News
In a 2012 study report, the Office of the Inspector General (OIG) noted that a number of physicians increased their billing of higher level, more complex and expensive Evaluation and Management (E/M) codes. Many providers submit claims coded at a higher or lower level than the medical record documentation supports. Use the following resources to bill correctly for E/M services:
What do you need to do to get ready?
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number on new Medicare cards for transactions like billing, eligibility status, and claim status. Prepare for this change by visiting the new overview and provider webpages, which include:
Medical Marijuana is moving fast into legalized status. State by state, the government is approving its usage as a medically appropriate alternative. However, it is far from complete. Once signed into law, it can take months or years before the legislation surrounding the act is passed and doctors can start offering to patients.
Read more here:
http://www.cleveland.com/open/index.ssf/2016/06/ohio_legalized_medical_marijua.html
Please be advised that there has been a lot of talk about convenience kits or injections kits as a reimbursable product for the medical groups.
The J codes created for these kits are a combination of the medication plus supplies. However, since the medication itself already has a procedure code and policy dictates that supplies are an inherent part of the injection reimbursement, these new kits are skirting a grey area of compliance and not being coded correctly.
Correct coding bundles the kit with the injection and it is not appropriate to bill separately.
Many companies have been going around selling doctors on entering into these agreements with legal back doors of becoming 'investors' on the pharmacy side to receive income from releasing these kits under the pharmacy benefit.
While these ventures will surely produce income now... it is inevitable that it will not last very long.
Please see released statement from Highmark. The insurance companies are becoming wise on these "kits" and will no longer be paying for them.
Please speak with me individually for details.
See released update here: https://www.highmarkblueshield.com/health/pdfs/pubs/sb-prescription-drug-cvg-convenience-kit-products-081516.pdf
CMS continues to deny many chiropractic claims because they do not meet Medicare’s requirements. During the 2015 reporting period, the Medicare Fee-For-Service (FFS) improper payment rate for chiropractic services was 51.7 percent, representing approximately $300 million in improper payments and accounting for 0.7 percent of the overall Medicare FFS improper payment rate.
The most common reason for the improper payments is insufficient documentation to support the billed services. This type of error occurs when the medical records do not contain enough information for the reviewer to make a decision about medical necessity for the item or service furnished. Avoid denied claims and overpayment recovery by understanding Medicare's requirements, especially around documentation requirements and medical necessity.
HERE IS AN EDUCATIONAL VIDEO RELEASED BY MEDICARE CMS RELATED TO CHIROPRACTIC DOCUMENTATION NEEDS.
Please review and watch with your staff.
https://www.youtube.com/watch?v=tMiw1X9KvDA
HERE ARE LINKS TO MEDICARE MLN POLICY ON DOCUMENTING CHIROPRACTIC SERVICES
On April 17, 2016, Gov. Tom Wolf signed into law SB 3, Pennsylvania’s compassionate medical cannabis legislation. The Senate had first approved the bill on May 12, 2015, and it was subsequently revised and approved by the House on March 14-16, 2016. The Senate made technical changes to the bill and sent it back to the House on April 12, and it received final approval in the House on April 13, 2016. The law went into effect on May 17, 2016, and the Department of Health will then have six months to issue temporary regulations.
Medicare released an update to coding definitions effective June 6, 2016.
While the majority of these updates are related to surgical procedures, they also have defined how to apply diagnosis to specific regions of the body.
A complete copy of the update can be found here: https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html
Please take note of the following details most related to your office(s):
Tendons, ligaments, bursae and fascia near a joint
B4.5
Procedures performed on tendons, ligaments, bursae and fascia supporting a joint are coded to the body part in the respective body system that is the focus of the procedure. Procedures performed on joint structures themselves are coded to the body part in the joint body systems.
Examples: Repair of the anterior cruciate ligament of the knee is coded to the knee bursa and ligament body part in the bursae and ligaments body system.
Knee arthroscopy with shaving of articular cartilage is coded to the knee joint body part in the Lower Joints body system.
Skin, subcutaneous tissue and fascia overlying a joint
B4.6
If a procedure is performed on the skin, subcutaneous tissue or fascia overlying a joint, the procedure is coded to the following body part:
Shoulder is coded to Upper Arm
Elbow is coded to Lower Arm
Wrist is coded to Lower Arm
Hip is coded to Upper Leg
Knee is coded to Lower Leg
Ankle is coded to Foot
Fingers and toes
B4.7
If a body system does not contain a separate body part value for fingers, procedures performed on the fingers are coded to the body part value for the hand. If a body system does not contain a separate body part value for toes, procedures performed on the toes are coded to the body part value for the foot.
Example: Excision of finger muscle is coded to one of the hand muscle body part values in the Muscles body system.
Anyone suffering from allergies knows what a bear allergy season is. Plants, pollen, animals...oh my!
Luckily, AllergyPro is here with a safe and simple testing and treatment program for the most common pollen, animal, insect, mold, and food allergens. This tried and proven method of treating allergies has excellent results for the patients and a safe, compliant reimbursement for the physicians. Learn more at: www.allergypro.us Call or email today if you are interested about incorporating this great service into your office!
Have you reviewed the OIG Work Plan for 2016? The OIG work plan illustrates areas of importance that the Office of Inspector General will primarily focus on in the upcoming year. This information is important in the health care industry to watch for trends and keep abreast on compliance issues. If you have any questions on the OIG update or any compliance areas that require attention, please reach out to us!
It’s been four years since the last regular annual update to both the ICD-9-CM and ICD-10 code sets. Between 2012-2014, both code sets received only limited updates to capture new technologies and diseases. Last year, those limited updates were reserved for ICD-10.
The partial code freeze ends Oct. 1, 2016.
Which means it’s going to be Update Time Again!!
There are:
· 1943 New codes
· 422 Revised from codes
· 422 Revised to codes
· 305 deleted codes
All Triple B clients have already been alerted to the codes that affect them directly. If anyone needs help researching codes, please let me know!
