Monday, April 9, 2012 

New health care law provisions cut red tape, save up to $4.6 billion

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act. 

The proposed changes would save health care providers and health plans up to $4.6 billion over the next ten years, according to estimates released by the HHS today. The estimates were included in a proposed rule that cuts red tape and simplifies administrative processes for doctors, hospitals and health insurance plans. 

“The new health care law is cutting red tape, making our health care system more efficient and saving money,” Secretary Sebelius said. “These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients.” 

Currently, when health plans and entities like third party administrators bill providers, they are identified using a wide range of different identifiers that do not have a standard length or format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility. 

The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems.  This will allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.
The proposed rule also delays required compliance by one year– from Oct. 1, 2013, to Oct. 1, 2014– for new codes used to classify diseases and health problems. These codes, known as the International Classification of Diseases, 10^th Edition diagnosis and procedure codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes. 

Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.

The proposed rule announced today is the third in a series of administrative simplification rules in the new health care law. HHS released the first in July of 2011 and the second in January of 2012, and plans to announce more in the coming months. 

More information on the proposed rule is available on fact sheets (4/9/12) at http://www.cms.gov/apps/media/fact_sheets.asp

The proposed rule may be viewed at http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1. Comments are due 30 days after publication in the Federal Register.

This is a notice from the Centers for Medicare and Medicaid Services (CMS)

• The name of the manufacturer.

And

• The model name of the equipment used for testing.

This information can be on an attachment for paper claims or in the comment field for electronically submitted claims.

For use in submitting this necessary documentation, go to Part B Fax/Mail EMC Documnetation Instructions and Cover Sheet form

A revised Local Coverage Determination (LCD) will be published in May 2012 with complete information on coverage and requirements for correct billing of nerve conduction testing. 

This is a Notice from TrailBlazer Health Enterprises. LLC, CMS Centers for Medicare and Medicaid Services

This content pertains to:

Programs:  Part B

Topics: Claims Information, Facility Types, Policies

Subtopics: IDTF, Local Coverage Determinations

Important changes effecting Medical Practices in TX

Texas Medicaid Dual Eligible Payment Cuts

The Texas Legislature directed HHSC to implement the change to reduce Medicaid costs.  The rules, scheduled to take effect n January 1, 2012, will eliminate payment of Medicare Part B coinsurance if the payment would result in Medicaid paying more than its allowable.  If Medicaid pays mopre than Medicare, then the state would pay the coinsurance or up to the Medicaid allowble, whichever is less.

Here are some examples.  They are for illustation purposes only.  Medicare payments vary by region of the state.

Example 1:  Established dual-eligible patient has not met any of the Medicare deductible and is seen during a routine office visit.  Physician bills Medicare “CPT code 99213″.  Maximum Medicare allowable is $66.90 (rest of Texas).  Medicare pays $0 because deductible has not been met.  Medicaid will pay $33.27, the Medicaid allowable for this code.

Example 2:  Established dual-eligible patient has met $100 of $140 Medicare 2012 deductible.  Patiet is seen in office for routine office visit.  Physician bills Medicare CPT code 99213.  Medicare pays $21.52, which is 80% of the allowable after deductible, ($66.90-$40).  Medicaid will pay $11.75 (33.27-21.52).

Example 3:  Established dual-eligible patient visits physician office for routine visit, Medicare deductible has been met.  Physician bills Medicare CPT code 99213.  Medicare allowable is $66.90.  Medicare pays $53.52, 80% of the allowable.  Physician bills Medicaid for the remaining 20%.  Medicaid allowable is $33.27, so no coinsurance will be paid.

Patients cannot be balance-billed

 TrailBlazer Loses Medicare Contract

This report-in part- was published by the Texas Medical Association Nov 15, 2011

The Centers for Medicare & Medicaid Services (CMS) says Highmark Medicare Services will replace TrailBlazer Healthcare Enterprises in paying Medicare Part A and Part B fee-for-service claims in Texas by late July 2012.  Highmark also will handle claims in Arkansas, Colorado, Louisiana, Mississippi, New Mexico and Oklahoma.  It now administers claims in Delaware, New Jersey, Pennsylvania, Maryland and the District of Columbia.

CMS says the change is part of its plan to reduce the number of Medicare administrator jurisdictions from 15 to 10 by 2016.

TrailBlazer said its contract runs through August 2012 and any transition to Highmark “will include extensive communications with providers and other impacted parties about transition requirements and activities.  Throughout such a transition, TrailBlazer will continue to provide cost-effective, efficient administrative services to the Medicare program and superior customer service to health care providers.”

Physician’s could see delays in payment if billing is not set up in their systems correctly to process through the new channels.  SMB will be working with Highmark and going through any training they will have available.

EMG Coding Changes

The American Academy of Neurology AAN published a guide to follow for the EMG coding changes that go into affect January 1, 2012.

Beginning January 1, 2012, new coding changes will affect physicians who perform electromyography (EMG) on the same patient on the same date of service as nerve conduction study (NCS).  The AAN has developed the following guidance to assist members with these changes.

When performing EMG and NCS on the same patient on the same date of service you will need to bill the EMG as an add-on code using one of the following new codes:

Use codes 95870 or 95885 when four or fewer muscles are tested in an extremity.  Use codes 96860-95864 or code 95886 when five or more muscles are tested in an extremity.

Use EMG codes (95860-95864 and 95867-95870) when no nerve conduction studies (codes 95900-95904) are performed on that day.  Use codes 95885, 95886 and 95887 for EMG services when nerve conduction studies (codes 95900-95904) are performed on the same day.  Report either code 95885 or 95886 once per extremity.  Codes 95885 and 95886 can be reported together up to a combined total of four units of service per patient when all four extremities are tested.  New code 95887 was written and valued to be used per site tested.  Sites recognized are unilateral face, cervical and lumbar paraspinal muscles without needle EMG examination of corresponding limb muscles, thoracic paraspinal muscles, laryns, hemidiaphragm, thoracic and abdomial muscles.  For example, if EMG is done in bilateral face muscles, the physcian should report two units of service of 95887.

For help with your EMG coding questions, register for the AAN’s Practice Management Webinar “CPT Coding for Nerodiagrnastic Procedures Made Easy” on Tuesday, March 13, 2012.

95885: Needle electromyography, each extremity with or without related paraspinal areas, done with nerve conduction, amplitude and latency/velocity study; limited (list separately in addition to code for primary procedure) per extremity

95886: Complete, five or more muscles studied, innervated by three nerves or four spinal levels (list separately in addition to code for primary procedure) per extremity

95887: Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary procedure)

Use 95887 in conjuction with 95900-95904

Do not report 95887 in conjuction with 95867-95870 or 95905

HIPAA 5010 Conversion In Effect 1/1/2012

 What is 5010?  The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the healthcare industry use standard formats for electronic claims and claims-related transactions.  Because the current version 4010 format cannot support new developments in health care and the upcoming ICD-10 code set changes, all electronic healthcare transactions must convert to the HIPAA-compliant version 5010 on January 1, 2012.

The Department of Health and Human Services (HHS) issued a final rule in 2009 replacing the current versions of the standards with version 5010.  Certain covered entities-including health plans, healthcare clearinghouses and healthcare providers-must adopt the new required standards for claims, remittance advice, eligibility and claim status inquiry.

What does this mean for your practice?

The HIPAA 5010 conversion requires substantial changes to the information that is submitted on claims.  If these changes are not made, processing of your claims could be delayed.

To prepare for the HIPAA 5010 conversion and avoid delays in reimbursement, the most important thing you can do is to contact your practice management software (PMS) vendor or billing service about the changes needed for your software.  They can help you identify needed updates and make a plan for implementing these changes to your system.

eRX 

-1%

Electronic Prescribing aka eRx Penalties Begin 2012

Some of you may be seeing the effects of the 1% decrease in reimbursements from Medicare.  If you did not report in 2011 the number of eRx measures needed to escape the cuts you will start seeing the decrease on dates of service 1/1/12 and forward.  If you continue to not report your eRx measures you will see a 1.5% decrease in 2013 and a 2.0% decrease in 2014.  SMB can help you start reporting now to insure no further decrease in your payments from Medicare. 

ICD-10 Code Set to Replace ICD-9

√  The differences between ICD-9 and ICD-10 are significant and physicians and practice management staff need to start educating themselves now about this major change so they will be able to meet the October 1, 2013 compliance deadline.

√  ICD-10-CM codes are the ones designated for use in documenting diagnoses.  They are 3-7 characters in length and total 68,000, while ICD-9-CM diagnosis codes are 3-5 digits in length and number over 14,000.  The ICD-1o-PCS are the procedure codes and they are alphanumeric, 7 characters in length, and total approximately 87,000, while ICD-9-CM procedures codes are only 3-4 numbers in length and toal approximately 4,000 codes.

√  Moving to ICD-10 is expected to impact all physicians.  Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will requiore significant planning, training, software/system upgrades/replacements, as well as other necessary investments.

√  Before the ICD-10 codes can be used however, physicians and others in the health care community must start using the new version of HIPAA transaction standards known as 5010 by January 1, 2012, as the current version, 4010, does not accommodate use of the ICD-10 codes.

Dual eligibility
Dual-eligible clients generally qualify for Medicare because of their age and for Medicaid because of their income. More than half of dual-eligible patients live on incomes of less than $10,000 per year. Half also have multiple health conditions, such as diabetes and congestive heart failure, according to the Kaiser Family Foundation.
“If you are dual-eligible, you essentially have no income and no assets,” said Dr. Bruce Malone, president of the Texas Medical Association.
These patients usually require more physician time because of the need to coordinate visits with specialists and ancillary services, he said.
The change arose from an effort during the state legislative session to reduce Medicaid costs without reducing the level of service, Goodman said. For most dual-eligible clients, Medicare pays for services first and Medicaid covers what is left, including premiums and co-pays.
Under current policy, Medicaid covers the full co-pay for a service even if the Medicare rate is higher than what Medicaid would have paid for the same service, she said. Under the new policy, Medicaid will only cover the co-pay up to the Medicaid rate.
An example: Under the current policy, if a client receives a service for which the Medicare rate is $100, then Medicare pays the provider $80 and Medicaid pays the remaining $20, she said. Under the new policy, if the Medicaid rate for the same service is $90, Medicaid would only pay $10 toward the co-pay.
Seventeen other states already have similar co-pay limits on dual-eligible clients, she said. Texas lawmakers, grappling with a $27 billion budget deficit, directed the commission to change Texas’ policy, too.

‘Sickest and frailest’
In testimony before the health commission in November, Malone acknowledged the difficult budget situation that lawmakers faced, but he cited a 2003 study that found that dual-eligible clients were less likely to receive outpatient care after such policy changes.
Medicare payments are already insufficient to cover the rising cost of services, he said.
A medical association 2011 physician survey on Medicare participation found that 25 percent of those who responded limit the number of new Medicare patients they accept, and 8 percent accept no new Medicare patients.
“The proposed rules penalize physicians who care for the sickest and frailest Medicare patients,” Malone said.

Source: Alex Branch, Read more here: http://www.star-telegram.com/2011/12/31/3627185/change-in-medicaid-policy-may.html#storylink=cpy

Solutions For Medical Billing will be sponsoring the Texas Neurological Society Winter Conference at the Hyatt Regency in Austin Texas, February 4th 2012.  This will be SMB’s fourth time to sponsor this event and we look forward to the event each time.

TNS Purpose:
The purposes of the Society are:

1. To Promote the interest of patients with neurologic disease by supporting the development and delivery of quality medical care to these patients, and by opposing those things adverse to their interests.
2. To Cultivate and foster cordial relations among all members of the neurological and allied scientific professions.
3. To establish contact between members of the profession who may seek assistance through advice on technical, economic, and political matters affecting the practice of neurology.
4. To encourage interest among graduates in medicine to enter this field of specialty.
5. To create through this organization a group devoted to special endeavors to promote the specialty of Neurology.
6. To provide an outlet for expression of professional opinions for the benefit and advancement of neurological sciences in Texas.

Beginning January 1, 2012, new coding changes will affect physicians who perform electromyography (EMG) on the same patient on the same date of service as nerve conduction study (NCS). The AAN has developed the following guidance to assist members with these changes.

When performing EMG and NCS on the same patient on the same date of service you will need to bill the EMG as an add-on code using one of the following new codes:

Use codes 95870 or 95885 when four or fewer muscles are tested in an extremity. Use codes 96860–95864 or code 95886 when five or more muscles are tested in an extremity.

Use EMG codes (95860–95864 and 95867–95870) when no nerve conduction studies (codes 95900–95904) are performed on that day. Use codes 95885, 95886 and 95887 for EMG services when nerve conduction studies (codes 95900–95904) are performed on the same day. Report either code 95885 or 95886 once per extremity. Codes 95885 and 95886 can be reported together up to a combined total of four units of service per patient when all four extremities are tested.

New code 95887 was written and valued to be used per site tested. Sites recognized are unilateral face, cervical and lumbar paraspinal muscles without needle EMG examination of corresponding limb muscles, thoracic paraspinal muscles, larynx, hemidiaphragm, thoracic, and abdominal muscles. For example, if EMG is done in bilateral face muscles, the physician should report two units of service of 95887.

For help with your EMG coding questions, register for the AAN’s Practice Management Webinar “CPT Coding for Neurodiagnostic Procedures Made Easy” on Tuesday, March 13. Learn more or email Luana Ciccarelli or call (651) 695-2779 for more information.