NARHC Spring Institute

Transcription

1 NARHC Spring Institute Tuesday, March 15, 2016 San Antonio Conference

2 Breakouts Your choice Regency Ballroom E Mac Discussion: Novitas Kim Robinson Live Oak Mac Discussion: Noridian Tana Williams You are HERE! Rio Grande Cnt & W Completing the PB Attestation Statement Jeff Bramschreiber

3 MAC Discussions: Noridian Tana Williams Education Rep Provider Outreach & Education Dept Noridian Healthcare Solutions

4 MAC Discussions: Noridian Presented by Medicare Part A Provider Outreach and Education March 2016

5 DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC. It may be freely distributed in its entirety but may not be modified, sold for profit or used in commercial documents. The information is provided as is without any expressed or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. All models, methodologies and guidelines are undergoing continuous improvement and modification by Noridian and CMS. The most current edition of the information contained in this release can be found on the Noridian website at and the CMS website at The identification of an organization or product in this information does not imply any form of endorsement. CPT codes, descriptors, and other data only are copyright 2016 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. March

6 Agenda Medicare Updates Chronic Care Management Billing resources List RHC Top Errors How to avoid recoupment Noridian Contacts March

7 RHC AIR CCM CARC RARC Helpful Acronyms Rural Health Clinics All-Inclusive Rate Chronic Care Management Claim Adjustment Reason Code Remittance Advice Remark Code HCPCS Healthcare Common Procedure Coding System IOM Internet Only Manual MAC Medicare Administrative Contractor MLN Medicare Learning Network March

8 Objectives for CE Credit Describe Medicare Updates including Chronic Care Management (CCM) List RHC top errors and how to avoid them List primary contacts and resources March

9 Noridian Contacts Noridianmedicare.com Upper right-hand corner click Contact Us March

10 Medicare Update Rural Health Clinic Preventive Services Chart Fee-for-Service- Payment/FQHCPPS/Downloads/RHC- Preventive-Services.pdf Revised to show when stand-alone visit may be bill and receive AIR March

11 Smoking Cessation Counseling RHC services are paid the AIR Not Eligible for Same Day Billing Can be billed as stand-alone Revenue Code 52X TOB 71X HCPCS G0436, G0437 Two individual attempts per year Coinsurance and deductible is waived March

12 Screening Pelvic and Breast Examinations RHC services are paid the AIR Not Eligible for Same Day Billing Can be billed as stand-alone Revenue Code 52X TOB 71X HCPCS G0101 Coinsurance and deductible is waived March

13 Screening for sexually transmitted infections (STI) RHC services are paid the AIR Not Eligible for Same Day Billing Can be billed as stand-alone Revenue code 52X TOB 71X HCPCS G0445 Counseling must be furnished by a qualified primary care physician Coinsurance and deductible is waived March

14 Required Billing Updates Effective April 1, 2016, RHCs, including RHCs exempt from electronic reporting under Section (d)(3), are required to report the appropriate HCPCS code for each service line along with the revenue code, and other required billing codes. NO change to the AIR system and payment MLN Matters Article 9269 March

15 RHC Service Level Information Professional component of qualified medical services and preventive health services Bill under revenue code 052x Mental health services Bill under revenue code 0900 Telehealth originating site Bill under revenue code 0780 March

16 HCPCS for Qualifying Visits Review RHC Qualifying Visit List Revenue Code HCPCS Service Date Service Units Total Charges Payment 052x $XX.XX AIR Yes Coinsurance and deductible applied March

17 HCPCS for Qualifying Visits 2 Review RHC Qualifying Visit List Preventive services with a medical visit are ineligible to receive an additional encounter payment at the AIR, except for the IPPE Revenue Code HCPCS Service Date Service Units Total Charges Payment 052x $XX.XX AIR Yes Coinsurance and deductible applied 052x G $XX.XX Included in the AIR No March

18 HCPCS for Qualifying Visits 3 Review RHC Approved Preventive Health Services List Revenue Code HCPCS Service Date Service Units Total Charges Payment 052x G $XX.XX AIR No Coinsurance and deductible applied March

19 HCPCS for Qualifying Visits 4 Review RHC Mental Health Services List Revenue Code HCPCS Service Date Service Units Total Charges Payment $XX.XX AIR Yes Coinsurance and deductible applied March

20 HCPCS for Qualifying Visits 5 Review RHC Mental Health Services List Revenue Code HCPCS Service Date Service Units Total Charges Payment 052x $XX.XX AIR Yes Coinsurance and deductible applied $XX.XX Included in the AIR No March

21 Medical Services and Incident to Must use valid revenue codes except 002x- 024x, 029x 045x 054x, 056x, 060x, 065x, 067x-072x, 080x-088x, 093x, or 096x-310x Incident to services are included in the AIR and not separately payable March

22 Medical Services and Incident to 2 Remittance Group code CO Contractual obligation CARC 97 benefit included in another service RARC M15 separately billed service have been bundled March

23 Billing Multiple Visits Encounters on the same day constitute a single RHC visit Exceptions require the use of modifier 59 Modifier 59 means the second encounter is totally unrelated Service(s) and condition(s) not present earlier the same day March

24 Chronic Care Management (CCM) Requirements Effective January 1, 2015 CCM HCPCS At least 20 minutes or more; per calendar month Coinsurance and deductible is applied Face-to-Face requirements are waived during CCM Patient agreement in the medical records March

25 Chronic Care Management (CCM) Requirements 2 Patient at significant risk of death, acute exacerbation/decompensation or functional decline 2 chronic conditions Duration 12 months (or life of patient) Comprehensive plan established, implemented, revised or monitored March

26 RHC Practitioners Physician and Non-physician Practitioner (NPP) Certified Nurse Midwives (CNM) Clinical Nurse Specialist (CNS) Nurse Practitioners (NP) Physician Assistants (PA) Clinical staff may provide incident to services of the billing physician March

27 Who qualifies as Clinical Staff? Consult CPT for definition of the term Medicare s incident to rules apply Case management company must meet incident to Expectation that all service element are routinely provided Unless not medically indicated or necessary March

28 Patient Agreement Requirements 24/7 access to physician/staff services Agreement to have medical information electronically shared among providers Documented discussion and patient s decision How to revoke service at any time One practitioner can furnish and be paid for service during a calendar month March

29 When does the CCM start? CCM discussion must be initiated during a comprehensive evaluation and management (E&M), Annual Wellness Visit (AWV) or Initial Preventive Physical Examination (IPPE) Required before CCM services are provided directly or by arrangement March

30 What date of service is correct? Service period for CPT 9940 is one month Bill at the end of the service period Select date of service at end of month Bill after completion of 20 minutes Select date of service at completion of 20 minutes March

31 Why it is important to code correctly? Avoid duplicate payments for the same or similar services for patients with chronic conditions CPT cannot be billed during the same period as: Transitional Care Management (CPT ) Home Health Care or Hospice Care supervision (HCPCS G0181, G0812) March

32 Hospice Services in the RHC Reimbursed only when the services are not related to the terminal illness Condition code 07 must be on the claim Exception only in the following situations RHC is reimbursed by the hospice March

33 Hospice Services in the RHC 2 RHC is under contractual agreement Provides services related to conditions during an extraordinary circumstance within the hospice Furnishes highly specialized nursing services that are provided infrequently by the hospice March

34 RESOURCES

35 CMS Resources Chronic Care Management Services FAQs icle-detail/-/view/10521/chronic-caremanagementservices-faqs Chronic Care Management Fact Sheet Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/ChronicCare Management.pdf March

36 Noridian Resources Care Management Services JE Under Browse by Provider Type>OPPS ovider-types/opps/chronic-care-managementservices JF Under Browse by Provider Type>OPPS vider-types/opps/chronic-care-managementservices March

37 Browse by Topic March

38 Browse by Provider March

39 Self-Paced Training Tutorials Trainings provide access to webinar material 24 hours a day Allows providers to train at their own pace Short sessions under 30 minutes May start and stop as needed Trainings supplement workshop material Incorporate within new staff training schedule Certificates of course completion are available No CEU is available for self-paced training March

40 Self-Paced Training Tutorials2 Appeals and Reopenings Trainings Currently Available Medicare Learning Network (MLN) Products Overview Critical Access Hospital (CAH) Direct Data Entry (DDE) Endeavor Portal Medicare Secondary Payer (MSP) Part A Modifiers Skilled Nursing Facility (SNF) Federally Qualified Health Centers (FQHC) Access Training Here! JFA: March

41 Written Correspondence/Mailings No staples No binders Do not shrink Enrollment Applications Select fit to paper before printing Enrollment fees are done through March

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43 Questions? Thank you!

44 Have a Good Evening! See you at 8:30 AM tomorrow