Office of Billing Compliance 2014 Professional Coding, Billing and Documentation Program. Radiation Oncology
|
|
- Brian King
- 6 years ago
- Views:
Transcription
1 Office of Billing Compliance 2014 Professional Coding, Billing and Documentation Program Radiation Oncology Prepared by: Medical Compliance Services, Miller School of Medicine/University of Miami and Compliance Concepts, Inc. March
2 What is a Compliance Program? 7 Elements of an Effective Compliance Program A centralized process to promote honest, ethical behavior in the day-to-day operations of an organization, which will allow the organization to identify, correct, and prevent illegal conduct. It is a system of: FIND FIX PREVENT The University of Miami implemented the Billing Compliance Plan on November 12, The components of the Compliance Plan are: 1. Policies and Procedures 2. Having a Compliance Officer and Compliance Committees 3. Effective Training and Education 4. Effective Lines of Communication ( or ) 5. Disciplinary Guidelines 6. Auditing and Monitoring 7. Detect Non-Compliance Issues and Develop Corrective Action Plans 2 2
3 The Government In order to address fraud and abuse in the Healthcare Field, the government has on-going reviews and investigations nationally to detect any actual or perceived waste and abuse. The Government does believe that the majority of Healthcare providers deliver quality care and submit accurate claims. However, the amount of money in the healthcare system, makes it a prime target for fraud and abuse. Centers for Medicare and Medicaid Services (CMS) Estimates > $50 Billion In Payment Errors Annually in Healthcare OIG reported that in FY 2013 that $5.8 billion was recovered from auditing providers 3 3
4 Health Care Laws There are five important health care laws that have a significant impact on how we conduct business: False Claims Act Health Care Fraud Statute Anti-Kickback Statute Stark Law Sunshine Act Requires manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs to report certain payments and items of value >$10 given to physicians and teaching hospitals. 4
5 False Claims Act : United States Code Title What is a False Claim? A false claim is the knowing submission of a false or fraudulent claim for payment or approval or the use of a false record that is material to a false claim. OR Reckless disregard of the truth or an attempt to remain ignorant of billing requirements are also considered violations of the False Claims Act. 5
6 How do you create a False Claim? One method is to submit a claim form to the government This certification forms the basis for a false claim. 6
7 7
8 What Are We Seeing Out There? Audits are being conducted for all payer types based on the medical necessity of E/M levels. The audits are generally expressed in two ways: Frequency of services (how often the patient is seen) and, Intensity of service (CPT level). 8
9 Elements of Medical Necessity CMS s determination of medical necessity is separate from its determination that the E/M service was rendered as billed. Complexity of documented co-morbidities that clearly influenced physician work. Physical scope encompassed by the problems (number of physical systems affected by the problems). 9
10 Referring Page: November 2012 E/M Coding: Volume of Documentation versus Medical Necessity Word processing software, the electronic medical record, and formatted note systems facilitate the "carry over" and repetitive "fill in" of stored information. Even if a "complete" note is generated, only the medically reasonable and necessary services for the condition of the particular patient at the time of the encounter as documented can be considered when selecting the appropriate level of an E/M service. Information that has no pertinence to the patient's situation at that specific time cannot be counted. An ISO 9001:2008 certified company 10
11 Office of the Inspector General (OIG) Audit Focus Annually OIG publishes it "targets" for the upcoming year. Included is: Cutting and Pasting Documentation in the EMR REMEMBER: More volume is not always better in the medical record, especially in the EMR with potential for cutting/pasting, copy forward, pre-defined templates and pre-defined E/M fields. Ensure the billed code is reflective of the service provided on the DOS. 11
12 Medical Record Documentation Standards Pre EMR: If it isn t documented, it hasn t been done. - Unknown Post EMR: If it was documented, was it really done and was it medically necessary to do. - Reviewers 12
13 Quality & Cost: Emphasis on Pay-for- Performance PQRS & Meaningful Use Practitioner reimbursement will likely be tied to outcomes soon. Some experts say that the CMS penalties for not participating in the Physician Quality Reporting System (PQRS) signal that the pay-for-performance trend is not fading away and will likely will be adopted by private payers. I think we re slowly transitioning out of fee-for-service and into a system that rewards for quality while controlling cost, says Miranda Franco, government affairs representative for the Medical Group Management Association. The intent of CMS is to have physicians moving toward capturing quality data and improving metrics on [them]. 13
14 Guidelines for Teaching Physicians, Interns, Residents and Fellows For Billing Services, All Types of Services Involving a Teaching Physician (TP) Requires Attestations In EHR or Paper Charts 14
15 Evaluation and Management (E/M) E/M IP or OP: TP must personally document at least the following: That s/he performed the service or was physically present during the key or critical portions of the service when performed by the resident; AND The participation of the teaching physician in the management of the patient. Example: I saw and examined the patient and agree with the resident s note Time Based E/M Services: The TP must be present and document for the period of time for which the claim is made. Examples : Critical Care Hospital Discharge (>30 minutes) or E/M codes where more than 50% of the TP time spent counseling or coordinating care 15 15
16 Procedures Minor (< 5 Minutes & 0-10 Day Global): For payment, a minor procedure billed by a TP requires that s/he is physically present during the entire procedure. Example: "I was present for the entire procedure." Endoscopy Procedures (excluding Endoscopic Surgery): TP must be present during the entire viewing for payment. The viewing begins with the insertion and ends with the removal. Viewing of the entire procedure through a monitor in another room does not meet the presence requirement. Example: "I was present for the entire viewing." Major (>5 Minutes) SINGLE Procedure / Surgery When the teaching surgeon is present or performs the procedure for a single non-overlapping case involving a resident, he/she or the resident can document the TP s physical presence and participation in the surgery. Example: I was present for the entire (or key and critical portions) of the procedure and immediately available. Medical Student documentation for billing only counts for ROS and PFSH 16 16
17 Unacceptable TP Documentation Assessed and Agree Reviewed and Agree Co-signed Note Patient seen and examined and I agree with the note As documented by resident, I agree with the history, exam and assessment/plan 17
18 Working With NP's and PA's (NPP's) The NP or PA MUST BE AN EMPLOYEE OF THE PRACTICE AND CANNOT BE A HOSPITAL EMPLOYEE TO UTILIZE ANY OF THEIR DOCUMENTATION FOR PHYSICIAN BILLING AS SHARED Shared visit with an NPP may be billed under the physician's name only if: The physician provides a face-to-face portion of the visit and The physician personally documents in the patient's record the portion of the E/M encounter with the patient they provided. If the physician does not personally perform or personally and contemporaneously document their face-to-face portion of the E/M encounter with the patient, then the E/M encounter may only be billed under the PA/ARNP's name and provider number Procedures must be billed under the performing provider & not the supervisor. They cannot be shared 18
19 National 12 CMS Data For Speciality E/M 60% 50% 52% 40% 30% 20% 10% 0% 24% 14% 2% 7% National Dist. 19
20 Top Procedure Codes Billed in 2013 Top 5 Procedure All other Procedure Codes Description % RADIATION THERAPY,DOSIMETRY PLAN 26% STEREOSCOPIC X-RAY GUIDANCE 16% RADIATION,MANGEMENT, TX'S 14% CT GUIDANCE PLACEMENT RAD THERAPY FIELDS 13% RADN TREATMENT AID(S) COMPLX 8% 12% Total 100.0% Top 5 E&M Description % All other E/M Codes OFFICE/OUTPT 50% OFFICE/OUTPT 11% OFFICE/OUTPT VISIT,EST,LEVL IV 10% OFFICE/OUTPT VISIT,EST,LEVL II 9% OFFICE/OUTPT VISIT,NEW,LEVL V 8% 12% Total 100.0% 20
21 2014 CPT Code Changes Review Interprofessional consultations New codes to report interprofessional ( doctor-to-doctor ) telephone/internet consulting. Code is defined as an interprofessional telephone/internet assessment and management service provided by a consultative physician, including a verbal and written report to the patient s treating/requesting physician or other qualified health care professional, and involves 5 to 10 minutes of medical consultative discussion and review : 11 to 20 minutes of medical consultative discussion and review 99448: 21 to 30 minutes of medical consultative discussion and review 99449: 31 minutes or more of medical consultative discussion and review Medicare Does Not Pay This Service 21
22 2014 CPT Code Changes Review Interprofessional consultations The services will typically be provided in complex and/or urgent situations where a timely face-to-face service with the consultant may not be possible. The written or verbal request, its rationale, and the conclusion for telephone/internet advice by the treating/requesting physician or other qualified health care professional should be documented in the patient s medical record. Medicare allowable $
23 Machines don t treat cancer. People do. A team of specialized experts provide all aspects of patient care Radiation Oncologists Radiation Therapists Medical Phy sicists Nurses Medical Dosimetrists 23
24 Radiation Oncology Continuum/Flow E&M Simulation Treatment Planning Physics Checks Treatment Delivery Weekly Management Follow-up 24
25 CT for Placement of Fields Simulation Patient Continuum Physician Orders All Procedures need written directives ACR Treatment Planning: Brachy, 2D, 3D, IMRT Dosimetry Calcs; Micro Dosimetry Tx Devices, Continuing Medical Physics Special Physics Consult, Special Tx Procedure, Port films 25
26 Sample Wording for Dose Distribution Plans The signature affixed to this document signifies the physician's review and approval of the entire document, including the dose distribution plan (when applicable), basic dosimetry calculations, verification calculations, treatment devices, and medical necessity documents (3-D and IMRT treatment planning document). 26
27 Physician Supervision Rules General furnished under a physicians general supervision. Direct present, in area and immediately available. Personal must be in attendance and in the room.
28 How to Interpret Direct Supervision Professional Supervision In a hospital campus the physician must be immediately available, on campus. The physician should not be performing another procedure or involved with another patient encounter. Hospital Supervision The majority of Radiation procedures performed or supervised by a physician fall under direct supervision.
29 Both and have direct supervision - what does that mean? 29
30 Both and now have direct supervision what does that mean MORE... 30
31 77421 CPT Insiders View Documentation Required The documentation for the IGRT, procedure, would consist of the therapist recording exactly what was performed with the patient's name, date and signature. Remember the documentation must be labeled IGRT, what type, "Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy", who, what, when, where and why. The physician then according to the AMA will, "The radiation oncologist reviews the images daily and compares with previous shifts. Feedback by the physician is given to the therapists about the adequacy of registrations and, if necessary, about the steps necessary to improve future registrations as well as for the required treatment modifications". AMA
32 Indications for IGRT Three-dimensional conformal therapy Intensity Modulated Radiation Therapy Particle Beam Therapy Stereotactic Radiosurgery (SRS) Stereotactic Body Radiation Therapy 32
33 Medicare Supervision Rules Apply to IGRT Codes Rules General supervision: The physician is not necessarily on-site. The services of the facility are provided under his or her supervision and control, however, and the physician is responsible for the calibration of the equipment, the training of the technologists, and overall operations. (76950-BAT) Direct supervision: The physician must be physically on the premises and in the suite of offices where the tests are being performed. In the office setting, the physician must be present in the office suite and immediately available. This is defined as within earshot (not just reachable by beeper, and not merely in the same building). ( IGRT/CT Based or KV IGRT 77421) 33
34 Medicare Supervision Summary of Common IGRT Codes (CT-guidance) : Direct supervision - Freestanding and Hospital Based can bill technical if performed and documented but packaged for Hospital must be on claim (stereoscopic x-rays: Direct Supervision Physician must approve prior to the next treatment in order to bill both technical and professional and both freestanding an hospital can bill both components if performed and documented however technical is packaged for Hospitals but must be on the claim : BAT - General supervision : Freestanding and Hospital can bill technical when performed and documented. Packaged for Hospital but must be on claim 34
35 Codes for IGRT Ultrasound : CPT aka BAT Stereoscopic X-ray : CPT (KV Based IGRT) Computerized Tomography : CPT (CT based IGRT) Cone beam CT Tomotherapy CT-on-Rails Fluoroscopy Port film
36 Tomotherapy /Cone-Beam CT /CT-on- Rails ASTRO currently recommends that CPT code 77014; Computed tomography guidance for placement of radiation therapy fields, be used for CT based IGRT. It is important to note that in order to meet the criteria for CT based IGRT, a radiation oncologist, medical physicist, or trained therapist under the supervision of the radiation oncologist must review the fused CT images and supervise any patient repositioning 36
37 IGRT Do not bill and for the same patient on the same day Do not bill and for the same patient on the same day Do not bill and for the same patient on the same day It is critical that appropriate documentation be made for physician involvement and for the technical aspects of all IGRT codes. This work is in addition to the physician work involved with the weekly management CPT code BID (Patients Treated 2 times daily) The same repeat service modifier (76 or77) will be used on the second image guidance service performed each day. Remember that the first IGRT service performed for the patient in the morning must be reviewed and approved by the physician prior to the second treatment that day. Each IGRT service must be reviewed and approved/accepted by the physician prior to the next patient treatment, so it would not be acceptable for the physician to review both the am and pm images at the end of the day in this case, you would report a single IGRT service. 37
38 Who is responsible for billing? Physician Physicist Therapist Patient Bill Dosimetrist Nurse Support Staff Every discipline plays a role in the charge capture process 38
39 77295 Therapeutic radiology simulationaided field setting; 3-dimensional Revised Therapeutic radiology simulation3-dimensional radiotherapy plan, including dose-aided field setting volume histograms 3-dimensional CPT 2014 revised so it better reflects current practice. The code now emphasizes the physics and dosimetry planning work 39
40 Radiation Therapist Treatment SIMPLE TREATMENT DELIVERY Codes ) SINGLE Port Parallel Ports No Devices SIMPLE Devices INTERMEDIATE TREATMENT DELIVERY ) Two Separate areas treated 3 or more ports on a single area Multiple Devices (including wedges) Tangential Ports without devices COMPLEX TREATMENT DELIVERY ( ) 3 or more areas treated Custom Devices Rotational Beam Compensator Special particle beam (e.g., electrons, neutrons) IMRT TREATMENT DELIVERY CODE (77418) Proton Treatment Delivery ( )
41 Radiation Therapist Treatment Establishment of Energy Level Photon Delivery Daily Kilovoltage Treatment Delivery Superficial and/or Orthovoltage Daily Treatment Delivery Simple Co-60, accelerator up to 5 MV maximum energy Accelerator 6-10 MV maximum energy Accelerator MV maximum energy Accelerator, 20 MV or greater maximum energy Daily Treatment Delivery Intermediate Co-60, accelerator up to 5 MV maximum energy Accelerator 6-10 MV maximum energy Accelerator MV maximum energy Accelerator, 20 MV or greater maximum energy Daily Treatment Delivery Complex Co-60, accelerator up to 5 MV maximum energy Gamma Knife Not used MDACC Accelerator 6-10 MV maximum energy Accelerator MV maximum energy Accelerator, 20 MV or greater maximum energy IMRT any energy
42 Charges Associated with the Radiation Therapist The professional values are related to the amount of time and effort expended by the physician in the care of a patient during the course of radiation therapy. Technical complexity is related to the difficulty encountered by the radiotherapist on the treatment machine in terms of set up and daily treatment delivery to the patient. Institutional treatment delivery is a technical (hospital or freestanding facility) component reported under these technicalonly codes. Technical treatment delivery is reported on a daily basis by all institutions. Medicare requires that these codes be separated with the physician component being billed on a weekly basis (77427) and the treatment delivery being billed per treatment fraction.
43 Charges Associated with the Radiation Therapist TREATMENT DELIVERY CODING GUIDELINES A treatment delivery code is reported for each treatment session In the case of hyperfractionation, there are 2 treatment sessions on the same day, therefore 2 delivery codes could be reported. If 2 different energies are used during the same treatment session, then the single code that corresponds to the highest energy used is reported. For Electrons, since the energies vary widely, the coding is based on the maximum beam capability of the equipment. The number of treatment delivery codes reported will depend on the number of fractions delivered. Only one code reported per treatment session.
44 Patient Service Charges Professional Charges (Bill on CMS 1500) Charges prompted by the physician s involvement into a process designed to provide care for the patient. The physician s intellectual involvement directs not only his or her direct involvement but also the Physics charges that are required for patient care. Technical Charges (Hospital bill on UB04) Charges rendered by the treatment center for provision of all of the equipment and personnel that the physician must use to deliver treatment. These include the treatment unit, examination rooms, simulators, and other procedures not directly supplied by the physician but required via the treatment plan. 44
45 CMS is Comparing, so what does that mean? The professional and technical complexity level must match. Physician billing must communicate with hospitals. Must share records and documentation. Billing Staff will have to be adequately trained to on determination of complexity Billing Staff for Hospitals and Doctors must communicate 45
46 IMRT and Medical Necessity Each chart should contain a patient specific statement by the treating physician documenting the medical necessity of performing IMRT rather than performing conventional or 3D planning and delivery detailing patient specific goals and requirements of the treatment plan, including the specific dose constraints for the target(s) and nearby critical structures. Although it may be apparent from the patient history, each chart should meet the LCD for IMRT From First Coast: LCD ID Number L28892 LCD Title: Intensity Modulated Radiation Therapy (IMRT) 46
47 Modifier Reminders Modifier 25: Significant, Separately Identifiable E/M by the Same Physician/Group on the Day of a minor Procedure: on the day a procedure the patient's condition required a significant, separately identifiable E/M service above and beyond the usual care associated with the procedure that was performed. Modifier 59: Distinct Procedural Service: Under certain circumstances, indicate that a procedure or service was independent from the services performed on the same day. Modifier GC: Service involved a resident or fellow. Payment not affected. 47
48 CCI Audit Reviews for Radiation Oncology: Support for medical necessity of IMRT in documentation ( review LCDs and NCDs) Providing services without proper physician supervision Weekly E/M code medical necessity to repeat specific history areas Frequency of visits after treatment 48
49 Increased specificity of the ICD-10 codes requires more detailed clinical documentation to code some diagnoses to the highest level of specificity. Coding and documentation go hand in hand ICD-10 based on complete and accurate documentation, even where it comes to right and left or episode of care. ICD-10 should impact documentation as physicians are required to support medical necessity using appropriate diagnosis code this is not an easy situation. Will not change the way a physician practices medicine 49
50 ICD-10 Implementation Example 50
51 HIPAA Final Reminders for All Staff, Residents, Fellows or Students Health Insurance Portability and Accountability Act HIPAA Protect the privacy of a patient s personal health information Access information for business purposes only and only the records you need to complete your work. Notify Office of HIPAA Privacy and Security at if you become aware of a potential or actual inappropriate use or disclosure of PHI, including the sharing of user names or passwords. PHI is protected even after a patient s death!!! Never share your password with anyone and no one use someone else s password for any reason, ever even if instructed to do so. If asked to share a password, report immediately. 51
52 Any Questions 52
53 Available Resources at University of Miami, UHealth and the Miller School of Medicine If you have any questions or concern regarding coding, billing, documentation, and regulatory requirements issues, please contact: Gemma Romillo, Assistant Vice President of Clinical Billing Compliance and HIPAA Privacy Officer; or Iliana De La Cruz, RMC, Director Office of Billing Compliance Phone: (305) Also available is The University s fraud and compliance hotline via the web at or toll-free at (24hours a day, seven days a week). Office of billing Compliance website: 53
RADIATION ONCOLOGY RESIDENCY SUPERVISION POLICY
RADIATION ONCOLOGY RESIDENCY SUPERVISION POLICY This policy is intended to guide the activities of radiation oncology residents in insuring that patient care activities in which residents participate are
More informationAPEx Program Standards
APEx Program Standards The following standards are the basis of the APEx program. Level 1 standards are indicated in bold. Standard 1: Patient Evaluation, Care Coordination and Follow-up The radiation
More informationRadiation Oncology Exclusive Joint Seminar
Radiation Oncology Exclusive Joint Seminar Coding, Billing, Documentation & Compliance in Radiation Oncology July 19, 20 & 21, 2017 Wednesday, July 19, 1:00-5:00 Thursday, July 20, 8:00-5:00 Friday, July
More informationClinical Implementation of Electronic Charting
Clinical Implementation of Electronic Charting Lisa Benedetti, M.S. Beaumont Health System 2013 AAPM Spring Clinical Meeting Outline I. Implementation Team II. III. IV. Process Mapping External Beam Radiation
More informationHOWARD UNIVERSITY Position Description. POSITION TITLE: Radiation Safety Officer SALARY GRADE: HU-13. DATE REVISED: December 01, 2014 EEO CODE: 02
DEPARTMENT: POSITION NO: REPORTS TO: GRANT: No Yes BASIC FUNCTION: SUPERVISORY ACCOUNTABILITY: NATURE AND SCOPE: PRINCIPAL ACCOUNTABILITIES: Directs, develops and maintains a comprehensive radiological
More informationCompliance Program Updated August 2017
Compliance Program Updated August 2017 Table of Contents Section I. Purpose of the Compliance Program... 3 Section II. Elements of an Effective Compliance Program... 4 A. Written Policies and Procedures...
More informationOffice of Billing Compliance 2015 Coding, Billing and Documentation Program. Department of Radiation Oncology
Office of Billing Compliance 2015 Coding, Billing and Documentation Program Department of Radiation Oncology 2015 Code Changes Radiation Therapy Code Revisions 2 2015 Radiation Therapy Code Revisions Not
More informationDear Valued Network Physician:
, Radiation Oncology As announced on July 1, 009 on OxfordHealth.com and UnitedHealthcareOnline.com, medical coverage reviews for radiation therapy
More informationPOLICY AND PROCEDURE
AND PROCEDURE NUMBER: 0020 PAGE NUMBER: 1 of 7 I. PURPOSE: To ensure compliance with Federal and State billing and documentation guidelines of all UMMG billing providers. II. SCOPE: University of Miami
More informationBasic Principles of Documentation, Billing, Coding & Compliance in Radiation Oncology
14 th ANNUAL BMSi-AMAC LAS VEGAS SEMINAR December 13, 14 & 15, 2017 Caesars Palace Resort & Casino Basic Principles of Documentation, Billing, Coding & Compliance in Radiation Oncology Two great companies
More informationAn Update of Radiation Oncology Quality and Safety Initiatives
An Update of Radiation Oncology Quality and Safety Initiatives Amy Heath, MS, RT(T) University of Wisconsin Hospital and Clinics Objectives Review importance of quality and safety in radiation oncology.
More informationPayment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL
Payment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL Effective Date: 6/2017 Last Review Date: See Important Reminder at the end of this policy for important
More information3/20/2012. Presentation Outline. Objectives Abt Associates Model (2008) Abt-III? What (who) is that?
Presentation Outline Michael D. Mills, Ph.D., Ph.D.(c) Chair, AAPM Workforce Assessment Committee Current Manpower Resources and Models Abt Model Battista Model Mills Model (work in progress) Current Manpower
More informationCloning and Other Compliance Risks in Electronic Medical Records
Cloning and Other Compliance Risks in Electronic Medical Records Lori Laubach, Partner, Moss Adams LLP Catherine Wakefield, Vice President, Corporate Compliance and Internal Audit, MultiCare 1 AGENDA Basic
More informationOutpatient Hospital Facilities
Outpatient Hospital Facilities Chapter 6 Chapter Outline Introduce students to 1. Different outpatient facilities 2. Different departments involved in the reimbursement process 3. The Chargemaster 4. Terminology
More informationCDx ANNUAL PHYSICIAN CLIENT NOTICE
CDx ANNUAL PHYSICIAN CLIENT NOTICE - 2018 CDX Diagnostics is providing this annual notice in accordance with the recommendations made by the Office of Inspector General (OIG) as part of our CDx Compliance
More information8/28/2014. Compliance and Practical Challenges When Using Scribes: Just What the Doctor Ordered? Objectives of the Presentation
Compliance and Practical Challenges When Using Scribes: Just What the Doctor Ordered? Jerry Williamson MD. MJ. CHC. LHRM Objectives of the Presentation Definition of a Scribe Duties of a Scribe Regulatory
More informationShared and Incident To Billing of E/M Services in Radiation Oncology Updated November 2017
ASTRO Guidance on Shared and Incident To Billing of Evaluation and Management Services in Radiation Oncology The Centers for Medicare and Medicaid Services (CMS) establishes Medicare policy for the payment
More informationChapter. CPT only copyright 2008 American Medical Association. All rights reserved. 30Radiation Therapy Services
Chapter 30Radiation Therapy Services 30 30.1 Enrollment...................................................... 30-2 30.2 Benefits, Limitations, and Authorization Requirements...................... 30-2
More information9/17/2018. Critical to Practices
Critical to Practices Provides: Reviewing quality of care provided to patients. Education to providers on documentation guidelines. Ensuring all services are supported, and revenue captured. Defending
More informationA Day in the Life of a Compliance Officer
A Day in the Life of a Compliance Officer (for small physician practices) Mina Sellami, MBA, PMP, JD MedProv, LLC Julia Konovalov Medical Business Partners September 29, 2016 Agenda Government Regulations
More informationUWDRO RESIDENT SUPERVISION POLICY
Roles, Responsibilities and Patient Care Activities of Residents UNIVERSITY OF WASHINGTON RADIATION ONCOLOGY RESIDENT EDUCATION PROGRAM UNIVERSITY OF WASHINGTON MEDICAL CENTER HARBORVIEW MEDICAL CENTER
More informationAVOIDING HEALTHCARE FRAUD AND ABUSE; Responsibility, Protection, Prevention
AVOIDING HEALTHCARE FRAUD AND ABUSE; Responsibility, Protection, Prevention Presented by: www.thehealthlawfirm.com Copyright 2017. George F. Indest III. All rights reserved. George F. Indest III, J.D.,
More informationCompliance Program Code of Conduct
City and County of San Francisco Department of Public Health Compliance Program Code of Conduct Purpose of our Code of Conduct The Department of Public Health of the City and County of San Francisco is
More informationINLAND EMPIRE HEALTH PLAN CODE OF BUSINESS CONDUCT AND ETHICS. Our shared commitment to honesty, integrity, transparency and accountability
INLAND EMPIRE HEALTH PLAN CODE OF BUSINESS CONDUCT AND ETHICS Our shared commitment to honesty, integrity, transparency and accountability UPDATED: February 2014 TABLE OF CONTENTS Topic Page A. The IEHP
More informationCertified Ophthalmic Executive (COE) Review Day
Certified Ophthalmic Executive (COE) Review Day Compliance Plan & Chart Audits Financial Disclosure The instructor acknowledges a financial interest in the subject matter of this presentation. Presented
More informationRadiation Oncology Practice Accreditation Program Requirements
Radiation Oncology Practice Accreditation Program Requirements Contents Introduction... 4 Application for Accreditation... 4 Preliminary Self-Assessment (ROPA Website Toolkit)... 4 Checklist for Site Survey...
More informationOffice of Billing Compliance 2014 Professional Coding, Billing and Documentation Program. Medicine Cardiology
Office of Billing Compliance 2014 Professional Coding, Billing and Documentation Program Medicine Cardiology Prepared by: Medical Compliance Services, Miller School of Medicine/University of Miami and
More informationChapter 4732 Modifications Summary SEPTEMBER 30, 2016
Chapter 4732 Modifications Summary SEPTEMBER 30, 2016 PURPOSE, SCOPE, AND DEFINITIONS 4732.0100 PURPOSE AND SCOPE. No changes at this time. 4732.0110 DEFINITIONS. Amend and update existing definitions.
More informationCompliance Considerations for Clinical Laboratories
Compliance Considerations for Clinical Laboratories Elizabeth Sullivan, Esq. McDonald Hopkins, LLC 600 Superior Ave., E, Suite 2100 Cleveland, Ohio 44114 P: 216.348.5401 / F: 216.348.5474 esullivan@mcdonaldhopkins.com
More informationChapter. CPT only copyright 2009 American Medical Association. All rights reserved. 31Radiation Therapy Services
Chapter 31Radiation Therapy Services 31 31.1 Enrollment...................................................... 31-2 31.2 Benefits, Limitations, and Authorization Requirements...................... 31-2
More informationElectronic Health Records - Advantages and Pitfalls of Documentation
Electronic Health Records - Advantages and Pitfalls of Documentation Kansas City, KS HCCA Regional Conference September 25, 2015 1:00 P.M. 2:00 P.M. Presented by: Cynthia A. Swanson, RN, CPC, CEMC, CHC,
More informationCompliant Documentation for Coding and Billing. Caren Swartz CPC,CPMA,CPC-H,CPC-I
Compliant Documentation for Coding and Billing Caren Swartz CPC,CPMA,CPC-H,CPC-I caren@practiceintegrity.com Disclaimer Information contained in this text is based on CPT, ICD-9-CM and HCPCS rules and
More informationhttp://www.bls.gov/oco/ocos299.htm Radiation Therapists Nature of the Work Training, Other Qualifications, and Advancement Employment Job Outlook Projections Data Earnings OES Data Related Occupations
More informationJean St. Germain, CHP, DABMP, RMP Attending Physicist Radiation Safety Officer Memorial Sloan-Kettering Cancer Center
Jean St. Germain, CHP, DABMP, RMP Attending Physicist Radiation Safety Officer Memorial Sloan-Kettering Cancer Center Public Concern About Radiation Articles in Philadelphia Inquirer about prostate treatments
More information1/21/2011. Cindy C. Parman, CPC, CPC H Coding Strategies, Inc.
Cindy C. Parman, CPC, CPC H Coding Strategies, Inc. www.codingstrategies.com The format and/or content of this presentation is copyright 2011 by Coding Strategies, Inc. (CSI), Powder Springs, GA. This
More informationHow to Overhaul your Internal Structure to be Prepared for the New Home Health CoPs. Program Objectives
How to Overhaul your Internal Structure to be Prepared for the New Home Health CoPs 2015 NAHC Annual Meeting 106 October 28, 4:30 5:30 p.m. Nashville, Tennessee Kathleen Spooner, RN, CMC Kathleen A. Hessler,
More informationHealthStream Regulatory Script. Corporate Compliance: A Proactive Stance. Version: [February 2007]
HealthStream Regulatory Script Corporate Compliance: A Proactive Stance Version: [February 2007] Lesson 1: Introduction Lesson 2: Importance of Compliance & Compliance Programs Lesson 3: Laws and Regulations
More information8/2/2012. ACR-ASTRO Radiation Oncology Practice Accreditation Program. Accreditation Program Goals
ACR-ASTRO Radiation Oncology Practice Accreditation Program Tariq M Patrick Conway, MD FACR Tariq Mian, Ph.D. FACR Accreditation Program Goals Provide impartial, third party peer review Evaluate and promote
More informationCompliance Advisory 3 A Challenge for the Electronic Health Record s of Academic Institutions : Purpose Background
Compliance Advisory 3 A Challenge for the Electronic Health Records of Academic Institutions: Physicians combining documentation or using information documented by others when billing for a professional
More informationBasic Teaching Physician Presence and Documentation
Basic Teaching Physician Presence and Documentation Welcome to the Children s University Medical Group (CUMG) training on the Teaching Physician Presence and Documentation. The goal of this module is to
More informationSeptember 5, Dear Administrator Tavenner:
Marilyn B. Tavenner Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS 1601-P P.O. Box 8016 Baltimore, MD 21244-8016 Submitted electronically:
More informationCompliance Program, Code of Conduct, and HIPAA
Compliance Program, Code of Conduct, and HIPAA Agenda Introduction to Compliance The Compliance Program Code of Conduct Reporting Concerns HIPAA Why have a Compliance Program Procedures to follow applicable
More informationConflict of Interest. Patient Safety and the Training of the Medical Physicist. Training in Patient Safety
Patient Safety and the Training of the Medical Physicist Peter Dunscombe, Ph.D. Derek Brown, Ph.D. University of Calgary/ Tom Baker Cancer Centre Conflict of Interest Peter Dunscombe and Derek Brown are
More informationSupervision of Radiation Therapy A White Paper Provided by Coding Strategies Inc.
Supervision of Radiation Therapy A White Paper Provided by Coding Strategies Inc. Radiation therapy uses high-energy radiation to shrink tumors and kill cancer cells. Radiation oncology, often in conjunction
More information9/25/2012 AGENDA. Set the Stage Monitoring versus Audit Identifying Risk Strategies related to an audit plan Corrective Action Plans Examples
The Art and Science of Designing a Physician Practice Audit : Unique Techniques Lori Laubach, Partner MOSS ADAMS LLP 1 AGENDA Set the Stage Monitoring versus Audit Identifying Risk Strategies related to
More informationAdvanced Evaluation and. AAPC Regional Conference Chicago 10/27/12
Advanced Evaluation and Management AAPC Regional Conference Chicago 10/27/12 Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC jaci@practiceintegrity.com Disclaimer Information
More informationSTANDARDS OF CONDUCT SCH
STANDARDS OF CONDUCT SCH01242018 2018 LETTER FROM THE CEO Welcome, Thank you for choosing St. Croix Hospice. The care you provide impacts our patients, families, caregivers, and countless others every
More informationThe Practice Standards for Medical Imaging and Radiation Therapy. Medical Dosimetry Practice Standards
The Practice Standards for Medical Imaging and Radiation Therapy Medical Dosimetry Practice Standards 2017 American Society of Radiologic Technologists. All rights reserved. Reprinting all or part of this
More informationFundamental Aspects of SBRT
What Are Fundamental Aspects? Fundamental Aspects of SBRT Fang-Fang Yin, PhD Duke University SBRT and its workflow Resources Staff Equipment Training Processes Safety Acceptance Commissioning Quality assurance
More informationJaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC Disclaimer
Advanced Evaluation and Management More than a roll of the dice? History Exam Medical Decision Making Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC jaci@practieintegrity.com
More informationStark, False Claims and Anti- Kickback Laws: Easy Ways to Stay Compliant with the Big Three in Healthcare
Stark, False Claims and Anti- Kickback Laws: Easy Ways to Stay Compliant with the Big Three in Healthcare In health care, we are blessed with an abundance of rules, policies, standards and laws. In Health
More information1. The new state-based insurance exchange for small businesses (SHOP) stands for:
Chapter 5 Review Questions 1. The new state-based insurance exchange for small businesses (SHOP) stands for: a. Small Business Health Options Program b. Small Business Health Option Plans c. State Health
More informationDecember 30, Dear Administrator Tavenner:
Ms. Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1612-FC P.O. Box 8013 7500 Security Boulevard Baltimore, MD 21244-8013
More informationMid-Level Providers: What You Need to Know to Use Them Successfully in Your Practice
Mid-Level Providers: What You Need to Know to Use Them Successfully in Your Practice Presented by Sarah Reed, BSE. CPC Senior Managing Consultant Medical Revenue Solutions, LLC AAPC 2016 Disclaimer The
More informationThe Practice Standards for Medical Imaging and Radiation Therapy. Radiation Therapy Practice Standards
The Practice Standards for Medical Imaging and Radiation Therapy Radiation Therapy Practice Standards 2017 American Society of Radiologic Technologists. All rights reserved. Reprinting all or part of this
More information2011 Melanoma Physician Quality Reporting (PQRS): FREQUENTLY ASKED QUESTIONS
Q: What is the Physician Quality Reporting System? A: The Physician Quality Reporting System, formerly known as PQRI, is a program developed by the Centers for Medicare and Medicaid Services (CMS) to provide
More informationResponsibility and Liability of Compliance Officer
Responsibility and Liability of Compliance Officer Cheryl Forino Wahl, VP, Chief Compliance Officer, University Hospitals Lori Oberholzer, JD, MS, RT(R), Director, Compliance and Risk Management, OSUPhysicians
More informationSan Francisco Department of Public Health
San Francisco Department of Public Health Barbara A. Garcia, MPA Director of Health City and County of San Francisco Edwin M. Lee, Mayor San Francisco Department of Public Health Policy & Procedure Detail*
More informationBrachytherapy-Radiopharmaceutical Therapy Quality Management Program. Rev Date: Feb
Section I outlines definitions, reporting, auditing and general requirements of the QMP program while Section II describes the QMP implementation for each therapeutic modality. Recommendations are expressed
More informationThe ASRT is seeking public comment on proposed revisions to the Practice Standards for Medical Imaging and Radiation Therapy titled Medical Dosimetry.
The ASRT is seeking public comment on proposed revisions to the Practice Standards for Medical Imaging and Radiation Therapy titled Medical Dosimetry. To submit comments please access the public comment
More informationMedical Errors in Radiation Therapy
Medical Errors in Radiation Therapy 2014-2015 T. Yvette Forrest Division of Emergency Preparedness and Community Support Bureau of Radiation Control Florida Department of Health 1 Reportable Medical Events
More informationRecover Health Training. Corporate Compliance Plan Code of Conduct Fraud & Abuse
Recover Health Training Corporate Compliance Plan Code of Conduct Fraud & Abuse 1 The Course Objectives When you complete this course you will be able to: Understand Recover Health s reasons for implementing
More informationPatient Risk (Safety) in Radiation Therapy
Patient Risk (Safety) in Radiation Therapy Michael G. Herman, Ph.D. Professor and Chair, Medical Physics Mayo Clinic Patient Safety 10/18/11 Herman # 1 Outline Radiation Therapy What Can/Did Happen? Is
More informationHIGHMARK RADIATION THERAPY AUTHORIZATION PROGRAM FREQUENTLY ASKED QUESTIONS
HIGHMARK RADIATION THERAPY AUTHORIZATION PROGRAM FREQUENTLY ASKED QUESTIONS Revised: April 1, 2015 GENERAL POLICIES AND PROCEDURES Q1. Can you provide me with an overview of this program? A1. Highmark
More informationRadiology Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2017 DXC Technology Company. All rights reserved.
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Radiology Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 4 4 P U B L I S H E D : D E C E M B E R 1 2, 2 0 1 7 P O L
More informationRadiation Therapy. 1. Introduction. 2. Documentation of Compliance. 3. Didactic Competency Requirements. 4. Clinical Competency Requirements
PRIMARY CERTIFICATION AND REGISTRATION Radiation Therapy 1. Introduction Candidates for certification and registration are required to meet the Professional Education Requirements specified in the ARRT
More information2. What is the main similarity between quality assurance and quality improvement?
Chapter 6 Review Questions 1. Quality improvement focuses on: a. Individual clinicians or system users b. Routine measurement of performance c. Information technology issues d. Constant training 2. What
More informationDoing Business As name (if applicable): 2. Mailing Address: (Street Address/City/State/Zip) 3. Physical Location: (Street Address/City/State/Zip)
ZZ113-120 REGISTRATION APPLICATION FOR USERS OF RADIATION MACHINES HEALING ARTS, DENTAL, VETERINARY MEDICINE AND MEDICAL ACADEMIC FACILITIES TEXAS DEPARTMENT OF STATE HEALTH SERVICES (DSHS) RADIATION SAFETY
More informationCMS Incentive Programs: Timeline And Reporting Requirements. Webcast Association of Northern California Oncologists May 21, 2013
CMS Incentive Programs: Timeline And Reporting Requirements Webcast Association of Northern California Oncologists May 21, 2013 Objective This webcast will address CMS s Incentive Program reporting requirements
More informationPharmacies Medicare Part D Training Obligations and Medicare Training Resources
Pharmacies Medicare Part D raining Obligations and Medicare raining Resources. Your obligation - MS regulations require that all pharmacies contracted with Medicare Part D Plan Sponsors, such as the Medco
More informationTHE MONTEFIORE ACO CODE OF CONDUCT
THE MONTEFIORE ACO CODE OF CONDUCT 2017 Approved by the Board of Directors on March 10, 2017 Our Commitment to Compliance As a central part of its Compliance Program, the Bronx Accountable Healthcare Network
More informationSee the Time chapter for complete instructions regarding how to code using time as the controlling E/M factor.
2015 EM Survival Guides Chapter 1: Office or Other Outpatient Visit (99201-99215) You should apply 99201-99215 for E/M visits in the office or other outpatient setting. These codes distinguish between
More informationGlobal Days Policy. Approved By 7/12/2017
Global Days Policy Policy Number 2018R0005A Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission of accurate
More informationGeneral Documentation Compliance. Review for Provider Reappointment
U N C U H N E C A L H T E H A L C T A H R E C A S R Y E S T E M General Documentation Compliance Review for Provider Reappointment May 2018 Objectives 1 2 Review the principles of compliant billing and
More informationThe Business of Medicine
The Business of Medicine Coding as a profession Objectives How the coder fits in Hospital vs. physician services Hierarchy of providers Reimbursement aspects Payers Medical necessity ABN 1 Regulations
More informationRegulatory Compliance Risks. September 2009
Rehabilitation Regulatory Compliance Risks September 2009 1 Agenda - Rehabilitation Compliance Risks Understand the basic requirements for Inpatient Rehabilitation Facilities (IRFs) and Outpatient Rehabilitation
More informationMEDICARE RULE FOR TEACHING PHYSICIANS Effective July 1, 1996.
MEDICARE RULE F TEACHING PHYSICIANS Effective July 1, 1996. 1.0 GENERAL RULE: If a resident participates in a service provided in a teaching setting, the teaching physician may not bill Medicare for such
More informationCode of Conduct. at Stamford Hospital
Code of Conduct at Stamford Hospital As a Planetree hospital, we are committed to personalizing, humanizing and demystifying the healthcare experience for patients and their families. Our approach is holistic
More informationThe Transition to Version 5010 and ICD-10
The Transition to Version 5010 and ICD-10 An Overview Denise M. Buenning, MsM Director, Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services
More information2019 Evaluation and Management Coding Advisor. Advanced guidance on E/M code selection for traditional documentation systems
2019 Evaluation and Management Coding Advisor Advanced guidance on E/M code selection for traditional documentation systems POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years.
More informationAlignment. Alignment Healthcare
Alignment CODE OF CONDUCT Alignment Healthcare Our commitment to ethical conduct and compliance depends on all Alignment Healthcare personnel. If you find yourself in an ethical dilemma or suspect inappropriate
More informationGetting Started with OIG Compliance
Getting Started with OIG Compliance Kathy Mills Chang, MCS-P CCPC Do You Feel Like This? Or This? Does Your Business Deserve the Same Focus Your Patients Do? How This Training Will Protect You! Stay within
More informationRadiation Dose Management Requirements from MACRA and Joint Commission, Potential Effects on Reimbursement
Radiation Dose Management Requirements from MACRA and Joint Commission, Potential Effects on Reimbursement Radiation dose requirements are being slowly integrated into key performance indicators and metrics
More informationLouisville, Kentucky! MEDICAL PHYSICS WORKFORCE ASSESSMENT 2012 AAPM SPRING CLINICAL MEETING. List of Topics. Complexity, Safety and Quality Assurance
Louisville, Kentucky! Michael D. Mills MEDICAL PHYSICS WORKFORCE ASSESSMENT 2012 AAPM SPRING CLINICAL MEETING List of Topics Complexity, Safety and Quality Assurance Where is the QA Knowledge? Staffing
More information601-Audit Plan for Medicare s Shared Visit Rule
601-Audit Plan for Medicare s Shared Visit Rule Elin Baklid-Kunz, MBA, CPC, CCS Health Care Compliance Association 6500 Barrie Road, Suite 250, Minneapolis, MN 55435 888-580-8373 www.hcca-info.org Presentation
More informationElectronic Medical Record (EMR) How to Audit the Risks. Schawn Pedersen, CPC, CPC-E/M Manager Moss Adams LLP
Electronic Medical Record (EMR) How to Audit the Risks Schawn Pedersen, CPC, CPC-E/M Manager Moss Adams LLP Health Care Compliance Association 6500 Barrie Road, Suite 250, Minneapolis, MN 55435 888-580-8373
More informationTelemedicine Guidance
Telemedicine Guidance GEORGIA DEPARTMENT OF COMMUNITY HEALTH DIVISION OF MEDICAID Revised: October 1, 2017 Policy Revisions Record Telemedicine Guidance 2017 REVISION DATE Oct. 1, 2017 SECTION REVISION
More informationCompliance Round-Up. March 11, 2014
Compliance Round-Up March 11, 2014 Medicare Billing Settlement, HIPAA Guidance Mental Health Information, HIPAA Settlement, Two Midnight Rule Legislation, HCFAC Report, Halifax Settlement 1 Faculty Brian
More informationSCRIBES, SMAS AND INCIDENT T0
SCRIBES, SMAS AND INCIDENT T0 Andrew R. McCulllough, MD In Transit Objectives Convince you to: Use Scribes Use Shared Medical Appointments Stop using Incident To The Facts of Life as a Physician Burnout
More informationMedical Management Program
Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent Fraud, Waste and Abuse in its programs. The Molina
More informationResponding to Today s Health Care Regulatory Environment
Responding to Today s Health Care Regulatory Environment St. Joseph s Health Michael R. Holper SVP, Compliance and Audit Services October 26, 2016 2014 Trinity Health. All Rights Reserved. 1 We operate
More informationTexas Tech University Health Sciences Center Billing Compliance Program Policy and Procedure
4.2 Teaching Physician Requirements for Evaluation & Management Services Provided under Medicare s Primary Care Exception (PCE) Rule Approved: May 5, 2011 Effective Date: May 5, 2011 Latest Revision: June
More informationRe: Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations, Proposed rule.
June 3, 2011 Donald Berwick, MD Administrator Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1345-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore,
More informationSNF Compliance: What s at Stake?
SNF Compliance: What s at Stake? HARMONY UNIVERSITY The Provider Unit of Harmony Healthcare International, Inc. (HHI) Presented by: Elisa Bovee, MS OTR/L Vice President of Operations About Elisa Elisa
More informationEMPLOYEE HANDBOOK EMPLOYEE HANDBOOK. Code of Conduct
EMPLOYEE HANDBOOK EMPLOYEE HANDBOOK L E A D I N G T E A C H I N G C A R I N G CODE OF CON DUCT Who We Are and What We Stand For In 2016, UNC Health Care adopted a system-wide. The purpose of this is to
More informationCare360 EHR Frequently Asked Questions
Care360 EHR Frequently Asked Questions Table of Contents Care360 EHR... 4 What is Care360 EHR?... 4 What are the current capabilities of Care 360 EHR?... 4 Is Care 360 EHR an EMR?... 5 Can I have Care360
More information8/2/2017. Strategies for Quality Improvement based on RO-ILS
Strategies for Quality Improvement based on RO-ILS Lakshmi Santanam Ph.D We cannot Change Human condition, but we can change the conditions under which humans work Active failures- Swat one by one Still
More informationOffice of Billing Compliance 2015 Coding, Billing and Documentation Program. Department of Pathology
Office of Billing Compliance 2015 Coding, Billing and Documentation Program Department of Pathology 2015 Code Changes 2 Surgical Pathology Changes Some of the bigger changes include changes to immunohistochemistry
More informationMedical Event Reporting
Medical Event Reporting Scott Dube, MS DABR Morton Plant Hospital Clearwater, FL New Voluntary Reporting System For some, reporting is mandatory Radioactive materials are regulated by either the NRC or
More information