10/1/ NOA 3 rd Party Update 2018 NOA 3 RD PARTY UPDATE

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1 2018 NOA 3 RD PARTY UPDATE What you need to know going forward into NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 3 1

2 2019 Changes in ICD-10 Diagnosis Coding ROUGHLY 200 ADDITIONS AND OR ALTERATIONS OF CODES AFFECTING ODs and OMDs LID AND LASH DISORDERS EYELID MALIGNANCIES Changes in ICD-10 Diagnosis Coding ICD-10 RESOURCES AVAILABLE TO NOA MEMBERS NOA ICD-10 NEWSLETTER ICD-10 DATA.COM ONLINE CMS ICD-10 INDEX AND TABULAR LIST NOA ICD-10 Coding Resource 6 2

3 2019 NOA ICD-10 Coding Resource 7 ICD-10 for 2019: NOA 3 rd Party Resource When to Use If you use EHR to select your diagnosis code, use it to confirm EHR codes If you don t have EHR, use to determine the correct 2019 ICD-10 codes 8 ICD-10 for 2019: NOA 3 rd Party Resource 9 3

4 ICD-10 for 2019: NOA 3 rd Party Resource ICD-10 for 2019: NOA 3 rd Party Resource Anatomy or Dx Category Search: 12 4

5 96 DIABETIC RETINOPATHY CODES 13 ICD-10 for 2019: NOA 3 rd Party Resource 14 ICD-10 for 2019: NOA 3 rd Party Resource 15 5

6 16 TYPE IN SEARCH TERM HERE ICD-10 Online Resource The Web's Free 2019 ICD-10- CM/PCS Medical Coding Reference/

7 19 Electronic 2019 ICD-10 Code Tables & Index Use Control F to Quickly Search 100 s of pages 20 Electronic 2019 ICD-10 Code Tables & Index 21 7

8 ICD-10 Coding CARDINAL Rules NEVER USE A GENERAL ICD-10 DIAGNOSIS CODE WHEN A MORE SPECIFIC CODE COULD BE USED ALWAYS, ALWAYS CODE AT THE MOST SPECIFIC LEVEL. DO NOT RELY ON YOUR EHR ICD-10 CODE SELECTION. MAKE SURE YOUR EHR HAS CODED THE VISIT AS SPECIFICALLY AS POSSIBLE. 22 ICD-10 Coding CARDINAL Rules AT LEAST ONCE A YEAR YOU SHOULD CODE ALL OF A PATIENT S EYE RELATED DIAGNOSES AT THEIR MOST SPECIFIC LEVEL, EVEN IF THAT VISIT POINTS TO ONLY ONE OF THOSE DIAGNOSES. SPECIFIC DIAGNOSIS CODING, ESPECIALLY WITH SYSTEMIC DISEASE, CAN INCREASE YOUR REIMBURSEMENT VIA MIPS LEAD TO CLOSER FOLLOWUP BY MEDICARE AND THE PCP HELP KEEP THE PATIENT HEALTHY AND OUT OF THE HOSPITAL 23 Hierarchical Condition Category (HCC) Coding Of Your Patient Mix 1 Risk adjustment facilitates more accurate comparisons by accounting for differences in the clinical complexity of beneficiaries between practices. 2 At least once a year you should code all of a patient s eye related diagnoses, at their most specific level, even if that visit points to only one of those diagnoses. 3 The results of HCC coding will affect your MIPS score and Medicare reimbursement in the future. 24 8

9 2018 NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 25 PROPOSED CHANGES IN 2019 MIPS MIPS PERFORMANCE CATEGORIES Previously Advancing Care Information SOURCE 27 9

10 MIPS EXEMPTIONS IN 2019 You are exempt if you do not exceed. BOTH ALL THREE SOURCE 28 OPTING-IN TO MIPS INDIVIDUAL OPTOMETRIST EXAMPLE EXCEEDS $90K LESS THAN 200 EXCEEDS 200 SOURCE 29 SOURCE 30 10

11 SOURCE MIPS ISSUE

12 2018 Promoting Interoperability IMPROVEMENT ACTIVITIES COST VALUE 36 12

13 SOURCE 37 MIPS REPORTING CAVEATS ** You must report measures compatible with your certified EHR technology. Ask your vendor which measures your software is designed to report, ask how you must configure your software to report correctly, and make certain you enter correct data on every appropriate patient. *** To use the AOA registry, your EHR software must be compatible with AOA s MORE, and you must have enrolled with AOA s MORE. Check with the AOA and your EHR vendor

14 2018 NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 40 New Medicare Patient Card Numbers Get NEW MEDICARE Ready! CARD ID NUMBERS 41 New Medicare card ID numbers Nebraska Medicare patients should have their new cards. If a Medicare patient says they did not get a card: Print and give them the Still Waiting for Your New Card? handout (in English or Spanish). Or tell them to call Medicare ( ). There might be something that needs to be corrected, such as updating their mailing address

15 New Medicare card ID numbers If there is a glitch with use of the new number, you can continue to use their original Health Insurance Claim Number through December 31, Just refile the claim with the old number NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 44 Reporting Diabetic Eye Exams to PCP To facilitate OD to PCP communication, below are links to membership information for the Nebraska Medical Association NMA The Metro-Omaha Medical Society Omaha Area the Lancaster County Medical Society Lancaster County

16 Reporting diabetic eye exams to PCP When a fax number is available, faxing might be the most expedient method of transferring eye exam findings. Important note: HIPAA does not require patient permission for forwarding protected health information (PHI) to the patient s PCP. [SOURCE] NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 47 Physician Compare 48 16

17 49 50 Documentation of Current Medication Diabetes: Eye Exam Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Controlling High Blood Pressure (outcomes measure) Closing the Referral Loop: Receipt of Specialist Report 51 17

18 52 Physician Compare Video Check out the Physician Compare How-To video The Physician Compare How-To video shows the various ways patients and caregivers can search for Medicare clinicians and groups on the website. Share this video with patients and caregivers to help them easily navigate the website to find a clinician or group that best fits their needs NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 54 18

19 HIPAA Privacy Disclosure of PHI to Family - Friends A HIPAA covered entity may share protected health information with a patient s family members, relatives, friends, or other persons identified by the patient as involved in the patient s care. A covered entity also may share information about a patient as necessary to identify, locate, and notify family members, guardians, or anyone else responsible for the patient s care, of the patient s location, general condition, or death. Source 55 HIPAA Privacy Disclosure of PHI to Family - Friends The covered entity should get verbal permission from individuals or otherwise be able to reasonably infer that the patient does not object, when possible; if the individual is incapacitated or not available, covered entities may share information for these purposes if, in their professional judgment, doing so is in the patient s best interest. Source 56 HIPAA Privacy Disclosure of PHI to Family - Friends For most disclosures, a covered entity must make reasonable efforts to limit the information disclosed to that which is the minimum necessary to accomplish the purpose. Minimum necessary requirements do not apply to disclosures to health care providers for treatment purposes. Source 57 19

20 HIPAA Privacy Disclosure of PHI to other Professionals The Privacy Rule allows doctors, nurses, hospitals, laboratory technicians, and other health care providers that are covered entities to use or disclose protected health information for treatment purposes without the patient s authorization. Examples given: such as X-rays, laboratory and pathology reports, diagnoses, and other medical information source, NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 59 CMS: Medicare-Medicaid Dual Eligible Claims You Cannot Charge a Qualified Medicare Beneficiary Medicaid Patient for Medicare Deductibles, Coinsurance, or Copayments 60 20

21 CMS: Medicare-Medicaid Dual Eligible Claims CMS is Implementing the Qualified Medicare Beneficiary Indicator in the Medicare Fee-For- Service Claims Processing System to notify the provider and the patient.. 61 CMS: Medicare-Medicaid Dual Eligible Claims As appropriate, one or more of the following new codes will be returned: N781 No deductible may be collected as patient is a Medicaid/Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance, deductible or co-payments. N782 No coinsurance may be collected as patient is a Medicaid/Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance, deductible or co-payments. N783 No co-payment may be collected as patient is a Medicaid/Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance, deductible or co-payments. 62 Medicare-Medicaid Dual Eligible Claims BALANCE BILLING MEDICAID AFTER RECEIVING MEDICARE REIMBURSEMENT Medicaid pays the lesser of the Medicare or Medicaid allowable amount of any remaining amount due. So, for example, Let s say the Medicare allowable is $100 for a service, with Medicare paying $80 (80% of the allowable). Let s say the Medicaid allowable is $60. Medicaid will pay nothing, since the provider has already received more from Medicare than the Medicaid allowable 63 21

22 MEDICAID MANAGED CARE United Health Care Community Plan Switch from Superior Vision to March Vision UnitedHealthcare Community Plan of Nebraska is pleased to welcome MARCH Vision Care as a new provider vendor for routine eye care services. The intended transition date for MARCH Vision Care to begin servicing UnitedHealthcare Community Plan of Nebraska members is November 1, MEDICAID MANAGED CARE United Health Care Community Plan Is signing up with March Vision Required? You are not required to enroll as a provider with March Vision Not enrolling as a provider with March Vision would prevent your office from providing routine care and glasses to patients covered by Nebraska Medicaid s United HealthCare Community Plan Whether you enroll with any 3 rd Party is a business decision that needs to be made by your office. 65 Before Enrolling with Any 3 rd Party Whether you enroll with any 3 rd Party is a business decision. It is suggested you assess such things as: The 3 rd Party s Contract Agreement The Provider Policy Manual** Usually more comprehensive than the contract and may be changed without provider input? Reimbursement rates Current patient load and demographics Chair costs, etc. **Policy Manual examples: March Vision 79 pages BCBSNE 120 pages Humana VCP 46 pages VSP: check website EyeMed: check website 66 22

23 Cataract Surgery Co-Management United HealthCare Community Plan File your medical claim line with Medicare as you do with any co-managed postop patient (post-op surgical claim with a 55 modifier, but omit refraction here). When you get your Medicare EOB, you can try to balance bill UHC for the medical claim lines, but you likely will not be paid anything additional since Medicare s reimbursement probably exceeds what the Medicaid UHC Community Plan allows. You cannot balance bill the patient for the difference, or the deductible, copay etc. 67 Cataract Surgery Co-Management United HealthCare Community Plan If the patient is getting cataract post-op glasses Bill DME as you would with any Medicare post-op patient Once you get the DME EOB, you can try balance billing Superior Vision (March Vision after 11/1). However, as before, you will most likely be paid nothing additional since the amount paid by DME will exceed what Superior or March allows. You cannot balance bill the patient for the difference, or the deductible, co-insurance, etc NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 69 23

24 2019 NOA 3RD PARTY RESOURCES Dr. Janet Fett Newsletter Bulletins Medicare representative Dr. Chris Wolfe Q&A Website resources Presentations (Spring conference, Kearney convention, etc.) NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 71 Unilateral vs. Bilateral Coding of CPT Services and Procedures Is Reimbursement Going to be Paid for One or Both Eyes? Do I Use the RT/LT Modifiers? You can determine this information by going to the CMS page entitled Physician Fee Schedule Search 72 24

25 1. Use Google to search Physician Fee Schedule Search 2. Select current year 3. Click in Payment Policy Indicators Select Single HCPCS Code 5. Select Specific MAC 6. Enter CPT code in question (example 92225) 7. Select All Modifiers [Extended Ophthalmoscopy] 8. Select NEBRASKA 9. Click SUBMIT

26 2018 NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 76 3 rd Party Index Page 20 pages containing links to articles previously published in the NOA 3rd Party Newsletter. Only current, relevant articles are included. Also included are links to Internet websites currently important to the practice of optometry. Medicare Medicaid HIPAA Etc. 77 1: Click (don t hover) 2: Click 78 26

27 3: Complete 4: Click 79 3 rd Party Index Page CAN BE SEARCHED USING CNTRL-F Search Function ALPHABETICAL Index TOPICAL Index 80 CNTRL-F 81 27

28 Alphabetical Index 82 Topical Index 83 Topical Index 84 28

29 2018 NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 85 May 2017 Issue of 3 rd Party News Links to 13 pages of 3 rd Party Resources

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32 NOA 3 rd Party Update ICD-10 Coding Changes Implemented This Month MIPS Proposed Changes for 2019 CMS WPS Topics Medicare Card Diabetic Eye Exam Reporting Physician Compare HIPAA Privacy MEDICAID Managed Care NOA 3RD PARTY RESOURCES Determining Unilateral vs. Bilateral Codes 3rd Party Index Page Online Other NOA Resources Online DR. QUACK S LOOK INTO THE FUTURE OF EYECARE Dr. Quentin Quack 96 32

33 A Look Into Your Future The rapid change in eye care Kiosk and online eye exams Internet prescription glasses and contact lenses Evolving 3 rd Party reimbursement changes Reimbursement based on Quality Reimbursement based on patient s diagnosis and severity Limited reimbursement for ancillary testing (fields, OCT) Medical diagnostic software 97 A Look Into Your Future The rapid change in eye care Kiosk and online eye exams 98 A Look Into Your Future The rapid change in eye care Internet prescription glasses and contact lenses 99 33

34 A Look Into Your Future The rapid change in eye care Medical diagnostic software 100 A Look Into Your Future The rapid change in eye care Evolving 3rd Party reimbursement changes 101 A Look Into Your Future The rapid change in eye care WHAT TO DO? REMAIN UNITED WITH YOUR PEERS VIA THE AOA and NOA GOING IT ALONE FORBODES PROESSIONAL HARDSHIP OR FAILURE Those who learned to collaborate and improvise most effectively have prevailed. Charles Darwin

35 A Look Into Your Future The rapid change in eye care WHAT TO DO? MEDICAL EYECARE SHOULD BECOME THE DOMINANT EMPHASIS OF YOUR PATIENT CARE PURSUE ENROLLMENT WITH MEDICAL INSURERS PURSUE COOPERATION OR ENROLLMENT WITH ACCOUNTABLE CARE ORGANIZATIONS STAY UP-TOO-DATE WITH EQUIPMENT AND SOFTWARE Those who learned to collaborate and improvise most effectively have prevailed. Charles Darwin 103 A Look Into Your Future The rapid change in eye care WHAT TO DO? BECOME LESS DEPENDENT ON PROVIDING THOSE SERVICES AND MATERIALS THAT CAN BE EASILY OBTAINED ON THE INTERNET WHEN PROVIDING OPTICAL MATERIALS, PLACE MAJOR EMPHASIS ON QUALITY PROVIDE EXCEPTIONALLY WARM, FRIENDLY, CARING SERVICE. MONITOR PATIENT EVALUATIONS ON PHYSICIAN COMPARE Those who learned to collaborate and improvise most effectively have prevailed. Charles Darwin 104 A Look Into Your Future The rapid change in eye care WHAT TO DO? EXCEED YOUR PATIENTS EXPECTATIONS; IF THE LOVE YOU AND LOVE YOUR STAFF, THEY WON T FORGET YOU!

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