JULY 2013

WCH Service Bureau is a proud member of the following professional organizations:

ILANAKOZAK-GENERALMANAGERon page 4

ICODE SERVICEon page 5

WCH REFERRAL PROGRAMon page 9 REPORT

CHANGES TO MEDICAREon page 10

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WCH Buzz

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Ilana Kozak - New General Manager

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ICode Service

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WCH Referral Program

11Medicare may deactivate Provider Number

Integra Partners

12-16

HealthcareNews

17-20

News bySpecialty

21-23

Question &Answers

24

Feedback

Get Your CEU Credits TODAY

For more information please contact Marianna Shapiro at 718-934-6714 Ex 1202 or by email to: mariannash@wchsb.com

IN THIS ISSUE

Follow Us:

3www.wchsb.com WCH Times Summer 2013

WCH BUZZ

Olga's child birth

Congratulations Olga! Congratulations Olga! Summer is full of fun and excitement, from Independence day to Labor day the

country enjoys days filled with sunshine and brightness. This month, the WCH

family celebrates Independence day and the newest addition to the WCH family.

We are thrilled to announce that on June 26th, 2013 our COO, Olga Khabinskay,

gave birth to a beautiful and healthy girl and named her Emma Valentina.

Olga and her baby girl are both healthy and well.

This is a very special event for Olga and her family and the WCH family is thrilled

to welcome Emma Valentina into the world and is excited for the journey ahead.

WCH shares the happiness and joy during this delightful

time, We Congratulate Olga Khabinskay and her family

on the birth of her daughter and wish them good health,

long life and happiness, prosperity and success.

As the WCH family grows and expands, we will bring

you more good news in our monthly publications.

Ilana brings with her to this position a wealth of ILANA KOZAK WAS APPOINTED knowledge of the industry supported by her GENERAL MANAGER business degree from Baruch College.

We are very pleased to announce the promotion of We are extremely excited about her new role. Let Ilana Kozak to General Manager of WCH. Ilana us all congratulate Ilana on her promotion and wish joined WCH as an account representative in 2006, her continued success at our company. since then she had multiple roles in the company in

the billing department. Her performance has been outstanding over the years; she gained massive knowledge of the industry which was attributed to her work. She has always demonstrated excellent customer service and preformed her job in a professional way. As an active voice in the company, Ilana has influenced the company's position over the years, her input and hard work has brought many benefits to WCH. Ilana's dedication became essential to the company's success in moving forward and growing. In this new position as a General Manager Ilana will now be responsible for managing the company's many divisions which include medical billing, coding and auditing provider credentialing and software development.

Ilana will ensure continued high quality of service, professionalism and consistent development in the industry. In addition she will focus on designing personalized solutions for WCH clients as well as develop internal policies and customary procedures which will enhance costumer experience in company and be responsible for the smoothness of current day to day operations. With the support of WCH management team, Ilana promises to incorporate her knowledge and experience in the industry to attribute to the growth and development of the company.

Ilana Kozak General Manager(718) 934-6714 ext. 1214ilanak@wchsb.com

4 WCH Bulletin July 2013 www.wchsb.com

At a more convenient time, the provider simply WCH SERVICE BUREAU reviews and approves or adjusts the information INTRODUCES BY after WCH has checked it to ensure that it complies DOCTORS FOR DOCTORS WHO with all regulations and proper medical

WANT TO MAXIMIZE OFFICE documentation guidelines.TIME AND MINIMIZE DATA ENTRY FOR EMR/EHR SYSTEMS “We know that providers need to spend every hour

possible seeing patients to ensure that they are NEW YORK, June 26, 2013 - WCH Service Bureau, a maximizing their time and resources,” Mr. leader in providing medical billing, credentialing, Romanychev explains. “For a small hourly cost, that EHR and other supporting services for health care is minimal compared with doctors billable time, providers in the tri-state area, is introducing the they can eliminate the hours of data input and

service. overcome the tedious, time consuming record inputting. “WCH will help them save time

will enable doctors to focus more time on allowing medical providers to focus on patient care, patient care with less effort required to accurately thus, increasing revenue while reducing the great complete medical documentation. r i sk assoc iated with improper medica l

documentation in case of an insurance company “Practitioners that are using EMR/EHR systems are audit. Furthermore, it allows medical providers to realizing that inputting diagnostic and procedure have more leisure time rather than catching up on codes as well as treatment notes “the new way” is creating medical records after hours. ”taking up to 20 percent more time than “the old way,” explains WCH CEO Aleksandr Romanychev. WCH : “Whether an office has a digital records system or џ Brings more income to the practice as a result not, a provider's time is too valuable to be spent of saved office time to see more patientsessentially doing data entry and coding.” џ Reduces the risks associated with improper

medical documentationWCH uses the brief notes taken during the џ Ensures that the work will be completed and patient exam which are processed by WCH's staff of not lost in the processmedical doctors and nurses; Certified Professional џ Provides professional workforce to write Coders as well as Certified Professional Medical documentationAuditors. The team creates a complete electronic џ Frees doctors' after hours time to spend on medical record as an electronic progress note, then other activities codes, audits and bills, all with minimal doctor Service costs will vary by volume and use of other involvement at a fraction of the time it takes for the WCH Services. doctor's office to process themselves. The provider then simply receives the finished form for approval and signature. t Ilana Kozak,

General Manager, at 718-934-6714 ext. 1214 or .

ICODE

ICode

ICodeICode

ICode

ICode

For more information go to or contac http://wchsb.com/Icode

ilanak@wchsb.com

5www.wchsb.com WCH Bulletin July 2013

Refer WCH to Your Colleagues and Friends for billing service!

Only happy clients refer others, and we want to make sure we exceed the expectations of every client who passes through our doors.

We understand that, we only grow if you are happy with our service.If you know anyone who needs billing service, WCH is here to help.

We are grateful for referrals that come our way and pleased to offer a Referral Reward Program.

WCH will provide you with

For more information contact Ilana Kozak

WCH GOLD certificate that has added value.

WCH Referral Program for our clients

General Manager

skype: ilanakwchsb(718) 934-6714 ext. 1214

ilanak@wchsb.com

INTEGRA PARTNERS

As of September 2013 Amerigroup/HealthPlus will terminate their direct contract with DME and O&P providers. Integra Partners was chosen as the exclusive agent to handle all DME and O& P. All DME providers who are enrolled with Integra and have a direct contract with Helath Plus at the time of transition will lose direct contract and will automatically be enrolled in it through Integra. Those DME and O&P providers, who are not enrolled with Integra, will lose their billing privileges for Amerigroup/Health Plus unless they enroll with Integra Partners. Please contact WCH Credentialing specialists if you need help with this matter or h a v e a n y e n r o l l m e n t questions.

Also, always report these significant changes within MEDICARE MAY DEACTIVATE A a specified time: P R O V I D E R ' S M E D I C A R E џ a change in ownership or control (report within 30 BILLING PRIVILEGESdays)џ a change in practice location (report within 30

Medicare may deactivate a provider's Medicare days)billing privileges if the provider does not report a џ a change in billing services (report within 90 days)change to the information supplied on the џ a change in special payments enrollment application within a specified time. In and correspondence address order to prevent or minimize deactivation or (report within 90 days)revocation of your medicare provider number , be sure to revalidate immediately at the time of the request to avoid the devastating consequences of revocation.

Julia BondarenkoCredentialing Specialist(718) 934-6714 x 1305

yuliyab@wchsb.com

Julia MouravyovaCredentialing Specialist (718)-934-6714 x 1211

juliam@wchsb.com

11www.wchsb.com WCH Bulletin July 2013

HEALTHCARE NEWS

Upon receipt of a CMS-855A, CMS-855B, or CMS-ENROLLMENT DENIALS WHEN 855S application, the Medicare contractor will OVERPAYMENT EXISTSdetermine –whether any of the owners listed in Section 5 or 6 of the application has an existing or

Under 42 Code of Federal Regulations (CFR) Section delinquent Medicare overpayment.424.530(a)(6), an enrollment application may be This applies only to initial enrollments and new denied if the current owner of the applying provider owners in a CHOW. Note also that if the Medicare or supplier, or the applying physician or non- contractor determines that the overpayment physician practitioner has an existing or delinquent existed at the time the application was filed, but the overpayment that has not been repaid in full at the debt was paid in full by the time the contractor time the application was filed. performed its review, the contractor will not deny Overpayments are Medicare payments that a the application because of that overpayment.provider or beneficiary has received in excess of amounts due and payable under the statute and regulations.

Source: http://www.ngsmedicare.com

12 WCH Bulletin July 2013 www.wchsb.com

Seventy-two percent of hospitals surveyed have ICD10 STATUS CHECK: THREE already begun ICD-10 education. This bodes well for HUNDRED HIM PROFESSIONALS HIM's leadership role in the ICD-10 transition. REPORTHowever, much work remains. Of the hospitals without an ICD-10 steering committee, nearly half

By Torrey Barnhouse and William Rudman, PhD, have not started education initiatives.

RHIAOne third of the participants will exclusively use web-based coder education. Academic medical

Most of the nation's 4,000-plus hospitals have only centers will also rely on in-house certified

just begun implementation efforts. instructors and outside educators. Fifty-three

That concerning conclusion was also reached this percent of respondents would like an education

past fall, when vendor TrustHCS and AHIMA firm to provide other ICD-10 services, which is a

conducted a comprehensive survey of ICD-10 signal to vendors to also deliver coding compliance

readiness through a professional survey firm, who audits and outsourced coding services.

interviewed more than 300 HIM professionals representing 293 healthcare facilities that included academic medical centers, teaching and non-teaching community hospitals, and critical access hospitals (CAHs). Eighty-four percent of the survey participants were HIM directors. The goal of the survey was to identify the HIM themes and best practices that are emerging as the healthcare industry moves closer to ICD-10's October 1, 2014 deadline. This research revealed four preparedness p a t t e r n s m o s t i m p o r t a n t t o A H I M A members—education, staffing, computer-assisted coding (CAC), and clinical documentation improvement (CDI).

Providers Behind on ICD-10 ReadinessAccording to the survey, over 50 percent were still in the beginning phases of ICD-10 migration in fall of 2012. A total of 25 percent had not even formed an ICD-10 steering committee, one of the first steps of implementation. Project plans were underway for only 17 percent of facilities, leaving the vast majority of providers with no plans, no budgets, and very little progress to report.

More ICD-10 Education Needed

Source: http://library.ahima.org/

13www.wchsb.com WCH Bulletin July 2013

(3) to CMS via a qualified electronic health record PHYSICIAN QUALITY (EHR) product, or REPORTING SYSTEM (PQRS)(4) to a qualified Physician Quality Reporting data submission vendor.

PQRS is a voluntary individual reporting program Reporting options: that provides an incentive payment to identified 1) Individual measureseligible professionals who satisfactorily report data 2) Measures groupon quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part Eligible professionals who choose to report 2013 B beneficiaries (including Railroad Retirement PQRS individual measures should select at least Board and Medicare Secondary Payer). Medicare three clinically applicable measures to submit in an Part C–Medicare Advantage beneficiaries are not attempt to qualify for a PQRS incentive payment. included in claims-based reporting of individual If fewer than three measures are reported via measures or measures groups. claims, CMS will apply a measure-applicability Notes: validation (MAV) process when determining * If a provider doesn't successfully report PQRS in incentive eligibility. 2013, there will be a -1.5% Medicare fee cut in To qualify for the incentive, the correct numerator 2015. PQRS will continue to provide bonuses of QDC must be reported on at least 80% of eligible 0.5% for 2013 through 2014. instances if reporting via a registry or 50% of the * You can earn the EHR Medicare incentive and also eligible instances if reporting via claims for each earn a bonus with PQRS reporting. If you earn the selected measure.EHR incentive, you will not earn the eRx incentive. Eligible professionals who choose to report 2013 However, you will still need to report eRx in order to PQRS measures group should select at least one avoid the Medicare eRx penalties. applicable measure group. To qualify for the

incentive, the correct numerator QDC must be Reporting period 01/01/2013 – 12/31/2013 reported > 20 applicable Medicare part B patients. Measures consist of two major components: Measures with a 0% performance rate and 1) A denominator that describes the eligible cases measures groups containing a measure with a 0% for a measure (the eligible patient population performance rate will not be counted.associated with a measure's numerator)2) A numerator that describes the clinical action required by the measure for reporting and performanceEach component is defined by specific codes Should you have any questions described in each measure specification along with please contact reporting instructions and use of modifiers. Helen KimReporting methods: Billing Specialist, (1) to CMS on their Medicare Part B claims, (718)-934-6714 x 1104(2) to a qualified Physician Quality Reporting registry, or

helenk@wchsb.com

For a list of professionals eligible to participate in 2013 PQRS Refer to For more information please visit

http://www.cms.govhttp://www.cms.gov

14 WCH Bulletin July 2013 www.wchsb.com

October 1, 2013 – The current (08/05) 1500 Claim NEW 1500 CLAIM FORM HAS Form is discontinued; only the revised (02/12) BEEN APPROVED AS OF JUNE 1500 Claim Form is to be used. All rebilling of 17TH claims will be on the revised (02/12) 1500 Claim Form from this date forward, even though earlier January 1st, 2014 till March, 2014 – Providers submissions may have been on the current can use either the current (08/05) or the revised (08/05) 1500 Claim Form.(02/12) 1500 Claim Form. Health plans,

clearinghouses, and billing vendors are able to accept and process either version of the form.

Source: http://www.nucc.org

“MAOs are not permitted to modify the currently -REIMBURSEMENT: APPEAL approved benefit or cost sharing structure in any MEDICARE ADVANTAGE TWO way,” Rice says in the memo. “This includes PERCENT SLASHESincreases in premiums or cost sharing, or reductions in benefits in an attempt to offset the

Double-check your contract to determine whether lower payments due to sequestration.”

your Medicare Advantage payer is allowed to cut The caveat: If you bill Medicare Advantage but you

your pay.aren't contracted with the plan, then sequestration cuts will apply, Rice adds. “A non-contract provider

If you find that your Medicare Advantage payer has must accept, as payment in full, the amount that it

been cutting your pay in line with Medicare's two could collect if the beneficiary were enrolled in the

percent sequestration cuts, you'll be happy to hear Medicare Fee-for-Service program,” the letter

what the Centers for Medicare & Medicaid Services states. Since Medicare Fee-for-Service is subject to

(CMS) has to say about it. In a surprising new the two percent cuts, so too will be Medicare

memorandum CMS actually reminds Medicare Advantage payments to non-contracted practices.

Advantage payers to stop taking two percent out of If You See MAO Cuts:

practices' checks.If you've noticed that your Medicare Advantage

Although Medicare Advantage has been hit with the payer has been cutting your pay by two percent

sequestration cut that impacted Part B payments since April 1, double-check your contract to

on April 1, Medicare Advantage must still must determine whether they are allowed to do so. If

honor the contracts it has with practices, says Cheri your contract does not include verbiage that lets

Rice, director of CMS's Medicare Plan Payment the program pass on the cuts to you, then you

Group, in a May 1 memorandum to Medicare should appeal your claim reductions to your

Advantage Organizations (MAOs).Medicare Advantage payer.

Source: http://www.ama-assn.org

15www.wchsb.com WCH Bulletin July 2013

direct supervision of the physician. CMS directs EVALUATION & MANAGEMENT that “Direct supervision in the office setting does (E/M): INCIDENT TO SERVICE not mean that the physician must be present in the GUIDELINESsame room with his or her aide. However, the physician must be present in the office suite and

Novitas Solutions Medical Review (MR) immediately available to provide assistance and Department has observed a recent trend of the direction throughout the time the aide is utilization of non-physician practitioners to perform performing services.” initial office visits as incident to services. CMS further indicates, under direct supervision, Documentation reviewed by the MR Department “This does not mean, however, that to be indicates that a non-physician practitioner considered incident to, each occasion of service by performs the initial visit and the supervising auxiliary personnel (or the furnishing of a supply) physician documents a note in the medical record need also always be the occasion of the actual similar to the following: rendition of a personal professional service by the “Nurse practitioner performed the history and physician. Such a service or supply could be physical and I was present for the entire encounter considered to be incident to when furnished during and my treatment plan is as follows……” a course of treatment where the physician performs This is incorrect use of the non-physician an initial service and subsequent services of a practitioner and incorrect billing under the incident frequency which reflects his/her active to guidelines. This article will explain the Medicare participation in and management of the course of definition of incident to services and the criteria treatment.” that must be met to properly bill incident to An initial history and physical performed by a non-services. physician practitioner, although the physician is CMS defines incident to services as “services or documented as being in the room, is not covered supplies are furnished as an integral, although under these guidelines. As underlined above, the incidental, part of the physician's personal physician must perform the initial service. This professional services in the course of diagnosis or includes the history and physical and examination treatment of an injury or illness.” portion of the service, not only the treatment plan. In order to be covered as incident to the physician's Therefore, it is expected that the physician will service, the following criteria must be met: perform the initial visit on each new patient to џ services must be an integral, although incidental, establish the physician-patient relationship.

part of the physician's professional service, Providers billing initial office visits as incident to џ commonly rendered without charge or included when the initial history and physical is performed by

in the physician's bill, a non-physician practitioner will have those claims џ of a type that are commonly furnished in denied by Novitas Medical Review.

physician's offices or clinics, andџ furnished by the physician or by auxiliary

personnel under the physician's direct supervision

Incident to services must be performed under the

Source: https://www.novitas-solutions.com

16 WCH Bulletin July 2013 www.wchsb.com

NEWS BY SPECIALTY

enroll a recipient in social day care unless the OMIG AUDITS SOCIAL ADULT recipient has a functional or clinical need for DAY CARE PROGRAMScommunity-based long term care services (CBLTCS). Social day care can contribute to the total care plan The Council learned today that the Office of the but cannot represent the primary service provided Medicaid Inspector General (OMIG) has begun to to the enrollee. Enrollees who no longer audit social adult day care programs located in New demonstrate a functional or clinical need for CBLTCS York City. This latest action from the state is in must be disenrolled from their MLTC plan.” Click response to the April 23, 2013 New York Times here to read the entire DAL.article and the federal indictment of Assemblyman

Eric Stevenson.In conjunction with the DAL, DOH released MLTC Policy 13.11 today. This guidance is a series of Q&A If you operate a social adult day care program, you intended for plans that contract with social models. should anticipate a visit from OMIG. OMIG staff may If you plan to open or have opened a social adult day take pictures of the building and clients, ask for care, please review the policy guidance. Click here building permits, interview the program director to read the most recent MLTC policy.and/or ask for client files. A social model program

reported to the Council that the audit took four hours to complete. A concern has been raised that OMIG does not understand many of the differences between medical and social adult day care models. Program directors should be prepared to defend the regulations with both copies of the regulations on hand should there be any confusion.

The Department is also working with OMIG to conduct audits on MLTC plans. The Department plans to recoup any capitation payments made to the plan for any non-eligible enrollees.DOH Issues Guidance to MLTC plans

Last week, the Department disseminated a Dear Administrator Letter to all MLTC plans regarding inappropriate utilization of social day care and enrollment of non-medically eligible recipients into MLTC. The letter reinforced that plans “should not

Source: http://m.leadingageny.org/

17www.wchsb.com WCH Bulletin July 2013

programs is needed immediately. We won't allow COUNCIL TAKES ACTION TO the operators of these programs to take advantage PROTECT SENIORS; our city's most vulnerable residents.” ANNOUNCED LEGISLATION TO

REGULATE SOCIAL ADULT DAY Social adult day care programs provide functionally CARE CENTERS challenged individuals – including those suffering

from Alzheimer's, dementia or other chronic health conditions – with specialized services for older Bill would provide regulation following expansion of adults in a protective setting during part of the day. “pop-up” social adult day programs New York State does not require a license, certification or registration to operate these Today, City Council Speaker Christine C. Quinn, centers, although programs that receive State or Health Committee Chair Maria del Carmen Arroyo local funding – including eight programs funded by and Aging Committee Chair Jessica Lappin the Council – adhere to regulations issued by the announced legislation to regulate social adult day New York State Office of the Aging. Private care centers, requiring them to provide proper programs operate without any oversight.supervision, monitoring, care and nutrition. Within

the past year, nearly 200 “pop-up” social adult day To rectify this issue, the Council's legislation will care programs have opened in the city, some of impose the same standards applied to government-which have been actively luring healthy clients from funded programs to all social adult day centers in traditional senior centers and referring them to the city, ensuring that only functionally impaired managed care plans. Through this scheme, the adults attend these programs and that these operators of these centers are able to collect participants receive appropriate services in a safe Medicaid reimbursements for each participant environment. All social adult day care centers enrolled by recruiting seniors that do not require operating in the city will be required to register with the level of care that social adult day care programs the Department of Health and Mental Hygiene are designed to offer. These practices threaten the (DOHMH), which will have oversight of the health and safety of functionally impaired seniors programs. The Department for the Aging will and hinder the operations of properly run programs function as an ombudsman, taking in complaints which depend on certain levels of attendance for and working with DOHMH and the State as funding. The Speaker and Council Members were necessary. Programs that violate standards or fail to joined by State Senator Diane Savino, Lenox Hill register will face fines ranging from $250 to $1,000 Neighborhood House Executive Director Warren B. per day.Scharf and advocates for the announcement at the

Lenox Hill Neighborhood House.

“It is outrageous that these so-called 'pop-up' centers are threating the wellbeing of our seniors while draining Medicaid resources from legitimate programs for older adults,” said Speaker Quinn. “Increased oversight and regulation of these

Source: http://council.nyc.gov/

18 WCH Bulletin July 2013 www.wchsb.com

PRIMARY CARE RATE INCREASE ATTESTATION NOW AVAILABLE

Under the Affordable Care Act, Medicaid primary care practitioners may qualify for increased reimbursement at the rate that would be paid for primary care services under Medicare. The New York State Medicaid Fee For Service and Managed Care Primary Care Rate Increase attestation form and FAQ document are now available on the eMedNY website at the following . Form

services effective for dates of service on and after located January 1, 2013 unless the provider requests a later The New York State Medicaid Fee For Service and effective date. As of August 1, 2013 the effective Managed Care Primary Care Rate Increase date will be the date your attestation was received.Attestation forms received prior to August 1, 2013

will result in the enhanced payment for applicable

linksHere.

Source: https://www.emedny.org

19www.wchsb.com WCH Bulletin July 2013

Effective July 1, 2013 Prior Authorization required approval before administration of the test, the for Polysomnography/ attended sleep testing claim will be denied and the member may not be Effective dates of service on or after July 1, 2013, billed for the service, in accordance with Medicaid UnitedHealthcare Community Plan will require requirements. UnitedHleahtcared's standard prior authorization for attended sleep testing appeal process will apply to any denied claims. performed in a healthcare of laboratory facility. Whether the requested sleep test requires prior Unattended sleep testing performed at home will authorization with medical necessity review is not require prior authorization based on the site of service. Procedure codes for Request for attended sleep testing will be subject to attended sleep testing which would require prior medical necessity review to determine coverage. authorization include CPT: 95805, 95807, 95808 If a physician fails to obtain prior authorization and 95810.

Changes to Medicare PPO prior approval rules for visit. To obtain prior approval, sign in to PT/OT/ST or fax your approval to 1-EmblemHealth will implement new prior approval 866-725-6603. rules for physical therapy, occupational therapy and Urgent or expedited prior approval requests after speech therapy for Medicare PPO members business hours should be made by calling 1-866-effective August 1, 2013. 557-7300. For questions regarding the status of a Under the new policy, EmblemHealth will require submitted request or the prior approval process, prior approval for services after the 6th visit. call customer service at 800-223-9870.Currently, prior approval is required after the 20th

www.emvlemhealth.com

20 WCH Bulletin July 2013 www.wchsb.com

QUESTIONS & ANSWERS

Question:l What will happen if Medicare and Medicaid What are the Medicare exemptions of the EHR Eligible Professionals don't switch to electronic penalty? health records (EHR)?

Answer:l

Physicians near retirement wouldn't suffer a Medicare pay cut for failing to adopt an electronic If Medicare eligible professionals, or EPs, do not health record (EHRs) system, and soloists would get adopt and successfully demonstrate meaningful use a 3-year hiatus from this penalty under a bill of a certified electronic health record (EHR) introduced last month by Rep. Diane Black (R-TN).technology by 2015, theEP's Medicare physician fee The measure, which Black had introduced in the schedule amount for covered professional services previous session of Congress, also would give will be adjusted down by 1% each year. The specialists some breaks in earning bonuses and adjustment schedule is as follows:avoiding penalties in the incentive program, џ 2015—99% of Medicare physician fee schedule designed to promote "meaningful use" of EHRs for covered amountthe sake of improved patient care and lower costs.џ 2016—98 % of Medicare physician fee schedule The Centers for Medicare & Medicaid Services covered amount(CMS) has paid bonuses under Medicare and џ 2017 and each subsequent year—97% of Medicaid since 2011 to physicians who meet strictly Medicare physician fee schedule covered defined measures of EHR use when it comes to amountprescribing, drug interaction alerts, medication lists, If less than 75% of EPs have become meaningful and the like. In 2015, the incentive program enters users of EHRs by 2018, the adjustment will change its penalty phase. That year, physicians who fall by 1% point each year to a maximum of 5%(95% of short of meaningful use standards in a prior Medicare covered amount).reporting period will experience a 1% Medicare pay The Recovery Act allows for hardship exception cut. There are no Medicaid penalties in the incentive from the payment adjustment in certain instances. program.The exemption must be renewed each year and will

not be given for more than 5 years. More CMS has already created several hardship information on payment adjustments and the exemptions from its EHR penalty, and retirement requirements to qualify for a hardship exemption age would become one more if Black's bill becomes will be provided in future rulemaking between now law. The American Medical Association and 98 other and the 2015 effective date.medical societies in May 2012 advocated this escape hatch in a letter to CMS about the agency's second stage of meaningful-use requirements. They wanted a retirement-age exemption not only from

Question:l

Answer:l

Source: http://www.healthit.gov/

21www.wchsb.com WCH Bulletin July 2013

EHR penalties, but also from penalties in the federal programs for electronic prescribing and quality-of- If a patient is seen after 5 p.m. and also after care reporting. "It would be economically regularly scheduled closing hours, can we code burdensome for physicians who intend to retire in both 99050 or 99051?the next several years to install and use an e-prescribing or EHR system," the societies wrote.

No, it is never appropriate to use both codes for In its final regulations defining stage-2 meaningful the same patient visit. If the service is after your use, CMS rejected the notion of a retirement-age clinic's regularly scheduled hours, use code 99050. If exemption from the EHR penalty. It noted that it is during your regularly scheduled hours during plenty of older physicians were earning bonuses evenings, week-ends, or holidays, use code 99051.and that a clinician's age does not represent "a significant hardship.” If your practice is normally open during evening

hours (say, until 9 p.m.), and the physician sees the Source: patient for the same service, you would still bill with

99051 to establish that although the service occurred after usual “business hours,” the

What holidays count for code 99051? Can we appointment was still within your practice's posted include religious holy days? hours.

You can use 99051 for all the Federal holidays. 99050 Services provided in the office at times Selecting multiple additional holidays to use 99051 other than regularly scheduled office hours, or days on will likely be seen by payors as abuse of the when the office is normally closed (eg, holidays, system. It may cause denials or reconsideration of Saturday or Sunday), in addition to basic servicethe policy to reimburse for 99051 in the first place. 99051 Service(s) provided in the office during

regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.Source: CPT Book

Source: CPT Book.

If we code with 99051, does this replace other codes, such as the evaluation and management (E/M) code?

No. 99051 is an add-on code. It is coded in addition to any and all other codes (E/M, CPT, HCPCS and ICD-9) that you would normally code for a given patient visit.

http://www.medscape.com/

http://medical-billing-updates.blogspot.com

Question:l

Answer:l

Question:l

Answer:l

Question:l

Answer:l

22 WCH Bulletin July 2013 www.wchsb.com

Question:l

Answer:l

According to Medicare, can fixed IDTF share space and equipment with another Medicare provider?

requirements will result in the revocation of its Medicare billing privileges

Sharing of Space and Equipment Effective January 1, 2008, with the exception of hospital-based and mobile IDTFs, a fixed-base IDTF does not: (i) share a practice location with another Medicare-enrolled individual or organization; (ii) lease or sublease its operations or its practice location to another Medicare-enrolled individual or organization; or (iii) share diagnostic testing equipment used in the initial diagnostic test with another Medicare-enrolled individual or organization. (See 42 CFR §410.33(g)(15).) If the contractor determines that an IDTF is leasing or subleasing its operations to another organization or individual, the contractor shall revoke the supplier's Medicare billing privileges.

One Enrollment per Practice Location An IDTF must separately enroll each of its practice locations (with the exception of locations that are used solely as warehouses or repair facilities). This means that an enrolling IDTF can only have one practice location on its Form CMS-855B enrollment application; thus, if an IDTF is adding a practice location to its existing enrollment, it must submit a new, complete Form CMS-855B application for that location and have that location undergo a separate site visit. Also, each of the IDTF's mobile units must enroll separately. Consequently, if a fixed IDTF site also contains a mobile unit, the mobile unit must enroll separately from the fixed location. Each separately enrolled practice location of the IDTF must meet all applicable IDTF requirements. The location's failure to comply with any of these

Source: http://www.cms.gov/

23www.wchsb.com WCH Bulletin July 2013

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