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Medco Consultants

Medicare Beneficiary Card Changes Beginning April 2018

 
 

By: Lorna Simons, CPC
Medco Consultants, Inc

The effects of the Medicare Access and CHIP Reauthorization Act (MACRA) are rippling all throughout the healthcare community. Medicare beneficiaries will also be effected as the current Health Claim Numbers (HICNs) will be replaced. As part of MACRA, the Medicare Beneficiary Cards which use the patient’s individual social security number, will be replaced with a Medicare Beneficiary Identifier (MBI).  

The MBIs will be 11 characters and alphanumeric. The new identifier will not affect the beneficiary’s benefits. The push for the new identification numbers is to safeguard patients against fraud and identity theft. Starting in April 2018, new beneficiary cards and numbers will be issued. All Medicare cards are expected to be replaced by April 2019. During the transition period healthcare providers will be able to use either patient identifier (HICN or MBI) when submitting claims until December 31, 2019. 


Stay Compliant When Utilizing Scribes

 

By: Jacqueline Thelian, CPC, CPC-I, CHCA
Medco Consultants, Inc. 
 

 

With the implementation of the electronic health record more and more providers are turning to scribes to assist with their documentation. While many providers utilize scribes, few are aware of the documentation requirements.

As we are all aware, The Centers for Medicare and Medicaid Services (CMS) utilizes Medicare Administrative Contractors (MACs) to process their claims The MACs are at the local level and they have the authority to issue documentation guidelines for their jurisdiction. Therefore, you should check with your MAC for their specific guidelines.

Having said that, there are certain documentation requirements for all MACs regarding scribe documentation.

Scribes are required to be present during the encounter documenting the word and services provided by the physician in real time. 


The scribes note should include:

  • The name of the scribe and a legible signature
  • The name of the physician providing the service
  • The date the service was provided
  • The patient’s name


The physician’s note should indicate:

  • Affirmation of that physician’s presence during the time the encounter was recorded
  • Verification that he/she reviewed the information
  • Verification of the accuracy of the information
  • Any additional information needed
  • Remember the physician is responsible for all documentation and is required to verify the accuracy of the scribes note.

 

Scribe Attestation Sample:
I, _______, M.D., hereby attest that I was present during the encounter and the medical record entry for date of service ___________accurately reflects signatures/notations that I made in my capacity as M.D. when I treated/diagnosed the above listed patient /Medicare beneficiary. I do hereby attest that this information is true, accurate and complete to the best of my knowledge.

Physician’s signature_____________________________ Date: _________

I _________________________ attest to being the scribe for Dr. ______ above named patient on ________________.

Signature of the Scribe:____________________________ Date: ________


Sources:

National Government Services / Part B / Policy Education Topics / Scribes

Building Blocks of Developmental Screening

 
 

By: Melanie Thelian CPC, CPC-I
Medco Consultants, Inc
 

CPT 96110 Developmental Screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument, is a commonly used code in the pediatric setting. The work and time provided by the treating provider identifies the development of the growing child. Because this service is recommended by the American Academy of Pediatrics (AAP) in providing quality preventive medicine, many physicians and/or other qualified healthcare professionals are oftentimes confused on how to document the service.

With an increasing number of commercial insurance carrier audits, requesting refunds for insufficient documentation of CPT 96110, it is important to document the full description of the code. The description of the code includes “instruments and scoring”. However, to date there is no official standardized instrument nationally recognized. 

Follow these documentation requirements when providing the screening to avoid potential overpayment requests:

  • Q&A on age appropriate growing an development (I.e Ages and Stages; Mchat)
  • Scoring by the physicians and/or other qualified healthcare professionals
  • A brief interpretation by the treating provider
  • The treating provider should sign and date the instrument utilized and scan/ save in the patient’s file/chart.
     

Sources:
American Medical Association Current Procedural Terminology Manual (CPT) 2017

CPT Changes, 2008, Preventive Medicine Services Counseling Risk Factor Reduction and Behavior Change Intervention

Understanding Modifier 24

 
 

Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period) is used when a provider performs a separately identifiable service during a patient’s post-op period. 

These services are not related to the procedure previously performed. Remember the following when using Modifier 24:

  • This modifier is used only with E/M services.
  • It is used when the E/M service provided is unrelated to the original procedure  
  • It is used when the E/M service is provided by the same physician who previously performed the original procedure on the patient
  • It is used when the E/M service is provided during the postoperative period of the procedure
  • This modifier does not increase or decrease reimbursement. It does get the E/M service reimbursed. (Bypass edits in carrier’s software systems)

If the patient presents with a complication requiring treatment, such as bleeding or infection due to the procedure, it would be inappropriate to append the modifier. 

Also remember that postoperative periods can vary from carrier to carrier and can be anywhere from 10- 90 days. Follow up visits performed outside of the global period should be coded with the appropriate E/M.

CMS to Share Physician MIPS Scores With The Public

 
 

If you were thinking of reporting the minimal amount of MIPS data to avoid a payment reduction, you might want to think again.

It has been well known that CMS publishes comparative physician data on their website (data.medicare.gov). This data in in an excel format and allows you to compare your utilization with your peers. 

You MIPS data is similar to a report card and CMS will make this data available to the public on the following sites, Physician Compare, Yelp, Consumer reports and Google. The database will include individual physician names.

Publishing this data can impact the physician in a number of ways:

  • Physicians looking to join new groups or selling their practice will more than likely have their scores reviewed
  • Physicians who are providing excellent quality of care for their patients but elect to report only the minimum amount of data will have a lower score available to the public. This could potentially reduce the number of new patients to the practice. 

It is important to keep in mind unreported measures and categories can be seen as poor performance by those who are seeking the physician’s score. 

Advanced Beneficiary Notice Refresher

 
 

With the new Advanced Beneficiary Notice (ABN) coming into effect on June 21, 2017, it is a wonderful time to give a refresher on the proper way to fill out the form. ABNs are provided to educate the patient on an item/service that may not be covered by Medicare but may aid in the patient’s treatment. The ABN, when filled out properly, lets the patient know what the item / service is, when and by whom the item/service will be given /performed and the potential cost of the service. With all of the information provided, the patient can decide whether or not to have the item/service and sill sign the notice. It is important to remember without a properly filled out written notice, the patient is not financially liable if Medicare denies the item/service.


All the blanks / boxes on the form should be filled out completely. Remember to use the full names of the Notifier (supplier/treating physician) and patient. The complete item/service that will be given/performed should be entered into box “D”. For example: if the patient is going to be given physical therapy (PT) rather than writing just “physical therapy” the actual PT modalities should be noted. In Box “E” state why the service may not be paid. The estimated cost is necessary for the patient to know how much the treatment may cost if it is not covered by Medicare. Per Medicare, the estimate should be reasonable for all items/services noted. The cost should be within $100 or 25% of the fee for the item/ service. Always makes sure the patient marks the option they are choosing and the notice is signed in cursive and dated (including month, day and year).


Avoiding Obesity Counseling Denials

 
 

In 2015 Obesity Counseling G codes (G0447 Face-to-face behavioral counseling for obesity, 15 minutes and G0473 Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes) were reported 240,913 times but were denied approximately 80% of the time.

There are a few key points to consider when providing and documenting for these services. First and foremost is the type of provider. The National Coverage Determination (NCD) requires the services are provided by a qualified primary care physician or other primary care practitioner in a primary care setting. The counseling can be provided by qualified auxiliary staff (e.g. dietitian) under the direct supervision of a primary care provider. Secondly these codes have a frequency limitation. • One face-to-face visit every week for the first month; • One face-to-face visit every other week for months 2-6; and • One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg (6.6 lbs.) weight loss requirement during the first 6 months.

Medlearn Matters MM7641 clearly defines the types of providers designated as primary care providers, frequency of services, and supporting diagnosis codes.

For more information on how to get it right click the following link: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7641.pdf

ICD-10-CM New/ Revised/ Deleted Code Preview Coming in Mid-April

 
 

In Mid-April we will be able to preview some of the upcoming changes to ICD-10-CM for 2018. CMS will be releasing the changes as a part of the proposed Medicare inpatient hospital payment rule. There will be fewer new, revised and deleted codes than those release for the 2017 edition. 

There are several notable changes that we will be seeing in the Mid-April preview. 

  • New codes proposed by the American Thoracic Society (ATS) for electronic nicotine delivery systems (ENDS or e-cigarettes) will be added to Chapter 5 Mental, Behavioral and Neurodevelopmental disorders, Chapter 19 Injury, Poisoning and certain other consequences of External Causes and Chapter 21 Factors Influencing Health Status and Contact with Health Services. 
  • New codes for Heart Failure and Myocardial Infarction(MI) will be offering better clarity and detail for coding the different types and variety of heart failure and MIs. 
  • New substance abuse remission codes with explanatory information will clarify the classification for coding mild, moderate and severe. This will aid in aligning ICD-10-CM coding with the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM-5).
  • New Orbital roof and wall fracture codes will include greater locational specificity.
  • New antenatal screening codes will be added to Chapter 21 Factors Influencing Health Status and Contact with Health Services for reporting specific screening tests administered to pregnant patients.
  • We will also be seeing new explanatory language for the Glasgow coma scale to help with selecting the appropriate coding level for pediatric patients based on age.

Though it is easy to get excited about these new codes, it is important to remember the preview is a part of proposed changes. These codes, as well as others that are not yet completed, will be seen in the final hospital payment rule in August. The completed codeset with all the new, revised and deleted codes will take effect on October 1st.