2013 Medicare Update for Clinical Social Workers.

2013 Medicare Update for Clinical Social Workers

Proprietary and Confidential

Today’s Presenters

• Kathy Dunphy Director Provider Outreach and Education

• Jim Bavoso Provider Outreach and Education, Lead Consultant


Disclaimer

National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction. National Government Services employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the Centers for Medicare & Medicaid Services (CMS) Web site at http://www.cms.gov.


No Recording

• Attendees/providers are never permitted to record (tape record or any other method) our educational events This applies to our Webinars, teleconferences, live events, and any other

type of National Government Services educational event


Acronyms

5

ACT Ask the contractor

ADR Automated development letter

AIC Amount in Controversy

AO Authorized official

AWV Annual wellness visit

CARC Claim adjustment reason code

CBT Computer based training

CMS Center for Medicare & Medicaid Services

CPT Current procedural terminology

CQM Core quality measures

CSW Clinical social workers

DO Delegated official

E&M Evaluation and management

EDI Electronic date interchange


Acronyms

6

EFT Electronic funds transfer

ERA Electronic remittance advice

FAQ Frequently asked questions

FFS Fee for service

ICD-9-CM International Classification of Diseases, Clinical Modification, 9th Revision

IOM Internet only manual

IPPE Initial physical preventive examination

IVR Interactive voice response

LCD Local coverage determination

MAC Medicare Administrative Contractor

MLN Medicare Learning Network

MSP Medicare secondary payer

MUC Medicare University credits

NPI National provider identifier


Acronyms

7

PECOS Provider Enrollment Chain & Ownership System

POS Place of service

PQRS Physician Quality Reporting System

PT Physical therapist/physical therapy

SIA Supplemental instruction article

SPR Standard paper remittance

TRU Telephone reopening unit

WBT Web based training


Objectives

• To assist providers and their office staff with keeping them current of recent changes to the Medicare program

• Eliminate errors in coding claims due to policy changes


Agenda

• How to Stay on Top of Medicare Changes• Recent Updates• 2013 New Procedure Codes• LCD• Provider Enrollment Changes• Help for the Office• Resources

How Do I Stay on Top of How Do I Stay on Top of Medicare Changes ?Medicare Changes ?

Code Pricing Search ToolCode Pricing Search ToolMake it a Favorite!Make it a Favorite!

http://www.NGSMedicare.comhttp://www.NGSMedicare.com


• New “look and feel”

• Search functionality included within the FAQs

• Topic index, including subcategories

• Display of the most popular topics, top reviewed questions, and most recently added questions

• Cross-references to related topics when viewing the FAQ search or answer page

• Cross-references to related Web site resources supporting the FAQ answers

• Feedback form for commenting on searched topics and questions

• Opportunity to comment on the helpfulness of FAQ answers and to submit new questions


Medicare Universityhttp://www.NGSMedicare.com

• Educational program designed to provide a broad variety of Medicare related training

• View events on National Government Services Web site• All teleconferences, Webinars, CBTs, and many seminars are free• Registration is required• Earn MUC Credits–self-report after training/print Report card of all

training


New Look To Medicare University!


Education Just for J13 Providers

• Part B News Flash Webinar • ACT Calls• Ask Provider Outreach and Education Lunch and Learn Webinar:

Web Site Navigation• Minimize Errors and Maximize Revenue: Get it done right!


CMS Web Sitehttp://www.cms.gov

• IOMs• Change requests and MLN matters articles• Free WBT training courses• FAQs• Free Medicare learning network materials

CD-ROMs and DVDs

Brochures and guides

Fact sheets


New CMS Web Site!


CMS Medicare FFS Provider e-News

• The same great content, with a new look as we transition to a new delivery system.

• Refreshed, cleaner design with new header graphic• Email body will be a preview of the week’s e-News issue Table of

Contents, with a link to the full text version of the newsletter. • New link to subscribe or manage your subscription. Refer your

colleagues

Now, For Some Recent Updates Now, For Some Recent Updates

To The ProgramTo The Program


2013 Fee Schedule

• 01/02/13 - President Obama Signs the American Taxpayer Relief Act of 2012

• New Law Includes Physician Update Fix Through December 2013• New Law prevents a scheduled payment cut for physicians and

other practitioners who treat Medicare patients from taking effect on January 1, 2013

• New Law provides for a zero percent update for such services through December 31, 2013

• The 2013 conversion factor is $34.0230• Be sure to check for fee changes since last year• Geographical Practice Index (GPCI) and/or Relative Value Units

(RVU’s) may have changed in 2013


Sequestration

• Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment.

• The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments


Sequestration

• Q: How is the 2% payment reduction under sequestration identified on the Medicare remittance? A: Claim adjustment reason code (CARC) 223 is used to report the

sequestration reduction on the ERA and SPR

• Q: What is the verbiage for CARC 223? A:“Adjustment code for mandated Federal, State or local law/regulation that

is not already covered by another code and is mandated before a new code can be created.”


Sequestration (cont)

• The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.

• Though beneficiary payments for deductibles and coinsurance are not subject to the two (2) percent payment reduction, Medicare's payment to beneficiaries for unassigned claims is subject to the two (2) percent reduction.


Sequestration (cont)

• CMS encourages Medicare physicians, practitioners, and suppliers who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare's reimbursement.

• We are hopeful that Congress will take action to eliminate the mandatory payment reductions.


2013 Coding Changes

• Most standard codes were revised in 2013• No longer report 90804-09080 and 90816-90821• Effective January 1, 2013

90832 psychotherapy 30 minutes



• For CSW billing, E&M and Psychotherapy to not apply 90833, 90836, 90838

Other codes have not changed in 2013.


New code - Crisis Psychotherapy

• 90830 - psychotherapy for crisis, first 60 minutes( 30-74 min.)• 90840 – each additional 30 minutes( beyond 74 min. )

Description: "Psychotherapy for crisis is an urgent assessment and history of a crisis state, a mental status exam, and a disposition, The treatment includes psychotherapy, mobilization of resources to defuse the crisis and restore safety, and implementation of psychotherapeutic interventions to minimize the potential for psychological trauma. The presenting problem is typically life threatening or complex and requires immediate attention to a patient with high distress." Documentation: The record must indicate that the guidelines under the "Description" and "Comments" sections were followed.


The Basics: Documentation Requirements

• Name of beneficiary and date of service• Type of service (individual, group, family, interactive, etc.)• Time element, determining factor for coding the service rendered• Modalities and frequency of treatment furnished• A clinical note for each encounter, diagnosis, symptoms functional

status, focused mental status examination, treatment plan, prognosis, and progress to date.

• Identity and professional credentials of the person performing service


Learn About PQRS

• Complete details on http://www.cms.gov New! April 16, 2013 National Provider Call with Question & Answer Session

on the Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program; 1:30 - 3:00pm ET. (03-22-2013)

• National Government Services J13: 2013 Physician Quality Reporting System

April 18, 2013 1:00 – 3:00 PM


Sample PQRS Measures

• 173 Preventive Care and Screening: Unhealthy Alcohol Use – Screening

• 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation

Intervention


PQRS 1500 Example


• 2012 Monthly Part B Premium for

Beneficiary $99.90 Higher Part B Premium

$85,000/$170,000 Part B Deductible $140 Part B Coinsurance 20%

Medicare Part BPremiums and Deductibles 2012/2013

• 2013 Monthly Part B Premium for

Beneficiary $104.90 Higher Part B Premium –

$85,000/$170,000 Part B Deductible $147 Part B Coinsurance 20%


Revised and Clarified Place of Service (POS) Coding Instructions (MM7631)

• National policy for the correct assignment of POS codes Facility and Non Facility POS code descriptions

• POS instructions/special considerations provided specific to: Professional Component (PC) and the Technical Component (TC) of

diagnostic tests

Mobile Unit Settings

Walk in Retail Health Clinic

Inpatient / Outpatient

Ambulatory Surgical Centers

Hospice

Global Services


MLN Matters®Number: SE1237Importance of Preparing/Maintaining Legible Medical Records

• Many Claim Denials Occur because Providers / Suppliers Do Not submit sufficient Documentation to Support Service or Supply billed General Principles of Medical Record Documentation

Signature Requirements

Amendments, Corrections and Delayed Entries


Alert Concerning Impacts Arising From Having Non Compliant Physical Or Practice Address Information On File With Medicare

• Special Edition Article SE1245• You need to ensure your designated A/B MAC no longer has a

Post Office (P.O.) Box or Lock Box address in association with your Billing Provider Address information on file for you

• Patient’s Claims Unable to Cross Over


New CMS Fraud Prevention Training Modules For Providers

• Two CMS Fraud Prevention Training Modules on Medscape Web site http://www.medscape.com

Must create free account to access, do not need to be health care professional

• Total of 1.25 hours of Continuing Medical Education (CME) credit can be earned Must be Medscape user registered as doctor or health care professional


Immediate Recoupment Process

• MLN Matters Article MM7688 Standardized immediate recoupment process to avoid interest effective

7/1/12

Allows you to request recoupment to begin prior to day 41

Providers/suppliers may avoid paying interest if overpayment is recouped in full prior to day 31


2013 Update to Amount in Controversy (AIC)Federal Register / Vol. 77, No. 189

• AIC threshold for ALJ hearing requests filed on or before December 31, 2013 = $140 Increase of $10 from 2012

• AIC threshold for Federal District Court review requests filed on or before December 31, 2013 = $1,400 Increased from $50 from calendar year 2012


Redesign Of The Medicare Summary Notice (MSN) MM7676

• Effective January 3, 2013• The content and format of the Medicare Summary Notice are

redesigned• The Plain Writing Act of 2010, which requires all government

communications to be written in plain language that is easily understood by the target audience


Electronic Summary Notice

• Asking Providers to Promote to Beneficiaries• Free Materials Available for your Office!

Welcome to MyMedicare.gov Fact Sheet

eMSN Overview Fact Sheets

Posters for the office

Over 7,500 enrolled

Preventive ServicesPreventive Services


Waiver of Coinsurance And Deductible For Preventive Services MM7012

• Coinsurance and Part B Deductible Waived for: IPPE

AWV

Other Preventive Services

Colorectal Cancer Screening Tests that Become Diagnostic

• Colonoscopy, flexible sigmoidoscopy, or barium enema

• Waived for surgical procedures furnished same date/encounter

• Append Modifier PT to Surgical Procedure

– CPT code range 10000-69999


Preventive Services

• MM7641 Screening/Counseling for Obesity• MM7636 Intensive Behavioral Therapy for Cardiovascular Disease• MM7637 Screening for Depression • MM7633 Screening/Counseling to Reduce Alcohol Misuse• MM7610 Screening for Sexually Transmitted Infections/Counseling

for Prevention

Local Coverage DeterminationsLocal Coverage DeterminationsLCD For Psychiatry And LCD For Psychiatry And

Psychology Services (L26895)Psychology Services (L26895)


LCD vs. SIA

• LCD Specific Information Needed to Bill Indications of Treatment

Limitations of Treatment

Primary/Secondary ICD-9-CM Codes Supporting Medical Necessity

Documentation Requirements

Utilization Guidelines/Frequency

• SIA Coding GuidelinesYou need both to accurately

bill

Electronic Data InterchangeElectronic Data Interchange(EDI)(EDI)


EDI Help Desk Information

• Questions that the EDI Help Desk can address:• Acquiring a Sender ID• Communication Issues• EDI Enrollment Information• Front-end Error Reports• Acquiring National Government Services Software• National Government Services Software Support Only

Questions regarding billing, codes, or denials on remits should be addressed to the Provider Contact Center


EDI Help Desk Information

• 877-273-4334 8:00 a.m. - 4:00 p.m. eastern time,

Monday through Friday

• EDI Help Desk Inquiry Form


EFT & ERA

• New initiative to increase these electronic transactions.• You may be contacted by us• To enroll go to Electronic Claim Submissions, under Quicklinks,

and Getting Started


Providers Who Are Not Receiving Electronic Remittances!

• Faster communication and payment • Faster account reconciliation • Improves office productivity • Automation of follow-up action • Paperwork reduction, and • Detailed information


Were You Sent A Request To Revalidate Your Medicare Enrollment?

• Lists of providers sent notices to revalidate their Medicare enrollment may be found on the CMS Web site: http://www.CMS.gov/MedicareProviderSupEnroll/11_Revalidations.asp

• Revalidations have been mailed from September-December 2011

• January-December 2012

• January 2013

CMS Incentive ProgramsCMS Incentive Programs


CMS Incentive Program Links

Help For Your Office!Help For Your Office!

Proprietary and Confidential 80

What Is Connex?

• http://www.NGSconnex.com Need Internet access and e-mail address

No cost

• Provides: Claim status and Beneficiary eligibility

Financial data

Provider demographics

Ability to order remittances

Initiate a redetermination/reopening request

Summer of 2013 - claims submission


New Enhancements

• Provider search options• Reason/rejection descriptions• Entitlement data is updated in real time

Obtained from CMS

• MSP insurer name and address• Ability to request access for multiple provider accounts• Ability to check appeal status


Connex Redetermination/Reopening Requests-Reminder

• We can now accept redeterminations /reopenings for claims through Connex-we need to remind you the rules for reopenings has not changed

• Only claims that have processed through our system are eligible• Claims rejected MA-130 must be corrected and resubmitted


Connex New Data Protection Security Procedure

• As of March 9, 2013, NGSConnex users will be locked out of their account for three hours after inputting their password incorrectly three (3) times.

• Please see the Connex Quick Steps Job Aid which outlines the procedure for resetting your password on pages three (3) and four (4).


Connex-Security

• If an NGSConnex account has not been used within the last 90 days, the account will be disabled

• Once an account has been disabled, the user will be required to request reactivation of their account through the Provider/Supplier Contact Center


Signature Requirements

• Signature Requirements for Medical Documentation The use of stamped signatures is not acceptable on any medical record

Medicare requires a legible identifier for services provided and ordered

Medicare will accept handwritten, electronic signatures or facsimiles of original written or electronic signatures for medical review purposes

The Medical Review Department will deny claims not meeting the signature requirements on records requested on ADR


Avoid Duplicate Claims

• Allow 29 days for paper claims and 14 days for electronic claims to be processed

• Electronic Claims Submitters should: Check your EDI validation report to verify claims were received and accepted

Check your software system to verify claims’ software system is not set up for automatic rebill every 30 days or at any other set time intervals

Ensure that your claims batching process is functioning properly


J13 Contact Information

• IVR 877-869-6504

• Provider Contact Center 866-837-0241

• Fax on Demand 866-709-1905

• EDI Helpdesk 877-273-4334

• CorrespondenceNational Government ServicesPart B Provider General Written Inquiries P.O. Box 6189Indianapolis, IN 46207-6189

• New Direct Telephone line for Provider Enrollment (J13) 888-379-3807


Contacting The Telephone Reopening Unit

• TRU Line 888-812-8905, follow prompt

• Part B TRU line hours of operation Monday–Friday, 8:00 a.m.–3:00 p.m.

eastern time

• Faxes are accepted and representatives are permitted to accept more than three claims per call


EDI Helpdesk

• 877-273-4334 Monday–Friday

8:00 a.m.–4:00 p.m. (eastern time) for all EDI requests

4:00 p.m.–6:00 p.m. for password resets only

[email protected]


Contacting The COBC SE1205

• Provider attempting update with the beneficiary in the office First time a call is made to update record after April 4, 2011, it will be updated

via the telephone call

Subsequent calls made to update the record after April 4 2011, no update will be made on the call, but two options are available:

• Proof of information can be faxed or mailed on the insurer or employer’s company letterhead, and the update will be made in 10-15 business days; or

• You can contact the insurer or employer organization that last updated the record


COBC Contact Information

• Telephone: 800-999-1118 (8 a.m.-8 p.m. Eastern Time)

• Fax: 734-957-9598 (address the fax to Medicare Coordination of Benefits)

• Mailing Address: Medicare –Coordination of Benefits

P.O. Box 33847Detroit, MI 48232

ResourcesResources


Resources

• http://www.NGSMedicare.com• http://www.cms.gov• http://www.NGSconnex.com• http://www.cms.gov/MLNProducts


Appeals – Part B

• Reversals due to: Correcting modifiers

Correcting diagnosis

Correcting procedures

• Recommended forms• Telephone reopenings

http://www.NGSMedicare.com

Select Appeals

National Government ServicesNational Government ServicesWeb UpdateWeb Update


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We read every comment our users submit

We use scores and comments to develop plans to improve the Web site

• We need to hear from more of you more often!


Web Site Survey

• This is your chance to have your voice heard - Say “yes” when you see this pop-up so National Government Services can make your job easier!

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Thank You!

• Thank you so much for taking the time out of your busy schedule to join us today for the 2013 Medicare Updates!

• Have a nice day and enjoy your other sessions

Kathy Dunphy & Jim Bavoso

2013 Medicare Update for Clinical Social Workers.

Documents

Transcript of 2013 Medicare Update for Clinical Social Workers.