INFORMATION:

Summary of the June 24th Medicare Carrier Advisory Committee Meeting in DesMoines Iowa. Submitted by Bruce R.Williams,D.O.. Please contact Dr. Williams with any comments or questions.

Medicare Carrier Advisory Committee Meeting – Jurisdiction 5
June 24, 2010
Iowa Medical Association, Des Moines Iowa

Comprehensive Error Rate Testing (CERT):
- Provider signature –needs to have an affidavit - if a record is requested, there must be an affidavit (signature card) that attests that the providers signature belongs to that provider.
- Large number of errors are related to evaluation and management coding, especially time based coding. Providers need to document actual times. Office – times need to be face to face.
Hospital – times need to be time spent on unit.
- If a CERT letter is received, send them ALL of the documentation. Many times a denial is issued after a CERT letter sent and record sent in. But when the contractor goes to appeal the denial, the provider will send additional records. If all of the information was sent initially, perhaps the denial would not have been issued.
- Claim sample – 200 claims/month/jurisdiction

Cummulative Errors:
- Service incorrectly coded (2 separate)
- Medically unnecessary service
- Insufficient documentation
- Services not rendered
- Unbundling
- Response received – improper documentation

Timely Filing:
- File within 1 year from date of service – full payment ˥
- After 1 year – 10% reduction in payment I - Old Policy
- Have 18 to 23 months to file ˩
- New Policy – Providers have 1 year to file
- 5010 – now we are filing using 4010 format
After 1/1/2011 all claims must be files using 5010 format
10/23/2013 – ICD-10 will be fully implemented
1/1/2011 – 10/23/2013 – transition to ICD-10

*If we are not prepared for this, we risk not being able to send electronic claims or receive electronic remittance.

All Local Carrier Determinations will need to be transitioned to ICD-10. Contractors will be using ICD- 10. CPT not procedure codes.

On demand training on Wisconsin Physicians Service (WPS) website.
Several useful calculators available to assist with filing claims.
Ask the contractor teleconference – September 2010

HIGLASS (Medicare Accounting Program) - J5 transitioning to it in Medicare Part B.
- This means there will be a brief alteration in payment of claims
- 7/28/2010 – Payment ceiling lowered from 29 to 14 days
- 7/29/2010 – Payment ceiling lowered from 14 to 7 days
- 7/30/2010 – Payment paid on all claims received
- 8/1-8/9-2010 – transition to HIGLASS so no claims paid.

Medical Director Comments:

PPCA(Healthcare Reform) – signed 3/23/2010
- RVU’s changed- some providers will see increase in RVU’s but some will see decrease.
- “Doughnut hole” will be phased out by 2020.
- Medicare advantage plans will be eligible for rewards for high quality.
- $250.00 will. be paid to beneficiaries when they hit the “doughnut hole” in 2010.
- Medically Unlikely Edits (MUE) – if MUE exceeded – no payment. There will be appeals.
- mostly this related to drugs, and is put in place to prevent
infusion fraud(clinics have been billing CMS for patients that don’t
exist.

Federal Trade Commission – delayed the “Red Flag Rule” until 12/31/2010. There is still hope that the FTC will say this does not pertain to physicians.

Local Carrier Determinations:

Comments due to Dr. Bussan at WPS 45 days from 6/24/2010 (~8/10/2010).

PHYS- 066 – Bio feedback – Generally used in treating GI or Urologic Disorders. Testing included(i.e. EMG) included in LCD.

OPTH – 014 – Computerized Corneal Topography – some types of corneal transplants will be added.

GU-020 – Diagnostic PAP.

INJ-023 – Erythropoiesis Stimulating Agents – Not covered if coded with a cancer diagnosis – due to increased mortality rate receiving Epogen. Epogen is covered in chemotherapy induced anemia but this would need to be coded as chemotherapy induced anemia and not cancer. Also, if iron infusion is given for iron deficiency anemia, or B12 is given for B12 deficiency, and epogen is given on the same day, the epogen will be denied. The epogen, iron, or B12 should be infused on different days as is appropriate.

PATH-028 – Heavy Metal Testing – testing is being done for inappropriate reasons. A question was raised if the policy should include testing for lead in EPA tested areas.

INJ-003 – Hemophilia Clotting Factor - This hit “High Dollar Edit” , $5000.00/claim line – will be edited so clarify Edit Department needed guidelines.

ALRG -03 – Immunizations – Preventive immunization not payable by Medicare. This LCD relates primarily to acute exposure.
CV-017 – Myocardial Perfusion Imaging and Cardiac Blood Pool Studies – Worldwide technetium shortage. It will be a challenge for cardiologist who would evaluate this patient population that would not necessarily need a catheterization but would need to be studied.

NEURO -009 - Polysomnography and other sleep studies.

PATH – 032 - Vitamin D Assay – Where it is appropriate.

Dr. Ken Bussan’s e-mail address is: Kenneth.Bussan@wpsic.com