Third Party Newsletter

Volume 2,Issue 12 Members Should Download Immediately AOA HIPAA Manual Now Available On-Line NEBRASKA OPTOMETRIC ASSOCIATION Third Party Newsletter The AOA has made available via the Internet an excellent HIPAA Privacy Compliance Manual. This manual walks the user through the HIPAA privacy maze, step-by-step, in an easily understood manner. It does, however, required time and dedication on the part of the user. The 160 pages of the manual appear intimidating when first viewed, despite the considerable white space on many pages. Dr. Quack and his staff used tabs to separate its sections and to locate the charts, policies, worksheets, and letters included in each part of the manual. The process of applying those tabs familiarizes one with the organization of the document and should help newbies understand the overall HI- PAA Privacy concept. Directions on use of this tabbing method is inserted in this newsletter should you wish to use it. Inside this issue: Compliance: Education and Training 2 xxx 3 HIPAA 4 xxx 5 Dr. Quack 5,6 Once the tabs are in place, the HIPAA Privacy Officer and the HIPAA doctor need to read the manual. We found five to eight hours (not all at one sitting!) adequate for this task. Then you can begin to take the action steps as described in the manual. An important reference in the document is the time-line (at the end of chart #4), which gives you and your staff a concept of what needs to happen by when. As long as you follow this time line, taking the action steps listed in the manual, you and your office should be well on your way complying with HIPAA Privacy by the April 14, 2003 deadline! One final note: if you do not have the facilities to download via the Internet at your office, home or elsewhere, it is possible to purchase a hard copy of the Manual for $15 from the AOA Order Department (800-262-2210). Although purchasing a hard copy of the Manual does not provide the convenience and the customization capability available with a downloaded document, we realize it may be necessary for some members. MORE ON PAGE TWO... DOWNLOAD YOUR AOA MANUAL Special points of interest: Xxx xxx xxx xxx

AOA HIPAA PRIVACY MANUAL: Getting Started 1 2 3 4 5 w-s 6 AOA HIPAA Privacy Compliance Manual ws 8 L 15-1 CHART TABS 3A 3B 5A POLICY TABS 5B 7A 8A 9A LETTER TABS WORKSHEET TABS Setting Up Your Manual: Dr. Quack s Suggestions 1) Print the document from the AOA web site. 2) Hole-punch the manual and insert it into a three-ring binder. 3) The document is divided into 31 parts or Charts. Attached a numbered tab at the top of the page for each respective chart. 4) Interspersed in the document are 30 HIPAA Privacy Policies that need at least some customization. Attach a number + letter tab (like 3A) on the right side of the page for each respective policy. 5) Twelve of the charts contain Worksheets. Attach a tab (like Worksheet 6) on the bottom of the page for each respective worksheet. 6) There are seven Model Letters that need to be customized. Attach a tab (like Letter 15-1) on the bottom of the page for each respective model letter. Charts The 31 sections or Charts make up the majority of the manual, and walk you through the action steps required to comply with HIPAA. The action steps provide background, then assist you in completing any necessary Worksheets, and finally advise you on customizing the Policies and Model Letters for your office. It might be helpful to check off each action step as it is taken. Worksheets The 12 worksheets are used to gather and organize data in your office. They will assist you in assessing how your office should approach the customization of the generic HIPAA policies and model letters provided in the Manual. You may find some worksheets simple or unnecessary; others will be time consuming. Policies Customized policies are an end result of your HIPAA Privacy endeavor. 31 generic policies are provided, but must be modified (some more than others) to fit your practice. You can use your computer to copy a given generic policy, paste that generic policy onto a blank file in your word-processor, then make changes and adaptations as suggested by the action steps and worksheets. that appears to generally address this topic: http://nha.cust.digitalims.net/hipaa/hipaa_preemption.htm. In addition, there is a 54 page.pdf file that a Nebraska law firm has researched regarding this topic. It is found at: http://nha.cust.digitalims.net/pdf/hipaa/hipaa_preemption_analysis.pdf. Model Letters Correspondence will be called for under various situations in HIPAA. Generic model letters have been supplied with the AOA Manual, but must be customized for each optometric practice. Use your computer to copy each generic model letter, paste that generic letter onto a blank file in your word-processor, then make changes and adaptations to the generic letter as suggested by the action steps and worksheets. The Final Result Once all of your customized policies are completed Dr. Quack would suggest that you copy them into a separate Dr. XXX s HIPAA Privacy Policy Manual that is easily accessible to you and your staff. You ll also want to save all parts of your original AOA HIPAA Privacy Manual, including all of your charts (with checked-off action steps) and worksheets, as proof of compliance. State Law Some of the AOA generic policies leave space for customization in regards to state law. Dr. Quack is not an attorney, and cannot give legal advice as to how HIPAA melds with Nebraska statutes. However, there is a web site, sponsored by the Nebraska Hospital Association, Page 2 THIRD PARTY NEWSLETTER

Index: 3rd Party Newsletter & Web Page 2000-2002 # 1997 E & M Guidelines to Continue [09-01] 1997 E & M Guidelines Wall Chart [03-02] (chart pages listed with Newsletters under April 2002) 2002 Medicare Fee Schedule Questioned [01-02] 25 Modifier: How to File a Service Along With a Procedure [02-01] 25 and 57 Modifiers [07-02] 92004 and 92014 Comprehensive Exam Requirements [08-01] [11-02] A A4262 and A4263 See Punctal Plug Coding [04-02] Advanced Beneficiary Notice (ABN): [Medicare: Find]...see also GA Modifier Advertising [1994** NE Opt Rules/Regs: Find] America Academy of Ophthalmology (AAO) American Optometric Association (AOA) American Society of Cataract & Refractive Surgeons (ASCRS) Anthem Nebraska Medicare Carrier Purchased by [09-01] Anti-kickback [HCFA Website Search kickback] Anti-kickback and Self-Referral Statutes [09-01] Audit by OIG [OIG] B Bilateral vs. Reduced Service Modifiers [03-01] [05-01 Table] Billing Errors [07-01] Billing Instructions: [Medicare] [Medicaid Adobe Find] Billing Instructions: Special instructions for post-op care and DMERC [Post-op claims] Block Vision Alters Medicaid Reimbursement for Eyeglasses [03-01] Block Vision Proposed Changes [01-01] Blue Cross Blue Shield of Nebraska Prefixes you should know: [09-01] [02-01] Blue Cross Blue Shield of Nebraska Routine Vision Care [06-01] [11-02] Blue Cross Blue Shield of Nebraska Home Page Board Certification [Optometry Law Adobe Find] [1994** NE Opt Rules/Regs: Find] C Charges, Fees, and Payments [Medicare] [Medicare Fee Schedule] [Medicaid] Chief Complaint [1997 E&M Guidelines] CL Rx Release [Mail Order CL Act Adobe Find] CL Rx Release (FTC) [07-02] Claims-filing routine claims on the Internet [05-02] CMS (formerly HCFA) [CMS Homepage] Coding and Billing Errors [07-01] Coding Fraud [06-02] Co-management (post-op care) [Medicare LMRP: Find post-op] Co-management Update from the AOA [04-01] Communicating with the Medicaid Primary Care Provider [11-01] Communiqués [Medicare] COMPLIANCE Compliance: Advanced Beneficiary Notice and Certificate of Medical Necessity [08-02] Compliance: After an Offense has been Detected [07-02] Compliance: Anti-kickback and Self-Referral Statutes [09-01] Compliance: Application of Compliance Program Guidance [02-01] Compliance: Auditing and Monitoring [05-02] Compliance: Billing for Non-Covered Service s [09-02] Compliance: Billing, Fines, and Jail [11-02] Compliance: Coding and Billing Errors [07-01] [06-01] Compliance: Conducting Effective Training & Education [12-01] Compliance: Continuing Education and Communication [01-02] Compliance: Designation of a Compliance Officer/Contact [11-01] Compliance: Documentation [08-01] Compliance: Enforcing Compliance Standards [02-02] [06-02] Compliance: Fraudulent and ``Erroneous'' Claims [03-01] Compliance: Officer or Contact Person [11-01] Compliance: Penalties [11-02] Compliance: Retention of Records [10-01] Compliance: THE SEVEN BASIC COMPLIANCE ELEMENTS [04-01] Compliance: Written Policies and Procedures [05-01] Comprehensive Ophthalmological Service [Medicare LMRP] [11-02] Confocal scanning laser glaucoma test, GDx, Scanning Laser Polarimetry [Medicare LMRP] Conjunctival FB Removal Coding [04-01] Consultation and Referral Coding [02-02] Contact Lens Prescription, Release [06-01] [Mail Order CL Act Adobe Find] Contact lenses [Post Cataract FIND] [Medicare Bandage] [Medicaid Adobe Find] [10-01] [1994** NE Opt Rules/Regs: Find] **Updated version of Optometry Rules and Regulations not yet available on Web Coordinated Vision Care, Inc. (CVC), [03-01] Co-pay for Medicaid patients [06-02] Corneal sensation [Medicare LMRP Find] Corneal topography [Medicare LMRP] Corporations; Release of Patient Data to [08-02] Covered services [Medicare LMRP] CPT [CPT Online (fee required)] CPT & ICD-9-CM 2002 [08-01] Customary charge [Medicare: Find charge in each chapter] [Medicaid] D Date of service [1997 E&M Guidelines] Deceased Patients: coding for services [02-04] DEA Controlled Substances Number [10-01] Diabetes [Medicare LMRP Find] Diabetes Coding ICD-9-CM [04-01] [05-02] Diabetes National Initiative: how to charge? [02-01] DMEPOS [DMERC] DMERC HCFA-1500 Claim requirements [Post-op Claims] DMERC [DMERC Homepage] [Eyeglasses and CLs] DMERC Documentation What to Keep in you Patient Records [09-01] DMERC (DMEPOS) Supplier Standards [11-02] Documentation Guidelines [1997 E&M Guidelines] Documentation Guidelines Revisited: The Basic Elements [11-01] Documentation What to Keep in you Patient Records for DMERC [09-01] E E & M Guidelines [1997 E&M Guidelines] EDI Extension for HIPAA [07-02] Electronic claims [Medicare: Search] Exophthalmometry [Medicare LMRP Find] Extended ophthalmoscopy [Other Carrier s LMRPs Search] Extension for HIPAA EDI [07-02] F Fees, Charges, and Payments (see also fee schedules below) [Medicare] [Medicaid] Fee Discounts [03-01] Fee limits Medicare: for non-participating providers [08-01] Fee schedule Medicare 2002 [Medicare Fee Schedule] Fields, Visual [Medicare LMRP] Filing Medicare Paper Claims [06-01] Fluorescein angiography [Medicare LMRP] Frames [Medicare DMERC] [Medicaid Adobe Find] Fraudulent and ``Erroneous'' Claims [03-01] [06-02] Frequency of services [Medicaid Adobe Find : frequent ] FTC Release of a CL Rx [07-02] Fundus Photography and V58.69 diagnosis [01-01] Fundus Photography, billing Medicare for [12-01] Fundus Photos [Medicare LMRP] G GA modifier [Medicare: Search] GA Modifier [01-02] GX Modifier [01-02] GY Modifier [01-02] GZ Modifier [01-02] GDx scanning laser GLC test [Medicare LMRP] [Audits] Glaucoma Screenings for Medicare [11-01] [02-04] Global fee [Medicare: Search] H HCFA [CMS] HCFA-1500 Paper Claims [06-01] HCFA-1500 Claim Requirements for Post-op Care and DMERC Glasses [Post-op Claims] HCPCS Codes [Electronic Search] Hints on Filing Medicare Paper Claims [06-01] HIPAA SPECIAL PAGE ON THIS WEB SITE (updated 11-02) HIPPA DMERC Communication [01-02] HIPAA EDI Extension [07-02] [08-02] [09-02] HIPAA Advertised Education [07-02] HIPAA The Health Insurance Portability and Accountability Act of 1996 [07-01] HIPAA: Prepare NOW! [02-02] HIPPA [Nebraska Hospital Assoc.] History of Present Illness (HPI) [1997 E&M Guidelines Adobe Find] Hospice Patient Coding [11-02] HRT [Audits] [Medicare LMRP] I ICD-9-CM [Electronic Search] ICD-9-CM Coding of Diabetes [04-01] Initiation of diagnostic and treatment program [1997 E&M Guidelines Adobe Find] Internet Claims filing routine claims [05-02] Invoice Requirements for Medicaid [08-02] K KX Modifier replaces ZX Modifier [04-02] [DMERC] [07-02] L Laser interferometry [Medicare LMRP Find] Laser scanning [Medicare LMRP] LASIK: Prudent Referrals [FDA Website] [04-01] Lens Code [DMERC] [Medicaid Adobe Find] LMRP: [Medicare s Local Medical Review Policies for Nebraska] LMRP: [Medicare Local Medical Review Policies for other locales] Local Medical Review Policy Manual: [Medicare s Local Medical Review Policies for Nebraska] VOLUME 2,ISSUE 12 Page 3

M Mail Order Contact Lens Act. [06-01] [Mail Order Contact Lens Act] Managed Care Medicaid [11-01] Managed Care Medicaid: Providing it Out of Area [11-01] MEDICAID Medicaid Appointments, Missed [07-01] Medicaid Co-pay [06-02] Medicaid Fee Schedule [10-01] Medicaid Invoice Requirements [08-02] Medicaid Managed Care [08-01] [11-01] Medicaid: Mother of an Unborn Child [06-01] Medicaid Patients with VSP Coverage [11-01] Medicaid Payments Section [Medicaid Adobe Find for specific topic in manual] Medicaid Primary Care Provider Communicating with the [11-01] Medicaid Reimbursement for Eyeglasses, Block Vision Alters [03-01] Medicaid Reimbursement Delays Explained [03-01] Medicaid Vision Care Manual [Medicaid Adobe Find for specific topic in manual] Medicaid Vision Care Staff [11-01] Medicaid & VSP [01-01] Medical Record Documentation [07-01] Medically necessary [Medicare: Search for GA Modifier and ABN] MEDICARE Medicare [Nebraska Medicare Home] Medicare Coding: 92004 and 92014 Comprehensive Exam Requirements [08-01] [11-02] Medicare disclosure [Medicare: Search for GA Modifier and ABN] Medicare fee limits for non-participating providers [08-01] Medicare Fee 2002 schedule [Medicare Fee Schedule] Medicare Fee 2002 Schedule Questioned [01-02]] Medicare Glaucoma Screenings [11-01][09-01] [02-04] Medicare Hospice patient coding [11-02] Medicare Managed Care: Medicare+Choice Plans [10-01] Medicare Modifier Changes: GA, GX, GY, GZ, ZX, ZY. [01-02] Medicare Modifiers: hospice patient coding [11-02] Medicare Modifiers: [Physician s Manual Billing Instructions Find ] Medicare Nursing Home Codes [Medicare Communique Search Nursing] Medicare Paper Claims [06-01] Medicare Physician's Manual on the Web [10-01] Medicare Program Integrity [Medicare Program Integrity] Medicare Secondary Payer [Medicare Manual] Medicare Toll-free Telephone Service [02-01] Modifiers Medicare [Physician s Manual Billing Instructions Find ] Modifier Changes by Medicare : GA, GX, GY, GZ, ZX, ZY [01-02] Mother of an Unborn Child Medicaid [06-01] MSP [Medicare Manual] Mutual of Omaha [07-01] N National Diabetes Initiative: how to charge? [02-01] Nebraska Controlled Substances Number [10-01] Nebraska Department of Revenue [Sales Tax] Nebraska Medicare Carrier Purchased by Anthem [09-01] New Contact Person for UHC Plan [04-01] NOA 3rd Party Web Page [09-01] Non-Discrimination Issues: Medicare+Choice Plans [10-01] Not covered services [Medicare: Search for ABN and GA Modifier] [Medicaid Adobe Find covered] Not medically necessary [Medicare: Search for ABN and GA Modifier] [Medicaid Adobe Find medically] Nursing home codes [Medicare Communique Nursing Home Codes Search Nursing] [10-01] O Office of the Inspector General (OIG) [OIG Home Page] Optometry Practice Act in Nebraska [Optometry Law] Optometry Rules and Regulations [1994** NE Opt Rules/Regs: Find] Optometry Services [Medicare LMRP] P Pachymetry [Medicare LMRP Find pachymetry] Potential Acuity Meter [Medicare LMRP Find potential] Paper Claims [06-01] Patient Data, Release to Corporations [08-02] Patient Information, Release of [10-01] Patient records [1997 E&M Guidelines Adobe Find record] [Medicaid Adobe Find record] Patient Records and HIPAA [03-01] Payments, Fees, and Charges [Medicare] [Medicaid] Physician s Manual Medicare [Medicare] Physician's Manual on the Web [10-01] Place of service [Medicare and Medicaid] Polycarbonate [Medicaid Adobe Find Polycarb] Post-cataract surgery glasses [DMERC] Post-Op Charge for Refraction [02-01] Post-Op HCFA-1500 Claim requirements [Post-op Claims] Post-Op Co-management [Medicare LMRP: Search for post-op] Post-payment audits [Medicare Program Integrity] Post-surgical care [Medicare LMRP Find Comments] Practice guidelines AOA [AOA Search Practice Guidelines] Primary Care Provider, Communication with [11-01] Primary Reason for Visit [1997 E&M Guidelines Adobe Find] Printing HCFA-1500s [03-01] Prism [DMERC] [Medicaid Adobe Find] Privacy Rules Promulgated [01-01] Prosthesis Cleaning Reimbursement [03-01] Punctal Plug Coding [Updated 04-02] Punctal Plug Insertion plus E&M Fees [09-01] Purchased services Medicare {see Purchased Services section of Physician Manual; not yet on-line} R Record Documentation [07-01] Records Retention [02-01] [10-01] Reduced service [50 and 52 Modifiers] Reduced Service Modifiers [03-01] Referral and Consultation Coding [02-02] Refraction of Medicare Patients [04-01] Refraction, Post-op Charge [02-01] Regulations in Nebraska [1994** NE Opt Rules/Regs] Release of a CL Rx (FTC) [07-02] Release of Medical Records [Medicaid Adobe Find record] [Nebraska Law] Release of Patient Information [10-01] Release of Patient Data to Corporations [08-02] Rent, Rental payments [OIG Fraud Alert] Retaining Records [02-01] Retinal drawing [Another carrier s LMRP Search Extended Ophthalmoscopy] Retinal Photos [Medicare LMRP] Routine care [08-01] [11-02] Routine care filing claims on the Internet [05-02] S Sales Tax [Nebr Dept of Revenue] Scanning Laser Glaucoma Test (SGLT) [Medicare LMRP] [Audits] Schirmer tear testing [Medicare LMRP Find Schirmer] Self-Referral Statutes [09-01] SGLT [Medicare LMRP] Slab-off [DMERC] [Medicaid Adobe Find] Stark II: Eyeglasses and Contact Lenses Excluded by [01-01] Supplier Manual [DMERC] Surety bond [DMERC] T Tint [DMERC] [Medicaid Adobe Find] Topography [Medicare LMRP] U UHC Plan, New Contact Person for [04-01] United HealthCare & Block Vision Alter Medicaid Reimbursement for Eyeglasses [03-01] V V-2020 [DMERC] V-2025 [DMERC] V58.69 diagnosis [01-01] Vision Discount Program by BCBS Update [06-01] Visual Fields [Medicare LMRP] VSP and Medicaid [01-01] [11-01] W Web Page Online [03-01] Wellness Option [07-01] Wide Segments [DMERC] [Medicaid Adobe Find] Workers Comp Reimbursement [Nebraska Statute] Z ZX Modifier [09-01] [01-02]

Dr. Quentin Quack s Queries and Questionable Quotes ~~~~~~~~~~~~~~~~~~~~~~~~~~ Third Party Questions from NOA Doctors and Staff ~~~~~~~~~~~~~~~~~~~~~~~~~~ Dr. Quentin Quack Reimbursement for Post-Op Care After Laser Capsulotomy Dear Dr. Quack, The reimbursement we received for post-op care after a bilateral laser capsulotomy was much less that what my doctor expected. I billed it with a 50 modifier, used 90 days for the post-op period, and believe I completed the HCFA-1500 correctly. Where did I go wrong? Dr Quack s Quote: I think you filed correctly, and the amount you say you were reimbursed appears to be correct to Dr. Quack. According to the 2002 fee schedule for Nebraska, surgical procedure 66821 YAG capsulotomy pays $205.70 per eye total for the surgery including pre-op and post-op care for a participating provider. These fees are available on-line at http://www. nebraskamedicare.com/part_b/ reimburse/2002/2002_fees/mfsdiscne-new.pdf Since it was a bilateral procedure using the 50 modifier, the second eye would pay only half as much as the first. So the total Medicare surgery fee payable to a participating surgeon, including pre and post-op care, would be roughly $310 for both eyes. According to the Medicare Physician Fee Schedule Database (MPFSDB), the post-op period for 66821 is 90 days and the portion allowed for post-op care is 20%. Therefore, if you provided all 90 days of post-op care, the maximum Medicare fee payable for post-op care would be about 20% of that $310, total for both eyes. Fee Discounts Revisited Dear Dr. Quack: Is it an act of non-compliance to occasionally code a new patient visit as an established patient visit because you want to give the patient a price break? Or to give the patient a discount for any reason? This might be done for all kinds of patients including Medicare, Medicaid and with actually no reference to the kind of insurance a patient has. Dr. Quack s Quote: As long as the provider does not waive co-pay or refraction fees, Dr. Quack does not see how occasionally charging less than your usual and customary fee can be illegal, or noncompliant, or immoral, or even a little bit naughty. This assumes, of course, that this happens on an occasional basis. On the other hand, routinely charging your private pay patients less than your third party patients would not be acceptable (that is, it would be naughty) since you would, in essence, have two fee schedules: one for insured folks, and one for un-insured. That is a big no-no. VOLUME 2,ISSUE 12 Page 5

NEBRASKA OPTOMETRIC ASSOCIATION 201 n. 8TH Street, Suite 400 P.O. Box 81706 Lincoln, NE 68501 BEWARE OF HIPAA EDUCATION SCAMS Dr. Quack Received this Email on Tuesday, 12/10/02 A company that goes by the name of US Seminars is contacting Legacy physicians and clinical staff with what we believe to be a scam that leverages the new HIPAA regulations. They ask for a person by name, advise that person that a HIPAA seminar is taking place at a certain hotel in or near their area. They are very aggressive and assert that the physician or clinician must attend this HIPAA seminar, that attendance is mandatory and that they will be breaking the law if they don't attend. The fee is $200 if they provide a credit card number right away but $400 if they want to pay at the door. They exert a lot of pressure to a credit card number while on the phone. We will be taking immediate action to ensure this company ceases contact with Legacy, but until then please do not engage this company in discussions. This is a scam. The seminar might be real but their tactics to secure registration fees or attendance are unethical and perhaps illegal. Elaine Elmore, Health Insurance Specialist Centers for Medicare and Medicaid Services Atlanta Regional Office 404-562-7408 Fax. No. 404-562-7481 Dr. Quentin Quack s Queries... O ccasionally Dr. Quack s fax machine or email contains a question that is inte resting, but may not pertain directly to third party care. Dr. Quack feels that he should share some of these more creative questions along with his insights on the topic....continued Dear Dr. Quack, Why? Dr. Quack s quote, Where The NOA Third Party Newsletter is published monthly by the Nebraska Optometric Association with the assistance of Ed Schneider, O.D., Third Party Consultant. Nebraska Optometric Association 201 North Eight Street, Suite 400 P.O. Box 81706 (68501) Lincoln, Nebraska 68508 Phone: 402-474-7716 Fax: 402-476-6547 Email: NOA@assocoffice.net Ed s Fax & Voicemail: 402-466-7470 Ed s Email Address: SchneiderEd@msn.com Ed s Emergency Pager: 402-790-7971