1

J a n u a r y 2 0 1 2 M a r c h 2 0 1 2

N o v e m b e r D e c e m b e r 2 0 1 2

January 31 Deadline to File for 2013 Medicare eRx Hardship This will allow physicians to avoid the eRx penalty Exemptions for physicians include

bull Unable to ePrescribe due to state federal or local lawregulation bull Fewer than 100 prescriptions between January 1 and June 30 2012 bull Rural areas without sufficient high-speed Internet access bull Areas without enough pharmacies available for ePrescribing

Additional information _________________________________________________________________ Alert New instructions for auditors from CMS discuss inappropriate templates and insufficient documentation regarding coding and coverage for Medicare reimbursement The Medicare Program Integrity Manual states ldquoSome templates provide limited options andor space for the collection of information such as by using ldquocheck boxesrdquo predefined answers limited space to enter information etc For additional information click here _________________________________________________________________ Alert Anthem Blue Cross sent warning letters to California providers who bill EM codes with modifier 25 ldquosignificantly more often than other physicians within the same specialtyrdquo based on claims paid between May 2011 and April 2012 _________________________________________________________________

Alert Punctuation can get your claims denied Medicare began rejecting claims processed October 1 2012 and after as unprocessable when the patients name andor Medicare number on the claim do not match their records Common errors include omission of the suffix Jr or Sr incorrect punctuation within the name such as omitting an apostrophe (O Connor or OConnor instead of OConnor) or inserting a comma after the last name and before Jr or Sr when the name on the card does not contain a comma When providers receive this rejection they must verify the information with the patient and submit a claim with the name and Medicare number exactly as it is on the patients most recent Medicare card Unprocessable rejections do not have any appeal rights nor can we reopen them Providers must correct the claim and resubmit it ________________________________________________________________

Alert Post office box addresses are not acceptable and will result in delayed or incorrect reimbursement It is critical that all physicians providers and suppliers check with their designated FI carrier DME MAC or AB MAC to make certain that your physical office address is on file PO Boxes are not an acceptable address format and will result in delayed or incorrectly processed claims and other key correspondence associated with your office

Thyroid Awareness Month is January

The public relations staff at AACE is gearing up for the 18th year of

Thyroid Awareness Month ACE and Abbott Labs are partnering again to bring public awareness to thyroid

issues conditions and diseases We are asking all AACE members to get

involved not only during January but on a continuing basis You can show your support by using the many resources we are offering like our educational

materials such as the neck check cards car magnets lapel pins and many more

items You can also post the blue paisley ribbon a symbol of thyroid

awareness month to your Facebook or Twitter profile Just go to

httptwibboncomsupportthyroid-awareness-month and choose how yoursquod like to support the campaign

Also please encourage your patients to visit wwwthyroidawarenesscom

2

This is the last year for Medicare eligible

professionals (EPs) to start participating in the EHR incentive programs in

order to receive their full Medicare incentive

payments

Registering does not mean you are required to participate - so register today CMS recommends that all eligible professionals (EPs) register as early as possible for Medicare and Medicaidrsquos EHR incentive programs

For more information on registration in the EHR incentive programs visit the Registration section of the EHR incentive programs Web page for the latest news and updates on the EHR incentive programs

Eligible professionals who do not participate in the 2013 e-Rx incentive program will receive 98 of their Medicare Part B allowable charges for their professional services Are you eligible Begin participation today

Alert AMA has learned that Preferred Medical Claims Solutions (PMCS) a client of MultiPlan is attaching notifications to reimbursement checks stating that by depositing the check your practice agrees to being reimbursed by your MultiPlan contracted rate within 10 working days and that you wish to participate in the Advanced Funded Program (AFP) with PMCS going forward If you do not wish to be included in the PMCS AFP program for a specific individual claim or any future claims do not deposit the check and contact PMCS You are encouraged to visit the PMCS website at wwwpmcsonlinecom or call PMCS at (800) 905-2589 with any questions You are also encouraged to visit the AMA website to access ProviderRental Network Contract resources to learn how payers could be taking advantage of your lowest contracted payment rate more often than you think

________________________________________________________________

Please call Novitas toll free at 1-855-761-1069 with any Hurricane Sandy emergenciesquestions If you leave a message someone will contact you within 24 hours Please note that this number is to be used

for Hurricane Sandy issues only all other calls will be referred to our Customer Contact Center

________________________________________________________________

On October 1 2014 your practice and the clearinghouses payers and billing companies that you work with will need to use ICD-10 codes One way to help your practice prepare for ICD-10 is to work on improving how you document your clinical services This will help you and your coding staff become more accustomed to the specific detailed clinical documentation needed to assign ICD-10 codes

Take a look at documentation for the most often used codes in your practice and work with your coding staff to determine if the documentation would be specific and detailed enough to select the best ICD-10 codes For example laterality is expanded in ICD-10-CM Therefore clinical documentation for diagnoses should include information on which side of the body is affected (ie right left or bilateral)

For example for diabetes mellitus physicians must document the following

information

bull Type of diabetes

bull Body system affected bull Complication or manifestation bull If type 2 diabetes long-term insulin use

Remember ICD-10 will not affect the way you provide patient care It will just be important to make your documentation as detailed as possible since ICD-10 gives more specific choices for coding diagnoses This information is likely already being shared by the patient during your visitmdashitrsquos just a matter of recording it for your coding staff Good documentation will also help reduce the need to follow-up on submitted claimsmdashsaving you time and money

Keep Up to Date on ICD-10

Visit the CMS ICD-10 website for the latest news and resources to help you prepare

Simple Steps to Improve Clinical Documentation

3

Starting January 1 2013 and running through December 31 2014 state Medicaid programs will increase payments for primary care services to Medicare payment levels for physicians with a primary specialty designation of family medicine general internal medicine and pediatric medicine as well as all subspecialties that fall under those designations For more information click here Are you protecting the privacy of your patient information effectively Preserving the integrity of Protected Health Information (PHI) is of paramount importance in the day-to-day operation of your practice This page provides guidance about methods and approaches to achieve optimal compliance in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule We strongly encourage you to take a few moments to review your officersquos HIPAA plan to avoid serious consequences associated with non-compliance and negligent privacy practices The 2013 Medicare Physician Fee Schedule (MPFS) rule was published on November 16 2012 It will take effect January 1 2013 The final rule updates payment policies and payment rates for services furnished under the PFS and includes changes to the quality reporting initiatives associated with the PFS the Physician Quality Reporting System (PQRS) the Electronic Prescribing (eRx) Incentive Program and the physician value-based payment modifier Do you really know how Medicare sets drug pricing payment limits We encourage you to inform yourself as to the data utilized in order for CMS to set the payment limit for Medicare Part B drug claims processed or re-processed during the 1st quarter of 2013 To best educate yourself with regards to this most important issue and the process by which the data is calculated we ask that you access January 2013 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files Did you know that healthcare services can be provided by someone else other than the physician but be billed under the practitionerrsquos NPI CGS a Medicare Administrative Contractor (MAC) offers information on ldquoincident tordquo services and supplies here It is called ldquoincident tordquo and under the Medicare provision services are submitted under the physicianrsquos NPI but are actually performed by someone else However caution should be exercised since there are very specific and targeted restrictions placed upon the types of services that ancillary personnel may perform under this provision The Medicare Learning Network (MLN) is an excellent source of information for any provider who submits claims to Medicare Engaging articles include but are not limited to the following Expansion of Medicare Telehealth Services for Calendar Year (CY) 2013 Update to Medicare Deductible Coinsurance and Premium Rates for 2013 Quarterly Update to Correct Coding Initiative (CCI) Edits Effective October 1 2012 Quarterly Update to Correct Coding Initiative (CCI) Edits Effective April 1 2013 Expansion of Medicare Telehealth Services for Calendar Year (CY) 2013 Update to Medicare Deductible Coinsurance and Premium Rates for 2013 Quarterly Update to Correct Coding Initiative (CCI) Edits Effective October 1 2012 Quarterly Update to Correct Coding Initiative (CCI) Edits Effective April 1 2013

Register with Your State Medicaid Board to Receive Increased Medicaid

Payments

EmPower Magazine A Resource

for Every Patient Are you looking for an engaging fun way to educate your patients about endocrine disorders Well

EmPower Magazine is a great resource with educational easy-to-

read articles written by endocrinologists Currently there

are 11 issues of EmPower Magazine that address multiple topics including diabetes thyroid

dysfunction osteoporosis and more All issues of EmPower Magazine

can be found online at httpempoweryourhealthorgempo

wer-magazine

If you would like to receive physical copies of EmPower Magazine

please contact AACE at 800-393-2223

4

CMS has posted the 2012-2013 Seasonal Influenza Vaccines Pricing List You may also refer to the MLN Mattersreg article MM8047 ldquoInfluenza Vaccine Payment Allowances - Annual Update for 2012-2013 Seasonrdquo Please visit the CMS Medicare Learning Networkreg Preventive Services Educational Products and CMS Immunizations Web pages for more information on coverage and billing of the flu and pneumococcal vaccines and their administration fees While some providers may offer the flu vaccine those who do not can help their patients locate a vaccine provider within their local community The HealthMap Vaccine Finder is a free online service where users can find nearby locations offering flu vaccines

Guidance on patient communication and education care coordination and aging patients is now at your fingertips thanks to an expanded library of resources on the AMA Practice Management Center website Taking the time to inform and engage your patients coordinate care and address the needs of aging patients can increase patient satisfactionmdashand your practicersquos overall efficiency The expanded website includes resources to

bull Help you better communicate with your patients including ldquoHealth literacy and patient safety Help patients understandrdquo

bull Distribute to your patients including ldquoTeam up to stay healthyrdquo and the ldquoCaregiver self-assessment questionnairerdquo (both resources are also available in Spanish)

bull Assist you in care coordination including the ldquoPhysician resource guide to patient self-management supportrdquo and ldquoMedical Management of the Home Care Patient Guidelines for Physicians 4th editionrdquo

bull Aid your practice in caring for aging patients including the brochure ldquoMedicare preventive servicesrdquo its related webinar ldquoMedicare preventive services Welcome to Medicare annual wellness visit and beyondrdquo and the ldquoPhysicians guide to assessing and counseling older driversrdquo

Explore these new resources and more on the AMA Practice Management Center website

Brush up on general EM documentation requirements by listening to a teleconference Palmetto GBA (a Medicare Administrative Contractor) offered on Tuesday December 11 2012 titled ldquoGeneral Documentation Requirements and EM Overviewrdquo Palmettorsquos disclaimer can be found here

Recommend Endocrine Practice to Your Institutionrsquos

Library Endocrine Practice is an essential

publication for the practicing clinical endocrinologist and serves as a valuable resource in endocrine care Institutional subscriptions to Endocrine Practice are available in print and online formats If

your medical library doesnrsquot subscribe to Endocrine Practice now is the time to act Please complete an online library recommendation form or download a

form complete and submit to the AACE Publications Department (fax 904-404-4189 e-mail publicationsaacecom)

and we will submit it on your behalf Thank you for your help

Remember ndash the influenza and pneumococcal vaccines and their

administration fees are covered Part B benefits

FDA Approves Signifor for Cushingrsquos Disease On Monday the Food and Drug Administration (FDA) approved Signifor (pasireotide diaspartate) injection for the treatment of Cushingrsquos disease patients who cannot be helped through surgery For more information and to view the FDA news release click here

2 0 1 3 C o d i n g amp P r a c t i c e M a n a g e m e n t

E d u c a t i o n a l O p p o r t u n i t i e s

Webinar- Medicare Updates for 2013

February 7 or 8

Electronic health Record (EHR) Incentive Programs-

What Does ldquoMeaningful Userdquo Have to Do with It

February 20

5

wwwpmimdcom Distance Learning and Total Access with PMIreg

Month by month - cancel at any time

$225 per month AACE members amp staff Registrants must use promotional code ldquoAACErdquo to receive discount $249 Non AACE members

bull Live weekly webinars where you can ask specific questions and get direct answers on a variety of current topics important to your practice

bull 24-hour access to TOTAL ACCESS Audio Library with almost 200 hours of pre-recorded training sessions and choose from 100+ topics

bull A fast way to bring both experienced and new staff up-to-speed on current issues bull Include your physician to learn about important coding billing compliance and operational updates bull Inexpensive convenient way to develop your own talent without leaving the office to attend training classes bull Use your offices speakerphone so that multiple staff can participate

Topics include ICD-10 Diagnosis Coding for Endocrinology (pre-recorded) Teambuidling for Practice Success HB 300- HIPAA Privacy is No longer Just a Federal Concern Mastering Medical Decision Making (previously recorded) Translating Efficiencies to Profit (previously recorded) Conducting ldquoPayer Proofrdquo EM Chart Audits (previously recorded) Top 5 Concerns of Medical Practice Managers (Listen to a sample of the prerecorded material in the middle of

the page here) Compliance is NOT an Option (previously recorded)

PMI National Certifications via Webinar

Live Certification Webinars include 10 to 12 90-minute learning sessions taught in a live Webinar format via your computer Interact ask questions and get answers real-time This option includes the full course manual shipped to the candidates address plus access to the streamed versions of the live sessions to review anytime Once the candidate is ready to take the exam heshe will arrange with PMI for an exam proctor to administer the test live in a nearby community Learn more

Certified Medical Insurance Specialist Certified Medical Coder Certified Medical Compliance Officer Certified Medical Office Manager Payment plans available Use promotional code AACE when registering For more information or to register call 800-259-5562 x242 AACE assumes no liability for the purchase(s) of these programs The content of the program(s) does not necessarily represent the policies or opinions of AACE All purchases and communications are between the attendee and the company

6

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 CPTreg ICD-9-CM and HCPCS codes change annually you should reference the current CPTreg 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 andor 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 (CPTcopy) 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 CPTcopy The AMA assumes no liability for the data contained herein Applicable FARSDFARS restrictions apply to government use

We want to hear

from you Tell us what you think of Endonomicstrade 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 Endonomicstrade valuable and useful for your office

o What other topics would you like to see offered in Endonomicstrade

o Other commentshellip AACEs Socioeconomics and Member

Advocacy Departments 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 Endonomicstrade is

currently a free newsletter for both members and non-members

Interested parties should send an e-mail to Endonomicsaacecom with their name phone and fax

numbers location and preferred e-mail address to be added to

our Practice Support Network database

Please submit comments or questions to Endonomicsaacecom

Coding TRAC

Tips on Reimbursement And Coding

The Taxpayer Identification Number (TIN) determines a group The enrollment application determines the same specialty If there are different TINs the physicians are not part of the same group for Medicare billing If there are different primary specialties in the enrollment application they are not the same specialty For more information see our Evaluation and Management (EM) website homepage here

Medicarersquos 3-day (or 1-day) payment window applies to outpatient services that hospitals and hospitalsrsquo wholly owned or wholly operated Part B entities furnish to Medicare beneficiaries The statute requires hospitals to bundle the technical component of all outpatient diagnostic services and related non-diagnostic services (eg therapeutic) with the claim for an inpatient stay when services are furnished to a Medicare beneficiary in the 3 days (or in the case of a hospital that is not a subsection (d) hospital during the 1-day) preceding an inpatient admission in compliance with Section 1886 of the Social Security Act

The JW modifier may or may not be warranted for discarded drugs Check with your individual Medicare Administrative Contractor (MAC) for their guidelines

A hospital discharge service (CPTreg code 99238 or 99239) must be reported for the date of the actual visit by the physician or qualified non-physician practitioner even if the patient is discharged from the facility on a different calendar date For more information please visit the Medicare Claims Processing Manual 100-04 chapter 12 Section 30692 B at CMS website

Ohio and Kentucky Effective for dates of service on or after October 1 2012 ICD-9 code V8281 is a covered diagnosis for CPTreg code 77080 This diagnosis is only covered for this particular code in the Bone Mass Measurement LCD (L31854)

We wish you amp your family

a Happy New Year