AAOMS.org - Practice Management and Allied Staff News

System Testing Should Begin Now for Transition to HIPPA 5010

webadmin@aaoms.org (Webmaster) — Thu, 05 Aug 2010 00:00:00 GMT

While implementation of the new HIPAA Electronic Transaction Standard 5010 and ICD-10 is a couple years away, AAOMS members should begin now for the transition, as the transition will require planning, education, and time for system testing. The rule requiring the implementation of ICD-10 was simultaneously released with a rule requiring the updating of the HIPAA electronic transaction standard to Accredited Standards Committee, ASC X12 version, 5010. The HIPAA ASC X12 version 5010 regulation went into effect March 17, 2009 and requires compliance by all covered entities no later than January 1, 2012. ASC X12 version 5010 will accommodate the increased length of ICD-10 codes as well as consist of several other edits and changes to the electronic claim format. A side-by-side comparison and additional information may be found on the CMS Web site.

There are two levels of compliance: Level I compliance, required by December 31, 2010, means "that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing." Level II compliance, required by December 31, 2011, means "that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards." Full compliance of ASC X12 version 5010 is required by January 1, 2012, leaving OMSs 18 months to complete the conversion. OMS are encouraged to begin now working with their vendors and clearinghouses to convert to the new ASC X12 version 5010 to assure a smooth transition and to avoid disruption of claims processing and payment. On a related note, full compliance with ICD-10 is October 2013. The AAOMS is hosting a webinar, "Making the Transition to ICD-10" on September 15, 2010. Additional resources on HIPAA, ICD-10 and details on September 15th webinar may be found on the AAOMS Web site.

Breach of Standardized Practice for Dental Instrument Reprocessing at St. Louis VA Hospital

webadmin@aaoms.org (Webmaster) — Fri, 16 Jul 2010 00:00:00 GMT

The John Cochran VA Medical Center in St. Louis recently began sending letters notifying 1,812 veterans from Missouri and Illinois, who received dental work at the hospital between February, 2009 and March, 2010 letting them know that some instrument processing steps for dental instruments were not in compliance with their standard policies, creating a low risk of exposure to hepatitis B virus, hepatitis C virus and HIV. The problem arose because workers prewashing dental equipment failed to use a detergent before the equipment was sterilized. The letters say the risk of infection is low. But the hospital is offering veterans free screening for hepatitis B and C as well as HIV.

As a reminder of proper sterilization and instrument processing, the Organization for Safety, Asepsis and Prevention (OSAP) has assembled targeted educational resources for the dental team on instrument processing. For more information, please visit OSAP, CBS News and ksdk.com.

Updated CDC Influenza Guidelines Draft Released for Public Comment

webadmin@aaoms.org (Webmaster) — Tue, 06 Jul 2010 00:00:00 GMT

The Centers for Disease Control recently released a draft of the updated influenza guidelines for public comment. The guidelines, similar to last year's interim guidelines, focus on vaccination as a primary method to prevent transmission. The document also addresses respiratory protection for healthcare workers, stepping back from the previous guidelines by calling for surgical masks instead of N95 respirators, except during aerosol generating procedures. The public comment period is open until July 22. For more information, please see the June 22 Federal Register.

New Resource for Medicare FFS Providers

webadmin@aaoms.org (Webmaster) — Tue, 06 Jul 2010 00:00:00 GMT

The Centers for Medicare & Medicaid Services (CMS) has recently announced a new resource for coding and billing professionals who work with Fee-For-Service (FFS) Providers to ensure they have the timely and accurate information they need to properly bill the Medicare Program. The Medicare Learning Network® Suite of Products and Resources for Billing and Coding Professionals is designed to help billers, coders and other reimbursement specialists submit claims correctly the first time.

Like all MLN products, the Suite has nationally consistent, up-to-date Medicare information prepared by subject-specific experts - and it is available at no cost! The Suite addresses - The Business of Medicare, Medicare Benefits and Services, Special Medicare Initiatives, and General Medicare Program Information and Resources, and offers an uncomplicated way to understand more about the Medicare Program.

To access this exciting new product, visit www.cms.gov/MLNEdWebGuide and click on "Medicare Learning Network Suite of Products and Resources for Billing and Coding Professionals" on the left side of the page.

CMS Releases Additional Guidance on the Implementation of ICD-10-CM

webadmin@aaoms.org (Webmaster) — Tue, 06 Jul 2010 00:00:00 GMT

The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Special Edition Article #SE1019 to provide updated information about the implementation of the International Classification of Diseases, 10th Edition, Clinical Modification and Procedure Coding System (ICD-10-CM/ICD-10-PCS) code. The first ICD-10-related compliance date is less than 2 years away - on January 1, 2012, standards for electronic health transactions change from Version 4010/4010A1 to Version 5010. For more details, please read the article on the CMS website.

President Signs Bill Postponing Medicare Physician Reimbursement Cuts through November 30, 2010

webadmin@aaoms.org (Webmaster) — Mon, 28 Jun 2010 00:00:00 GMT

Late on June 24th the US House of Representatives passed a bill postponing Medicare physician reimbursement cuts for 6 months. The measure, H.R. 3962, was approved by the Senate the Friday before, but House Speaker Nancy Pelosi (D-Calif.) stalled floor consideration in hopes of forcing action in the Senate on the jobs and economic relief package. This tactic proved fruitless, and on the evening of June 24th, H.R. 3962 was passed by a vote of 417-1. President Obama signed the bill into law the next morning.

The Centers for Medicare & Medicaid Services (CMS) postponed the processing of claims for two weeks after Congress missed the original June 1 deadline, but was forced to begin implementing the cut on June 18th. H.R. 3962 reverses the cut and provides for a 2.2 percent raise for physician reimbursements through November 30, 2010. At that point, Congress will need to pass new legislation to prevent a 23% cut in Medicare reimbursement.

CMS has said it will begin processing claims at the new rate beginning July 1 and they will retroactively adjust any claims paid at the reduced rate.

AAOMS continues to advocate for a permanent solution rather than addressing this issue with short-term fixes. Congress has had to pass legislation to prevent reimbursement cuts due to the flawed sustainable growth rate formula (SGR) ten times in the last eight years, including four times since January.

The Electronic Health Record (EHR) Incentive Program Website is Now Available

webadmin@aaoms.org (Webmaster) — Tue, 22 Jun 2010 00:00:00 GMT

The Centers for Medicare & Medicare Services (CMS) has launched the official website for the Medicare & Medicaid EHR Incentive Programs. This website provides the most up-to-date, detailed information about the EHR incentive programs including payments to eligible professionals and hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. To learn about who is eligible for the programs, how to register, meaningful use, and upcoming EHR training and events, please visit and bookmark http://www.cms.gov/EHRIncentivePrograms.

Medicare Physician Claims Payment Update

webadmin@aaoms.org (Webmaster) — Tue, 22 Jun 2010 00:00:00 GMT

It has been brought to the AMA's attention that physicians may have received conflicting reports about how Medicare claims for services provided on or after June 1, 2010, will be processed since Congress failed to send legislation to the President in time to avert implementation of the scheduled 21 percent payment cut. The AMA checked again today with senior officials at the Centers for Medicare and Medicaid Services, and physician claims submitted for services provided in June are, in fact, being processed under the reduced payment rate on a rolling, first in / first out basis. In other words, claims submitted earliest are now being paid at the reduced rate, while newer claims will continue to be held for a ten-day period until the President is able to sign legislation into law.

The AMA still anticipates that whatever legislation is passed will apply retroactively to all services provided since June 1, and that claims that have already been processed will be adjusted automatically without physicians having to resubmit them.

The AMA expects Congress to resolve the issue before the end of the week, and will provide updates on new developments.

Health Reform Law Calls for Testing of Alternative Payment Models

webadmin@aaoms.org (Webmaster) — Wed, 16 Jun 2010 00:00:00 GMT

The new CMS Center for Medicare and Medicaid Innovation (CMI), whose establishment by January 1, 2011 is required under the Health Reform law, will test innovative payment and service delivery models to improve quality of care while reducing health spending. Concepts such as the medical home, accountable care organizations (ACOs), payment bundling across episodes of care, a value-based payment modifier under the physician fee schedule and greater overall emphasis on pay for performance are among the alternative reimbursement models being floated.

According to the Congressional Research Service (CRS) Report, Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA), the CMI would work in conjunction with the Patient-Centered Outcomes Research Institute (PCORI), also created under the Patient Protection and Affordable Care Act (PPACA), "to generate new information about how alternative treatments affect patient outcomes as well as evidence to support how different payment methods might alter the incentives for providers and the outcomes for patients."

Also according to the CRS report, "successful models could be expanded nationally. The CBO (Congressional Budget Office) estimates that this provision will lead to an additional savings of $1.3 billion over 10 years." The report concludes that "in the long run, these provisions combined have the potential to be the most substantial of the PPACA and the Reconciliation Act modifications affecting physicians and related providers." AAOMS will continue to monitor these issues to keep the membership informed.

PPACA Prompts Earlier Enforcement of Recent PECOS Rule

webadmin@aaoms.org (Webmaster) — Wed, 16 Jun 2010 00:00:00 GMT

While the Centers for Medicare and Medicaid Services (CMS) had extended, to January 2011, the deadline of a new rule requiring that providers who order/refer items/services for Medicare patients have current enrollment records in Medicare, enforcement could happen as early as July 6, 2010. A CMS Interim Final Rule (IFR) published in the May 5th Federal Register becomes effective July 6, 2010, prompting some confusion regarding the actual drop dead date for compliance with the PECOS rule. The recently passed health reform legislation, PPACA (Patient Protection and Affordable Care Act), requires "certain provisions be implemented quickly", adding to the uncertainty. AAOMS members who treat Medicare beneficiaries but have not yet enrolled in PECOS will be contacted by CMS to do so. The letter providers will receive states "carriers and A/B MACs are expected to process your enrollment application within 60 days as long as you submit your enrollment application before September 1, 2010." Therefore, AAOMS encourages all AAOMS members treating Medicare beneficiaries to enroll as soon as possible so that reimbursement is not interrupted.

The Interim Final Rule also includes requirements about keeping, for a time period of seven years, written documentation of orders and referrals made and/or received. The documentation must include the NPI of the ordering or referring provider and must be made available to Medicare when requested to avoid penalties including a one-year suspension of Medicare billing privileges. In addition, the IFR requires that providers include the NPI on any enrollment applications to Medicare and Medicaid, as well as on any payment claims. For more information on the recent PECOS rule, possible earlier deadline and record keeping requirements visit the Medicare Enrollment news on the AAOMS web site.