NOA 3rd Party Newsletter

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1 NOA 3rd Party Newsletter May 2012 Nebraska Optometric Association Volume 12, Issue 5 WPS and CMS New CMS Medicare Billing Certificate Programs P.2. CMS Changes Website P.2. Medicare Physician & Supplier Directory Updated P.2. PECOS signatures now electronic P.3. Upgrade Instructions for PC ACE Pro32 P.3. Q & A on Registration for EHR Incentive Programs P.4. CMS FAQs on Attesting with Multiple Certified EHRs P.5. Medicare Ties Doctor s Pay to Quality & Cost of Care Pp.6 7. HIPAA HIPAA 5010 Extended to June 30th. P.8. Medicaid Medicaid Electronic Claim Information P.9. Medicaid Pay raised 1.5 % starting in July P.10. BCBS BCBS Spring Newsletter Available P.10 Coding DME Proof of Delivery Form. P.11. Dr. Must Do HPI: WPS Information on the History Component of E&M Services The history component of each E/M service includes some or all of the following elements: chief complaint, history of present illness, review of systems, and past, family, and/or social history. The WPS website includes several Questions and Answers that pertain specifically to this key component of an E/M service. To access this helpful information, visit their History of E/M web page at [Quack Note: Although all of the FAQs are interesting, Dr. Quack found the following two items of particular interest. The requirement seemed to be corroborated at Q 18. Who can perform the History of Present Illness (HPI) portion of the patient's history? A 18. The history portion refers to the subjective information obtained by the physician or ancillary staff. Although ancillary staff can perform the other parts of the history, that staff cannot perform the HPI. Only the physician can perform the HPI. Q 19. If the nurse takes the HPI, can the physician then state, "HPI as above by the nurse" or just "HPI as above in the documentation"? A 19. No. The physician billing the service must document the HPI. From CMS: Medicare Vision Services Fact Sheet Now Available The Medicare Vision Services fact sheet (ICN ) has been released and is now available in both downloadable and hardcopy formats. See This fact sheet is designed to provide education on Medicare coverage and billing information for vision services, and includes specific information concerning coding requirements and an overview of coverage guidelines and exclusions. To order hardcopies of this fact sheet, visit and click on MLN Product Ordering Page under Related Links Inside CMS at the bottom of the webpage.

2 Page 2 NOA 3rd Party Newsletter New CMS Medicare Billing Certificate Programs for Part B Providers CMS has launched new Medicare Billing Certificate Programs for Part A and Part B providers. To participate in either the Part A or Part B provider type program, visit and select the "Web-Based Training Modules" link under the heading "Related Links Inside CMS." This Program is designed to provide education about Medicare Part B. This Program is designed to provide education about Part B of the Medicare Program. It includes required web-based training courses and readings and a list of helpful resources. Upon successful completion of this Program you will receive a certificate in Medicare billing for Part B providers from the Centers for Medicare & Medicaid Services (CMS). Successful completion of this Program includes completion of all required WBT courses, required readings and a score of 75% or higher on the post-assessment. NOTE: It is recommended that you use Internet Explorer as your Internet browser to complete this Program. 3DC00128&strFunction=width%3D200%2Cheight%3D100&strTable=undefined&strContentID=undefined [To use this URL you must cut and paste the entire address] CMS Changes Entire Website CMS has completed the upgrades to the website. Bookmarked links to items posted in the Downloads sections on the CMS website have not been affected, but other bookmarked URLs are redirected to the index webpage for that topic. For example, if you bookmarked the page containing National Provider Calls and Events, you will be taken to the index page for National Provider Calls. On the index page, select the webpage you d like to view from the left-hand side. Once you open the correct page, you can create a new bookmark. We appreciate your understanding and apologize for any inconvenience during this process. Medicare Participating Physicians/Suppliers Directory (MEDPARD) Now Available The new Medicare Part B Participating Physician/Supplier Directory (MEDPARD) for 2012 is now available on the WPS Medicare website at Please review this site for the most up-to-date information. If you have questions about a specific provider's participation status, please call our Provider Contact Center at (866) Nebraska Optometric Association 1633 Normandy Court, Suite A Lincoln, NE The NOA Third Party Newsletter is published monthly by the Nebraska Optometric Association with the assistance of Ed Schneider, O.D., Third Party Consultant. To reach Ed (aka Dr. Quack): BEST to contact via at: SchneiderEd@msn.com Ed s mobile phone is Voic available, but delays are possible. Fax number is Call Ed before faxing.

3 Volume 12, Issue 5 Page 3 PECOS Signatures Now Electronic Internet-based PECOS (Provider Enrollment, Chain, and Ownership System) now allows providers to sign Medicare enrollment applications electronically. You can save time and expedite review of your application by utilizing the electronic signature process. This feature does not change who is required to sign the application. Authorized officials of the Organization will receive an providing the steps they need to take to electronically sign the enrollment application. This will be automatically sent when the enrollment application is submitted. Make sure to add customerservice-donotreply@cms.hhs.gov to your safe sender list and check your spam or junk mail folders to ensure you receive the electronic signature notifications. An example of the beginning of the to the authorized official is shown below: From: customerservice-donotreply@cms.hhs.gov Subject: Pending Medicare E-Signature Request ( Tracking ID: XXXXXX0047) An application on behalf of Lexa Hospital was recently submitted by: Submitters Name: Lexa Smith Submitters Phone: Submitters lexa.smith@lexahospital.com For more information about signing your Medicare enrollment electronically, see Sign Your Medicare Enrollment Application Electronically in the March 29 edition of the e-news at CEDI: Upgrade Instructions for PC-ACE Pro32 An document is available on the CEDI Web site to assist in upgrading the software. Version 2.36 includes: Updates to the code lists including the Claims Adjustment Reason Codes, Remittance Advice Reason Codes, HCPCS Codes, and Diagnosis Codes Ability to send the required 5010A1 claim format Update to include a validation check for the procedure code description of Not Otherwise Classified codes For more information about the changes, review the PC-ACE Pro32 Newsletter for PC-ACE Pro32 Release 2.36 Professional located at the following link: Help documents for assistance in using PC-ACE Pro32 version 2.36 as well as importing and reading the new 999 and 277CA transaction acknowledgement files are available on the CEDI Web site under Resource Materials. If you have any questions or need assistance in downloading the PC-ACE Pro32 Upgrade from the CEDI Web site, please contact the CEDI Help Desk at ngs.cedihelpdesk@wellpoint.com or at

4 Page 4 NOA 3rd Party Newsletter Important Questions and Answers about Registration for the EHR Incentive Programs After determining your eligibility for the Electronic Health Record (EHR) Incentive Programs, you should then register as early as possible for the Medicare and/or Medicaid program. CMS EHR Information Center is open to assist the EHR provider community with registration and other program-related inquiries. The center can be reached at (primary number) or (TTY number) from 7:30 a.m. 6:30 p.m. (Central Time) Monday through Friday, except federal holidays. Here are a few of the Information Center s most frequently asked questions about registration: Included are a few of the Information Center s most frequently asked questions about registration. Question: What information should I have ready before I begin the registration process? Answer: When you register, you will need: If you are registering as an eligible hospital or Medicare eligible professional, you will need an approved enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS). Medicaid eligible professionals are not required to be enrolled in PECOS. If you do not have a record in PECOS, you should still register for the Medicare and Medicaid EHR Incentive Programs. (Please note your eligible hospital or Medicare eligible professional registration status will remain in an issue pending status until you have an active enrollment record in PECOS.) A National Provider Identifier (NPI) A National Plan and Provider Enumeration System Identity and Access Management ID and password for the individual provider A Payee Tax Identification Number (if you are reassigning your benefits) A Payee NPI (if you are reassigning your benefits) Question: Which option do I select when registering on behalf of an eligible professional in the Identity and Access Management System? Answer: Click on You are requesting to act on behalf of an individual provider. Question: How can I check my registration status in the Registration and Attestation System? Answer: Log in to the Registration and Attestation System and click the Status tab to view your registration information. Question: How do I re-submit my registration? Answer: To re-submit a registration, you will need to: Login to the EHR Incentive Program Registration and Attestation System; Navigate to the Registration tab; Select the Modify action for the registration; Select the Personal Information registration topic; and Save the updated payee information and submit the registration. CMS provides helpful registration guides and resources on the Registration page of the EHR website found at Additionally, FAQs about registration can be found on the FAQs page of the CMS website. Want more information about the EHR Incentive Programs? Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs at

5 Volume 12, Issue 5 Page 5 CMS Has an Updated FAQ about Attesting with Multiple Certified EHRs We want to help keep you updated with information on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. CMS has recently updated an FAQ on attesting with multiple certified EHRs. Take a minute and review the updated information below. Question: For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, how should an eligible professional (EP), eligible hospital, or critical access hospital (CAH) that sees patients in multiple practice locations equipped with certified EHR technology calculate numerators and denominators for the meaningful use objectives and measures? Answer: EPs, eligible hospitals, and CAHs should look at the measure of each meaningful use objective to determine the appropriate calculation method for individual numerators and denominators. The calculation of the numerator and denominator for each measure is explained in the July 28, 2010 final rule (75 FR 44314). For objectives that require a simple count of actions (e.g., number of permissible prescriptions written, for the objective of "Generate and transmit permissible prescriptions electronically (erx)"; number of patient requests for an electronic copy of their health information, for the objective of "Provide patients with an electronic copy of their health information"; etc.), EPs, eligible hospitals, and CAHs can add the numerators and denominators calculated by each certified EHR system in order to arrive at an accurate total for the numerator and denominator of the measure. For objectives that require an action to be taken on behalf of a percentage of "unique patients" (e.g., the objectives of "Record demographics", "Record vital signs", etc.), EPs, eligible hospitals, and CAHs may also add the numerators and denominators calculated by each certified EHR system in order to arrive at an accurate total for the numerator and denominator of the measure. Previously CMS had advised providers to reconcile information so that they only reported unique patients. However, because it is not possible for providers to increase their overall percentage of actions taken by adding numerators and denominators from multiple systems, we now permit simple addition for all meaningful use objectives. Please keep in mind that patients whose records are not maintained in certified EHR technology will need to be added to denominators whenever applicable in order to provide accurate numbers. To report clinical quality measures, EPs who practice in multiple locations that are equipped with certified EHR technology should generate a report from each of those certified EHR systems and then add the numerators, denominators, and exclusions from each generated report in order to arrive at a number that reflects the total data output for patient encounters at those locations. To report clinical quality measures, eligible hospitals and CAHs that have multiple systems should generate a report from each of those certified EHR systems and then add the numerators, denominators, and exclusions from each generated report in order to arrive at a number that reflects the total data output for patient encounters in the relevant departments of the eligible hospital or CAH (e.g., inpatient or emergency department (POS 21 or 23)). CMS has recently updated an FAQ on attesting with multiple certified EHRs. Website Update CMS is in the process of making upgrades to the website. If you encounter problems accessing information while on the site, please try refreshing the page or check back later. CMS is working to correct the site to ensure any issues are temporary. Please also note that the EHR Incentive Programs FAQs were reorganized during the CMS.gov website upgrade. The EHR Incentive Programs FAQs are now incorporated in the same page as other CMS program FAQs. To navigate the EHR Incentive Program FAQs you must go to the FAQ page and click Electronic Health Records Incentive Programs on the blue navigation pane on the left-hand side. We appreciate your understanding and apologize for any inconvenience. Want more information about the EHR Incentive Programs? Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs at

6 Page 6 NOA 3rd Party Newsletter QRUR: Quality and Resource Use Reports: Medicare moves to tie doctors pay to quality and cost of care The following information is from the AOA: The article below was published in the Washington Post Sunday edition and perhaps elsewhere. Medicare moves to tie doctors pay to quality and cost of care By Jordan Rau, Published: April 14 Twenty-thousand physicians in four Midwest states received a glimpse into their financial future last month. Landing in their inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska. The resource use reports, which Medicare plans to eventually provide to doctors nationwide, are one of the most visible phases of the government s effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health-care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare s costs without better results. [See reports at Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/downloads/2010_individual_qrur_template.pdf ] Value-based QRUR for MDs will begin in 2015, probably based on performance in It will take effect for optometry in 2017, perhaps based on performance in Making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health-care spending, which amounts to more than $2.5 trillion a year. It s also key to keeping Medicare solvent. Efforts have begun to change the way Medicare pays hospitals, doctors and other providers who agree to work together in new alliances known as accountable care organizations. This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year. But applying these same precepts to doctors is much more difficult, experts agree. Doctors see far fewer patients than do hospitals, so making statistically accurate assessments of doctors care is much harder. Comparing specialists is tricky, since some focus on particular kinds of patients that tend to be more costly. Plus, properly assessing how a doctor affects costs must include not just the specific services she directly provides, but also care other providers may give, either because the patient was referred to them or because the original doctor didn t take the right preventive steps to avoid more expensive treatments later on. And without properly adjusting for patients health problems, paying bonuses to physicians who use fewer Medicare resources might encourage doctors to stint on care or shun patients with expensive-to-treat ailments. It may be the most difficult measurement challenge in the whole world of value-based purchasing, said Dr. Donald Berwick, former administrator of the federal Centers for Medicare and Medicaid Services, or CMS. We do have to be cautious in this case. It could lead to levels of gaming and misunderstanding and incorrect signals to physicians that might not be best for everyone. Dr. Michael Kitchell, a neurologist and chairman of the board at the McFarland Clinic in Ames, Iowa, one of the state s biggest multi-specialist practices, predicted the Medicare reports will be a huge surprise to almost every physician. That s because the calculations of how much those doctors patients cost Medicare include not just the services of the individual doctor but of all the doctors that provided any treatment to the patient. Kitchell said his patients saw on average 13 physicians besides himself. You re a victim or a beneficiary of your medical neighborhood, Kitchell said. If the primarycare doctors are doing the preventative screening tests, you ll get credit for that, but if you re (Continued on page 7)

7 Volume 12, Issue 5 Page 7 (Continued from page 6) in a community where the community doctors are doing a poor job, you re going to look bad. Medicare officials are trying to refine the way they judge doctors as they follow the health-care law s directive to phase in the new payment system, called a Physician Value-Based Payment Modifier, starting in It will initially apply only to physician groups and some specialists selected by the government, but by 2017 the payment change is supposed to apply to most if not all doctors. The assessment is a very important change we re putting into place, one where we re going to need a lot of feedback and deliberation, said Jonathan Blum, CMS s deputy administrator. We re not blind to the challenges that are coming toward us. Although the program is still being devised, it will become reality for many doctors starting in January, because CMS plans to base the 2015 bonuses or penalties on what happens to a doctor s patients during As the nation s biggest insurer, Medicare s adoption of this approach would be a game changer in terms of making physicians directly accountable for costs, said Anders Gilberg, senior vice president at the Medical Group Management Association, which represents doctors groups. Medicare is going to be shifting money from... physicians who are deemed to be high-cost relative to their peers to low-cost physicians. That s going to create all kinds of new incentives in fee-for-service. Private insurers may follow Medicare s lead, said Paul Ginsburg, president of the Center for Studying Health System Change, a Washington think tank. The formula Medicare ultimately designs to judge and pay doctors, Ginsburg said, could become a valuable asset for private insurers, with a tool that will be somewhat bulletproof, that physicians won t attack because they ve been part of the process of developing them. But getting physician support may not be so easy, said Margaret O Kane, president of the National Committee for Quality Assurance, a nonprofit in Washington. Doctors are a very powerful political segment, she said. In addition, she added, Patients are not behind this agenda. The public is very scared about managing costs. Dana Gelb Safran, who oversees quality measurement for Blue Cross Blue Shield of Massachusetts, says she doubts it will be possible for the government to judge individual doctors. She predicts CMS will ultimately have to find ways to evaluate doctors as parts of groups either formal affiliations as part of group practices or informal affiliations among doctors who refer to each other. There really are very few measures that we can reliably evaluate on the individual doctor level, she said. When they move forward with the value-based modifier, there is going to have to somehow allow physicians to identify other physicians with whom they say they practice and who they say they share clinical risk for performance. Kaiser Health News AOA Note: QRUR and Optometry CMS chose to roll out the reports in the J5 states because WPS has relative good communication tools. The value-based modifier for MDs will begin in 2015, probably based on performance in The modifier will take effect for optometry in 2017, perhaps based on performance in 2015.

8 Volume 12, Issue 5 Page 8 HIPAA 5010 Extended Through Saturday, June 30th Although the Version 5010 upgrade deadline was Sun Jan 1, 2012, CMS recently extended their enforcement discretion period for the Version 5010 upgrade for all HIPAA-covered entities for an additional three months, through Sat June 30. It s important that all HIPAAcovered entities continue to take the necessary steps to complete the upgrade to Version 5010 as soon as possible. Recently, some providers have experienced issues with Version 5010 claims processing or payment. CMS has created a factsheet that provides guidance to help providers troubleshoot some of the difficulties they are experiencing with claims submissions. The factsheet contains information on: How to handle claims that have failed edits during the delivery process What providers can do if they have difficulty receiving information from clearinghouses and/or billing vendors Links to each of the Medicare Administrative Contractor (MAC) websites, which include lists of their top 10 edits for Version 5010 claims Additional reasons why some providers may receive claims rejections The MACs will continue to work closely with clearinghouses, billing vendors, and healthcare providers requiring assistance in submitting and receiving Version 5010 compliant transactions. If any entity is experiencing difficulty reaching a MAC, they should send a message describing their issue to ProviderFeedback@cms.hhs.gov with 5010 Extension in the subject line. Make sure to take a look at the Version 5010 section of the ICD-10 website which can be found at for helpful factsheets on the upgrade to Version 5010 and previous listserv messages discussing the Version 5010 upgrade. Keep Up to Date on Version 5010 and ICD-10. Please visit the ICD-10 website found at for the latest news and resources to help you prepare, and to download and share the implementation widget today found at Updated HIPAA 5010 FAQ System CMS has updated the FAQ system and the way it is organized. There are now three ways to more easily find Version 5010 FAQs by going to the CMS FAQs Page at questions.cms.gov/ and: Click on the Topic HIPAA Administrative Simplification on the left side of the page Click on the Subtopic Versions 5010 and D.0 that will appear as a dropdown under the topic (FAQs on Version 5010 and D.0 will be listed on the right side of the page) Click on the Topic Coding on the left side of the page Click on the Subtopic ICD-10 that will appear as a dropdown under the topic (FAQs on Version 5010 will be listed out on the right side of the page) Entering the search term Version 5010 in the Search box on the upper left side of the page CMS Version 5010 and D.0 FAQs can also be found on the Version 5010 page located at of the ICD-10 website, under the FAQs: Versions 5010 and D.0 Transition Basics fact sheet.

9 Page 9 NOA 3rd Party Newsletter Medicaid Electronic Claim Information Acceptance of the 4010 electronic claim format has been extended, but you must transition to 5010 by July 1, Suggestions on how to accomplish the transition are provided. PROVIDER BULLETIN No RE: Acceptance of 4010 Electronic Claim Transactions Ends June 30, 2012 Nebraska Medicaid has been compliant with HIPAA 5010 electronic transactions since the mandated date of January 1,2012 and has been accepting 5010 transactions since that date. However, to accommodate trading partners and providers who were not ready to submit claim transactions, Nebraska Medicaid has continued to accept 4010 claim transactions while actively working with trading partners to enroll and successfully test 5010 transactions. CMS has also recognized the need for additional time for trading partners, providers, clearinghouses and software vendors to become 5010 compliant by extending the enforcement discretion period through June 30, Steady progress has been made by trading partners and providers to become 5010 compliant; currently more than 80% of electronic claims are being submitted to Nebraska Medicaid in the 5010 format. The continued dual functionality of accepting both 4010 and 5010 claims has been difficult for all involved, putting considerable stress on the Nebraska Medicaid Management Information System (MMIS). With Trading Partners not yet in production for 5010, there has been a dramatic increase in paper claim volume and processing time. The purpose of this notice is to advise that while we anticipate 5010 compliance with Trading Partners prior to then, NE Medicaid has made the decision to extend the acceptance of 4010 through June 30, Trading Partners who are not approved for 5010 production by May 15, 2012, must submit a plan for compliance no later than May 15th to the Medicaid EDI Help Desk at DHHS.MedicaidEDI@Nebraska.gov. The Plan should include: remaining tasks and expected completion dates (including testing plan and date compliance expected) and a contingency plan should you fail to make the June 30th deadline for being in production with 5010 with Nebraska Medicaid. Planned compliance dates will be shared with providers, upon request. To accomplish the transition to 5010, Nebraska Medicaid suggests the following: Providers: If not yet submitting 5010 claim transactions, contact your trading partner to ensure that testing is being aggressively pursued to ensure a successful transition to 5010 claims prior to July 1, Review the Trading Partner Activity Status report at: If your trading partner is not listed in the column 5010 Transactions in Production with the 837 that you require (837P, 837I or 837D), contact your trading partner to determine their plan for compliance for Also, ensure that software vendors and your IT staff are ready for the transition. If your NPI, Taxonomy Code and Nine-digit Zip code for each Medicaid billing provider account have not been reported to Nebraska Medicaid, contact the Medicaid Provider Validation staff at dhhs.providervalidation@nebraska.gov or immediately. If paper claims are being denied or returned for correction, review the claim completion instructions at: Trading Partners: If not in Production with 5010, begin the enrollment process immediately at test aggressively, and communicate regularly with providers. Begin testing as soon as possible; allow 4 6 weeks to become approved and promoted to production. Review the Trading Partner Activity Status report at: Review to ensure your status is reflected accurately. Contact the EDI Help Desk, DHHS.MedicaidEDI@Nebraska.gov, with any corrections. ============================ For a listing of current Nebraska Medicaid EDI Clearinghouses and their 5010 activity status, see Please check the publication date as the spreadsheet will be updated on a regular basis.

10 Volume 12, Issue 5 Page 10 For Medicaid Providers, a 1% Cut is Better than a 2.5% Cut! From Lobbyist Ron Jensen s Legislative Newsletter If Nebraska Medicaid providers had a major accomplishment in the 2012 session, it was joining with the other long-term care association and other health and human services providers in securing some major relief from the budget cuts imposed by the 2011 session. That and heading off the cuts in Medicaid services and clients outlined by the DHHS Division of Medicaid and Long-Term Care in a letter to the Legislature of December 1, Both the letter and the lawmakers actions in restoring 1.5% - effective for the fiscal year beginning July 1, 2012 of last year s 2.5% cut in Medicaid reimbursement rates, have been reported on here in some detail but nevertheless are worth prominent mention in this final report on the session. What s left hanging, of course, is what the 2013 Legislature will do in crafting a budget for the biennium. BCBS Spring Update Newsletter Available The Blue Cross and Blue Shield Spring newsletter is now available at BCBSNE Credentialing Now Available Online via CAQH Blue Cross and Blue Shield of Nebraska has entered into an arrangement with the Council of Affordable Quality Healthcare (CAQH) as part of an initiative to obtain professional credentialing information electronically. CAQH follows an industry standard for collecting provider data used in the credentialing process, making it more efficient. The council offers an electronic application that can be completed online, saving you time and effort since CAQH is used by other health insurance companies. Using CAQH will help reduce some of the administrative duplication of efforts related to credentialing and ensures that providers are aware of necessary information needed. To ensure applications are processed quickly, the CAQH online application should be used for initial credentialing and recredentialing. We encourage you to provide this information at your earliest convenience even if you re currently a part of the BCBSNE network.

11 Volume 12, Issue 5 Page 11 Dr. Quentin Quack s Queries and Questionable Quotes ~~~~~~~~~~~~~~~~~~~~~~~~~~ Third Party Questions from NOA Doctors and Staff Dr. Quentin Quack Noridian DME Proof of Delivery Dear Dr. Quack, Do you have a sample form of a written post cataract glasses proof of delivery form for DME? We currently have a hard copy order form in the chart that we put all of the glasses information (frame, prescription, type of lenses, seg height, pd etc) and then on the exam sheet used that day it also has the prescription and then the doctor signs the form. Currently we have the patient sign the bottom of the ABN stating that they have received their glasses and they put the date along with their signature. I took the refractive lens class and it doesn't sound like what we are doing meets their requirements. During the class I sent the question about the patient signing the bottom of the ABN and they responded that it would not meet the requirements found in the IOM for DME or the POD (proof of delivery). Received by Date delivered Signature Dr. Quack s Quote: Dr. Quack has not created a delivery form. What we have recommended in the past is stamping the completed ORDER form (containing all Rx specifications, date, and prescriber s signature) with a "DELIVERED TO" stamp, which contains lines for the patient name, date of delivery & patient s signature. I still think that would be adequate since it explicitly demonstrates delivery of the ordered Rx, when it was delivered & to whom. But then, what does a feather-brained duck know!? Bandage CL Coding Dear Dr. Quack, We have a patient who is seen monthly for exam (99213), bandage CL (92370) and fitting of CL (92071) with exam diagnosis of and the others all pointing to the correct diagnosis. The exam and fitting are covered, but the CL are not. The patient has Medicaid secondary and I am listing an L5 modifier as well as listing in replacement reason. Is there any hope of getting the CL covered for this patient? The denial is through both Medicare and Medicaid. Dr. Quack s Quote: Well, a couple of things is the CPT code for refitting glasses...not appropriate for your apparent situation is chronic open angle GLC (and which must be filed along with ); but it is not a diagnosis that justifies a bandage CL is the diagnosis for true aphakia (not pseudophakia), and is not a justification for a bandage CL Suggestions: is the correct code for the fitting of a bandage CL, but you must have a diagnosis of ocular surface disease to use this code. Regarding the code for reimbursement for the CL when filed with or that is a nationwide problem right now. Take a look at the AOA s suggestion regarding the coding of the lens itself on page 10 of Medicare B does not pay for contact lens materials, and Medicare DME only pays for CLs if the patient is a true aphakic. So, if your patient is a true aphakic, you would file the CL with Noridian. But that would not be a bandage CL...

12 Page 12 NOA 3rd Party Newsletter Dr. Quentin Quack s Quacked Humor First Job A young family moved into a house, next to a vacant lot. One day, a construction crew turned up to start building a house on the empty lot. The young family's 5-year-old daughter naturally took an interest in all the activity going on next door and spent much of each day observing the workers. Eventually the construction crew, all of them "gems-in-the-rough," more or less, adopted her as a kind of project mascot. They chatted with her, let her sit with them while they had coffee and lunch breaks and gave her little jobs to do here and there to make her feel important. At the end of the first week, they even presented her with a pay envelope containing ten dollars. The little girl took this home to her mother who suggested that she take her ten dollars "pay" she'd received to the bank the next day to start a savings account. When the girl and her mom got to the bank, the teller was equally impressed and asked the little girl how she had come by her very own pay check at such a young age. The little girl proudly replied, "I worked last week with a real construction crew building the new house next door to us." "Oh my goodness gracious," said the teller, and will you be working on the house again this week, too?" The little girl replied, "I will, if those #%&^# s at Home Depot ever deliver the &*+$@# sheet rock..." To access the new NOA 3rd Party web page directly: 1. Go to 2. Click on DOCTORS (gray horizontal bar) 3. Click on THIRD PARTY INDEX (gray bar, left side of screen) 4. Enter your User Name (AOA member #) and Password (DOB MMDDYY) when requested.