Fall - Indiana Academy of Family Physicians

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Medicare Coalition Summary July 18, 2003 By: Joy Newby, LPN, CPC Consultant, Commission on Health Care Services HIPAA UPDATE Connie Nichols presented the latest update on HIPAA transaction standards taking effect on Oct. 16. The AdminaStar Federal’s (ASF) 4010A1 version has been fully implemented including claim status inquiry. According to Ms. Nichols, 5 percent of providers are fully implemented and billing with the ANSI format necessary to be HIPAA complaint. An additional 40 percent of providers have completed their testing. The remaining 55 percent of providers has Medicare concerned that they will not receive Medicare payment after Oct. 16. The External Affairs Part B Provider Relations Team recently contacted approximately 400 providers asking them about their HIPAA readiness. Based on the majority of responses, the Carrier believes there is a lack of urgency in the providers’ minds about becoming HIPAA compliant. This may be partly due to the Medicare Program’s frequent extension of their deadlines. What makes HIPAA so important is that the deadline was established in the Health Insurance Portability and Accountability Act of 1996. Only Congress can change the deadline and then only through legislation. The External Affairs Part B Provider Relations Team recently contacted approximately 400 providers asking them about their HIPAA readiness. Ms. Nichols stated that ASF expects to receive additional instructions from the Centers for Medicare & Medicaid Services (CMS) in August. At presstime, the Carrier’s position is that for any practice having 10 or more full-time employees, all claims, even those that are corrected and resubmitted or were "lost" in the system and are being resubmitted after Oct. 16, must be submitted in the required HIPAA transaction standard. The Carrier had 49 HIPAA Educational Programs scheduled throughout the state between July 22 and Aug. 27. This series of programs was designed to include the majority of small providers defined as providers of services having fewer than 25 full-time equivalent employees or for physicians, practitioners, facilities, or suppliers with fewer than 10 employees. FILING OF CLAIMS WHEN MEDICARE IS SECONDARY PAYER (MSP) Claims with a single primary payer should be submitted electronically. Under HIPAA, the payer isn’t allowed to request additional paper documentation as long as the coordination of benefits (COB) information regarding the primary payer is included in the COB segment of the ANSI 837 4010A1 MSP claims. CMS Program Memorandum B03-050, CR #2758, issued July 3, 2003, instructs physicians and suppliers "that MSP claims with multiple primary payers shall be submitted on paper with the appropriate explanation of benefits or remittance advice, and shall not be submitted electronically." EVALUATION AND MANAGEMENT (E/M) CODING WITH COUMADIN LEVEL The description of CPT code 99211 is "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services." There are no special guidelines nor exceptions for visits related to patients for whom anticoagulation is being monitored. Any such visit would need to meet the usual criteria for CPT code 99211 and when not performed by the physician or nonphysician practitioner, the "incident to" guidelines. 24
Scheduled visits to the physician’s office to obtain blood for prothrombin time and INR should be billed as G0001. CPT code 99211 should NOT be additionally billed. Adjustments in medications based on laboratory results are frequently made for patients with chronic medical illnesses, e.g., diabetes mellitus. Medication adjustment, alone, is not separately payable. The CPT codes 99371-99373 for "Telephone Calls" have a "B" = "bundled code" status on the Medicare Physician Fee Schedule Database (MPFSDB). WEBINAR DEMONSTRATION Susan Hodge, External Affairs, presented an excellent overview of Medicare’s webinars. The Carrier expects to have additional webinars in the future months. The Provider Communications Advisory Group has suggested topics for the future webinars. Webinars are cost effective for both Medicare and the physician community. At this time, there is no cost to the physician for participation in the webinar. Previous webinar slides and frequently asked questions can be reviewed at the Carrier’s website, adminastar.com. Topics include Quarterly Updates, 1500 Claim Form, Local PET Education Training, and Dermatology. Webinars are cost effective for both Medicare and the physician community. At this time, there is no cost to the physician for participation in the webinar. There is no travel involved and the whole office can participate. The Carrier is attempting to keep the webinars to a one or two hour time frame and not to provide these programs at peak work time, e.g., the first and last week of the month. 25
Page 1: A Publication of the Indiana Academ
Page 5: President’s Message Richard Feldm
Page 9 and 10: INDIANA ACADEMY OF FAMILY PHYSICIAN
Page 11 and 12: 03-4 (emergency resolution) Residen
Page 13 and 14: The Future of Family Medicine Proje
Page 15 and 16: An Interview with Dr. Kintanar Q. T
Page 17 and 18: PLATINUM Merck France Foundation As
Page 19 and 20: Thursday, October 16 7:00 am Regist
Page 21 and 22: Cathy A. Bryant, MD Bruce Burton, M
Page 23: HIPAA Update Act Now To Protect You
Page 27 and 28: Indiana - Update Tar Wars ® certai
Page 29 and 30: Membership Update Re-election Remin
Page 31 and 32: Innovative Publishing Ink! has assi

Fall - Indiana Academy of Family Physicians

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