CMS Clears IPPE Billing Confusion In This Question Answer Article

Posted on 13. May, 2012 by dchandhok.

The initial preventive physical exam (IPPE) is an important service for every family physician’s office, so be sure to report it appropriately. Know the criteria IPPE visits must meet and when to use G0402, straight from a recent CMS National Provider Call.

Learn the IPPE Basics

“The IPPE is a one-time visit and is covered for beneficiaries within the first 12 months of Medicare Part B enrollment,” says Jamie Hermansen, a health insurance specialist with CMS’s Office of Clinical Standards and Quality/Coverage and Analysis Group. “The IPPE is covered by Medicare Part B.”

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Avoid 2013 E-Prescribing Penalty: Submit Your Hardship Exemption Applications to CMS before June 30

Posted on 29. Apr, 2012 by dchandhok.

If you had been hoping to avoid a 1.5 percent hit to your Part B pay next year, you might be in luck. You can request hardship exemptions from CMS if you think your practice meets any of the four eligibility criteria.

As you would probably know, if you didn’t successfully participate in e-prescribing in 2011, you’ll undergo one percent payment adjustment on your Part B pay this year. However, just before the start of 2012, CMS began to accept hardship exemptions for the 2012 adjustment. But since the timeline was so tight and the rules were new that many practices didn’t know what to do and missed the application deadline.

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Online Security Issues Threaten Most Practices, Experts Say

Posted on 15. Apr, 2012 by dchandhok.

You know how important it is to maintain patient privacy—but you may not be aware of all of the new ways by which it might be stolen away from you.

Medical ID theft can occur in two ways: either from the inside with the involvement of employees or at the point of care where patients present themselves as being someone else so as to gain expensive treatments or drugs without having to pay for them, Ester Horowitz, CMC, CITRMS, CIISA says. The bad news is that often “the very people we trust the most are actually the ones committing the fraud and it could have been going on for years,” she warns.

Illicit cash: Although rare, when medical ID theft is an inside job, “it means that someone who works for a covered entity is taking the IDs and passing them or using them for money,” says Horowitz. “The street value of an ID is about $100 per name which can be sold repeatedly.” If a patient steals a health insurance card or ID, it is generally for the purpose of gaining services and prescriptions. Scripts have a tremendous street value because hard drugs can be sold underground for a lot more than the cost of selling them via the pharmacy, she warns.

Medical IDs do not usually include health information — only name, address, social security number, date of birth, and health insurance ID number. You don’t need an address to commit ID theft, but you do need a date of birth with a name, Horowitz adds. “When you can take someone’s identity without permission, it is a crime even if nothing is done to use it in any way,” she clarifies.

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Don’t Bill Annual Wellness Visit As ‘Incident To,’ CMS Says

Posted on 01. Apr, 2012 by dchandhok.

Whether you consider yourself a pro in Medicare preventive service or are just working up on your Welcome to Medicare and Annual Wellness Visit (AWV) coding, you can always use some tips to better your work. Here’s some help from CMS direction on accurately reporting these services.

Check out the following answers to your most frequently-asked Medicare preventive visit questions, which were answered during CMS’s “Medicare Preventive Services National Provider Call” on March 28.

Avoid Incident-to for WTM, AWV Patients

Question 1: Can the “Welcome to Medicare” (WTM) exam or the annual wellness visit (AWV) be reported based on “incident-to” guidelines?

Answer: No. The WTM exam, also referred to as the Initial Preventive Physical Examination (IPPE), “is not subject to incident-to billing,” said Stephanie Frilling, health insurance specialist with CMS, during the call. “The payment policy for furnishing services incident-to a physician do not apply to the IPPE, as this service has its own benefit category,” she said.

“Likewise, the AWV is not subject to incident to rules,” Frilling said. If a non-physician provider such as a nurse practitioner performs either of these services, he must bill under his own NPI, the CMS reps added.

Question 2: Which diagnosis code should be reported with the WTM exam and the AWV?

Answer: CMS does not dictate which ICD-9 code should be linked to the WTM exam code (G0402, Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment). Instead, you should select the most applicable diagnosis code from your physician’s documentation.

“An example of diagnosis codes that could be included on the WTM claim are V70.0 (Routine general medical examination at a health care facility), V70.3 (Other general medical examination for administrative purposes), or V70.9 (Unspecified general medical examination),” said CMS’s Kathleen Kersell during the call. “These all could be considered acceptable diagnosis codes, as well as any other valid, appropriate diagnosis codes,” she said.

As for the AWV, “There are no specific ICD-9 diagnosis codes that are required for the annual wellness visit,” said CMS’s Thomas Dorsey. He noted that V70.0, V70.3, and V70.9 are being accepted by MACs for the AWV visits as well.

Question 3: If we find a problem during the WTM exam, can we report a separate E/M code for that?

Answer: Yes, “Medicare allows for payment of medically necessary evaluation and management services that are furnished” during the same visit as the IPPE or WTM, Frilling said.

When those E/M services are clinically appropriate, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service code (99201-99215), she said.

A caller asked whether a problem-focused E/M code would be separately payable if the patient is discussing a chronic condition (such as uncontrolled diabetes or hypertension) during the AWV and the physician finds that the chronic condition needs to be addressed on a deeper level, (for instance, if a change in medication is necessary). “Yes they can,” CMS reps replied. “If it is medically necessary, you would bill the additional E/M service, and append modifier 25 to that claim line for payment,” she added.

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Start Getting Reimbursed For Treatment of Endometrial Hyperplasia Medicare Patients with IUDs

Posted on 18. Mar, 2012 by dchandhok.

If your ob-gyn treats uterine bleeding in patients with endometrial hyperplasia with intrauterine devices (IUD), then you can now look forward to payment for this service by CMS, according to Palmetto GBA in its February 2012 Medicare Advisory. Be careful, however, about what you report.

What happens: Ob-gyns sometimes treat patients who have abnormal uterine bleeding caused by endometrial hyperplasia by inserting an IUD — especially when the patient with abnormal uterine bleeding cannot not tolerate (or are at high risk for complications of) oral megestrol.

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Here’s Why POS 11 May Not Apply for Office Interpretations

Posted on 03. Mar, 2012 by dchandhok.

CMS recently announced a new place of service (POS) rule that every radiology practice needs to know.

The new rule is that when you report POS for your physician, it should reflect the “setting in which the beneficiary received the face-to-face service,” according to MLN Matters MM7631. CMS has created exceptions to the rule, however, so be sure to read the rule in full and pay attention to each element.

Important dates: The effective date is April 1, 2012, and the implementation date is April 2, 2012.

The Pro Fee POS May Surprise You

Under CMS’s announced rule, “providers performing the PC [professional component] of interpretation of tests must use the POS where the face-to-face service – test – was performed, i.e. outpatient facility, ASC [ambulatory surgical center], etc.,” says Catherine Brink, BS, CMM, CPC, CMSCS, president of NJ-based Healthcare Resource Management.

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J1561’s New Look Reveals Trade Name and Admin Modifications

Posted on 13. Feb, 2012 by dchandhok.

The way you’ll report acetaminophen, denosumab, and immune globulin in 2012 is going to change, and if you don’t stay on top of the changes, you could be missing out on your pay. Look out for administration methods for Ofirmev and Gamunex-C especially.

A New Addition for Acetaminophen: J0131

HCPCS 2012 adds J0131 (Injection, acetaminophen, 10 mg) for reporting acetaminophen administered by infusion. The brand name for this injectable form is Ofirmev. (more…)

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CPT® Revises ‘New Patient’ E/M Rules, But Medicare Won’t Update

Posted on 03. Feb, 2012 by dchandhok.

As many of you would already be aware, just because CPT® makes a change, Medicare wouldn’t necessarily follow suit. That’s exactly what’s happening  with the “new vs. established” patient definition published by CPT® 2012, which won’t have much impact on Part B claims, CMS reps said during a Jan. 24 Open Door Forum.

Background: CPT® 2012 states, “A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.” The portions of the description that are new for 2012 are underlined.

Many practices worried that was that a lot of payers — including Medicare — don’t acknowledge (more…)

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96110 Helps Fight Medicaid Denials for Developmental Screening

Posted on 19. Jan, 2012 by dchandhok.

Getting denials for your developmental screening claims? Don’t lose hope; simply add this tool to your basket and fight the zero-reimbursement situations with ease.

Testing vs. Screening

Annual CPT® updates always bring surprises for you. They can either help your practice substantially or threaten to bring your revenue down. Unfortunately, that’s what’s been happening for numerous pediatric practices that have been affected by the recent changes to the developmental screening code 96110 (Developmental screening, with interpretation and report, per standardized instrument form). (more…)

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More Reimbursement For Flu Vaccine in 2012

Posted on 05. Jan, 2012 by dchandhok.

New Year brings some good news for internal medicine physicians as the CMS updates vaccine reimbursement amounts.

The payment changes related to flu vaccines are as follows: (more…)

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