PRACTICEFIRST’S CODING CORNER JANUARY 2013

By Lisa Kropp, Coding and Credentialing Manager

2013 New, Deleted, and Revised CPT and HCPCS CODES:

Revisions, addition and deletions to the CPT and HCPCS code set are effective January 1, 2013. Use of deleted codes will delay payment, as we will need to return the charge slips to your office for the correct code.

To determine which clients will be impacted by the 2013 changes, we have compared these changes to each client’s procedures performed in 2012.

We have faxed, mailed or delivered customized reports to our Clients that are impacted by the 2013 CPT changes.

We apologize for the late notice, but based on the complexity of CPT changes, it took some time to compile thisinformation for you.

If you would like a complete listing of all the Deleted, New, and Revised Codes, we can provide that upon request.

Importance of Legible Medical Records

Medicare is reminding ALL providers that CMS MUST deny a service when it isn’t reasonable or necessary. To determine Medical Necessity, CMS must rely on the medical documentation submitted by the provider.

Therefore, legibility of clinical notes and other supporting documentation is critical to avoid denials.

ALL Medical records should be:

 Complete and legible; and

  • Include the legible identity of the provider and the date of service.

Amendments, Corrections and Delayed Entries MUST follow these record keeping principles:

  • Clearly and permanently identify any amendments, corrections or addenda.
  • Clearly indicate the date and author of any amendments, corrections, or addenda.
  • Clearly identify all original content (do not delete).

 Signature Requirements:

 Reviewers are required to authenticate the author by their handwritten or electronic signature. Note the following:

  •  If the signature is illegible or missing from the medical documentation (other than an order), the review contractor shall consider evidence in a signature log or attestation statement to determine the identity of the author of a medical record entry.
  • If the signature is missing from an order, the review contractor shall disregard the order during the review of the claim (i.e. the reviewer will proceed as if the order was not received). Signature attestations are not allowable for orders.

COMPLIANCE UPDATES JANUARY 2013

By Becky Amann, PracticeFirst Compliance and Training Manager

2013 OIG WORK PLAN

TWO AUDITS BEING CONDUCTED BY THE OIG

The OIG’s Work Plan for 2013 includes two audits for the following:

Improper Payments to Providers for Incarcerated Beneficiaries

In general, Medicare does not pay for services rendered to incarcerated beneficiaries, unless there is an obligation for the cost of care.

Payments for Alien Beneficiaries Unlawfully Present in the U.S.

Medicare prohibits payment for services rendered to individuals who are not “qualified aliens”.

In both of these cases, audits conducted identified overpayments to providers across the country, including those serviced by NGS. The OIG and CMS have charged NGS to begin the process of recouping any overpayments that have occurred. Letters to providers were issued on Monday, December 10th with a listing of claims impacted by these audits. The letter will indicate “Claim adjustments due to a mass adjustment”.

These audits may not impact you, but please be aware of these overpayment notifications that you could receive.

JANUARY 2013 BILLING UPDATES

By Karin Bajak, PracticeFirst Medical Management Billing Manager

CENTERS FOR MEDICARE AND MEDICAID (CMS)

MEDICARE PART B DEDUCTIBLE / CO-INSURANCE

The Medicare Part B annual deductible for 2013 will be $147.00. Co-insurance remains at 20%.

UNIVERA NEWS

CONSULTATION CODES

Effective January 1, 2013, Univera Community Health (PlusMed, Child Health Plus, and Family Health Plus) will no longer reimburse consultation codes for all lines of business. As you know, providers should submit the appropriate Evaluation and Management codes, 99201-99215, 99221-99223 and 99304-99310 for these services.

Admitting physicians need to add modifier AI to initial hospital services (99221-99223). This modifier will allow carriers to differentiate between the admitting physician and all other physicians using these same codes.

UPDATES TO RADIOLOGY CLINICAL EDITS EFFECTIVE JANUARY 15, 2013

Effective January 15, 2013, Univera Healthcare and Univera Community Health will update radiology clinical edits. There will be no impact to coverage; however, some procedure code combinations will no longer be reimbursable and/or allowed on the same date of service, which may affect reimbursement.

Revisions to some existing edits will result in a different procedure code considered for reimbursement within the same code pair. Other edits include new combinations where one or more procedure codes may not be reimbursable.

In addition, to align with Medicare reimbursement, Univera is implementing an administrative policy regarding 3-D rendering of a tomographic modality and will NO LONGER PAY SEPARATELY FOR THESE CODES. The use of 3-D will be considered inclusive to the radiology imaging reimbursement.

Areas of greatest impact include:

  • Mammography procedure code pairs
  • Obstetric ultrasound procedure code pairs
  • Computed tomography with position emission tomography that includes the same anatomic site(s)
  • Office visits or lidocaine with ultrasonic guidance for needle placement
  • 3-D rendering in conjunction with majestic resonance imaging, computed tomography, positron emission tomography, microscopy and ultrasound  imaging techniques

To verify what procedure codes will be affected; you can refer to the Univera clinical editing tool “Clear Claim Connection” available at https://univerahealthcare.com/wps/portal/xl/prv/adm/clinical/