AHLA. UU. Diagnostic Imaging Services. Thomas W. Greeson Reed Smith LLP Falls Church, VA
|
|
- Nickolas Miles
- 8 years ago
- Views:
Transcription
1 AHLA UU. Diagnostic Imaging Services Thomas W. Greeson Reed Smith LLP Falls Church, VA Institute on Medicare and Medicaid Payment Issues March 26-28, 2014
2 Diagnostic Imaging Services AHLA Medicare-Medicaid Payment Institute Baltimore, MD March 28, v1 Agenda Current Environment Medicare Coverage and Payment Rules for Imaging New Focus on Supervision Rule Place of Service/Date of Service Billing Rules Breast Biopsy Challenges for IDTFs Accreditation Standards for Advanced Imaging New CMS 1500 Claim Form 1
3 Latest Medical Imaging Payment Cuts 2013 Multiple Procedure Payment Reduction (MPPR) CMS applied the 25% cut to the professional component (PC) and 50% cut to the technical component (TC) to multiple physicians within the same practice for a second imaging procedure in the PFS* * when performed on the same patient, in the same session, on the same day 2014 Utilization Rate (UR) in the American Taxpayer Relief Act (ATRA) CBO Score: $800 million over 10 years CMS raises the UR to 90% (up from 75%) Included in Obama 2015 Budget proposals Exclude advanced imaging from the Stark in-office ancillary services exception to the prohibition against physician self-referrals, except in cases where a practice meets certain accountability standards Expand the authority CMS to mandate prior authorization of advance imaging services 2
4 Supervision of Diagnostic Tests Medicare Supervision Rules Physician Offices IDTFs Provider-Based Entities HOPPS Supervision of Diagnostic Tests Levels of Supervision General Supervision Direct Supervision Personal Supervision 3
5 Supervision of Diagnostic Tests Level 1: General Supervision The supervising physician need not be present for the test, but he/she has overall responsibility for the control and direction of the service. Supervision of Diagnostic Tests Level 2: Direct Supervision The supervising physician need not be in the room when the procedure is performed, but must be present in the same office suite and immediately available to assist if required. 4
6 Supervision of Diagnostic Tests Level 3: Personal Supervision The supervising physician must be in the same room where the test is performed throughout the procedure. Non-Physicians Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants may not function as supervising physicians under Medicare s Diagnostic Test Benefit They may perform diagnostic tests pursuant to State Scope of Practice laws 5
7 Radiologist Assistants and Radiology Practitioner Assistants Cannot supervise test for Medicare patient Cannot perform an invasive or surgical procedure for Medicare patients who are then billed under the NPI of a radiologist Note: Incident to services may be billed only in a physician s office - not in the hospital - and only for non-test services that are performed for patients being treated by the practice HR th Congress Medicare Access to Radiology Care Act of 2013 Creates independent right to bill for RA/RPA services Payment to radiology group Does not permit RA/RPA to supervise a test Even PAs may not supervise tests 6
8 HOPPS Direct Physician Supervision Physician Supervision of Medicare Hospital Outpatient Diagnostic Tests Standard varies based on location: In the hospital or an on-campus provider-based department Off-campus provider-based department Under arrangement services HOPPS Direct Physician Supervision 2011 Rule In the hospital or an on-campus provider-based department "Direct supervision" means immediately available to furnish assistance and direction throughout the performance of the procedure (i.e., services) Does not require physical proximity "Immediately available" no specific spatial or temporal standard 7
9 HOPPS Direct Physician Supervision 2011 Rule Off-campus provider-based department "Direct supervision" means immediately available to furnish assistance and direction throughout the performance of the procedure (i.e., services) Does not require physician proximity HOPPS Direct Physician Supervision Non-hospital location, i.e. mobile or fixed-site diagnostic testing facility furnishing services "under arrangements" "Direct supervision" means physician present in the office suite immediately available to furnish assistance and direction throughout the performance of the procedure (i.e., services) Does not require presence in the room 8
10 HOPPS Direct Physician Supervision Qualifications: Does the supervising physician for imaging services have to be a radiologist? Physician must be qualified to furnish assistance and direction HOPPS Rule: knowledgeable about the test Transmittal 128, May 28, 2010 Transmittal 137, December 30, 2010 Place of Service Billing Rules Multiple Attempts to Address Issue (Transmittal 1823, CR 6375, October 2, 2009) Chapter 26, et seq. Initially to be effective in 2010 Guidelines were issued, reissued and delayed multiple times! Transmittal 2613 issued December 14, 2012 provides the most recent guidance Effective April 1,
11 Place of Service Billing Rules Terminology POS Code: denotes whether the service was provided in a facility or non-facility setting Payment Locality: denotes the relative resource cost in a particular geographic area Global Billing: Use of single CPT code for PC & TC (e.g., no use of -26 modifier or TC) Place of Service Billing Rules Place of Service Billing 11 Office 12 Home 21 Inpatient Hospital 22 Outpatient Hospital 99 Other 10
12 Place of Service Billing Rules POS for Diagnostic Tests For diagnostic tests the POS code for the interpretation is the setting where the patient received the TC service If the interpretation was performed in the physician s office and the patient received the TC service in the outpatient hospital setting, the physician assigns POS 22 on the claim for the PC Place of Service Billing Rules The physical location of the radiologist interpreting the study (entered in Block 32 of the CMS-1500 form) 11
13 Place of Service Billing Rules Global Billing If the same physician or entity does not furnish both the TC and PC, or if the professional interpretation was furnished in a different payment locality, the professional interpretation must be separately billed with modifier -26 and the address and ZIP code of the interpreting physician s location Employees of the entity that performs and bills the TC are considered part of the same entity Global billing is permitted when physician-employee of radiology group interprets tests pursuant to a professional service agreement between the radiology group and the TC supplier. (Joinder Agreements) Place of Service Billing Rules Payment Jurisdiction Rule Claims must be billed to the Medicare Administrative Contractor (MAC) responsible for the jurisdiction where the service was furnished (unless the interpretation was performed in an unusual and infrequent location) The payment-jurisdiction rule is particularly relevant when the professional component is routinely performed in a different state (or MAC jurisdiction) from where the technical component is performed (e.g., teleradiology and in urban areas that cross or border state lines) 12
14 Place of Service Billing Rules CMS Transmittal 503 Dated January 24, 2014 Inter-Jurisdictional Reassignments Entity taking reassignment must still enroll with MAC where interpretation services provided but CMS has relaxed enrollment restrictions MAC must allow entity to enroll in the state where the interpretation was performed and can use interpreting physician s home or office address Date of Service For services in MACs run by WPS and CGS No global billing for advanced imaging if DOS for TC and PC differ 13
15 Accreditation Its Nexus with Supervision MIPPA The Medicare Improvements for Patients and Providers Act of Accreditation Required for Advanced Diagnostic Imaging Services: o MR o CT o Nuclear Medicine (including PET) January 1,
16 Mandates Qualifications of Non-Physician Personnel Qualifications of Medical Directors and Supervising Physicians CMS has until now relied on standards of accrediting organizations CMS has requested comments on quality standards for suppliers of advanced diagnostic imaging services Breast Biopsy Procedures - Problem for IDTFs The following codes are DELETED for 2014 Code Definition Stereotactic localization guidance for breast biopsy or needle placement (eg, wire placement or for injection), each lesion RS&I Mammographic guidance for needle placement, breast (eg, for wire localization or for injection), each lesion RS&I New Breast Biopsy Codes for 2014 Code Definition Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance each additional lesion, including stereotactic guidance Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance each additional lesion, including ultrasound guidance Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance each additional lesion, including magnetic resonance guidance 15
17 New CMS 1500 Claim Form Effective April 1, 2014 Role of Provider: Qualifier Provider Role DN Referring provider DK Ordering provider DQ Supervising provider Enter the qualifier to the left of the dotted vertical line on Item
Frequently Asked Questions Related to Change Request 7631 (Revised and Clarified Place of Service Coding Instructions)
Frequently Asked Questions Related to Change Request 7631 (Revised and Clarified Place of Service Coding Instructions) Change Request (CR) 7631 (Transmittal 2679) entitled Revised and Clarified Place of
More informationDiagnostic Testing Equipment Leasing Companies Appear To Escape IDTF Enrollment Requirements
2008 American Health Lawyers Association December 19, 2008 Vol. VI Issue 48 Diagnostic Testing Equipment Leasing Companies Appear To Escape IDTF Enrollment Requirements By Thomas W. Greeson and Heather
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services News Flash Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request
More informationMedicare s New Enrollment Procedures for IDTFs
Medicare s New Enrollment Procedures for IDTFs Beginning October 1, 2001, the Centers for Medicare & Medicaid Services ( CMS ) will have implemented major revisions to its Form 855 enrollment materials
More informationPlace of Service (POS) and Date of Service (DOS) Instructions for Interpretation of Diagnostic Tests
News Flash Medicare will cover immunizations for H1N1 influenza also called the "swine flu." There will be no coinsurance or copayment applied to this benefit, and beneficiaries will not have to meet their
More informationInpatient Hospital (21) Office (11) Home (12) June 4, 2014
Inpatient Hospital (21) Home (12) Office (11) 1 June 4, 2014 Today s event is a teleconference Slides will not be advanced during the presentation Attendees are instructed to refer to their handout material
More informationHow To Bill For A Health Care Facility
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Subscribe to the MLN Connects Provider enews: a weekly electronic publication with the latest Medicare program information,
More informationSummary of the Final Rule on the 2009 Medicare Physician Fee Schedule
Summary of the Final Rule on the 2009 Medicare Physician Fee Schedule The Centers for Medicare and Medicaid Services (CMS) released the review copy of the 2009 Medicare Physician Fee Schedule (MFS) final
More informationMedicare s Physician Supervision Requirements. 1. Incident To Services in an Outpatient Hospital Setting (Section 1861(s)(2)(B));
Medicare s Physician Supervision Requirements The Centers for Medicare and Medicaid Services or CMS (formerly known as the Health Care Financing Administration) is responsible for administering the Medicare
More informationOffice Visits. Breast
Early Detection Works Reimbursement Fee Schedule Effective for services on or after July 1, 2015 Program guidelines require that be the payor of last resort. Program funds cannot be used to supplement
More informationMEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT FORM APPROVED OMB NO. 0938-0373 Name(s) and Address of Participant*
More informationHow Do I Ask Questions During this Training? Questions that arise during the training may be emailed to: elibrarytraining@ahca.myflorida.com.
How Do I Ask Questions During this Training? Questions that arise during the training may be emailed to: elibrarytraining@ahca.myflorida.com. 2 Training Objectives Describe new information contained in
More informationUpdate to Second-Quarter Procedure Code Review Updates
Update to Second-Quarter Procedure Review Updates Information posted September 11, 2009 This is an update to an article posted on this website on the TMHP Updates Procedure Review web page on May 15, 2009,
More informationPayment Policy. Evaluation and Management
Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions
More informationProvider Reimbursement for Women's Cancer Screening Program
Reimbursement Schedule July 1, 2015 June 30, 2016 Office Visits - Established Patients Office Visit / Minimal / no physician 99211 $ 16.70 Office Visit / Problem focused History / exam 99212 $ 36.46 Preventive
More informationRegulatory Compliance Policy No. COMP-RCC 4.07 Title:
I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.07 Page: 1 of 7 This policy applies to (1) any Hospital in which Tenet Healthcare Corporation or an affiliate owns a direct or indirect equity interest
More informationQ: What differentiates a diagnostic from a screening mammography procedure?
The following Q&As address Medicare guidelines on the reporting of breast imaging procedures. Private payer guidelines may vary from Medicare guidelines and from payer to payer; therefore, please be sure
More informationFacility Name: Street Address: City: County: State: Zip: Web Site Address: Office Manager Name: Phone and Ext: Email:
FACILITY CREDENTIALING APPLICATION USI.V5.2009.02 FACILITY INFORMATION Please complete a separate application for each facility. Facility Name: Street Address: City: County: State: Zip: Phone: Fax: Federal
More informationThe ASA defines anesthesiology as the practice of medicine dealing with but not limited to:
1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia
More informationHow To Get A Hospital Stay For A Year
2-Midnight Rule: Implications for Auditor Behavior and Appeal Strategies Jessica L. Gustafson, Esq. The Health Law Partners, P.C. 29566 Northwestern Hwy., Ste. 200 Southfield, MI 48236 www.thehlp.com 1
More informationTransformers: The Changing Face of Health Care Delivery
1 Transformers: The Changing Face of Health Care Delivery Steve Lokensgard Derek Kang HCCA Compliance Institute April 21, 2015 2 Agenda People Physician Assistants Nurse Practitioners Pharmacists Radiology
More informationMedicare & Incident To Billing for Mental Health Services
Medicare & Incident To Billing for Mental Health Services Under Medicare Part B, services may be provided by one healthcare practitioner incident to another Medicare-enrolled practitioner. This allows
More informationMLN Matters Number: MM4246 Related Change Request (CR) #: 4246. Related CR Transmittal #: R808CP Implementation Date: No later than January 23, 2006
MLN Matters Number: MM4246 Related Change Request (CR) #: 4246 Related CR Release Date: January 6, 2006 Effective Date: January 1, 2006 Related CR Transmittal #: R808CP Implementation Date: No later than
More informationUNRAVELING THE MYSTERIES OF SPLIT
UNRAVELING THE MYSTERIES OF SPLIT BILLING FOR HOSPITAL-BASED DEPARTMENTS AND CLINICS AUGUST 23, 2012 JEAN RUSSELL, MS, RHIT 518-369-4986 JRUSSELL@EPOCHHEALTH.COM AGENDA Based on Medicare and NY Medicaid
More informationProfessional/Technical Component Policy
Policy Number 2015R0012C Professional/Technical Component Policy Annual Approval Date 1/27/2014 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible
More informationPresident Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 --New Law Includes Physician Update Fix through February 2012--
President Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 --New Law Includes Physician Update Fix through February 2012-- On Friday, December 23, 2011, President Obama signed into law
More informationSuzanne Honor-Vangerov, Esq. CPC, CPC-I
Suzanne Honor-Vangerov, Esq. CPC, CPC-I 1 Managing Attorney, Lien Unit Floyd Skeren & Kelly LLP Owner of Honor System Consulting Prior Manager of the Division of Workers Compensation Medical Unit, in charge
More informationIWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule
Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule a) In accordance with Sections 8(a), 8.2 and 16 of the Workers' Compensation Act [820 ILCS 305/8(a), 8.2 and 16] (the Act),
More informationFinal Comments for Hyperbaric Oxygen (HBO) Therapy (PHYS-056) DL31357
Final Comments for Hyperbaric Oxygen (HBO) Therapy (PHYS-056) DL31357 Comment An association stated WPS Medicare s Physician Credentialing Requirements are not clinically supported and directly conflict
More informationExpanding 340B Participation: The Provider-Based Challenge
Expanding 340B Participation: The Provider-Based Challenge Presentation by Karen Smith, Esq. & David Johnston, Esq. Bricker & Eckler LLP www.bricker.com Columbus l Cleveland l Cincinnati-Dayton I Marietta
More informationRecent Enforcement Actions in Radiology: Lessons Learned and Problems to Avoid
Recent Enforcement Actions in Radiology: Lessons Learned and Problems to Avoid December 10, 2014 NEW YORK LONDON HONG KONG CHICAGO WASHINGTON, D.C. BEIJING PARIS LOS ANGELES SAN FRANCISCO PHILADELPHIA
More informationMedicare Preventive Services National Provider Call: The Initial Preventive Physical Exam and the Annual Wellness Visit.
Medicare Preventive Services National Provider Call: The Initial Preventive Physical Exam and the Annual Wellness Visit March 28, 2012 1 Today s Panel of Experts Jamie Hermansen Health Insurance Specialist
More informationFederally Qualified Health Centers (FQHC) Billing 1163_0212
Federally Qualified Health Centers (FQHC) Billing 1163_0212 Today s Presenter Charles Wiley- Provider Outreach and Education Representative 2 Disclaimer has produced this material as an informational reference
More informationAdvanced Imaging Services
Advanced Imaging Services July 17, 2013 Joan Cleary Miron, MPH Director Division of Primary Care Development MIPPA Definition: Advanced Diagnostic Imaging Services * Section 135 (B) ADVANCED DIAGNOSTIC
More informationCoding and Billing Guidelines *Psychiatry and Psychology Services PSYCH-014 - L30489. Contractor Name Wisconsin Physicians Service (WPS)
Coding and Billing Guidelines *Psychiatry and Psychology Services PSYCH-014 - L30489 Contractor Name Wisconsin Physicians Service (WPS) Contractor Number 00951, 00952, 00953, 00954 05101, 05201, 05301,
More informationFact Sheet on the Resource Based Relative Value Scale (RBRVS) Fee Schedule Effective January 1, 2014
Fact Sheet on the Resource Based Relative Value Scale (RBRVS) Fee Schedule Effective January 1, 2014 1. When did the new RBRVS-based fee schedule become effective? 1.1. The RBRVS-based physician and non-physician
More informationCMS PROPOSED STARK REGULATIONS MATERIALLY IMPACT HOSPITAL-PHYSICIAN JOINT VENTURES AND VARIOUS OTHER PHYSICIAN ARRANGEMENTS
CMS PROPOSED STARK REGULATIONS MATERIALLY IMPACT HOSPITAL-PHYSICIAN JOINT VENTURES AND VARIOUS OTHER PHYSICIAN ARRANGEMENTS Health care providers beware: Many commonplace hospital and physician arrangements
More informationHow To Opt Out Of Medicare
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services NEW products from the Medicare Learning Network (MLN) Transitional Care Management Services, Fact Sheet, ICN 908682, Downloadable
More informationRegulatory Changes Ahead for Medical Imaging
Ready, Set, Go: Regulatory Changes Ahead for Medical Imaging In the next two years, already-inundated radiology administrators will face an onslaught of new regulatory challenges By Sheila Sferrella There
More informationMedicare Outpatient Therapy Billing
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Medicare Outpatient Therapy Billing August 2010 / ICN: 903663 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare
More informationCompliance Risks with Non-Physician Practitioners
Compliance Risks with Non-Physician Practitioners Kim Huey, MJ, CPC, CCS-P, PCS Health Care Compliance Association Clinical Practice Compliance Conference October 2013 NPP Coding and Billing Definitions
More informationRADIOLOGY HOUSE STAFF MANUAL
RADIOLOGY HOUSE STAFF MANUAL The Department of Radiology offers a wide range of services/procedures and operates 12 divisions/sections, which are listed separately below. The procedures offered are listed
More informationHow To Write A Procedure Code
Manual: Policy Title: Reimbursement Policy Technical Component (TC), Professional Component (PC/26), and Global Service Billing Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number:
More informationProlonged Services (Codes 99354-99359) Key Words. Provider Types Affected. Key Points
Related MLN Matters Article #: MM5972 Date Posted: April 30, 2008 Related CR #: 5972 Prolonged Services (Codes 99354-99359) Key Words MM5972, CR5972, R1490CP, Prolonged Provider Types Affected Physicians
More informationProviding and Billing Medicare for Transitional Care Management
PYALeadership Briefing Providing and Billing Medicare for Transitional Care Management Updated November 2014 2014 Pershing Yoakley & Associates, PC (PYA). No portion of this white paper may be used or
More informationGlobal Surgery Fact Sheet
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Global Surgery Fact Sheet Fact Sheet Definition of a Global Surgical Package Medicare established a national definition
More informationComplex 2015 Changes to Radiation Oncology Coding
Complex 2015 Changes to Radiation Oncology Coding The Centers for Medicare & Medicaid Services (CMS) issued its Final Rule on October 31 outlining the codes it would recognize in calendar year (CY) 2015.
More informationBasics of Skilled Nursing Facility Consolidated Billing (SNF-CB) Medicare Part A and B Presentation March 19, 2013
Basics of Skilled Nursing Facility Consolidated Billing (SNF-CB) Medicare Part A and B Presentation March 19, 2013 2 Agenda Skilled Care Defined Background on SNF-CB Under Arrangements Inclusions and Exclusions
More informationNote: This article was updated on October 1, 2012, to reflect current Web addresses. All other information remains unchanged.
Related Change Request (CR) #: 3444 Related CR Release Date: September 10, 2004 Effective Date: N/A Related CR Transmittal #: R299CP Implementation Date: N/A Note: This article was updated on October 1,
More informationInpatient or Outpatient Only: Why Observation Has Lost Its Status
Inpatient or Outpatient Only: Why Observation Has Lost Its Status W h i t e p a p e r Proper patient status classification affects the clinical and financial success of hospitals. Unfortunately, assigning
More informationMEDICARE ENROLLMENT APPLICATION
MEDICARE ENROLLMENT APPLICATION REASSIGNMENT OF MEDICARE BENEFITS CMS-855R SEE PAGE 2 FOR INFORMATION ON WHERE TO MAIL THIS APPLICATION. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID
More informationMedicare- Tennessee Overview
Medicare- Tennessee Overview Medicare is a government-administered program providing health insurance to 43 million Americans. The Centers for Medicare and Medicaid Services (CMS) implements laws and establishes
More informationMedicare Benefit Policy Manual Chapter 6 - Hospital Services Covered Under Part B
Medicare Benefit Policy Manual Chapter 6 - Hospital Services Covered Under Part B Transmittals for Chapter 6 Table of Contents (Rev. 194, 09-03-14) 10 - Medical and Other Health Services Furnished to Inpatients
More informationComprehensive Outpatient Rehabilitation Facility (CORF) Manual JA6005
Comprehensive Outpatient Rehabilitation Facility (CORF) Manual JA6005 Note: MLN Matters article MM6005 was revised to clarify the language that referred to the correct types of therapy. All other information
More informationMedicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014
Medicare 101: Basics of Modifier Billing Part B Provider Outreach and Education February 26, 2014 Housekeeping Tips When you called in, did you enter your attendee code? Dial-in number: 1-800-791-2345
More informationThe Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97
6 The Collaborative Models of Mental Health Care for Older Iowans Model Administration Collaborative Models of Mental Health Care for Older Iowans 97 Collaborative Models of Mental Health Care for Older
More informationMedicare Information for Advanced Practice Nurses and Physician Assistants. September 2010 / ICN: 901623
R Medicare Information for Advanced Practice Nurses and Physician Assistants September 2010 / ICN: 901623 This publication provides information about required qualifications, coverage criteria, billing,
More informationHealth Care Compliance Association 888-580-8373 www.hcca-info.org
Volume Twelve Number Five Published Monthly Meet Miaja Cassidy Director of Healthcare Compliance at Target page 14 Feature Focus: Managing security risks in business associate relationships page 32 Earn
More informationMedicare Coding and Billing Part 2 Sequestration Revalidation Comparative Billing Reports Importance of PQRS CMS 1500 Form Item 14 -
Medicare Coding and Billing Part 2 Sequestration As of now there are no changes in Sequestration. The Medicare Fee Schedule will change April 1. If you are a non-par doctor, check your MAC website for
More informationProvider-Based: What Is It?
Compliance Risks for Provider-Based and Other Hospital-Based Provider Services 2015 HCCA Compliance Institute Presented by Regan E. Tankersley, Esq. Hall, Render, Killian, Heath & Lyman, P.C. Paul W. Kim,
More informationANNUAL NOTICE TO PHYSICIANS
NOVEMBER 2014 ANNUAL NOTICE TO PHYSICIANS Dear Physician Colleague: Genoptix Medical Laboratory is committed to complying with all applicable laws and regulations governing the health care industry. We
More informationUS Reimbursement Guide
US Reimbursement Guide The information with this notice is general reimbursement information only. It is not legal advice, nor is it about how to code, complete or submit any particular claim for payment.
More informationAmerican Association of Physicists in Medicine
001@umn.edu American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846 (301) 209-3350 Fax (301) 209-0862 http://www.aapm.org September 2, 2015 Andrew Slavitt Acting
More informationProposed Medicare Rule Would Restrict Permitted Business Arrangements
Proposed Medicare Rule Would Restrict Permitted Business Arrangements July 2007 Boston Brussels Chicago Düsseldorf London Los Angeles Miami Munich New York Orange County Rome San Diego Silicon Valley Washington,
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Mental Health Services ICN 903195 January 2015 This booklet was current at the time it was published or uploaded onto the
More informationSummary. CY 2014 Medicare Physician Fee Schedule (MPFS) Final Rule
Summary CY 214 Medicare Physician Fee Schedule (MPFS) Final Rule On November 27, 213, the Centers for Medicare & Medicaid Services () released the 214 final rule. The final rule contains payment and programmatic
More informationFrequently Asked Questions
Frequently Asked Questions Medicare Shared Savings Program Contents General Questions... 1 *NEW* Assignment... 5 ACO Participant List... 5 *UPDATED* Form CMS-588 Electronic Funds Transfer (EFT)... 7 Governing
More informationEmpire BlueCross BlueShield Professional Reimbursement Policy
Subject: Modifier Rules NY Policy: 0017 Effective: 02/01/2014 06/30/2014 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationFUNDAMENTALS OF PROVIDER ENROLLMENT
FUNDAMENTALS OF PROVIDER ENROLLMENT Jeanne L. Vance Salem & Green, A Professional Corporation 3604 Fair Oaks Boulevard, Suite 200 Sacramento, CA 95864 (916) 563-1818 jvance@salemgreen.com March 1, 2013
More informationFRIEND TO FRIEND CPT CODES 2015 2016. Diagnostic digital breast tomosynthesis, unilateral (list separately in addition to code for primary procedure)
FRIEND TO FRIEND CPT CODES 2015 2016 CPT CODE SERVICE DESCRIPTION FEE EFFECTIVE G0101 Screening pelvic examination $36.69 01 Jan 16 G0202 Mammography, screening, digital, bilateral (2 view film study of
More informationMLN Matters Number: MM5972 Related Change Request (CR) #: 5972. Related CR Transmittal #: R1490CP Implementation Date: July 7, 2008
The NPI will be Required for all HIPAA Standard Transactions on May 23 rd. As of May 23, 2008, the NPI will be required for all HIPAA standard transactions. This means: - For all primary and secondary
More informationStatus Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session.
Status Active Reimbursement Policy Section: Surgery/Interventional Procedure Policy Number: RP - Surgery/Interventional Procedure - 001 Assistant Surgeons Effective Date: June 1, 2015 Assistant Surgeons
More informationProvider-Based Status, Under Arrangements, Enrollment and Related Medicare Requirements
Provider-Based Status, Under Arrangements, Enrollment and Related Medicare Requirements Catherine T. Dunlay and Thomas E. Dowdell 1 I. WHAT IS PROVIDER-BASED STATUS AND WHEN DO REQUIREMENTS APPLY? A. A
More informationMidlevel Practitioner Billing and Incident To
Midlevel Practitioner Billing and Incident To Health Care Compliance Association North Central Regional Conference October 5, 2012 Presented by Joy Newby, LPN, CPC, PCS Newby Consulting, Inc. 5725 Park
More information3. Disability. An individual who has received disability benefits for 25 months may enroll for Medicare Part B benefits, even if under the age of 65.
MEDICARE PART B Barry D. Alexander, Esq. Nelson Mullins Riley & Scarborough, LLP 4140 ParkLake Ave., GlenLake One, 2 nd Floor Raleigh, NC 27612 919.877.3802 barry.alexander@nelsonmullins.com I. MEDICARE
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Mental Health Services ICN 903195 September 2013 This booklet was current at the time it was published or uploaded onto
More informationCompliance Risks with Non-Physician Practitioners
Compliance Risks with Non-Physician Practitioners Kim Huey, MJ, CPC, CCS-P, PCS HCCA 2013 Compliance Institute April 2013 NPP Coding and Billing Definitions Compliance Issues Medicare Incident-to Split/Shared
More informationThe ABCs of the Initial Preventive Physical Exam and the Annual Wellness Visit. National Provider Call July 21, 2011
The ABCs of the Initial Preventive Physical Exam and the Annual Wellness Visit National Provider Call July 21, 2011 1 Today s Panel of Experts Jamie Hermansen Health Insurance Specialist Coverage & Analysis
More informationPage 1 of 11. MLN Matters Number: SE1010 REVISED Related Change Request (CR) #: 6740. Related CR Release Date: N/A Effective Date: January 1, 2010
News Flash Version 3.0 of the Measures Groups Specifications Manual released in November 2009 for 2010 PQRI has been revised. Version 3.1 of the 2010 PQRI Measures Groups Specifications Manual and Release
More informationReimbursement Risks with Radiologist Extenders: There Is No Free Lunch!
Reimbursement Risks with Radiologist Extenders: There Is No Free Lunch! William T. Thorwarth, Jr., MD There is great allure in the concept of using qualified health care providers to assist radiologists
More informationGEORGIA MEDICAID TELEMEDICINE HANDBOOK
GEORGIA MEDICAID TELEMEDICINE HANDBOOK CONNECTING GEORGIA OVERVIEW The Department of Community Health s (DCH) Telemedicine and Telehealth policies are slated to improve and increase access and efficiency
More informationOperationalizing Compliance with Medicare s Incident-to Rules in Both Provider-Based. September 2008. Incident To" Coverage The.
Operationalizing Compliance with Medicare s Incident-to Rules in Both Provider-Based and Freestanding Settings September 2008 Hugh Aaron, MHA, JD, CPC, CPC-H 1 Agenda Incident To" Coverage The Big Picture
More informationDepartment of Veterans Affairs VHA DIRECTIVE 1063. Washington, DC 20420 December 24, 2013 UTILIZATION OF PHYSICIAN ASSISTANTS (PA)
Department of Veterans Affairs VHA DIRECTIVE 1063 Veterans Health Administration Transmittal Sheet Washington, DC 20420 December 24, 2013 UTILIZATION OF PHYSICIAN ASSISTANTS (PA) 1. REASON FOR ISSUE: This
More information2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010
2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010 Consultations The Centers for Medicare/Medicaid Services (CMS) finalized its proposal to require claims for consultation services
More informationMEDICARE PAYMENTS FOR DIAGNOSTIC RADIOLOGY SERVICES IN EMERGENCY DEPARTMENTS
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL MEDICARE PAYMENTS FOR DIAGNOSTIC RADIOLOGY SERVICES IN EMERGENCY DEPARTMENTS Daniel R. Levinson Inspector General April 2011 OEI-07-09-00450
More informationNew York State Public Health Law TITLE II-D HEALTH CARE PRACTITIONER REFERRALS
New York State Public Health Law TITLE II-D HEALTH CARE PRACTITIONER REFERRALS Sec. 238. Definitions. 238-a. Prohibition of financial arrangements and referrals. 238-b. Provider requests for payment. 238-c.
More informationCMS Releases Final 2010 Medicare Physician Fee Schedule Update
CMS Releases Final 2010 Medicare Physician Fee Schedule Update November 23, 2009 Boston Brussels Chicago Düsseldorf Houston London Los Angeles Miami Milan Munich New York Orange County Rome San Diego Silicon
More informationOverview 4/24/2014. Supervision of Physician Assistants ( PAs ) Georgia Society of Clinical Oncology (GASCO) 2014 Spring Meeting
Georgia Society of Clinical Oncology (GASCO) 2014 Spring Meeting Georgia Scope of Service Laws, Supervision, Documentation and Billing for Midlevel Services May 2-3, 2014 Richard D. Sanders THE SANDERS
More informationIndependent diagnostic testing FacIlItIes site InvestIgatIon 42 cfr 410.33
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Independent diagnostic testing FacIlItIes site InvestIgatIon 42 cfr 410.33 Form Approved OMb. 0938-1029 Date Ordered: Date
More informationHEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) LEVEL II CODING PROCEDURES
HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) LEVEL II CODING PROCEDURES This information provides a description of the procedures CMS follows in processing HCPCS code applications and making coding
More informationNurse Practitioners and Physician Assistants as Billing Providers
Office of Origin: UCSF Clinical Enterprise Compliance Program I. PURPOSE To establish guidelines for UCSF Nurse Practitioners (NP) and Physician Assistants (PA) to bill Medicare, Medi-Cal and other payors
More informationIncident To Services
Policy Number INT04242013RP Approved By Incident To Services UnitedHealthcare Medicare Committee Current Approval Date 11/18/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable
More informationRadiology Multiple Imaging Reduction Policy
Policy Number 2015R0085C Radiology Multiple Imaging Reduction Policy Annual Approval Date 7/8/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission
More informationATTENTION PRACTICE MANAGERS
Volume VI; June 2013 ATTENTION PRACTICE MANAGERS MUST USE Easier to Read Asterisks detailing required information New telephonic team working to give you timely status updates AZPCP Prior Authorization
More informationAgency for Health Care Administration
Page 1 of 498 FED - A0000 - INITIAL COMMENTS Title INITIAL COMMENTS CFR Type Memo Tag FED - A0001 - NON-PARTICIPATING HOSPITALS, EMERGENCIES Title NON-PARTICIPATING HOSPITALS, EMERGENCIES CFR 482.2 Type
More informationMedicare Physician Fee Schedule Modifiers
Basics of MPFS Part 3 Medicare Physician Fee Schedule Modifiers Presented by Part B Provider Outreach and Education July 16, 2013 Disclaimer This information released is the property of Cahaba GBA and
More informationMid-Level Providers Best Practice for Compliance and Operations in the Hospital and Physician Office Settings
Mid-Level Providers Best Practice for Compliance and Operations in the Hospital and Physician Office Settings The Health Insurance for the Aged and Disabled Act (title XVIII of the Social Security Act),
More informationSteve LeFar. 9th Annual Survey. Earn CEU credit. Equal access for people with disabilities. Medicare hospital Outpatient Prospective Payment System
Volume Nine Number Four Published Monthly Earn CEU credit see insert Meet Steve LeFar President of MediRegs page 16 Special Focus: 9th Annual Survey Equal access for people with disabilities page 4 Also:
More informationIncident To Services Documentation and Correct Billing July 23 2013 Presented by: Ellen Berra, Outreach Senior Analyst Karen Kroupa, Outreach Analyst
Incident To Services Documentation and Correct Billing July 23 2013 Presented by: Ellen Berra, Outreach Senior Analyst Karen Kroupa, Outreach Analyst Agenda Overview Documentation Requirements Part A Part
More informationMEDICAL SERVICE RESEARCH AND DEVELOPMENT PLAN AND UT PHYSICIANS
MEDICAL SERVICE RESEARCH AND DEVELOPMENT PLAN AND UT PHYSICIANS BILLING AND DOCUMENTATION GUIDELINES MEDICAL SERVICE RESEARCH AND DEVELOPMENT PLAN AND UT PHYSICIANS BILLING AND DOCUMENTATION GUIDELINES
More information