Maryland AAHAMDecember 21, 2012

Proprietary and Confidential

Disclaimer

• All Current Procedural Terminology (CPT) codes and descriptors used in this presentation are copyright© by the American Medical Association. All rights reserved.

• The information enclosed was current at the time it was presented. Medicare policy changes frequently; links to the source documents have been provided within the document for your reference. This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations.

• Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services.

• Novitas Solutions employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide.

• This presentation is a general summary that explains certain aspects of the Medicare program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings.

• Novitas Solutions does not permit videotaping or audio recording of training events.

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• Medicare Updates

• Medicare Initiatives

• Website

• Self Service Options

Agenda

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Medicare Updates

National Correct Coding Initiative (NCCI) Associated Modifier Changes (Additions)

• Change Request #8111• Effective date: January 1, 2013• Implementation date: January 7, 2013• Key Points

– Additional modifiers added to the list of NCCI-associated modifiers that will allow an edit with modifier indicator of ”1” to be bypassed when the modifier is utilized.

• LM (left main coronary artery),• RI (ramus intermedius),• 24 (unrelated evaluation and management service by the same

physician during a postoperative period)• 57 (decision for surgery)

• http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1136OTN.pdf

• Change Request #8052• Effective: January 1, 2013• Key Points

– Part A • Deductible

– $1,184.00• Coinsurance

– $296.00 a day for 61-90 day– $592.00 a day for 91-150 day– $148.00 a day for 21-100 day (Skilled Nursing Facility)

– Part B• Deductible

– $147.00 a year• Coinsurance

– 20 percent

2013 Medicare Deductible and Coinsurance

January 2013 Update to Hospital OPPS

Change Request #8141• Effective: January 1, 2013; Implementation: January 7,

2013• Key Points

– Intracoronary Stent Placement Procedure Codes– Changes to Cardiac Electrophysiologic Evaluation and

Ablation Codes– Coding Changes for PHP Services– Drugs, Biologicals and Radiopharmaceuticals

• http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2611CP.pdf

CR 8141 (cont’d)

• Intracoronary Stent Placement Procedure Codes– AMA deleting CPT codes 92980, and 92981– AMA replacing with new CPT codes

– CMS deleting 2 HCPCS codes G0290, and G0291– CMS creating 9 HCPCS C-codes

92928 92929 92933 92934

92937 92938 92941 92943

92944

C9600 C9601 C9602 C9603 C9604

C9605 C9606 C9607 C9608

• Coding Changes for Partial Hospitalization Program (PHP) Services– 2 New CPT codes for Behavioral Health Treatment/Services for

Revenue Code 900• 90791 and 90792

– 7 New CPT codes for Individual Psychotherapy Revenue Code 914

CR 8141 (cont’d)

90875 90832 90833 90834

90836 90837 90838

CR 8141 (cont’d)

• Drug, Biologicals, and Radiopharmaceuticals– New CY 2013 HCPCS Codes

• Attachment A, Table 1

• Revisions to HCPCS and CPT Codes– Changes in Code Descriptors– Several Temporary C-codes Deleted

• Attachment A, Table 2

• Cardiac Electrophysiologic Evaluation and Ablation Codes– AMA Deleted CPT Codes

• 93651 and 93652

– AMA Created New CPT Codes

CR 8141 (cont’d)

93653 93654 93656

Part A Recurring Updates

• Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for Fiscal Year (FY) 2013

– http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2012-Transmittals-Items/R2518CP.html

• Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update Fiscal Year (FY) 2013

– http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2012-Transmittals-Items/R2507CP.html

• Update-Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Fiscal Year 2013

– http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2012-Transmittals-Items/R2520CP.html

Part A12

Parts A/B Recurring Updates

• Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) and PC Print Update

– http://www.cms.gov/Regulations-and-– Guidance/Guidance/Transmittals/2012-Transmittals-Items/R2521CP.html

• Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

•http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2012-Transmittals-Items/R2485CP.html

• 2013 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update

– http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8037.pdf

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ICD-10 Delayed

• ICD-10 compliance date delayed to October 1, 2014

• Keep Up to Date– Sign up for CMS ICD-10 Industry Email

Updates-http://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD-10_Industry_Email_Updates.html

– Follow @CMSGov on Twitter 

– Subscribe to Latest News Page Watch - https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_609

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Medicare Initiatives

Comprehensive Error Rate Testing (CERT)

• National Claim Paid Error Rate– Part A Institutional Facilities

• 7.9% Inpatient hospitals• 4.4% Non-inpatient hospital facilities

– Part B Physician/Non-physician providers• 9.2% Physician, lab and ambulance

• Impacts all providers submitting Fee for Service claims

• Limited random claim sample

• Record requests must be received within 30 days from the initial CERT letter

• Right to Appeal? Yes

Aims to ensure correct payments are made to legitimate providers for covered appropriate and reasonable services in all federal health care programs

Expanded federal government effort to reduce fraud and other improper payments health care programs to help ensure long-term viability 

Federal government recovered $4 billion last year   Fraud prevention efforts focus on a more proactive “prevention and detection” model that will help prevent fraud and abuse before payment is made.    This information is available in the Fraud Prevention Toolkit on the web at: https://www.cms.gov/Partnerships/04_FraudPreventionToolkit.asp#TopOfPage  

Fraud Prevention Initiative

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CMS Provider Compliance

• CMS Provider Compliance Webpage– Educational products on how to avoid billing errors and improper

payments– Compliance Products

• Quarterly Newsletter with CERT and RA findings– October 2012 RA Findings on Major Joint Replacement, Cardiac Procedures,

Acute Inpatient Respiratory Conditions• Podcasts

– September 2012 RA Findings on Medical Necessity of Renal and Urinary Tract Disorders

• Fact Sheet– August 2012 Complying with Medicare Signature Requirements

– http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ProviderCompliance.html

– https://www.novitas-solutions.com/cert/index.html

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OIG Work Plan 2013

• OIG Work Plan outlines their current focus areas and states the primary objectives of each project

• Hospital Specific Items Include:– Inpatient Billing for Medicare Beneficiary– Same Day Readmission– Compliance with Medicare Transfer Policy

• https://oig.hhs.gov/reports-and-publications/workplan/index.asp

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Website Features

Medicare Part A Center• https://www.novitas-solutions.com/parta/index.html

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Medical Policy Center

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Medical Policy Search

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Self Service Options

Stay Up-to-Date

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and other informative topics– Subscribe-

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Jurisdiction 12 Contact InformationProvider Customer Contact Center

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• Call Flow– Customer Service Center– https://www.novitas-

solutions.com/csc/index.html

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Contact Information

Laura MinterJ12 Project Manager717-526-6280laura.minter@highmarkmedicareservices.com

Janice MummaProvider Outreach and Education Supervisor717-526-6528janice.mumma@highmarkmedicareservices.com