2013 Medicare Update for Clinical Social Workers

2013 Medicare Update for Clinical Social Workers

Today’s Presenters • Kathy Dunphy § Director Provider Outreach and Education • Jim Bavoso § Provider Outreach and Education, Lead Consultant Proprietary and Confidential

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. Proprietary and Confidential

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 Proprietary and Confidential

Acronyms ACT 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 5 Ask the contractor Electronic date interchange Proprietary and Confidential

Acronyms 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, 9 th Revision IOM Internet only manual IPPE 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 6 Initial physical preventive examination National provider identifier Proprietary and Confidential

Acronyms PECOS 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 7 Provider Enrollment Chain & Ownership System Web based training Proprietary and Confidential

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 Proprietary and Confidential

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

How Do I Stay on Top of Medicare Changes ?

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Code Pricing Search Tool Make it a Favorite! http: //www. NGSMedicare. com

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• • 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 Proprietary and Confidential

Medicare University http: //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 Proprietary and Confidential

New Look To Medicare University! Proprietary and Confidential

Education Just for J 13 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! Proprietary and Confidential

CMS Web Site http: //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 Proprietary and Confidential

New CMS Web Site! Proprietary and Confidential

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 Proprietary and Confidential

Now, For Some Recent Updates To 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 Proprietary and Confidential

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 Proprietary and Confidential

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. ” Proprietary and Confidential

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. Proprietary and Confidential

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. Proprietary and Confidential

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 § 90834 psychotherapy 45 minutes § 90837 psychotherapy 60 minutes • For CSW billing, E&M and Psychotherapy to not apply § 90833, 90836, 90838 § Other codes have not changed in 2013. Proprietary and Confidential

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. Proprietary and Confidential

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 Proprietary and Confidential

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 (e. Rx) Incentive Program; 1: 30 - 3: 00 pm ET. (03 -22 -2013) • National Government Services § J 13: 2013 Physician Quality Reporting System § April 18, 2013 1: 00 – 3: 00 PM Proprietary and Confidential

Sample PQRS Measures • 173 § Preventive Care and Screening: Unhealthy Alcohol Use – Screening • 226 § Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Proprietary and Confidential

PQRS 1500 Example Proprietary and Confidential

Medicare Part B Premiums and Deductibles 2012/2013 • 2012 • 2013 § Monthly Part B Premium for Beneficiary $99. 90 § Higher Part B Premium $85, 000/$170, 000 § Part B Deductible $140 § Part B Coinsurance 20% Proprietary and Confidential § 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 (MM 7631) • 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 Proprietary and Confidential

MLN Matters®Number: SE 1237 Importance 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 Proprietary and Confidential

Alert Concerning Impacts Arising From Having Non Compliant Physical Or Practice Address Information On File With Medicare • Special Edition Article SE 1245 • 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 Proprietary and Confidential

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 Proprietary and Confidential

Immediate Recoupment Process • MLN Matters Article MM 7688 § 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 Proprietary and Confidential

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 Proprietary and Confidential

Redesign Of The Medicare Summary Notice (MSN) MM 7676 • 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 Proprietary and Confidential

Electronic Summary Notice • Asking Providers to Promote to Beneficiaries • Free Materials Available for your Office! § Welcome to My. Medicare. gov Fact Sheet § e. MSN Overview Fact Sheets § Posters for the office § Over 7, 500 enrolled Proprietary and Confidential

Preventive Services

Waiver of Coinsurance And Deductible For Preventive Services MM 7012 • 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 Proprietary and Confidential

Preventive Services • • • MM 7641 Screening/Counseling for Obesity MM 7636 Intensive Behavioral Therapy for Cardiovascular Disease MM 7637 Screening for Depression MM 7633 Screening/Counseling to Reduce Alcohol Misuse MM 7610 Screening for Sexually Transmitted Infections/Counseling for Prevention Proprietary and Confidential

Local Coverage Determinations LCD For Psychiatry And Psychology Services (L 26895)

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 Guidelines Proprietary and Confidential You need both to accurately bill

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Electronic Data Interchange (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 Support Only § Questions regarding billing, codes, or denials on remits should be addressed to the Provider Contact Center Proprietary and Confidential

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 Proprietary and Confidential

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 Proprietary and Confidential

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 Proprietary and Confidential

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/Medicare. Provider. Sup. Enroll/11_Revalidations. asp • Revalidations have been mailed from September-December 2011 • January-December 2012 • January 2013 Proprietary and Confidential

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CMS Incentive Programs

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Help For Your Office!

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 80 Proprietary and Confidential

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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 Proprietary and Confidential

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 Proprietary and Confidential

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). Proprietary and Confidential

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 Proprietary and Confidential

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 Proprietary and Confidential

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 Proprietary and Confidential

J 13 Contact Information • IVR § 877 -869 -6504 • Provider Contact Center § 866 -837 -0241 • Fax on Demand § 866 -709 -1905 • EDI Helpdesk § 877 -273 -4334 • Correspondence National Government Services Part B Provider General Written Inquiries P. O. Box 6189 Indianapolis, IN 46207 -6189 • New Direct Telephone line for Provider Enrollment (J 13) § 888 -379 -3807 Proprietary and Confidential

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 Proprietary and Confidential

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 § NGS_EDI_Part. B@wellpoint. com Proprietary and Confidential

Contacting The COBC SE 1205 • 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 Proprietary and Confidential

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 33847 Detroit, MI 48232 Proprietary and Confidential

Resources

Resources • • http: //www. NGSMedicare. com http: //www. cms. com/ http: //www. NGSconnex. com http: //www. cms. gov/MLNProducts Proprietary and Confidential

Appeals – Part B • Reversals due to: § Correcting modifiers § Correcting diagnosis § Correcting procedures • Recommended forms • Telephone reopenings § http: //www. NGSMedicare. com § Select Appeals Proprietary and Confidential

National Government Services Web Update

We Need To Hear From You! • Survey presents when using the National Government Services Web site § We look at survey scores every day § 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! Proprietary and Confidential

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! • Any comments today ? Proprietary and Confidential

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 Proprietary and Confidential