Home Health Care Delivery

MSMS Reimbursement Advocate Alert for December 8, 2011

Medicare Revalidation; 5010 Implementation; AMA Practice Management Tools; MDCH Injectable Reimbursement Methodology Changes 

Medicare Revalidation
The Centers for Medicare & Medicaid Services (CMS) recently announced that the requirement that physicians/providers revalidate their Medicare enrollment under provisions of the Affordable Care Act (ACA) has been extended through June 2015. The original revalidation effort was scheduled to be completed by March 23, 2013. The updated Provider Revalidation MLN provided complete details regarding the extension and revalidation process.

Version 5010
On Friday, November 17, 2011, the CMS’ Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement with respect to any HIPAA covered entity that is not in compliance on January 1, 2012 with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Subrogation 3.0 (NCPDP 3.0) standards until March 31, 2012. Notwithstanding OESS’ discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012 (small health plans have until January 1, 2013 to comply with NCPDP 3.0).

Medicare Fee-for-Service will soon issue direction to the Medicare Administrative Contractors (MACs) on how these transactions are to be processed on January 2, 2012. Further guidance related to Medicare Fee-for-Service will be available via listserv messages and the CMS website.

Links to information on Version 5010, NCPDP D.0, and NCPDP 3.0 are available at http://www.cms.gov/Versions5010andD0.

AMA Practice Management Modifier 25 Webinar
Proper coding is critical to managing a practice’s claims revenue cycle. However, the complexity can also be daunting. Knowing when and how to use codes such as Modifier 25 ensures that your practice accurately records the services it delivers—and is paid fairly for those services.

The American Medical Association’s (AMA) Practice Management Center has recorded a brief, instructive webinar, “Definitions and use of Modifier 25,“ to help you correctly and confidently record the performance of procedures and services. AMA experts Marie Mindeman, of CPT Coding and Regulatory Affairs, and Danielle Pavloski, of CPT Education and Information Services, walk you through the proper and improper uses of Modifier 25. The approximately 20-minute webinar includes a checklist to evaluate the appropriate use of the modifier, as well as answers to the most common questions about this important topic.

AMA Practice Management – Workers’ Compensation eBilling
Download a free toolkit from the AMA about automating workers’ compensation claims.

Claims for services covered by homeowners, automobile and business insurance—including workers’ compensation—are all categorized as property and casualty. Workers’ compensation claims can cause administrative hassles, but there is a way to avoid these headaches. The AMA’s webinar on how to automate your workers’ compensation claims and its related toolkit provide educational materials and other tips to help physician practices adopt eBilling for property and casualty and workers’ compensation claims. eBilling can help your practice:
• Decrease administrative costs
• Receive timely acknowledgement of claim status
• Reduce the time it takes your practice to get paid

By sending and receiving electronic health care transactions, physicians can free their practice staff to perform other revenue-enhancing functions.

Be sure to bookmark ama-assn.org/go/htc to access new updates as they become available.

MDCH Injectable Reimbursement Methodology Changes
The Michigan Department of Community Health (MDCH) is implementing a new reimbursement methodology for specific injectables effective January 1, 2012. For certain drugs this will represent an increase over current ASP rates.

The MDCH would like to invite the person(s) from your office who handles the buying and billing of injectables to an informational session the week of December 12, 2011 regarding the new methodology and how reimbursement could be impacted for your practice.

Please respond to provideroutreach@michigan.gov with the name, physician/provider NPI and email of the person(s) in your office who you would like to attend so we can forward the invitation with session details. Seating is limited.

For more information about the change, see Notices of Proposed Policies #1135 injectables on the MDCH website located at http://www.michigan.gov/mdch.

For more information about reimbursement issues, contact Stacie Saylor, CPC, at MSMS at 517-336-5722 or ssaylor@msms.org. For more news and information, visit www.msms.org where you can read Medigram and Michigan Medicine online.