Ask-the-Contractor Teleconference (ACT)

Transcription

1 Ask-the-Contractor Teleconference (ACT) Moderator: Sue Brewer March 10, :00 pm CT Good afternoon ladies and gentlemen. My name is (Leticia) and I will be your conference operator. At this time, I would like to welcome everyone to Part B Ask-the-Contractor Teleconference. All lines have been placed on mute to prevent any background noise. After the presenter s remarks, there will be a question and answer session. If you would like to ask a question during this time, simply press star then the number one on your telephone keypad. If you would like to withdraw your question, press the pound key. Thank you. I would now like to turn the call over to your host, Ms. Sue Brewer. Go ahead, ma'am. Thank you, (Leticia). Good afternoon everyone and welcome to the March 10th, 2015 Part B Ask-the-Contractor Teleconference Call. My name is Sue Brewer. I'm an analyst in the Provider Outreach and Education Department at WPS Medicare and I will be facilitating today's call. I've asked additional Medicare staff to join us on the line today to assist in responding to your questions. We have allotted 90 minutes for today's call and we will be allotting most of that time to a question and answer period. If there are no further questions of course we will end the call sooner than the 90 minutes. Please be aware that we are recording this call. If you have an objection to being recorded, you'll want to disconnect at this time. Today's call is being held for providers in both Jurisdiction 5 for our providers in the states of Iowa, Nebraska, Missouri and Kansas, as well as for Jurisdiction 8 for providers in the states of Michigan and Indiana. We offer these calls on a quarterly basis. It is an opportunity for our provider community to ask questions that they feel are pertinent to their relationship 03/31/

2 with Medicare. And we've assembled what we call a panel of experts to increase our chances of being able to answer your questions while we're live on the call. That is our goal today. We have people representing the Medicare Publications area, Medicare Internal Processes, Medicare Policy, Customer Service, Appeals, Electronic Data Interchange, Claims and Provider Enrollment on the call today. If I have forgotten anyone, I apologize. Again, we're hoping to answer as many of your questions as we possibly can on the call today. If for some reason we are not able to answer your question, we may ask that you share with us your name and phone number. We'll do the research and call you back with a response. Again, this call will be taped, recorded and we'll be publishing a transcript on our On Demand page as well as a recording and that will be done at approximately three weeks after the call. I have a few reminders for all of you today before we open it up for questions and answers. One thing I want to remind everyone, I'm sure you're all aware that ICD-10 is coming. It's only seven months away. Effective for October 1st 2015 and after dates of services you need to be ready to go with your ICD-10. WPS is ready to go. So again, we're just reminding you again to make sure that you are testing and doing the things you need to do because as of October 1st you're ready to go with your ICD-10 coding. Provider Enrollment: Nowadays, revalidation is ongoing and wait for your letter and be careful to complete the information for your efficient processing of your app and be very careful when you're sending in applications of any kind to our Provider Outreach our Provider Enrollment, I'm sorry, that it is complete and the information is there if you need to get your claim your app processed appropriately. Provider Outreach and Education: Again, please be checking our catalog, our course catalog on our webpage. We are in the process right now of getting our Days with Medicare lined up. They're going to be advertised very soon, so make sure you're watching for those. And when they do become 03/31/

3 available, make sure you sign up for them because they do fill fairly rapidly. And, again, make sure you're watching for other educational events as well, teleconferences, webinars, those types of things will be available on the course catalog on in the J5 or J8 Provider Outreach and Education page. We have been having a few issues with our provider community when they register for some of our courses, especially the teleconferences and webinars. We use a registration system called Constant Contact and we send out those confirmation s, using the that you provide to us when you register. We've been having some providers coming back and telling us that sometimes they don't get those s. So we're asking providers if you registered for a class, registered for a teleconference or webinar to please make sure you're checking your spam and your junk mail as well because some of those may very well be going into those mailboxes or folders. So make sure you're checking for that, it'll save you some time and effort that way. Other than that, I want to remind everybody about the C-SNAP, the new features that have been out there. We had three new features we've added in the last three, four months. Make sure you're taking advantage of C-SNAP, what it can offer for you. And make sure you're looking at our CERT page, our Comprehensive Error Rate Testing page. We put out our quarterly errors summaries out there; it's very valuable information for you, to see what kind of errors we've seen. And there are also a lot of articles out there to help you prevent future errors. At this time, I would like to refer the call over to my colleague Ellen Berra, who will address the question we had on Chronic Care Management. Ellen, you want to go ahead and address that issue? Sure, Sue. Thanks so much. One of the questions that we have received following the teleconference we did on Chronic Care Management was concerning billing for the chronic care management service itself and then the possibility of billing for a facility charge either for a hospital, for an outpatient clinic, a provider-based clinic 03/31/

4 something along those lines that billing a facility charge on a UB form. make Medicare Part A processing. We can't find anything that would say that this would be payable by Medicare. The question is, you know, can they submit both the professional and the facility claim? Based on the information within the 2014 and 2015 Final Rule and then also recent information that had been published by CMS, it does not appear that Medicare will allow payment for this facility charge. The physician would be documenting the services for, you know, what they're providing up to that 20- minute worth of threshold. We understand that, you know, of course CMS may publish something different on this in the future. However, at this time we show nothing that would tell us that a facility charge can also be billed for this service. Like I said, Sue, earlier, it is a question that we've, you know, received quite often. Providers certainly can take the question to CMS if they choose to. Hopefully if based on the response, CMS will publish that. But as of right now, this would not be a service billable or payable to a facility. I'll turn it back to you. Thank you, Ellen. At this time, I would like to turn over to (Leticia) to go ahead and set up our Q&A session. (Leticia)? Yes, ma'am. And as a reminder, to ask a question or make a comment, please press star and then number one on your telephone keypad. Again, that's star and the number one. Your first question comes from the line of Laura Schwartz. Go ahead. Laura Schwartz: Hello. This is Laura Schwartz at Neurodiagnostic and Sleep Disorder Center. 03/31/

5 I've recently (inaudible) a question what codes to use for outpatient hospital services. My doctor is a neurologist. He's not the supervising physician for observation service but he does get called to see patients. So he sees them for an initial visit and then he may see them another couple days or so for follow-up visits. Would I be using the outpatient codes, the to the 205 for the initial and then the to for follow-up? Because I don't think it's appropriate to use, the code for outpatient hospital since he's not the supervising physician. Hey, Sue, I can take this one if you want me to. Yes, please do. This is Ellen and I want to make sure that I understand what you're saying. Is the patient considered an inpatient or is the patient in observation care? Laura Schwartz: The patient is in observation care. If the patient is in observation care, you are exactly correct because you're not the admitting physician or the principal physician of record for that patient in observation then you would use the office or other outpatient services. You can use the initial services and then the subsequent services. Laura Schwartz: Thank you very much. You're welcome. Thanks, Ellen. Thank you. And your next question comes from the line of Steve Brown. Go ahead. Hi. Good afternoon. I'm calling about on remote pacemaker checks. We are having an issue with ones that are being billed to the Kansas jurisdiction. A patient might live in Missouri and it s being interpreted in Kansas. And according to the policies that we've seen, we would bill that with the place of 03/31/

6 service 12 but show the where the reading took place to be in Kansas. And we're getting denials stating that we're billing the wrong Jurisdiction and we checked our billing system and it shows that we're sending it to the Kansas jurisdiction. Is there any known issues with remote pacemaker checks for the Kansas jurisdiction? We haven't seen any. I'm thinking the best thing in this situation will be taking look at a claim and see if that what's what, I don't know what else to do on that one. Sue, this is Ellen again. If I can jump in here, would you care? Sure, yes. Steve, when you're submitting the information, one of the things we'd like you to check on before contacting our customer service department with some examples of the ones you've seen denied is whether or not your system is allowing you in what would be the equivalent of box 32, I believe it is, whether your system is overriding the 12 and it's actually putting your address in box 32 which is what should happen. Your place You're exactly right, your place of service 12, what goes in the box that shows where you did the service should be your Kansas address. Right, yes. It is showing that address. Are you sure that's what's coming in to us, though? Because a lot of times the 12 will override that. We've seen that with some providers where the 12 is overriding what they're entering into that field. So I would ask that you check that. OK? 03/31/

7 Got it. And go ahead. No, I was saying I will do that to make sure that the address isn t shown, the Kansas address. Correct. And then if it is then what we'd like you to do is to take advantage of C-SNAP. Steve Brown Yes. Do you have access to that? Yes. And submit an inquiry giving them the information and C-SNAP is secure so you can give Heath Insurance Claim Numbers (HICNs) and all that kind of stuff that the HICN, the data service, and then the control number and then we can our customer service people can investigate that further. I will do that. All right, thank you. Thank you and your next question comes from the line of Linda Elley. Linda Elley: Hello? Go ahead. Linda Elley: Yes. My question is if a new patient is seen in the office by a non-physician provider and this provider does the history and exam and documents it. Then the physician actually comes in and does the assessment and plan and documents that portion, can this visit be billed under the non-physician provider or the physician? OK, Sue, I can respond to this one too if you don't care. 03/31/

8 Linda Elley: Richard Parke: Richard Parke: Sure, go ahead. In this situation, because it is a new patient, it does not meet the incident to qualifications and therefore it must be billed under the non-physician practitioner provider number. All right, that's what I thought. OK, thank you. Thank you. Your next question comes from the line of Richard Parke. Go ahead. Richard Parke. OK, go ahead. I have a question regarding the preventive services that are done for like a Medicare well visit after that any services that would be ordered. We understand that these services are provided and the incident to rules are waived for those. The question that we're wondering is when we bill those services out, if a mid-level provider does that service, in order to get it paid at the physician rate, should we be then billing it under that supervising physician? Or can we bill any preventive services that would be done; we re family practice that would be done in the office as well as the actual well visit the G0402, 438 and 439. If we were to bill those under the mid-level provider, because those incident to rules don't apply would those then they pay at the physician rate or do we have to actually bill then under the physician in order to get paid at the physician rate? Sue, would you like me to take this one? Yes, I think you better. Go ahead, because you've been doing more of that. Go ahead. 03/31/

9 Richard Parke: Richard Parke: Richard Parke: Richard Parke: For the annual wellness visit, the welcome to Medicare visit, the incident to rules do not apply to that. Therefore, you're going to bill under the person who did the service. So if your non-physician practitioner is the person who did it, that's the person that you need to bill it under. You would not bill under the physician's provider number unless the physician is the one who provided the service. So then that will be paid at the physician rate then? The rate of the service the way it's worded in the information is that non-- physician practitioners are paid based on 85 percent of the physician's fee schedule. If the annual wellness visit or the welcome to Medicare visit is paid under the physician fee schedule then the NPP would be reimbursed 80 percent of the 85 percent. Sorry, I didn't follow that. We understood that any well services that are done any of the Medicare preventive services as well as the actual wellness visit would be reimbursed at the physician rate regardless of who does the service. And that's entirely possible because they do have their own payment category. So because they have their own payment category, they kind do have some different rule that you do need to bill in under your under the person who is doing that whether your mid-level or your physician. And then I'm not the administrator here, so the administrator in our office would probably like to have a reference, some kind of a document either on CMS or on your Web site. Would you have something that would explain that it does need to be actually billed under that, the person that does the service regardless of what it, you know, that it does get reimbursed at the physician rate, though? The reference for this is going to be in Chapter 12, so it's the Internet Only Manual 03/31/

10 Richard Parke: Publication Chapter 12 and right off the top of my head, I don't know the specific section. I do know, however, that it is prior to I will look that up and see what I can find. Thank you for your help. Thank you. And your next question comes from the line of Tosha Lee. Go ahead. Good morning. We're billing for CoaguCheck patient services for the code G0249 and we're trying to get some understanding around Medicare's policy is billing once per week for this code. Is your one because what we're being told by your specialist is that it's 28 calendar days, so is your once per week every seven days or how do you define that? What service was that again? I'm sorry, I didn't catch it. It's for CoaguCheck patient services and the codes that we're billing for is G0249, for the testing. Does anyone on the line have that information or is this something we need to research? Tosha Lee/female: So it's PT/INR. Female: OK, Sue, I have this is Ellen again, and I have I thought we had published something on this. I don't have the procedure code right in front of me; I can't find it real quick. But I believe that well, let me ask this question, Tosha, can you read me the description of the procedure code? The We don't have it right in front of us. There s very limited information in the system. And the research I've reviewed has been very limited and they've had to be on it for, I think, three months, they've had to have face to face training They have to be on coumadin and warfarin. 03/31/

11 Right. And it just says they have to test only once per week. It doesn't specify it doesn't really define what the once per week is, if it's a Sunday through Saturday, if it's every seven days. Let me pull up a document here real quick and see if I can see this. I don't know The information within the Change Request that I'm looking at does not indicate once for seven days. It just says should not occur more frequently than once per week. Per week. Correct. Are you having some difficulties in kind of determining that week? What's the situation that you're running into? We personally have been following Sunday through Saturday. And we've been following the calendar days that we've been getting told by Medicare is the 28 days which we follow at billing rule 21 days to allow for calendar date we've been allowing for weekends and government holidays to make sure we follow the calendar days of 28 days. And even based on the Sunday through Saturday and the billing of 21 to allow for that weekends and the holidays, we're still receiving denials or not denials but we were a matter of fact we were just going to have this, it says reason for overpayment, the claim was processed incorrectly causing an overpayment to be made and that's the only information we've received. It's not stating why they think there's an CMS received, believes there to be an overpayment. But as far as we can tell, the test dates are between Sunday through Saturday, not exactly seven days apart but Sunday through Saturday. 03/31/

12 Female: Female: And they we billed the date of service between those billing dates. So why they think that it should be taken back. So you are billing the procedure code G0429, which is the provision of the test materials. G02 G0249. And that's for the testing itself, the second service, not the supplies. G0249 is the test materials. The provision Right? It's the provision; it's providing the INR test materials and equipment. So is that (Inaudible). It's (inaudible). Yes. We provide the supplies and then they call in the results, right. And then they do the testing from home and they call in their results. They report their results to us for us to report to the physician. So then in the number of services that you're or are you billing for multiple units of service with the G0249? We're billing for the services for them calling in their results and reporting that to their doctor Thank you. that's what's actually getting So you're billing for four. For four. Yes, ma'am. That's what's incorrect. If you look in Change Request 03/31/

13 So we're billing for four so on our claim we're going to show one date of service but within that one date of service for the charge of what we're billing, the 250, we show the four dates of which they called in their results to us. So we have a date of service on the claim but in our narrative, it will show you the four test dates of when the patient reported results to us. But which procedure code are we going with? The G02 G0249. Female: The 249 is the test material. And for, the monthly service, you only bill one because the test materials include four tests. If you're billing for the physician review and interpretation, that could have multiple services on it but then you would also have to give, you know, kind of your range of dates in there. So which one have we taken back? No, the supplies themselves are billed as an (e-code), that's (E1399) But when we bill Medicare it's all Tosha Lee/female: but we don't bill Female: Female: We're going to bill separately for this. Medicare So Medicare doesn't allow us to bill for the supplies. We have to ship the supplies at zero dollars and let that in with the services. OK, all right. Tosha, let's we're going to need to take this one off the phone. Can I get your telephone number? Yes. It's And spell your first name for me. Tosha Tosha. 03/31/

14 T, O, S, H, A. Mary Moore: And what's your office? In Roche Health Solutions Inc. I'll give you a call a little bit later. Thank you. Thank you. And your next question comes from the line of Mary Moore. Go ahead. Could you clarify for me documentation for the status of three chronic or inactive conditions? And does that status have to be documented at the beginning of the progress note under the history section or can the status of those conditions be documented by the physician under the final assessment in plan? Sue, would you like me to take this one? I think that's definitely in your ballpark, Ellen. Go ahead. Yes. Again, this is Ellen. When we're talking about the documentation of the status of three chronic or inactive conditions, what Medicare would be expecting to see is that, you know, the chronic or inactive conditions that they have and then the status of those, are they better or are they worse, are they stable? You know, has there been an exacerbation, has there been a change something along those lines? Generally speaking when Medicare is looking at a piece of documentation, we're looking at the entirety of the documentation. So Medicare doesn't necessarily expect to see a document that has history and then it states 03/31/

15 exam and then it states medical decision making although, you know, that's kind of helpful to us. But we look at the whole document and as we can find the information within the document that supports the procedure codes that you have submitted then that's what we'll do. Where it appears in the document is not the important part. Now, Medicare won't however do kind of what's called double dipping in which case we won't count a piece of information twice. Generally speaking, we don't count a piece of information twice. So if the physician and as part of your billing staff if you're trying to use the information and what you're physician's doing with these three chronic or inactive conditions as part of the medical decision making and we counted there we would not count it in history. So, you know, we won't count it in both. Mary Moore: Thank you very much. Thank you. And again, to ask a question or make a comment, please press star and then number one on your telephone keypad. Your next question comes from the line of Linda Thames. Yes, we are getting ready to start a new program with Medicare B billing and we're just trying to find out what the regulations are for collecting a copay and deductible. Sue, would you like me to take this one? Yes, just make sure we put yes, go ahead and make sure we clarify what she's asking us. So, Linda, you're going to be billing Medicare Part B for your services. Is that correct? Correct. And specifically kind of an let me go this way, an overview of this is that when Medicare processes the claim we're going to notify both you and the beneficiary of how much we have allowed, how much we have paid for 03/31/

16 that and what is the patient's responsibility. So that will appear on your remittance notice for each of the services that you do, you know, such as the lab service would not have patient responsibility whereas your office visit service would have patient responsibility. So is there something other than that you're kind of looking for? The requirements for collecting that copay and deductibles. You are required to collect it. And is there, I guess, on there's a certain copay amount for Yes, the Medicare approved let's say we approved $100, Medicare is only going to pay for most services, we're going to pay $80 and then that patient then is responsible for the 20. Are you talking about the possibility of waiving that coinsurance for the patient? Yes. I mean if that's a possibility. It is not. OK? And let me just tell you why. Because Medicare's viewpoint is that if you are waiving that coinsurance across the board then you're charging too much for the service. You're really only expecting to receive 80, therefore you should only charge 80. Now, you can have provisions within your office that apply across the board to all of your patients, not just your Medicare patients where you could say that, you know, we're not going to pursue any amounts less than $5 for an example, or we're only going to pursue amounts three times, or, you know, I mean whatever your business practices are. 03/31/

17 A couple of things, as long as it does not apply only to your Medicare beneficiaries because, again, if you're waiving it then that could be considered an abusive or fraudulent situation, we don't want to go there. And then, you know, you just want to make sure that the services whatever your business decisions are applies to all of your patients across the board. Same thing holds true with deductible. You know, you want to make an effort to collect that. Of course if the patient has secondary insurance, you know, then that could be picking up those cost. Female: Sure. Yes. So the secondary insurance is billable and then that would take off what the patient would owe? Excuse me. That is correct. And for a lot of Medicare patients, that process is done automatically and then your remittance notice will tell you that this is has been transferred to, you know, kind of whoever it is been transferred to. Female: Female: Female: Thank you. Thank you. Just as an FYI for you two. We do have and I believe it's under the Resources section on our Web site, I think; we have a whole section for new providers to Medicare. I would encourage you to kind of take a look at that. We've also got some On-Demand training out there under general subjects that might help you. OK, great. Thank you so much. 03/31/

18 Female: Thank you. Thank you. Thank you and there are no more questions at this time from the phone line. Ellen, can you think of anything else we need to bring up today that we want our provider community know about? Sue I would just I think you have already mentioned this, just the course catalogs and things that we have available on our Web site. We've got a lot of different things going on, preventive services; we're really kind of going indepth into a lot of the pieces of information. We're getting ready in putting together a session on mental health services. We're also going to be doing either a teleconference or a webinar, I'm not sure what the status is on that yet on polysomnography, I never can say that word all at once, you know, but the sleep studies and all of that kind of stuff. We have based on some Office of the Inspector General reports, we have seen some difficulties and some concerns that are in that area. So if it's a service that you bill for I would, you know, or order for that matter then I would kind of keep a watch on our Web site and our course catalog for that. We also encourage everyone to of course sign up for our Listserv messages and also as frustrating as that little pop up box can be, you know, when it pops up and asks you to take the survey, we really do want to hear from you, hear what you like about the Web site, hear what you think that we could improve on the Web site. That's very true. And the other thing as Ellen mentioned, I really want to stress the On-Demands because like she said there's a lot of great information out there for you. ICD-10, please keep a watch on that, watch our enews, anything that CMS is taking the lead on ICD-10. We have a page, we refer you out there, I know there's some future testing coming down the pipe very soon so please be really watch that because that's we have that information out there. It would help you. 03/31/

19 EDI people, do you have anything that you want to add, anything that's coming down the pipe that providers need to be aware of that you could help us out with at all? Lisa Cuocci: Definitely. As you mentioned, Sue, end-to-end testing is coming up. Folks had to pre-register in order to participate in that. Folks are able to do some independent front end testing where they can get a 999, 277CA based on the claim files that they submit to WPS for ICD-10 testing. And we will also be having EDI Ask- The- Contractor Teleconference on April the 9th and you can look to your enews and to the our Web site for information regarding the April 9th EDI ACT. Great. I knew there's information. I just wanted to make sure we brought that up. Thanks, Lisa, I appreciate that. Do we have any more questions, Leticia? You do have some more questions submitted. The first question comes from the line of Melissa Rufenbarger. OK, go ahead. Melissa Rufenbarger: Hi. Yes, we bill for many anesthesiologists in Indiana and we've been having some problems with colonoscopy billing. Here recently in 2015, they updated to require the 33 modifier for a screening colonoscopy and we've been billing that I believe successfully, we also saw that the PT modifier was to be added but we both, though, had problems with that. I know we've been told that WPS has not done anything for the PT modifier at this time. My question is, is the 33 modifier appropriate at that time to apply so that it does not be responsible for the deductible and what not? Yes, I think Sue, I can take this one. 03/31/

20 The information in the Final Rule provided an inference, I guess you could say that for anesthesia services where it is moving from a screening to a diagnostic that the PT modifier, which the surgeons currently use would also be appropriate. CMS has not yet notified the contractors of the use that particular use of the PT modifier. When that modifier first came out, the notification to contractors and how the national edits were set up for that, edits and audits were set up, for that does allow that modifier only for surgical codes at this time. It is not appropriate to continue to use the 33 when it moves from a screening to a diagnostic, because there is a difference in what is waived on the particular service. Contractors, WPS included have sent this issue to CMS and the Central Office in order to determine kind of what should be happening with this. At this time, we don't have an answer for you. My suggestion to you, and this is simply my suggestion, is to continue to bill using the PT knowing that you're going to be denied. The other option that you have is you can hang on to those claims until such time as we publish because once we get this information back we will be publishing this. It would not be appropriate, however, to continue to keep that 33 modifier on there. Melissa Rufenbarger: Is there anything going to be posted on your Web site at all regarding this information? You mean what I just said? Probably not. We are have sent like I said, we've sent this to CMS. We are anticipating a response back from them fairly soon based on some preliminary information that we've received back from them. However, we have no control over when CMS will actually respond. Melissa Rufenbarger: OK, thank you. Richard Parke: Thank you and your next question comes from the line of Richard Parke. Hi. I was just wanting to get some more point of clarification on the preventive services. If you don't mind. 03/31/

21 You had mentioned that it was in Chapter 12 and I wasn't able to find it in there just while we were on the phone here. I'm wondering if that's something that you could send me in a link, maybe the page number or the exact reference, you know, once you figure out where that is so that I've got that handy. Richard, what's your phone number? Richard Parke: Richard Parke: OK, we'll get back with you. I appreciate it. Thank you and your next question comes from the line of Steve Brown. Go ahead. I received notice that procedures it's for the tomo breast tomo procedure the 77063, there's a CCI edit which does not currently allow the procedure code. I received notice that starting in April that CMS is turning off that edit. And so it's supposed to be retro back to January 1st. Will WPS go back and reprocess any claims that the and were billed on the same claim? Or will we need to do reconsiderations on those? You will have to do reconsideration on or redeterminations on both. Redeterminations? Right. Because if I remember correctly, when we get a CR. or whatever we get from CMS they tell us that providers have to bring those to our attention. Usually that's what we do. Based on how it's written. We'd have to take a look at it. I don't have it in front of me but that's usually the general rule. All right, thank you. 03/31/

22 Thank you and there are no more questions at this time. So at this point I want to remind everyone that we do appreciate your feedback and attending our call. You will be receiving a survey probably yet today or tomorrow, it'll send out automatically to the you use when you register for the call. If you pre-registered for this call, we appreciate that you took some time and gave us some feedback on the call, because we do take a look at those, it s very valuable to us. And at this point, we would like to go ahead and we can close the call. Thank you. Thank you and this concludes today's teleconference, we ask you now to disconnect. 03/31/