February 1, 2017 Volume 2, Issue 2 Microsoft Ellenville Extra Stop.. Influenza time (C mon, you know you re rapping Hammer Time ) It s the most wonderful time of the year..influenza time!!!!! Lets make sure your practice is current on the 2016-2017 codes and payment allowances for flu vaccine and administration. I found this helpful chart on the CMS website. Enjoy 90630 90653 90654 90655 90656 90657 90661 90662 90672 90673 90674 90685 90686 90687 90688 CPT Code Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular Influenza virus vaccine, split virus, preservative-free, for intradermal (IIV3), split virus, preservative free, 0.25 ml dosage, for intramuscular (IIV3), split virus, preservative free, 0.5 ml dosage, for intramuscular (IIV3), split virus, when administered to children 6 35 months of age, for intramuscular (cciiv3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 ml dosage, for intramuscular Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular Payment Allowance $20.34 $37.38 $17.72 $42.72, live (LAIV4), for intranasal $26.88 (RIV3), derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular (cciiv4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 ml dosage, for intramuscular (IIV4), split virus, preservative free, 0.25 ml dosage, for intramuscular (IIV4), split virus, preservative free, 0.5 ml dosage, for intramuscular (IIV4), split virus, when administered to children 6 35 months of age, for intramuscular (IIV4), split virus, 0.25 ml dosage, for intramuscular $40.61 $22.94 $26.27 $19.03 $9.40 $17.84 Q2035 Q2036 Q2037 Q2038 Q2039 HCPCS Level II Code and older, for intramuscular (Afluria) and older, for intramuscular (Flulaval) and older, for intramuscular (Fluvirin) and older, for intramuscular (Fluzone) and older, for intramuscular (not otherwise specified) Above codes are effective August 1,2016 Payment Al- $16.28 $16.28 Flu Vaccine Adult Not Otherwise Classified: Payment allowance is to be determined by the local claims processing con- through July 31, 2017. 90674 is a new code for 2017 and the code descriptors are revised to include dosage instead of age. Medicare will cover one seasonal flu vaccination per seasons. For 2017 the CDC is not supporting the effectiveness of the Flu Mist.
2 Ellenville Extra Compliance Corner with Chris Cardiac Rehabilitation (Continued) The cardiac rehabilitation professional should the prescription as a dynamic blueprint and continuously monitor and record the patient's objective and subjective responses to the exercise therapy. While the supervising physician may not personally orchestrate each change in the exercise program, he or she will certainly rely on recorded data and observations based on the exercise sessions in his or her periodic reviews of the patient's progress. Medicare stipulates, as with Other Third-Party Payers, that CR items and services must be furnished in a physician s office or a hospital outpatient setting. All settings must have a physician immediately available and accessible for medical consultations and emergencies at all times items and services are being furnished under the program. This provision is satisfied if the physician meets the requirements for the direct supervision of physician s office services and for hospital outpatient therapeutic services. In general, CR program sessions are limited to a maximum of 2 one-hour sessions per day for up to 36 sessions over up to 36 weeks, with the option for an additional 36 sessions over an extended period of time if approved by the Medicare contractor. In order to report one session of cardiac rehabilitation services in a day, the duration of treatment must be at least 31 minutes. Two sessions of cardiac rehabilitation services may only be reported in the same day if the duration of treatment is at least 91 minutes. CR is billed on a monthly basis, so reviews of claims should cover all instances of CR services rendered in a calendar month. Codes billed for these services are based upon whether or not continuous ECG monitoring was performed: 93797 Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session) 93798 - Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session) From an auditing perspective, coders should be looking for documentation of a prescription/referral, a Plan of Care, individual encounter documentation of the exercises performed with the results of each exercise, ECG monitoring (if performed), and ongoing review by the physician. Lack of any of these components can impact compliance with billing requirements. Don t hesitate to ask for additional documentation if you are reviewing these services as sometimes data is stored in a paper chart or EMR location separate from the other documents you are reviewing. If additional services are rendered to the patient during his/her time in the office, review time calculations d to assign units for each line item on the claim. Also check your National Correct Coding Initiative (NCCI) edits to make sure there are no bundling conflicts across services listed separately from the CR codes. Suggested Coding and Coverage References: NGS Policy Education Topics: Reminder for Billing Cardiac Rehabilitation Session and Session Limitations Cardiac Rehabilitation Incentive Payment Model from CMS https://innovation.cms.gov/initiatives/cardiac-rehabilitation/ Anthem CG-REHAB-02 Outpatient Cardiac Rehabilitation Clinical UM Guidelines 11/5/2015 United Healthcare Medicare Advantage Rehab_Cardiac_UHCMA_CS Rehabilitation: Cardiac Rehabilitation Services (Outpatient) Coverage Summary Medicare Claims Processing Manual, Chapter 32, 140 CGS Medicare Cardiac Rehabilitation Coverage and Documentation Requirements http://www.cgsmedicare.com/parta/pubs/ news/2012/0912/cope19971.html CPT Manual 2016 (procedures) ICD-10-CM Manual 2016 (diagnoses) cnvcox@gmail.com 2
3 Volume 2, Issue 2 HIPAA-tized by Lance Hello Is My Mother There? When a hospital or other covered entity ( CE ) receives a call asking if a certain patient is being treated, the question can be answered, but the following steps must be taken before that information is disclosed. First, it must be determined if the patient has opted out of the CE s directory. Upon admission, all patients must be asked if they wish to opt out of the directory. If the patient does agree to this, then that person is stating that he or she does not want anyone in the public to know that he or she is receiving any services at the CE. This person will have his or her name excluded from the patient directory. If the patient has not opted out, the following information may be shared with callers or other individuals who have inquired about a specific patient by name: Patient s name Patient s location in the facility, i.e. Room 222A Patient s general condition, i.e. good, stable, critical The CE s staff must ALWAYS consult with the patient before disclosing any additional information concerning the patient s care and this should always be limited to the minimum necessary as discussed in a previous HIPAA-tizing article. So to summarize, yes, the hospital can tell you if your mother is there but only if she is there and only her general condition. If you need anything else, the best bet is to be a good son or daughter and call or better yet, visit Mom you ll be glad you did! Lance.smith@hahv.org 3
4 Team Ellenville Regional Hospital 2017 Pancake Breakfast To Benefit the American Heart Association When: February 11, 2017 Where: Applebee s 1171 Ulster Ave Kingston, NY 12401 Time: 8:00am-10:00am Ticket price: $7.00 Breakfast includes pancakes, bacon and unlimited beverages. 50/50 will be drawn at 9:30am Come join us in supporting our local hospital to raise money for a great ca! For any question or Tickets please contact Melissa Hanigan 845-647-6400 x303 Your 2017 Ellenville Chapter officers: Gina Piccirilli, President (gpiccirilli@ellenvilleregional.org) Christine Cox, VP (CNVcox@gmail.com) Kimberly Piccirilli, Treasurer (pageturner128@gmail.com) We are on Face Book!! Ellenville NY AAPC Local Chapter -Members can join our Private group Maggie Dvoskin, Member Dev (mdvoskin@ellenvilleregional.org) Lance Smith, Secretary (lance.smith@hahv.org) Stephenie Rodriguez, Education (steph.lynn45@gmail.com) Upcoming Events 3/8/17-Chapter Meeting 6pm ERH Café 3/11/17-AAPC Exam-8am-ERH Café 4/4/17-AAPC Exam 8am ERH Café May Mania!!!!! 5/17/2017-6pm-ERH Café 4
5 Employment Opportunities Inpatient Coder (Remote) **Send all resumes to kait.grainger@gebbs.com** GeBBS Healthcare Solutions, an industry leader in Health Information Management (HIM) and Revenue Cycle Management (RCM) solutions, is seeking highly-motivated individuals with a passion for excellence & collaboration, for careers in the healthcare industry. Job Title: Inpatient Coder Division: Direct Department: Facility Coding & AuditSummary: GeBBS Healthcare Solutions is actively recruiting for the role of an Inpatient Coder. This is a full-time, contract position, anticipated to commence as soon as qualified applicants are identified. Current AHIMA certifications required. The Inpatient Coder position will be based from your home-based office, reporting to our Facility Coding Manager.Roles and Responsibilities: Review medical records to identify diagnoses/procedures. Independently organizes and prioritizes all work to ensure that records are coded in timeframes that will assure compliance with regulatory requirements. Demonstrates a comprehensive, expert-level of knowledge of all procedures concerning the sequencing of diagnoses, procedures such as but not limited to those outlined in ICD-10-CM, CPT, Uniform Hospital Discharge Data Set, Medicare guidelines and other appropriate classification systems. Demonstrates knowledge of anatomy and physiology to interpret general medical classifications for coding discharge data including the most complicated encounters/cases. Codes all diagnostic and operative information from the medical record using ICD-10-CM, CPT and HCPCS coding classification systems and independently quality checks own work. GeBBS delivers a people-oriented, equal opportunity culture that supports a friendly work environment, innovative ideas, and a benefits-rich employee package. Paid Time Off (PTO) Medical, Dental, Vision and Life Insurance AD&D 401K Eligibility Medical Coding Specialist Full Time Immediate Opening Expanding local multi specialty billing company has a position available for an experienced medical coding specialist in our Primary Care and Other Specialties Team. The candidate must be able to learn quickly with attention to detail in a hi volume, fast paced environment. Perform comprehensive review of patient records to assure appropriate CPT and ICD-10 coding of medical record prior to billing payers; including decipher handwriting and interpret documentation Communicate with provider to obtain incomplete or missing information needed to process accurate and clean claims * Demonstrate understanding of CPT guidelines for separate procedures, bundling and add-on-codes *Experience in using electronic health record software, eligibility and electronic billing *Ability to interact and communicate with clarity, tact and courtesy with patients, staff and faculty; both written and verbally. *Ability to participate as a member of a team in identifying priorities and work flow *Ability to work with supervision to identify and describe priorities* Participate in professional development activities through seminars, coding reference materials, newsletters, etc. in maintain CPC credentials and remain current with coding changes *Assist Billing in claim error resolution, i.e. verifying and correcting coding issues. Provide reinforcement of correct coding guidelines to maintain compliance standards Required experience:* medical coding: 2 years *Candidate must be AAPC certified or be in the process of getting AAPC certified *Strong computer skills *Competitive compensation and comprehensive benefits package: medical, dental, 401K, flexible spending, vision, AFLAC and paid time off. E/M coding Specialist (Remote) Altegra Health AAPC Certification requirements CPC Specialty Requirements Physician Years of Experience 2-5 years This is a temporary remote position for experienced, certified professional coders with extensive knowledge of E/M service coding for multi-specialties, mult-specialty surgeries and reports to the Professional Coding Manager of Altegra Health s Provider Coding & Audit Division. Qualifications: 3+ years of professional coding experience in multi-specialties with a strong coding background in E/M, CPT, Modifiers and ICD-10. ICD-10 coding certification highly preferred. ICD-coding experience highly preferred. Certification from AAPC or equivalent. Ability to accurately assign E/M codes in multiple settings including; outpatient office, inpatient, observation, Emergency Department and Urgent Care. Extensive knowledge and experience with the following coding and documentation guidelines; 1995 and 1997 E/M Documentation Guidelines, Teaching Physician Guidelines, Global Surgical Package, Critical Care, Incident-To and Split/Shared Services. Knowledge of medical terminology. Experienced with CCI edits. Knowledge of federal and state guidelines on all coding systems and sponsored programs, i.e., Medicare, Medicaid, HMO/PPO. Please email resumes to: liz.rowland@altegrahealth.com Please fax or email your resume to our Human Resources Department fax: 845-565-3395 5