NOA 3rd Party Newsletter

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1 NOA 3rd Party Newsletter May 2015 Nebraska Optometric Association Volume 15, Issue 5 Please forward to all of your doctors and staff Click FILE and Click PRINT for a Printed Copy of This Newsle er CMS AOA Explains MACRA, the New Medicare Reimbursement Law 1,2. Provider "Signature on File" Errors May Cause Claim Denials & Recoupment on Mul ple Claims Pp. 3,4. CMS versus American Medical Associa on Modifier Coding Advice P.5. Free Billing So ware PC ACE Pro32 Version 2.60 Upgrade P.5. Quality and Resource Use Reports (QRURs) Are Available Online P.6. PQRS ICD 10 The New CMS Value Modifier Changes Reimbursement in 2017 P.7. Register for PQRS as a Group: 2015 PV PQRS GPRO Registra on is Now Open P.8,9. Reminder: Open Payments Sunshine Act Physician Review and Dispute Period Ends May 20, 2015 P.10. Road to 10: The Small Physician Prac ce's Route to ICD 10 P.9. Noridian AOA Noridian Revises Web Site, Changes Site Links P.11. Important 3rd Party Informa on from the AOA P.12. Potpourri Copies of an Rx Do Not Require Pa ent Release P.13. Interpreter Required for Limited English Proficiency Pa ents P.13. AOA Explains MACRA, the New Medicare Reimbursement Law FROM THE AOA: Now that Medicare physician payment reform is in effect, optometrists need to know how it will affect future payments and how new programs are intended to work. As a result of AOA advocacy, doctors of optometry are recognized as physicians for major quality improvement and payment and delivery reforms. On April 16, President Obama signed the "Medicare Access and CHIP Reauthoriza on Act of 2015" (MACRA) into law. Thanks to optometry's advocacy efforts, the historic legisla on fully recognizes doctors of optometry as physicians for all major quality improvement and payment and delivery reforms. Just hours before the Senate signed the bill, more than 500 AOA doctor and student Congressional Advocacy Conference a endees were on Capitol Hill, urging their elected leaders to scrap Medicare's flawed annual update formula and help advance optometry's other top priori es. What's in the new MACRA law? A changing payment system The new law repeals Medicare's sustainable growth rate (SGR) formula and creates a narrow pathway to higher Medicare payments, largely through a consolidated and expanded incen ve program called the Merit Based Incen ve Payment System (MIPS). The system will comprise elements of the Physician Quality Repor ng System, Value Based Modifier and Electronic Health Records Meaningful Use. (Continued on page 2)

2 Volume 15, Issue 5 Page 2 (Continued from page 1) With Medicare fee for service retained, physician rates will increase by 0.5 percent star ng in July and each January un l Through MIPS, doctors of optometry and other physicians could earn significant bonuses, based on a 100 point scale that reflects performance on quality, resource use, clinical prac ce improvement ac vi es and meaningful use of cer fied electronic health record technology. Star ng in 2019, bonuses could reach 12 percent, and 27 percent by 2022, though some doctors might face penal es for not mee ng quality targets. ODs may earn an addi onal five percent bonus each year by par cipa ng in an accountable care organiza on or other alterna ve payment model. MACRA's new quality improvement efforts also focus on the use of clinical data registries, making AOA's MORE (Measures and Outcomes Registry for Eyecare) an even more important AOA member benefit. See Ongoing advocacy Even while suppor ng MACRA's final passage, the AOA was working with other physician groups to raise concerns about two misguided provisions in the legisla on. Although they would not impact optometry or the delivery of eye health care through Medicare today, the provisions are based on limited physician level par cipa on, an approach AOA opposes in all instances as a ma er of policy. Care Management Lead for Complex Chronic Condi ons Optometrists are not eligible for a new program open only to providers who oversee and coordinate all of the care needed by Medicare beneficiaries with complex chronic condi ons. While this won't interfere with an OD's ability to provide care to those with chronic condi ons, it does preclude the possibility of receiving a specific incen ve for coordina ng all of the care these pa ents need. Resource Use Measurement Delay The law delays for one year (to 2019) the ability of ODs to par cipate in a program that assesses how to be er measure physician resource use during certain episodes of care and for specific pa ent condi ons. A delayed start under this new and separate effort does not limit full OD par cipa on in larger pay and delivery reforms, including the calcula on of "resource use" under the MIPS program, which will largely be based on the exis ng Value Based Modifier. AOA will con nue to press Congress and CMS on these concerns and push for access and physician fairness as a founda on of the implementa on process, and con nue to analyze each individual provision of the legisla on so that member doctors can access the latest and most relevant updates on the MACRA law and other coming changes to Medicare. For more informa on, contact AOA Washington staffer Ma Wille e@aoa.org, director of congressional rela ons. 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 To access the NOA 3rd Party Fax number web page: is Call Ed before faxing.

3 Page 3 NOA 3rd Party Newsletter Provider "Signature on File" Errors Cause Claim Denials & May Result in Recoupment on Multiple Claims WPS Medicare con nues to see Comprehensive Error Rate Tes ng (CERT) errors assessed for missing provider signatures in medical record documenta on. We have recently noted error findings where the signature sec on of the medical record contained only the statement "signature on file" for the performing provider. This is not considered a valid provider signature per Medicare regula ons and will result in an addi onal request to the provider for a signature a esta on statement. If an a esta on statement is not received, services will be denied. To avoid requests for addi onal documenta on or claim denials, we recommend all providers authen cate their medical record documenta on with a valid handwri en or electronic signature. For more informa on on Medicare signature requirements, refer to the Guidance for Provider Signature Requirements below. Guidance for Provider Signature Requirements WPS Medicare con nues to see Comprehensive Error Rate Tes ng (CERT) errors assessed for illegible or missing provider signatures in medical record documenta on. With only a few excep ons, Medicare requires that services provided/ordered be authen cated by the author. The method used shall be a hand wri en or electronic signature. Stamped signatures will be permi ed in the case of an author with a physical disability who can provide proof to a CMS contractor of his/her inability to sign their signature due to their disability. By affixing the rubber stamp, the provider is cer fying that they have reviewed the document. As a reminder, providers should not add late signatures to the medical record, (beyond the short delay that occurs during the transcrip on process) but instead may make use of a signature a esta on statement confirming they performed the service. For more detailed guidelines on specific signature related topics, select one of the links below, or scroll to read the full ar cle. Dictated Notes and Use of Ini als h p:// guidance.shtml#ictate Electronic Medical Records (EMR) h p:// guidance.shtml#r Physician Orders h p:// guidance.shtml#der Signature Logs or Cards h p:// guidance.shtml#og A esta on Statements h p:// guidance.shtml# est Dictated Notes and Use of Ini als The physician must review the transcribed note to correct any errors and affirm the note's contents for it to be considered the final documenta on of the service It is not sufficient that the provider is designated as dicta ng the note or his/her name is present in the record If an illegible handwri en signature is present and the record contains no other iden fica on of the author (i.e., printed name below, or le erhead with name) a signature log or a esta on statement must be included with your response to the documenta on request If the record is missing a signature, an a esta on statement must be included in your response to the documenta on request A legible signature that includes the provider's full name and creden als is always the best prac ce Ini als are acceptable if signed over a typed or printed name without a typed name to iden fy the author, a signature log or a esta on statement must be submi ed or services may be denied (Continued on page 4)

4 Page 4 NOA 3rd Party Newsletter (Continued from page 3) Electronic Medical Records (EMR) For providers using EMR systems, it is crucial that the electronic signature is affixed to the records when responding to all Medicare requests for documenta on. Although CMS has not published formal regula ons regarding electronic signatures, we recommend that an electronic signature be accompanied by a statement indica ng that the signature was applied electronically. We also recommend including the date and me the record was authen cated. Electronic signature nota ons can include the following (not allinclusive): 'Electronically signed by' 'Verified by' 'Reviewed by' 'Released by' 'Signed by' 'Authen cated by' 'Authorized' 'Confirmed by' 'Finalized by' 'Electronically approved by' Physician Orders Medicare will disregard an unsigned order during the review of the claim. An a esta on statement is not acceptable for an unsigned physician order. To meet Medicare signature requirements: Documenta on (i.e., a progress note) must be submi ed which clearly indicates the intent that the specific service(s) be provided If the progress note suppor ng intent does not contain a valid provider signature, an a esta on statement should also be submi ed in response to the record request For more informa on on physician order requirements refer to CMS Internet Only Manual, Publica on , Chapter 15, Sec on 80.6 Requirements for Ordering and Following Orders for Diagnos c Tests. See Signature Logs or Cards If the medical record contains an illegible signature, providers should include a signature log in their submi ed documenta on, lis ng the typed or printed name of the author associated with the ini als or illegible signature. The signature log can be included on the actual page with the ini als or illegible signature, or can be a separate document. Please remember that since a provider's signature may change over me, signature cards or logs should be kept current. CERT may assess errors for signature cards with signatures that no longer match the signature on medical record documenta on. A esta on Statements An a esta on statement can be used in cases of illegible or missing provider signatures (excluding physician orders). In order to be considered valid for Medicare medical review purposes, an a esta on statement must be signed and dated by the author of the medical record entry and must contain sufficient informa on to iden fy the beneficiary. An a esta on example can be found on WPS Medicare's Forms page, under Medical Review at forms/. It is crucial that medical record documenta on be complete and legible, and be authen cated and dated promptly by the praconer who is responsible for ordering, providing or evalua ng the service(s) rendered. The lack of these elements in your documenta on may result in claim denials upon review. You can find complete signature requirement regula ons in the Centers for Medicare and Medicaid Services (CMS) Internet Only Manual, Publica on , Chapter 3, Sec on See pim83c03.pdf

5 Volume 15, Issue 5 Page 5 CMS versus American Medical Association Modifier Coding Advice There are mes when the coding and modifier informa on issued by CMS differs from the American Medical Associa on's (AMA) coding advice regarding the use of modifiers. A clear understanding of Medicare's rules and regula ons is necessary in order to assign the modifier correctly. To access and view general modifier informa on and modifier fact sheets, visit our Modifier web page at Free Billing Software PC-ACE Pro32 Version 2.60 Upgrade Available The PC ACE Pro32 version 2.60 upgrade is now available for download from the CEDI Web site under PC ACE Pro32. The link to this page is: Start the upgrade by clicking the blue bu on that reads PC ACE Pro32 So ware Downloads. This will redirect you to the PC ACE Pro32 Download Page. You will need to enter your Trading Partner ID, Requestor's Name, ZIP Code, and E mail Address. Then select the radio bu on for the "PC ACE So ware Upgrade version 2.60" and the "Submit Request" bu on to begin the download process. Note: The installa on code needed for running the upgrade will be sent to the E mail address entered on the download page. An Upgrade Instruc ons for PC ACE Pro32 document is available on the CEDI Web site to assist you with upgrading the so ware. Version 2.60 includes updates to the code lists including: Claims Adjustment Reason Codes Remi ance Advice Reason Codes HCPCS Codes Diagnosis Codes For more informa on about the changes, review the PC ACE Pro32 Newsle er for PC ACE Pro32 Release 2.60 Professional. To view the newsle er, select Release Newsle ers and User's Guides located on the CEDI Web site under PC ACE Pro32 Documenta on at qs=6b320c6f3e47bfa91ad1f93007e238f fb2b19b44722a7aba0 If you have any ques ons or need assistance in downloading the PC ACE Pro32 Upgrade from the CEDI Web site, please contact the CEDI Help Desk at ngs.cedihelpdesk@anthem.com or at

6 Volume 15, Issue 5 Page 6 Quality and Resource Use Reports (QRURs) Are Available Online The Quality Resource Use Reports (QRURs) are part of CMS's Physician Feedback Program which provides physicians with compara ve informa on about the quality and cost of the care delivered to their Medicare fee for service pa ents. CMS provided Quality and Resource Use Reports (QRURs) to physicians in groups of all sizes and physician solo praconers in September of The 2013 QRURs provide clinically meaningful and ac onable informa on that can be used to improve the quality and efficiency of care provided to Medicare beneficiaries and also to understand and improve performance on quality and cost measures. If you are a physician subject to the Value Based Payment Modifier (VM) Program, the reports also contain informa on about how your performance is affec ng your Medicare payments in You can access a Quality and Resource Use Report (QRUR) on behalf of a group or solo praconer at QRURs are provided for each Medicare enrolled Taxpayer Iden fica on Number (TIN). You or one person from your group will need to obtain an Individuals Authorized Access to the CMS Computer Services (IACS) account with the correct role first. The sec ons below Se ng up an IACS account to access a group s QRUR and Se ng up an IACS account to access a solo praconer s QRUR will tell you how. Once you have an IACS account, follow the step by step instruc ons provided in the quick reference guide located in the Downloads sec on below, to access the QRUR. To find out whether there is already someone who can access your or your group s QRUR, please contact the QualityNet Help Desk at the number provided in the Technical Assistance sec on below and provide the your TIN and the name of your group (or your name, if you are a solo praconer). If your group has already registered for a PQRS group repor ng mechanism, then the same person who registered the group can access the group s QRUR using his or her IACS User ID and password. See more at Need Assistance? For technical ques ons about obtaining your QRUR, please contact the QualityNet Help Desk Monday through Friday from 8am to 8pm ET. Phone: (TTY ) Fax: qnetsupport@hcqis.org For ques ons about the contents of the QRUR, please contact the Physician Value Help Desk Monday through Friday from 8am to 8pm ET. Phone: , press op on 3; (TTY )

7 Volume 15, Issue 5 Page 7 The New CMS Value Modifier Changes Reimbursement in 2017 Your 2015 Services and PQRS Will Determine Your 2017 Payments CY 2017 Payment Adjustment Physician Solo Praconers and Physicians in Groups of 2 or more Eligible Professionals In CY 2017, Medicare will apply the Value Modifier to physician payments under the Medicare PFS for physician solo praconers and physicians in groups of 2 or more EPs. This policy completes the phase in of the Value Modifier to all physicians and groups of physicians as required by the statute. CY 2015 is the performance period for the Value Modifier that will be applied in CY In order to be eligible for upward, downward, or neutral payment adjustments under the Value Modifier quality ering methodology and to avoid an automa c nega ve two percent ( 2.0% ) (for physician groups with between 2 to 9 EPs and physician solo praconers) or nega ve four percent (" 4.0%") (for physician groups with 10 or more EPs) Value Modifier payment adjustment in CY 2017, EPs in groups and solo praconers MUST par cipate in the PQRS and sa sfy repor ng requirements as a group or as individuals in CY Quality ering is mandatory for groups and solo praconers subject to the Value Modifier in CY Groups with 10 or more EPs are subject to upward, neutral, or downward adjustment under quality ering, and groups with between 2 to 9 EPs and physician solo praconers are subject to only upward or neutral adjustment under quality ering in Physician groups with 2 or more EPs can avoid the automa c 2.0% (for groups with between 2 to 9 EPs) or " 4.0%" (for groups with 10 or more EPs) Value Modifier payment adjustment in CY 2017 by par cipa ng in the PQRS GPRO in CY 2015 and mee ng the sa sfactory repor ng criteria to avoid the 2.0% CY 2017 PQRS payment adjustment. Alterna vely, physician groups with 2 or more EPs can avoid the automa c 2.0% (for groups with between 2 to 9 EPs) or " 4.0%" (for groups with 10 or more EPs) Value Modifier payment adjustment in CY 2017, if the EPs in the group par cipate in the PQRS as individuals in CY 2015 and at least 50% of the EPs in the group meet the sa sfactory repor ng criteria as individuals (or in lieu of sa sfactory repor ng, sa sfactorily par cipate in a Qualified Clinical Data Registry) to avoid the 2.0% CY 2017 PQRS payment adjustment. Physician solo praconers can avoid the automa c 2.0% Value Modifier payment adjustment in CY 2017, if the solo praconer par cipates in the PQRS as an individual in CY 2015 and meets the sa sfactory repor ng criteria as an individual (or in lieu of sa sfactory repor ng, sa sfactorily par cipate in a Qualified Clinical Data Registry) to avoid the 2.0% CY 2017 PQRS payment adjustment. To access the NOA 3rd Party web Source: page:

8 Page 8 NOA 3rd Party Newsletter Register for PQRS as a Group: 2015 PV-PQRS GPRO Registration is Now Open Groups can now register to par cipate in the 2015 Physician Quality Repor ng System (PQRS) Group Repor ng Op on (GPRO) via the Physician Value Physician Quality Repor ng System (PV PQRS) Registra on System. PQRS GPRO is an op on available to groups with 2 or more eligible professionals (EPs). Groups must meet the sa sfactory repor ng criteria through the PQRS GPRO in order to avoid the 2.0% CY 2017 PQRS payment adjustment. More informa on about the CY 2017 PQRS payment adjustment will be available on the PQRS Payment Adjustment Informa on webpage. In addi on, physicians in groups of all sizes and physician solo praconers are subject to the Value Modifier in 2017, based on performance in Under the Value Modifier, these physicians and groups must meet the criteria to avoid the downward payment adjustment under PQRS in order to avoid an addi onal automa c downward adjustment under the Value Modifier and qualify for adjustments based on their quality performance. Sa sfactorily repor ng via a PQRS GPRO is one of the ways groups can avoid automa c downward adjustments and qualify for performance based payment incen ves under the Value Modifier. Please see the What Physicians Need to Do in 2015 for the 2017 VM document on the Value Modifier webpage for more informa on. Groups can par cipate in the PQRS program for the 2015 performance period, by selec ng one of the GPRO repor ng mechanisms between April 1, 2015 and June 30, 2015 (11:59 pm EDT): Qualified PQRS Registry Electronic Health Record (EHR) [via Direct EHR using cer fied EHR technology (CEHRT) or CEHRT via Data Submission Vendor] Web Interface (for groups with 25 or more EPs only) Consumer Assessment of Health Providers and Systems (CAHPS) for PQRS Survey via a CMS cer fied Survey Vendor (as a supplement to another GPRO repor ng mechanism) Note: In 2015, the CAHPS for PQRS survey is mandatory for groups with 100 or more EPs and op onal for groups with between 2 to 99 EPs. Groups with 2 or more EPs can elect whether to include the results of their 2015 CAHPS for PQRS survey in the calcula on of their 2017 Value based Payment Modifier (Value Modifier). In 2015, for groups that elect or are required to report the CAHPS for PQRS survey, the (Continued on page 9)

9 Page 9 NOA 3rd Party Newsletter (Continued from page 8) group is responsible for selec ng and paying a cer fied a survey vendor to implement the survey on behalf of the group. Some groups may have insufficient sample sizes for valid and reliable CAHPS for PQRS survey results, as a result of pa ent a ribu on and sampling rules. CMS will no fy groups that do not have enough beneficiaries assigned. Groups should make sure to report a sufficient number of measures via their primary chosen GPRO repor ng mechanism (Registry, EHR, or Web Interface) to meet program requirements. Physician groups with 2 or more EPs that choose not to register, must ensure that at least 50% of the EPs in the group meet the criteria to avoid the 2017 PQRS payment adjustment as individuals in order for the group to avoid the automa c 2017 Value Modifier downward payment adjustment ( 2.0% or 4.0% depending on the group s size). The Registra on System can be accessed at using a valid Individuals Authorized Access to the CMS Computer Services (IACS) account. Step by step instruc ons for obtaining an IACS account with the correct role are provided on the PQRS GPRO Registra on webpage at Step by step instruc ons for registering to par cipate in the 2015 PQRS GPRO are provided in the 2015 PQRS GPRO Registra on Guide located in the Downloads sec on of the PQRS GPRO webpage at Road to 10: The Small Physician Practice's Route to ICD-10 Ge ng Started: Tell us a li le about your prac ce, so we can create an Ac on Plan for you. My Prac ce Size (1 2, 3 6, or over 6 providers) My Technology and Staffing Partners check all that apply (EHR, Billing Service, Clearinghouse, etc.) My Trading Partners check all that apply (Medicare, Medicaid, etc.) My ICD 10 Readiness (Planning, Assessment, Implementa on, Tes ng) Based on your responses to the above ques ons, and ac on plan will be provided for you by CMS. action-plan/get-started/ Additional ICD-10 Resources flyer with multiple links:

10 Page 10 NOA 3rd Party Newsletter Reminder: Open Payments Sunshine Act Physician Review and Dispute Period Ends May 20, 2015 Physicians have un l May 20, 2015 to voluntarily review data reported by drug and medical device makers about them, and, if necessary, dispute payments, before the data is made public on June 30, To review data, physicians and teaching hospitals must register in both the CMS Enterprise Portal and the Open Payments system at This is the second repor ng cycle for Open Payments, and it covers payments made in Last year, CMS published informa on about 4.45 million payments valued at $3.7 billion for the last five months of Physicians and teaching hospitals who registered last year do not need to register again in the CMS Enterprise Portal or the Open Payments system. Go to the CMS Enterprise Portal at log in using your user ID and password, and navigate to the Open Payments system home page. Use the Review and Dispute Process Quick Reference Guide at to assist you with reviewing the submi ed informa on and affirming or dispu ng the reported data before it is published. The CMS Enterprise Portal locks accounts if there is no ac vity for 60 days or more and deac vates accounts if there is no ac vity for 180 days or more. To unlock an account, go to the CMS Enterprise Portal at enter your user ID, and correctly answer all challenge ques ons; you ll then be prompted to enter a new password. To reinstate an account, contact the Open Payments Help Desk at openpayments@cms.hhs.gov. TIPS FOR SUCCESSFUL REGISTRATION: Use Internet Explorer versions 8 10, or the latest version of Firefox browsers. Currently the Open Payments system is not op mized for the Safari or Chrome browsers. Understand that registra on is a two step process, that should not take more than 30 minutes: Registra on in CMS Enterprise Portal is the required first step, followed by Open Payments system registra on. Consider answering op onal ques ons during the registra on process (skipping these ques ons can slow your registra on). Learn more about the review and dispute process by accessing the educa onal materials available on the Resources page of the Open Payments website at

11 Volume 15, Issue 5 Page 11 Noridian Revises Web Site, Changes Site Links The most frequently visited website pages have been listed below along with the hyperlink to what the new website address effective April 21, Suppliers are encouraged to visit the new website and adjust any bookmarks they may have set to assist in prompt access to frequently referenced website content. Noridian will offer a feature that redirects website visitors from the old website to the new website for one month following the new website launch. Topic Previous Site Link New Site Link Homepage med.noridianmedicare.com/web/jddme Active LCDs Fees med.noridianmedicare.com/web/jddme/policies/lcd/ active med.noridianmedicare.com/web/jddme/fees-news/fee -schedules Policies med.noridianmedicare.com/web/jddme/policies Education med.noridianmedicare.com/web/jddme/education Latest Updates med.noridianmedicare.com/web/jddme/fees-news/ latest-updates Forms med.noridianmedicare.com/web/jddme/forms Supplier Manual Endeavor Coverage Checklists Redeterminations Education Materials / Presentations Appeals ICD10 PECOS Same or Similar Chart EDI CERT Prior Authorization Recovery Auditor Enrollment index.html endeavor.html checklists.html redeterminations.html education_tools.html icd_10_cm.html _may/same_or_similar_reference_chart.html prior_authorization_demonstration_pmd/ rac.html med.noridianmedicare.com/web/jddme/education/ supplier-manual med.noridianmedicare.com/web/jddme/topics/portal med.noridianmedicare.com/web/jddme/policies/ documentation-checklists med.noridianmedicare.com/web/jddme/education/ event-materials med.noridianmedicare.com/web/jddme/topics/icd-10 med.noridianmedicare.com/web/jddme/claimsappeals/appeals/redetermination med.noridianmedicare.com/web/jddme/claimsappeals/appeals med.noridianmedicare.com/web/jddme/claimsappeals/claim-submission/pecos-edits med.noridianmedicare.com/web/jddme/topics/sameor-similar med.noridianmedicare.com/web/jddme/claimsappeals/cedi med.noridianmedicare.com/web/jddme/cert-reviews/ cert med.noridianmedicare.com/web/jddme/cert-reviews/ mr/prior-authorization med.noridianmedicare.com/web/jddme/cert-reviews/ rac med.noridianmedicare.com/web/jddme/topics/ enrollment Contact med.noridianmedicare.com/web/jddme/contact Dear Physician Letter resources.html med.noridianmedicare.com/web/jddme/policies/ physician-resources

12 Volume 15, Issue 5 Page 12 Important 3rd Party Information from the AOA... AOA FOCUS Articles Regarding 3rd Party Issues Know where you stand with an trust laws Whether doing business or simply talking shop, it's important for doctors to understand that their dealings are subject to an trust laws, regardless of the se ng. See complete ar cle at CMS proposes shorter meaningful use repor ng periods AOA has been figh ng to improve Medicare requirements for meaningful use of electronic heath records. A new federal proposal indicates that regulators have listened to optometry's concerns by shortening repor ng periods and simplifying the repor ng process for 2015 and beyond. See complete ar cle at AOA ICD 10 coding bundle with digital Codes for Optometry This coding bundle provides the tools needed for optometric professionals to confidently transi on from ICD 9 to ICD 10 with four great products approved and recommended by AOA's coding experts. See complete ar cle at Repor ng code There has been some confusion regarding the appropriate repor ng of code The Coding Experts would like to clarify whether it is appropriate to report scanning laser ophthalmoscopy technology when it is used to produce fundus photographs. See complete ar cle at A model for integrated care (Rhode Island) Integrated care is about aligning one cohort of physicians that all work collabora vely to provide the best pa ent care, o en using the same medical record system and having the same goals in mind. See complete ar cle at New NCQA recogni on program open to doctors of optometry The Na onal Commi ee for Quality Assurance has announced their new "Pa ent Centered Connected Care Recogni on Program". The program evaluates delivery, amount, me and coordina on of care. Sites awarded an NCQA seal demonstrate that they deliver quality care using the latest clinical protocols. Doctors of optometry are eligible to par cipate in this new program. See complete ar cle at AOA Announces Ini al Registry EHR Vendors Optometry's clinical registry will launch at Optometry's Mee ng, June 24 28, with three par cipa ng electronic health record systems, and more vendors are an cipated in the months ahead. See complete ar cle at tinyurl.com/oytvfph

13 Volume 15, Issue 5 Page 13 Dr. Quentin Quack s Queries and Questionable Quotes ~~~~~~~~~~~~~~~~~~~~~~~~~~ Third Party Questions from NOA Doctors and Staff Dr. Quentin Quack Copies of Rx Do Not Require Patient Release Dear Dr. Quack: It has been the standard in our office to obtain health informa on release forms from pa ents before faxing over copies of their prescrip ons to other offices. I was told today that they changed that policy and we no longer need authoriza on from pa ents to release their Rx. I thought I would go straight to the source that governs a lot of what we do and see which is correct. Thank you. Dr. Quack s Quote: Forwarding pa ent informa on to another health care provider is considered part of treatment and health care opera ons, and does not require pa ent authoriza on as described in the links below: Interpreter Required for Limited English Proficiency Patients Dear Dr. Quack: Recently, we had an issue regarding non English speaking pa ents with no access to an interpreter. Neither the pa ents nor our office would be able to effec vely interpret the exam. How is our office supposed to handle this situa on? My office manager was curious on what entails a refusal of service and what type of trouble an office could be in to deny non emergent services based on language. Dr. Quack s Quote: If your office accepts federal money, such as from Medicaid, CHIP, etc, then the federal government requires that an interpreter be available to assist you in providing services to any of your pa ents with limited English proficiency (LEP). A family member of the pa ent is acceptable in most cases, or a bilingual staff member. There are also telephone interpre ng services available, or you can engage an interpreter to come to your office. Any expense for interpreter services is your responsibility, and cannot be passed on to the pa ent. This, unfortunately, can result in the cost of an employed interpreter exceeding the reimbursement for the visit. Although this seems patently unfair to providers, it is federal law. The following resources can give you the par culars. Must Medicaid, CHIP and Medicare Part A providers, and organiza ons offering Medicare Part C and Part D plans, provide interpreters for limited English proficient (LEP) beneficiaries and translate their documents into languages other than English? Guidance to Federal Financial Assistance Recipients Regarding Title VI and the Prohibi on Against Na onal Origin Discrimina on Affec ng Limited English Proficient Persons Summary summaryguidance.html Ques ons And Answers Regarding The Department Of Health And Human Services Guidance To Federal Financial Assistance Recipients Regarding The Title Vi Prohibi on Against Na onal Origin Discrimina on Affec ng Limited English Proficient Persons Sorry for the very bad news!!!

14 Page 14 NOA 3rd Party Newsletter Dr. Quentin Quack s Quacked Humor Dear Diary. For my seventy-fifth birthday this year, my wife (the dear) purchased a week of personal training at the local health club for me. Although I am still in great shape since playing on my college tennis team 50-some years ago, I decided it would be a good idea to go ahead and give it a try. I called the club and made my reservations with a personal trainer named Belinda, who identified herself as a 26-year-old aerobics instructor and model for athletic clothing and swim wear. My wife seemed pleased with my enthusiasm to get started! The club encouraged me to keep a diary to chart my progress. MONDAY Started my day at 6:00 a.m. Tough to get out of bed, but found it was well worth it when I arrived at the health club to find Belinda waiting for me. She is something of a Greek goddess - with blond hair, dancing eyes and a dazzling white smile. Woo Hoo!! Belinda gave me a tour and showed me the machines. She took my pulse after five minutes on the treadmill. She was alarmed that my pulse was so fast, but I attribute it to standing next to her in her Lycra aerobic outfit. I enjoyed watching the skillful way in which she conducted her aerobics class after my workout today. Very inspiring! Belinda was encouraging as I did my sit-ups, all though my gut was already aching from holding it in the whole time she was around. This is going to be a FANTASTIC week!! TUESDAY It took a whole pot of coffee, but I finally made it out the door after yesterday s exercise. Belinda made me lie on my back and push a heavy iron bar into the air --then she put weights on it! My legs were a little wobbly on the treadmill, but I made the full mile. Belinda's rewarding smile made it all worthwhile. I feel GREAT!! It's a whole new life for me. WEDNESDAY The only way I can brush my teeth is by laying on the toothbrush on the counter and moving my mouth back and forth over it. I believe I have a hernia in both pectorals. Driving was OK as long as I didn't try to steer or stop. I parked on top of a GEO in the club parking lot. Belinda was impatient with me, insisting that my screams bothered other club members. Her voice is a little too perky for early in the morning and when she scolds, she gets this nasally whine that is VERY annoying. My chest hurt when I got on the treadmill, so Belinda put me on the stair monster. Why the hell would anyone invent a machine to simulate an activity rendered obsolete by elevators? Belinda told me it would help me get in shape and enjoy life. She said some other crap too. THURSDAY Belinda was waiting for me with her vampire-like teeth exposed as her thin, cruel lips were pulled back in a full snarl. I couldn't help being a half an hour late, it took me that long to tie my shoes. Belinda took me to work out with dumbbells. When she was not looking, I ran and hid in the men's room. She sent Lars to find me. Then, as punishment, she put me on the rowing machine -- which I sank. FRIDAY I hate that witch Belinda more than any human being has ever hated any other human being in the history of the world. Stupid, skinny, anemic little cheerleader. If there was a part of my body I could move without unbearable pain, I would beat her with it. Belinda wanted me to work on my triceps. I don't have any triceps! And if you don't want dents in the floor, don't hand me the %#$@& barbells or anything that weighs more than a tuna sandwich. The treadmill flung me off and I landed on a health and nutrition teacher. Why couldn't it have been someone softer, like the drama coach or the choir director? SATURDAY Belinda left a message on my answering machine in her grating, shrilly voice wondering why I did not show up today. Just hearing her made me want to smash the machine with my planner. However, I lacked the strength to even use the TV remote and ended up catching eleven straight hours of the Weather Channel. SUNDAY I'm having the Church van pick me up for services today so I can go and thank GOD that this week is over. I will also pray that next year my wife will choose a gift for me that is fun -- like a root canal or a vasectomy.