Maryland AAHAM
December 21, 2012
Proprietary and Confidential
Disclaimer
•
All Current Procedural Terminology (CPT) codes and descriptors used in this presentation are copyright©
by the American Medical Association. All rights reserved.
•
The information enclosed was current at the time it was presented. Medicare policy changes frequently;
links to the source documents have been provided within the document for your reference. This
presentation was prepared as a tool to assist providers and is not intended to grant rights or impose
obligations.
•
Although every reasonable effort has been made to assure the accuracy of the information within these
pages, the ultimate responsibility for the correct submission of claims and response to any remittance
advice lies with the provider of services.
•
Novitas Solutions 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 guide.
•
This presentation is a general summary that explains certain aspects of the Medicare program, but is not
a legal document. The official Medicare Program provisions are contained in the relevant laws,
regulations, and rulings.
•
Novitas Solutions does not permit videotaping or audio recording of training events.
2
Agenda
•
•
•
•
Medicare Updates
Medicare Initiatives
Website
Self Service Options
3
Medicare Updates
4
National Correct Coding Initiative
(NCCI) Associated Modifier Changes
(Additions)
•
•
•
•
Change Request #8111
Effective date: January 1, 2013
Implementation date: January 7, 2013
Key Points
– Additional modifiers added to the list of NCCI-associated
modifiers that will allow an edit with modifier indicator of ”1” to be
bypassed when the modifier is utilized.
• LM (left main coronary artery),
• RI (ramus intermedius),
• 24 (unrelated evaluation and management service by the same
physician during a postoperative period)
• 57 (decision for surgery)
• http://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/Downloads/R1136OTN.pdf
2013 Medicare Deductible
and Coinsurance
• Change Request #8052
• Effective: January 1, 2013
• Key Points
– Part A
• Deductible
– $1,184.00
• Coinsurance
– $296.00 a day for 61-90 day
– $592.00 a day for 91-150 day
– $148.00 a day for 21-100 day (Skilled Nursing Facility)
– Part B
• Deductible
– $147.00 a year
• Coinsurance
– 20 percent
January 2013 Update to
Hospital OPPS
Change Request #8141
• Effective: January 1, 2013; Implementation: January 7,
2013
• Key Points
– Intracoronary Stent Placement Procedure Codes
– Changes to Cardiac Electrophysiologic Evaluation and
Ablation Codes
– Coding Changes for PHP Services
– Drugs, Biologicals and Radiopharmaceuticals
• http://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/Downloads/R2611C
P.pdf
CR 8141 (cont’d)
• Intracoronary Stent Placement Procedure Codes
– AMA deleting CPT codes 92980, and 92981
– AMA replacing with new CPT codes
92928
92929
92933
92934
92937
92938
92941
92943
92944
– CMS deleting 2 HCPCS codes G0290, and G0291
– CMS creating 9 HCPCS C-codes
C9600
C9601
C9602
C9603
C9605
C9606
C9607
C9608
C9604
CR 8141 (cont’d)
• Coding Changes for Partial Hospitalization
Program (PHP) Services
– 2 New CPT codes for Behavioral Health Treatment/Services for
Revenue Code 900
• 90791 and 90792
– 7 New CPT codes for Individual Psychotherapy Revenue Code
914
90875
90832
90833
90836
90837
90838
90834
CR 8141 (cont’d)
• Drug, Biologicals, and Radiopharmaceuticals
– New CY 2013 HCPCS Codes
• Attachment A, Table 1
• Revisions to HCPCS and CPT Codes
– Changes in Code Descriptors
– Several Temporary C-codes Deleted
• Attachment A, Table 2
CR 8141 (cont’d)
• Cardiac Electrophysiologic Evaluation and
Ablation Codes
– AMA Deleted CPT Codes
• 93651 and 93652
– AMA Created New CPT Codes
93653
93654
93656
Part A Recurring Updates
•
Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment
System (PPS) Pricer Changes for Fiscal Year (FY) 2013
– http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2012Transmittals-Items/R2518CP.html
•
Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System
(PPS) Pricer Update Fiscal Year (FY) 2013
– http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2012Transmittals-Items/R2507CP.html
•
Update-Inpatient Psychiatric Facilities Prospective Payment System (IPF
PPS) Fiscal Year 2013
– http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2012Transmittals-Items/R2520CP.html
Part A
12
Parts A/B Recurring
Updates
•
Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code
(RARC), and Medicare Remit Easy Print (MREP) and PC Print Update
– http://www.cms.gov/Regulations-and– Guidance/Guidance/Transmittals/2012-Transmittals-Items/R2521CP.html
•
•
•
Medicare Contractor Annual Update of the International Classification of
Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
http://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/2012-Transmittals-Items/R2485CP.html
2013 Annual Update of Healthcare Common Procedure Coding System
(HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB)
Update
– http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/MM8037.pdf
13
ICD-10 Delayed
• ICD-10 compliance date delayed to October 1,
2014
• Keep Up to Date
– Sign up for CMS ICD-10 Industry Email Updateshttp://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD10_Industry_Email_Updates.html
– Follow @CMSGov on Twitter
– Subscribe to Latest News Page Watch https://public.govdelivery.com/accounts/USCMS/subscriber
/new?topic_id=USCMS_609
Medicare Initiatives
15
Comprehensive Error Rate
Testing (CERT)
•
National Claim Paid Error Rate
– Part A Institutional Facilities
•
•
7.9% Inpatient hospitals
4.4% Non-inpatient hospital facilities
– Part B Physician/Non-physician providers
•
9.2% Physician, lab and ambulance
•
Impacts all providers submitting Fee for Service claims
•
Limited random claim sample
•
Record requests must be received within 30 days from the initial CERT
letter
•
Right to Appeal? Yes
Fraud Prevention
Initiative
Aims to ensure correct payments are made to legitimate providers for
covered appropriate and reasonable services in all federal health care
programs
Expanded federal government effort to reduce fraud and other improper
payments health care programs to help ensure long-term viability
Federal government recovered $4 billion last year
Fraud prevention efforts focus on a more proactive “prevention and
detection” model that will help prevent fraud and abuse before payment is
made.
This information is available in the Fraud Prevention Toolkit on the web at:
https://www.cms.gov/Partnerships/04_FraudPreventionToolkit.asp#TopOfPage
17
CMS Provider
Compliance
• CMS Provider Compliance Webpage
– Educational products on how to avoid billing errors and improper
payments
– Compliance Products
• Quarterly Newsletter with CERT and RA findings
– October 2012 RA Findings on Major Joint Replacement, Cardiac Procedures,
Acute Inpatient Respiratory Conditions
• Podcasts
– September 2012 RA Findings on Medical Necessity of Renal and Urinary Tract
Disorders
• Fact Sheet
– August 2012 Complying with Medicare Signature Requirements
– http://www.cms.gov/Outreach-and-Education/Medicare-LearningNetwork-MLN/MLNProducts/ProviderCompliance.html
– https://www.novitas-solutions.com/cert/index.html
18
OIG Work Plan 2013
• OIG Work Plan outlines their current focus
areas and states the primary objectives of
each project
• Hospital Specific Items Include:
– Inpatient Billing for Medicare Beneficiary
– Same Day Readmission
– Compliance with Medicare Transfer Policy
• https://oig.hhs.gov/reports-andpublications/workplan/index.asp
19
Website Features
20
Medicare Part A Center
• https://www.novitas-solutions.com/parta/index.html
22
Medical Policy Center
23
Medical Policy Search
24
Self Service Options
25
Stay Up-to-Date
• Weekly Podcast
– Weekly podcast of the latest Medicare Updates
and other informative topics
– Subscribe- https://www.novitassolutions.com/podcasts/
• Web Updates
– Daily E-mail of the latest Medicare Updates
– Subscribe- https://www.novitassolutions.com/mailinglists.html
26
Jurisdiction 12 Contact
Information
Provider Customer
Contact Center
Interactive Voice
Response (IVR)
• 1-877-235-8073
• Hours of Operation
• 1-877-235-8073
• Hours of Operation
– Monday-Friday 8 am – 4
pm
• Call Flow
– Customer Service Center
– https://www.novitassolutions.com/csc/index.ht
ml
– Monday: 6 am- 8 pm
– Tuesday-Friday: 4 am- 8
pm
– Saturday: 6 am- 4 pm
• Step-by-Step Guide
– Customer Service Center
– https://www.novitassolutions.com/csc/index.ht27
ml
Contact Information
Laura Minter
J12 Project Manager
717-526-6280
laura.minter@highmarkmedicareservices.com
Janice Mumma
Provider Outreach and Education Supervisor
717-526-6528
janice.mumma@highmarkmedicareservices.com
