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MedaPhase Newsletter - June 2008 [Full Issue]

Medicare Physician Fee Schedule for last half of 2008
Robert Kottman, MD, FACEP
Legislative Advocate

There is still time to contact your US Congressmen and US Senators regarding the Medicare Physician Fee Schedule for the last half of 2008 and for the year of 2009, As we all know, if Congress does not act, on July 1, 2008 the Medicare Physician Fee Schedule will decrease by 10.6%. Now is the time to make contact by e-mail, phone or letter or even personal visit to a Representative’s local of Washington, D.C. office to urge you legislators to stop the draconian fee cut.

Will You Be At the Table?
Lynne Kottman, CCP, CHBME
Legislative Advocate

The following article recently came out from Leah S. Cohen, a MGMA Government Affairs Representative:

The Centers for Medicare and Medicaid Services (CMS) May 16 announced that beginning Jan. 1, 2009, it will launch a three-year Acute Care Episode (ACE) demonstration project that will include bundling Medicare payments to hospitals and physicians into a single payment.

The demonstration is limited to applicants from Texas, Oklahoma, New Mexico, and Colorado. CMS will competitively award only one ACE demonstration site per market area (defined as a metropolitan core-based statistical area, or the aggregate of rural areas within a state) during the first year of the demonstration, but plans to expand the program and award multiple providers within a market area in the following two years.

Leadership Opportunities
W. Rick White, Jr., MBA, FACMPE
Chief Executive Officer

Early in my career I worked for a company that displayed great pride in the “esprit de corps” among its leadership. Their common slogan was “We do not have problems at our company; we have only opportunities to demonstrate our leadership ability!” This year MedaPhase’s leadership team has had such opportunities as well. In an effort to create greater efficiencies and control cost, we have restructured jobs, office locations and switched to a new computer system. Although I am pleased with our progress overall, it has not been without some challenges. With every new challenge, however, came a corresponding new learning opportunity. I am extremely grateful for the team of people in our organization that have demonstrated great responsiveness and creativity in developing ways of overcoming obstacles along the way.

Clearing the Air on Fracture Care
Jennifer Hackworth, RHIA
Director of Coding

ED physicians can provide a tremendous amount of care when a patient presents with a fracture or dislocation. In those cases, there are several potential codes that may be utilized, depending on the type of fracture/dislocation and the care that is given. Documentation of that care is vital to ensure minimal liability risk and proper reimbursement. In most cases, there will be one of three scenarios:

MedaPhase Newsletter 2008 03 [Full Issue]

New Trailblazer EM tool
Robert Kottman, MD
Medical Director
Legislative Advocate

New TrailBlazer (Texas, Oklahoma, New Mexico and Colorado Medicare Administrative Contractor) Evaluation and Management “Coding and Documentation Reference Guide” (Audit Tool) is official and on the TrailBlazer website as of Feb. 27, 2008.

http://www.trailblazerhealth.com/partb/downloads/empocketref.pdf

New Twist on Balance Billing
Lynne Kottman, CCP, CHBME
Chief Compliance Officer
Legislative Advocate

While some of the largest states Florida, Texas, and California are in different levels of state regulation over balance billing, the state of New York is now weighing in with the attorney general Andrew Cuomo’s investigation and potential suit against UnitedHealth Group. United is one of the largest medical insurers and the largest in New York. Cuomo is also currently investigating Aetna, Cigna and Empire BlueCross/BlueShield.

MedaPhase Metamorphoses
W. Rick White, Jr., MBA, FACMPE
Chief Executive Officer

The old adage that there is nothing constant but change is certainly true of MedaPhase, Inc. today. On January 1^st of this year we began using a new billing software called AdvancedMD. Gradually phasing out the use of our other two systems we are currently working from three separate software databases simultaneously. Follow-up of accounts receivable for dates of service prior to January 1 is being done in the former systems in order to ensure continuity of collection processes on each individual account level. Accurate reporting requires the combining of two separate databases and then reconciling these totals to the actual bank deposits. At the end of another three to four months the few active accounts on each system will be loaded into AdvancedMD for further action. The inactive accounts will be archived or sent to an outside collection agency as appropriate. This is only one stage of our metamorphoses.

MedaPhase Newsletter 2007 12 [Full Issue]

CPT Code Changes for 2008
Robert Kottman, MD, FACEP

Relatively few of the CPT Code changes for 2008 will have an impact on emergency medicine:

Hydration, Injection and Infusion Codes
Behavioral intervention
New thoracentesis codes
New chest tube insertion code
Other new codes
Observation Services

PQRI 2008 Update
Lynne Kottman, CCP, CHBME

Guidance for the 2008 Physician Quality Reporting Initiative (PQRI) was released with the 2008 Medicare Physician Fee Schedule Final Rule in November. The reporting period for the 2008 program will be January 1 - December 31, 2008.

The rules for the 2008 program are virtually unchanged for Emergency Department Providers. The reporting requirements remain at least 80% of at least 3 of the quality measures to qualify for the 1.5% bonus on allowable Medicare charges.

New Beginnings�New Opportunities
W. Rick White, MBA, FACMPE
Chief Executive Officer

Beginning January 1, 2008, MedaPhase will start to use a new computer system for its billing information system. After months of reviewing proposals and viewing demonstrations AdvancedMD was the unanimous selection by MedaPhase directors, managers and supervisors. Anyone interested in knowing more about the system itself and the company can review several of its features on the internet at www.advancedmd.com.

Documentation of Treatment of Phimosis to Facilitate Correct Coding
Robert Kottman, MD, FACEP
Maria Johnson, CPC, ACS-EM

Phimosis is a pathological condition in which the foreskin of an uncircumcised male cannot be retracted over the head of the penis (glans) back onto the shaft of the penis. This condition is due to adhesions between the foreskin and the glans of the penis.

The proper ICD-9 code for this condition is 605- Redundant prepuce and foreskin.

Physician Shortage Area Bonus to Sunset

The Physicians Shortage Area bonus program established in the Medicare Modernization Act of 2003 was established for the time frame January of 2005 through December of 2007. CMS has announced that this program, which pays a 5% bonus on provider Medicare payments to providers in designated physician shortage areas, will be allowed to sunset and will no longer be paid after December of 2007.

Legislative Update Newsflash [Full Issue]

The Medicare �Fix� may be Out
MedaPhase Legislative Advocates
Robert Kottman, M.D., FACEP & Lynne Kottman, CCP, CHBME

Chances for a Congressional “fix” to the impending 10.1% pay cut in the Medicare Physician Fee Schedule for 2008, which we reported earlier this week, are now looking dim partially due to a threatened veto. The Senate Finance Committee had been working on a bill that would have eliminated the 10.1% Medicare pay cut for all physicians by obtaining the funds necessary to “pay for” the fee freeze through reductions in Federal payments to Medicare Advantage health plans. Medicare Advantage plans are private Medicare plans run by commercial insurance companies, which receive Federal funds to subsidize their operations. These Federal funds to the Medicare Advantage plans are felt by many to be too large- thus making a reduction in this funding the mechanism which would permit a “freeze” on Medicare Physician Fees for 2008 and avoiding the 10.1% pay cut.

Legislative Newsflash [Full Issue]

Legislative Advocacy Report
MedaPhase Legislative Advocates
Robert Kottman, M.D., FACEP & Lynne Kottman, CCP, CHBME

Dr. Robert Kottman and Mrs. Kottman report the following from their meeting with Congressional Staff members on Monday, November 26:

Items of discussion –

Medicare Fee Schedule

Renewal of the SCHIPS program

ACEP access to Emergency Medical Services bill

MedaPhase Newsletter September 2007 [Full Issue]

Addressing the Upcoming Medicare Reduction

As it currently stands, without Congressional intervention, Medicare payments to Emergency Physicians will be reduced by 12% in 2008. While the House had originally addressed this issue with a potential fix in their SCHIP bill, the Medicare section was removed in the reconciliation bill with the Senate.

Please contact your House members and urge them to:

co-sponsor and promote the passage of H.R. 882/S.10 to provide additional funding for emergency department physician services
support congressional hearings to address the problems in our nation's emergency departments
support a bill that provides redress to the proposed 12% payment reduction for Emergency Medicine physicians and for a small increase in Medicare payments
continue to support this bill when it is reconciled with the Senate’s initiatives after the August recess
support an overturning of any Presidential veto of the reconciliation bill for H.P.3162

To contact your House representative, just click on this link http://www.house.gov/writerep/ and fill out the information. The link will take you to the Write your Representative page on the United States House of Representatives website.

Below you will find a sample letter to a House Member, created by Dr. Robert Kottman, our Legislative Advocate. If you do not have time to write your own letter, you could use this as a template for addressing this issue as well as the ACEP sponsored “Access to Emergency Medical Services Act of 2007”
(http://www.acep.org/webportal/Advocacy/fed/accessems/default.htm).

Does Your Documentation Support the Use of IV Infusion/Hydration Codes?
Jennifer Gannon, RHIA, ACS-EM
Coding Manager

In 2006, CPT made numerous changes to the IV infusion code section. This section was revised and expanded to allow reporting of hydration and therapeutic, prophylactic or diagnostic intravenous infusions and injections. CPT directs “if a significant separately identifiable Evaluation and Management service is performed, the appropriate E/M service code should be reported using modifier 25 in addition to 90760-90779.” However, there are several elements of documentation that should be included in the record in order for the professional service to be reported.

�On-Call� Payments To Specialists At Risk

Many hospitals around the country are encountering problems with specialist on-call coverage for their emergency departments. The reasons are varied and largely involve problems with obtaining specialty care for un-funded patients. Many hospitals are attempting to address this problem by paying physicians to take emergency department call. Due to the Stark prohibition on self-referral, some hospital-physician “on call” arrangements may be problematic. One hospital asked the Office of Inspector General ("OIG") for an opinion on their program and while that advisory opinion was favorable to that hospital’s program, it may call into question the legality of other less rigorous plans.

New TrailBlazer E&M Audit Tool - October 2007
Robert Kottman, M.D., FACEP
Legislative Advocate

For the past 3 years, Trailblazer has been developing a new “E&M Documentation Guide” to be used by coders when assigning evaluation and management codes for physician services. The new TrailBlazer E&M Documentation Guide (Audit Tool) should appear on the TrailBlazer website by Oct. 15, 2007 and will replace the audit tool which currently appears on the site.

MedaPhase Newsletter August 2007 [Full Issue]

Medicaid: New Compliance Enforcement
Lynne Kottman, CCP, CHBME
Corporate Compliance Officer
Legislative Advocate

In response to an OMB report that identified Medicaid and SCHIP as programs susceptible to payment errors, Congress has authorized and funded a number of programs designed to identify and eliminate overpayments. Some of the programs include: Payment Accuracy Measurement (PAM), Medicare-Medicaid Data Match (Medi-Medi), Payment Error Rate Measurement (PERM), and the Medicaid Integrity Program (MIP) and 5 year Comprehensive Medicaid Integrity Plan (CMIP).

The country may soon be overrun with Federal and State Medicaid Auditors and Contractors. It will be imperative that providers and their billing agents stay on top of audit and record requests to avoid potential recoupments (or worse).

Called to a Code Blue
Jennifer Gannon, RHIA, ACS-EM
Coding Manager

Do you know what kind of documentation your coders are looking for when you get called to a Code Blue? There are several elements that should be documented in order for the ED physician’s inpatient encounter to be coded and billed appropriately. The progress note should contain a date/time; documentation of the encounter, including written procedure notes; a diagnosis; and a signature of the physician.

Meds & Dxs which frequently reflect Critical Care Services
Robert Kottman, M.D.
Critical Care is defined as care provided to patients with Critical illness or injury that acutely impairs one or more vital organ systems or where there is a high risk of life threatening deterioration. A patient that is potentially unstable could fall under the definition of Critical Care.

Critical Care codes are time driven and require at least 30 minutes of patient care, excluding time spent performing separately billable procedures.

Some of the drugs and diagnosis that often, but not always, could indicate Critical Care are listed below.

New Texas Provider Billing Disclosure Law

The Texas Legislature passed into law SB 1731 authored by Senator Robert Duncan. (R-Lubbock) In addition to disclosure requirements for all Texas physicians, there are a number of issues included in this bill which directly impact Hospital based physicians.

Newsflash - re: MCR, SCHIP, Champ Act, & CHIP [Full Issue]

Medicare Fee Fix in Future?

H.R. 3162 - the "Children's Health and Medicare Protection Act of 2007”

H.R. 3162 would replace the scheduled 9.9 percent cut to the Medicare Physician Fee Schedule for 2008 with a 0.5 percent positive update for both 2008 and 2009.

Please contact your House members ...

SCHIP Reauthorization

We received this important information from one of our physicians.

Please read and consider contacting your Senators to support this effort.

Senators to Vote to Reauthorize SCHIP!

The U.S. Senate is scheduled to vote on legislation that would reauthorize the State Children’s Health Insurance Program (SCHIP) before the end of July. The reauthorization of this successful child health program will help countless pediatric patients in South Texas.

Champ Act

The following information was provided by the TMA:

The Children's Health and Medicare Protection (CHAMP) Act <http://waysandmeans.house.gov/media/pdf/110/CHAMP/summary.pdf> should be up for debate on the floor of the U.S. House of Representatives this week. TMA and the AMA both support the CHAMP Act as the best chance to avoid a 10-percent cut in physicians' Medicare payments next year.

Here are the good things we see in the CHAMP Act so far:

CHIP Rate Hike Coming

The Texas Health and Human Services Commission proposed a 15-percent increase for evaluation and management codes for treating adult Medicaid patients.

Newsflash- BlueCross RICO Settlement Claims Coming [Full Issue]

Blue Cross RICO Settlement Claims Coming

We received the following information today from the TMA that applies to providers in all states.

Blue Cross and Blue Shield (BCBS) Settlement Update

The BCBS settlement claim forms are being mailed to physicians on July 27.

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