On February 16, 2012, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that HHS intends to delay the compliance date for ICD-10. Currently, the compliance deadline stands at October 1, 2013 (which is already a two-year delay from the original date outlined in the January 2009 final rule). While no new date has been declared, this new release suggests that HHS is listening to the voices of healthcare providers, medical billing companies, and others with stake in the healthcare industry who are concerned that ICD-10 may bring about an increase in administrative burden that providers are currently unprepared to shoulder. The original HHS press release can be read here.

As the March 1, 2012 deadline approaches, all physicians, healthcare providers, and medical billing companies are keeping a watchful eye on Congress to make sure that the staggering 27% reduction in the Medicare Physician Fee Schedule is blocked. The bill, often referred to as the “doc fix,” is wrapped up in a broader deal concerning the payroll tax cut and unemployment benefits. Political analysts most recently are reporting that a bipartisan compromise is likely to occur and the drastic cut will not go into effect. For a recent news article following the story, click here.

Worried about under-coding or over-coding your patients’ Evaluation & Management (E/M) services? Not sure of whether to bill for a level 3, 4, or 5 exam? Many physicians experience confusion when deciphering what level of care is appropriate to bill. On one hand, under-coding can result in a decrease in reimbursement that rightly belongs to your practice; on the other, over-coding can result in denials for lack of medical necessity or even inadvertent insurance fraud. Whether you are working in a specialty practice, primary care setting, or are making hospital rounds, the challenge of E/M coding is universal. Fortunately, resources abound to help physicians determine the most appropriate coding of E/M exams. On February 7, 2012, Highmark Medicare (the Medicare contractor for physicians billing in Maryland, Delaware, Pennsylvania, and the District of Columbia Metropolitan Area) is offering a free webinar on the (advanced) Evaluation and Management scorecard. Registration is required. The webinar is offered between 1 – 2:30 PM EST. Short on time? Medicare offers free access to its webinar handouts for both the Basic and Advanced presentation on E/M Coding.

Registration & Handouts are available on the Highmark Medicare Services website: https://www.highmarkmedicareservices.com/calendar/partb/webinar/index.html.

For additional resources or questions, please feel free to contact Healthcare Data Management, Inc. directly!

The state of Maryland is considering a proposal for the creation of “health enterprise zones.” These “health enterprise zones” would consist of rural and urban regions in Maryland in which the population has notably underserved medical needs; primary care physicians and healthcare providers who practice in these regions would then be eligible for financial incentives for their service. These financial healthcare incentives may take the form of tax breaks, student loan forgiveness for indebted physicians, and other financial rewards. The goal of this endeavor would be to increase access to primary care, decrease geographical healthcare disparities, and reduce the number of hospital emergency room visits for patients with neglected routine ailments. The Maryland Legislature is expected to examine the proposal in 2012. To learn more click here.

On January 30, 2012 Medicare amended its Not-Otherwise-Classified (NOC) code set to remove unspecified anesthesia codes (CPT’s 00100 through 01996) from the list of codes that require a specific description to be supplied in order to pass 5010 edits. While this change may seem minor, it is indeed good news for medical billing services and providers alike, as one more obstacle toward quick reimbursement has been removed. More information on the new 5010 code edit for not-otherwise-classified CPT’s and a complete listing of affected codes can be found here.

As a part of Medicare Part B’s 5-year phase out of the 62.5% mental health limitation, providers will see an increase in Medicare pay from 68.5% to 75% from 2011 to 2012; reducing patient liability from 45% to 40%. Great news for behavioral health providers and beneficiaries alike.

For more information click here.

Medicare’s recent policy changes reflect a heightened awareness of the value of preventive care. The newest changes include reimbursement to providers that offer alcohol misuse counseling, cardiovascular screenings, depressions screenings, and obesity screening and counseling. Additional preventive services that Medicare currently covers include annual wellness visits, abdominal aortic aneurysm screenings, bone mass measurements, colon cancer screenings, diabetes screenings, diabetes self-management training, EKG screenings, flu shots, glaucoma tests, Hepatitis B shots, HIV screenings, mammograms, medical nutrition therapy services, PAP tests and pelvic exams, Pneumococcal shots, prostate cancer screenings, and smoking cessation counseling. For more information on the coding and reimbursement details for these services, please feel free to contact us here at Healthcare Data Management, Inc., or click here for a complete listing from Medicare.

While our medical billing team keeps on the cutting edge of technology developments on our end of the healthcare reimbursement cycle, we also want our physicians to share in the wealth of available technological resources. Smart phones and tablets are becoming widely used in healthcare, and many applications are being designed specifically for the physician’s use.

These apps cover a wide span of functions, including medication searches, pill identifiers, dictation tools, medical Spanish translations, EHR assistants, diagnosis coding, and far more. If you are interested in exploring these tools, you can find a helpful start here, where a writer for Becker’s Hospital Review has compiled a list of the most popular apps.

As we launch into 2012, Carefirst has several new updates to their plans and policies:

• Carefirst recently launched its new insurance plan, HealthyBlue 2.0. For information on how to recognize this plan and how to properly bill for services, healthcare providers can sign up for free training with Carefirst. Visit www.carefirst.com/providers and check out the Seminars & Training page.
• Carefirst announced in its December 2011 edition of BlueLink that Zoster Vaccinations are now covered for all members who are 50 years of age and older as a preventive service. These vaccinations can be offered in a variety of healthcare settings, including physician offices.
• An important reminder for providers and patients alike: BCBS Federal Employee Program (FEP) requires beneficiaries to update their coordination of benefits information with Carefirst upon enrollment; failure to do so can result in a delay in provider reimbursement and claim processing.

For more information on these news pieces and other updates relevant to Carefirst healthcare billing, please click here.

The Centers for Medicare & Medicaid Services (CMS) has published details regarding the 2012 Electronic Prescribing (eRx) Incentive Program. To check these educational products out, please click here to read more.