Enhanced Evaluation and Management Services Documentation Tool

By: Lisa Kropp, CPC, CPMA; Practicefirst Coding & Credentialing Manager

National Government Services (NGS) has designed a tool to help Part B providers assess their E & M documentation.  This tool follows guidelines as established by CMS and uses a system of scoring.  It is based on the three key elements of history, exam, and medical decision making.

Due to the vague nature of the 1995 E & M Guidelines, it’s important to consider the use of this tool as it provides the framework for properly coding E & M Services.  The worksheet breaks down all of the individual components and is a great resource to help providers code for all the work they do!

The tool can be accessed by going to: www.ngsmedicare.com, but here is a quick breakdown of NGS site navigation.

Quick Links Navigation

  • Select Forms from the Quick Links navigation menu
  • Select the Evaluation & Management Documentation Training Tool link under the Documentation category.

Forms Section

  • Select the Forms option under Resources located in the top navigation menu
  • Select the Evaluation & Management Documentation Training Tool link under the Documentation category

Tools and Materials Section

  • Select the Tools and Materials option under Resources located in the top navigation menu
  • Select the Evaluation & Management Documentation Training Tool link under the Self-Help Tools category

Questions About 2012 CPT Changes?

There’s still time to ask questions about the 2012 CPT changes!  You may also be planning to add new services, procedures or supplies to your practice and knowing the codes and reimbursement for those codes is the first step to making sure your practice succeeds!

At Practicefirst, our coding department is here to guide you through changes or additions to the codes you use, and to ensure coding to the highest specificity.

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp, CPC, CPMA; Coding & Credentialing Manager at 716.348.3904 or lisak@pracfirst.com

CMS will re-examine ICD-10 timeline, Tavenner says

As reported in Modern Healthcare; February 14, 2012

The acting head of the CMS on Tuesday signaled that the agency will extend the timeline on ICD-10 implementation.
After speaking to attendees at the American Medical Association Advocacy Conference in Washington, acting CMS Administrator Marilyn Tavenner told reporters that the CMS will “re-examine the timeframe” through a rulemaking process. She did not say when that rulemaking process will begin but said the CMS would send details about the process in the coming days.
“There’s concern that folks cannot get their work done around meaningful use, their work around ICD-10 implementation and be ready for exchanges,” Tavenner said. “So we’re trying to listen to that and be responsive.” Separately, Tavenner said she the CMS has had “good results” with accountable care organization applications and expects to make an announcement about selected applicants “at the beginning of the second quarter of this year.”

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OIG Alerts Physicians To Exercise Caution When Reassigning Their Medicare Payments

OIG ALERT – Release Date February 8, 2012  (Physicians May Be Liable for False Claims Submitted by Entities Receiving Reassigned Medicare Payments)

Physicians who reassign their right to bill the Medicare program and receive Medicare payments by executing the CMS-855R application may be liable for false claims submitted by entities to which they reassigned their Medicare benefits.

OIG encourages physicians to use heightened scrutiny of entities prior to reassigning their Medicare payments. Physicians should carefully consider entities to which they choose to reassign their Medicare payments and ensure that the entities are legitimate providers or suppliers of health care items and services.

OIG recently reached settlements with eight physicians who violated the Civil Monetary Penalties Law by causing the submission of false claims to Medicare from physical medicine companies. Specifically, these physicians reassigned their Medicare payments to various physical medicine companies in exchange for Medical Directorship positions.

While serving as Medical Directors, the physicians did not personally render or directly supervise any services. There was evidence that the services the physical medicine companies claimed the physicians performed were not actually performed or were not performed as billed.

The failure of the physicians to monitor the services billed using their reassigned provider numbers resulted in individuals with little to no medical background serving as physical therapy “technicians.” These unlicensed “technicians,” including retail cashiers and massage therapists, rendered unsupervised in-home physical therapy services to Medicare and Medicaid beneficiaries.

The physical medicine companies falsely billed Medicare using the physicians’ reassigned provider numbers as if the physicians personally rendered the services or directly supervised a “technician” rendering the services. Many of the owners and operators of the physical medicine companies were criminally prosecuted. OIG determined that the physicians were an integral part of the scheme and pursued their liability under the Civil Monetary Penalties Law.

Note: A physician who reassigns to any entity his or her right to bill the Medicare program and receive Medicare payments has the right to access the entity’s billing information concerning the services the physician is alleged to have performed and for which the entity billed Medicare. Physicians have unrestricted access to claims submitted by an entity for services that the entity billed using the physicians’ reassigned provider numbers to provide added assurances that the services for which the entity billed Medicare were, in fact, performed and were performed as billed.

This OIG Alert does not alter any individual’s or entity’s obligations under any other applicable Medicare statutes or regulations governing billing or claims submissions.

To read the advisory: http://oig.hhs.gov/compliance/alerts/guidance/20120208.p