search for local providers at www.Fluzone.com.

About InfluenzaInfluenza is a serious respiratory illness that is easily spread and can lead to severe complications, even death. Each year in the U.S., 5 to 20 percent of the population gets the flu, and an estimated 226,000 people are hospitalized from influenza-related complications. Influenza seasons are unpredictable and can be severe. Depending on virus severity during the influenza season, annual deaths can range from a low of 3,000 to a high of about 49,000 people. Combined with pneumonia, influenza is the nation's ninth leading cause of death. Vaccination is safe and effective and the best way to help prevent influenza and its complications.

The CDC recommends influenza vaccination for everyone six months of age and older. Children six months through 8 years of age who have not previously received two doses of influenza vaccine may require two doses of vaccine for the 2013-2014 influenza season and should consult their health care provider about the number of doses of influenza vaccine required based on their prior immunization history. Health care providers are recommended to begin offering influenza vaccine as soon as the vaccine becomes available and continue vaccination efforts throughout the entire influenza season. Influenza disease activity typically peaks in February, so individuals who are not immunized early in the season still have time to do so prior to the peak of influenza activity. Influenza vaccination is beneficial in December and January, or even into the spring, as long as influenza viruses are still in circulation.Click here to read the original article.

About Fluzone VaccinesIndicationFluzone, Fluzone Quadrivalent, Fluzone Intradermal, and Fluzone High-Dose vaccines are inactivated influenza virus vaccines indicated for active immunization for the prevention of influenza disease caused by influenza subtype A and type B viruses contained in the vaccines.Fluzone and Fluzone Quadrivalent vaccines are approved for use in people six months of age and older. Fluzone Intradermal vaccine is approved for use in people 18 through 64 years of age. Fluzone High-Dose vaccine is approved for use in people 65 years of age and older.Approval of Fluzone High-Dose vaccine is based on superior immune response relative to Fluzone vaccine. Data demonstrating a decrease in influenza disease after vaccination with Fluzone High-Dose vaccine relative to Fluzone vaccine are not yet available.

Safety InformationThe most common local and systemic adverse reactions to Fluzone, Fluzone Quadrivalent, Fluzone Intradermal, and Fluzone High-Dose vaccines include pain (tenderness in young children receiving Fluzone or Fluzone Quadrivalent vaccine), redness (erythema), and swelling at the vaccination site; and muscle aches (myalgia), fatigue (malaise), headache, and fever (also irritability, abnormal crying, drowsiness, appetite loss, and vomiting in young children receiving Fluzone or Fluzone Quadrivalent vaccine). Redness, firmness (induration), swelling, and itching (pruritus) at the vaccination site occur more frequently with Fluzone Intradermal vaccine than with Fluzone vaccine. Other adverse reactions may occur.Fluzone, Fluzone Quadrivalent, Fluzone Intradermal, and Fluzone High-Dose vaccines should not be administered to anyone with a severe allergic reaction (e.g., anaphylaxis) to any vaccine component, including egg protein, egg products, or thimerosal (the only Fluzone vaccine product containing thimerosal is the multi-dose vial of Fluzone vaccine), or to a previous dose of any influenza vaccine. The decision to give Fluzone, Fluzone Quadrivalent, Fluzone Intradermal, or Fluzone High-Dose vaccine should be based on the potential benefits and risks, especially if Guillain-Barre syndrome (severe muscle weakness) has occurred within six weeks of receipt of a prior influenza vaccine. Vaccination with Fluzone, Fluzone Quadrivalent, Fluzone Intradermal, or Fluzone High-Dose vaccine may not protect all individuals.Before administering Fluzone, Fluzone Quadrivalent, Fluzone Intradermal, or Fluzone High-Dose vaccine, please see the full Prescribing Information available at www.sanofipasteur.us orwww.vaccineshoppe.com.

Sanofi Pasteur Announces Shipment of First Lots

12

What sort of flu season is expected this year?

Flu seasons are unpredictable in a number of ways. Although epidemics of flu happen

every year, the timing, severity, and length of the season varies from one year to another.

Will new strains of flu circulate this season?Flu viruses are constantly changing so it's not unusual for new flu virus strains to appear each year. For more information about how flu viruses change, visit How the Flu Virus Can Change.

When will flu activity begin and when will it peak?The timing of flu is very unpredictable and can vary from season to season. Flu activity most commonly peaks in the U.S. in January or February. However, seasonal flu activity can begin as early as October and continue to occur as late as May.

What should I do to prepare for this flu season?CDC recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease. While there are many different flu viruses, the flu vaccine is designed to protect against the three main flu strains that research indicates will cause the most illness during the flu season. Getting the flu vaccine as soon as it becomes available each year is always a good idea, and the protection you get from vaccination will last throughout the flu season.

In addition, you can take everyday preventive steps like staying away from sick people and washing your hands to reduce the spread of germs. If you are sick with flu, stay home from work or school to prevent spreading influenza to others.

Where can I get a flu vaccine?Flu vaccines are offered in many locations, including doctor’s offices, clinics, health departments, pharmacies and college health centers, as well as by many employers, and even in some schools.

Even if you don’t have a regular doctor or nurse, you can get a flu vaccine somewhere else, like a health

department, pharmacy, urgent care clinic, and often your school, college health center, or work.

Visit the HealthMap Vaccine Finder to locate where you can get a flu shot.

How much vaccine will be available during 2013-2014?Manufacturers have projected that they will produce between 135 million and 139 million doses of influenza vaccine for use in the United States during the 2013-2014 influenza season.

What kind of vaccines will be available in the United States for 2013-2014?A number of different manufacturers produce trivalent (three component) influenza vaccines for the U.S. market, including intramuscular (IM), intradermal, and nasal spray vaccines. See Key Facts About Seasonal Flu Vaccine for more information about the different types of vaccine available in the United States.

Most of the flu vaccine offered for the 2013-2014 season will be trivalent (three component). Some seasonal flu vaccines will be formulated to protect against four flu viruses (quadrivalent flu vaccines) and will be available as well according to manufacturers. All nasal spray vaccines are expected to be quadrivalent, however, this makes up only a small portion of total vaccine availability.

What flu viruses does this season’s vaccine protect against?Flu vaccines are designed to protect against three influenza viruses that experts predict will be the most common during the upcoming season. Three kinds of influenza viruses commonly circulate among people today: Influenza A (H1N1) viruses, influenza A (H3N2) viruses, and influenza B viruses,. Each year, one flu virus of each kind is used to produce seasonal influenza vaccine.

Click here to read the entire article from the CDC. More information about influenza vaccines is

available at Preventing Seasonal Flu With Vaccination.

What You Should Know for 2013-2014 Flu Season

Centers for the Disease Control and Prevention

What You Should Know for 2013-2014 Flu Season

13

Manager

Coder

Biller

Clinical Staff

Provider

ICD-10 Implementation

Planning

ICD-10 Doc Requirements

Assessment of ICD-10 Pre-Requisites

ICD-10 for Office

Managers

Office Readiness for ICD-10

ICD-10 Implementation

Planning

ICD-10 Doc Requirements

Advanced Anatomy & Physiology

Basic Coding for ICD-10

Specialty Coding for

ICD-10

Certification Exam

(Pre-Requisite: Registered

Medical Biller)

Advanced Anatomy & Physiology

Billing for ICD-10

Certification Exam

ICD-10 Doc Requirements

ICD-10 for Office Staff

(Pre-Requisite: Need to be licensed)

ICD-10 Doc Requirements

ICD-10 for Qualified Health

Care Professionals

Specialty Coding for

ICD-10

ICD-10 CERTIFIED

Your Guide to Becoming ICD-10 Certified Effective October 1, 2014, the ICD-9-CM code sets will be replaced with ICD-10 codes. ICD-10 will be a radical change, requiring extensive planning and training. MMI will be launching a fully customizable ICD-10 certification training program in the next coming months, which you can learn more about here: mmi-classes.com/collections/icd-10.

Your guide to certification is detailed below:

$200 Off Any ICD-10 Training Path

Promo Code: MBJ200Exclusive MBJ Offer | Expires 09/01/2013

Cannot be combined with any other offers/promotions/discounts/referralsmmi-classes.com/collections/icd-10 | 866-892-2765

ICD-10 Certification Training 13

14

August 2013 MBJ Crossword PuzzleWe hope you enjoyed this issue of the MBJ

...now put your knowledge to the test!

Across1. The Health Insurance Portability and Accountability Act

3. Centers for Disease Control

6. A substance used to stimulate the production of antibodies and provide immunity against one or several diseases

8. Helps protect against four influenza strains, is the newest addition to Sanofi Pasteur's Fluzone family of influenza vaccines

9. An inactivated influenza virus vaccine given to people 18 through 64 years of age for active immunization against influenza disease caused by influenza virus subtypes A and type B contained in the vaccine

11. A French multinational pharmaceutical company headquartered in Paris, France, the world's fourth-largest by prescription sales

12. A common cause of influenza-related morbidity and mortality in children and has been associated with pneumonia and other respiratory illnesses, nervous system disease, muscle pain and inflammation, and other complications

13. Founded in 1930 by 35 pediatricians to work on pediatric healthcare standards

14. A virus that infects the bowels and is most commonly found in children and is a genus of double-stranded RNA virus in the family Reoviridae

15. A virus from the papillomavirus family that affects human skin and the moist membranes that line the body, such as the throat, mouth, feet, fingers, nails, anus and cervix

16. Inactivated influenza virus vaccines indicated for active immunization for the prevention of influenza disease caused by influenza subtype A and type B viruses contained in the vaccines

Down2. A serious respiratory illness that is easily spread and can lead to severe complications, even death

4. His blog, Mr Cash Flow’s Tips and Tricks provides practical solutions for practice optimization

5 . A f o r m o f p e r i p h e r a l p o l y n e u r i t i s characterized by pain and weakness and sometimes paralysis of the limbs

7. Set of five-digit codes describing medical services that are used for billing by professional providers

10. A vaccine approved for children 6 weeks through 17 years of age for the prevention of invasive disease caused by 13 streptococcus pneumoniae strains

August 2013 MBJ Crossword Puzzle

15August 2013 MBJ Crossword Puzzle

16

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

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

Editor in ChiefCarleigh Benscoter

ContributorsKathy DysonDavid Wiener

Layout & DesignCarleigh Benscoter

MBJ

THE MONTHLY NEWSLETTER FOR THE INFORMED HEALTH CARE PROFESSIONAL

ISSUE 7 VOL. 4