Woodland Hills AAPC Medicare Seminar

1. Woodland Hills AAPCMedicare Seminar Presented by Kathy A. Montoya Senior Provider Relations Representative Palmetto GBA

2. The information provided in this presentation was current as of May 1, 2013. Any changes or new information super ceding the information in this presentation will be provided in articles and publications dated after May1, 2013 posted at www.palmettogba.com/J1B.

3. Objectives • To enhance the knowledge base of Medicare coverage and billing guidelines • To decrease the National Paid Claims Error Rate • To protect the Medicare Trust Fund • To ensure the delivery of quality care to our Medicare beneficiaries

4. Agenda • Updates/Reminders • JE bid • Fee Schedule changes • Therapy Services • Ordering/Referring

5. Agenda • Documentation • Principles of documentation • Common Errors • Amendments

6. A/B MAC Jurisdiction E May 2013

7. Jurisdiction E Awarded • Announced September 20, 2012 • Noridian Administrative Services (NAS)

8. Jurisdiction E • Noridian launched JE website April 16, 2013 • https://www.noridianmedicare.com/je/ • Outlines implementation timeline • Presents calendar of transition events • States physical presence in California

9. https://www.noridianmedicare.com/je/

10. Implementation Dates • Noridian will be the MAC for Jurisdiction E: • Part A – August 26, 2013 • Part B –September 16, 2013

11. Communication Resources • Website/Listserv: www.noridianmedicare.com/JE • Contact provider organizations/associations • Meet and Greet meetings with providers • Mailings to providers • Web based provider workshops/ACTs

12. Listserv2 • For providers not registered with J1 prior to March 1, 2013 • Go to: https://www.noridianmedicare.com and select “E-mail Newsletter Sign Up” at the bottom of the left hand navigation menu. • Instructions listed in Listserv article on JE website

13. Key Website Items • Contact Information • phone numbers and mailing addresses • implementation questions • Current news and relevant changes • IVR • Schedule of Events

14. Key Website Items • Cutover dates • Payment cycles • FAQs • EDI - focus on vendors and direct submitters • Provider Portal

15. Contact Information • Single Toll-free number after JE Implementation • Provider Contact Center (PCC) • Electronic Data Interchange Support Services (EDISS) • Telephone Reopenings • Provider Enrollment • User Security

16. Contact Information • Questions regarding implementation • Email to JEQuestions@noridian.com or • Call Implementation Hotline at 1-800-361-8289 • Hot Line available 8:00 am to 5:00 pm (PT), Monday-Friday

17. Welcome • Noridian is proud to be your Medicare Administrative Contractor (MAC) for Jurisdiction E (JE) – formerly Jurisdiction 1. They look forward to working with you in the near future to serve your Medicare needs.

18. New Costs

19. 2013 Part B Deductible and Coinsurance Rates Deductible-$147.00 Coinsurance 20% of eligible charges

20. 2013 Part A Deductibleand Co-Pays • $1,184 deductible • 1st 60 days of hospitalization • $296 co-pay • Days 61-90 • $592 co-pay • Days 91 – 150 Lifetime Reserve • $148 co-pay • SNF days 21 - 100

21. 2013 Part B Premiums

22. 2013 Part A Premium • Fewer than 30 quarters • $441.00 per month • 30 to 39 Quarters • $243.00 per month

23. Updates

24. Payment ReductionApril 1, 2013 • The Budget Control Act of 2011 • Requires Federal spending reductions, sequestration • The American Taxpayer Relief Act of 2012 postponed sequestration for two months • President Obama issued a sequestration order on March 1, 2013

25. Payment ReductionApril 1, 2013 • Medicare FFS claims • Part B - dates-of-service ≥ April 1, 2013 • Part A - dates-of-discharge ≥ April 1, 2013 • Two percent reduction • CR7825

26. Transitional CareManagement Services (TMC) • New codes 99495 and 99496 • Established patient • Moderate to high complexity medical decision making

27. Transitional CareManagement Services (TMC) • Transition period from an inpatient setting (IP, LTC, SNF, rehab) to the patient’s community setting • TMC begins on date of discharge + 29 days • One face-to-face visit combined with non FTF services provided by physician or clinical staff

28. Transitional CareManagement Services (TMC) • Medical decision making/date of the first face-to-face visit are used to select the code • 99495 TMC service • Communication with patient/caregiver within 2 business days • Moderate complexity • Face to face within 14 calendar days of discharge

29. Transitional CareManagement Services (TMC) • 99496 TMC service • Communication with patient/caregiver within 2 business days • High complexity • Face to face with 7 calendar days of discharge

30. Transitional CareManagement Service (TMC) • Date of Service = 30th day • Place of Service = POS for face to face visit • What if patient dies during the 30 day period • Bill E/M code only

31. Psychiatry • Initial Psychiatric Evaluation • 90801 and 90802 were deleted • Distinction made between service by MD and one by non physician

32. Psychiatry – New Codes • 90782 = Initial evaluation with physician services • 90791 = Initial evaluation done by a non physician • 90785 = New add on code for interactive complexity

33. Multiple Procedure Payment Reduction (MPPRs) • CR7848 • Effective January 1, 2013 • Reduction to Technical Component (TC) • Diagnostic Cardiovascular • Ophthalmology procedures

34. Multiple Procedure Payment Reduction • Multiple services to same patient, same date • Affected codes • http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1149OTN.pdf • Remittance Advice • Adjustment Reason Code 59

35. Multiple Procedure Payment Reduction • Cardiovascular Services • Same physician, or multiple physicians in same group • Full TC payment with highest value • Subsequent TC paid at 75%

36. Multiple Procedure Payment Reduction • Ophthalmology services • Same physician, or multiple physicians in same group • Full TC payment with highest value • Subsequent TC paid at 80%

37. MPPRs Cardiovascular Payment Reduction Example

38. MPPRs Ophthalmology Payment Reduction Example

39. CR7260 • Health Insurance Claim Number (HICN) and Name Mismatch • Effective October 1, 2012 • Claims will reject MA 130 and MA61 • Take information exactly as shown on Medicare card

40. MEDICARE HEALTH INSURANCE SOCIAL SECURITY ACT NAME OF BENEFICIARY JOHN D. DOE MEDICARE CLAIM NUMBER SEX 123-45-6789A MALE IS ENTITLED TO EFFECTIVE DATE HOSPITAL INSURANCE (PART A) 1/1/98 MEDICAL INSURANCE (PART B) John D. Doe SIGN HERE

41. Therapy Services

42. Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services • CR 8206 • Effective April 1, 2013 • MPPR increased to 50% from 20% for all settings • Applies to the practice expense • Applies to HCPCS codes on the “always therapy” list

43. 2013 Financial Limitation for Outpatient Therapy Services • Effective January 1, 2013 • 2013 Therapy Cap amounts: • $1,900 for OT • $1,900 combined PT and SLP

44. 2013 Financial Limitation for Outpatient Therapy Services • Section 603 of American Taxpayer Relief Act of 2012 • Outpatient Therapy claims cap • Extended through DOS December 31, 2013 • $3,700 for PT and SLP • $3,700 for OT • Manual Review of claims > $3,700

45. Changes for Therapy Services in 2013 • Reporting requirements • Use Functional status codes • Use Functional Limitation modifiers • Every 10 treatments or 30 calendar days, whichever is earlier

46. Functional Reporting G-Codes

47. Functional Reporting G-Codes

48. Functional Status Codes • Three codes • Current status • Goal status • Discharge status

49. Severity Complexity Modifiers

50. Functional Reporting • Use of G codes and modifiers is required • At the onset of therapy episode of care • At least once every 10 treatment days