Issues and Updates
Medicare physician fee schedule
The Medicare, Medicaid and SCHIP Extension Act of 2007 made changes affecting the payment fee schedule with a .5 percent increase to the conversion factor. This .5 percent increase is for dates of services from Jan. 1, 2008, through June 30, 2008.
Find the new fee schedule>>
Go to Fee Schedules and scroll to 2008 Physician Fee Schedule (half-way down).  

Medical Policy
Incident to
When auxiliary personnel perform services outside the clinic premises, the services are covered only if performed under the direct supervision of a clinic physician. If the clinic refers a patient for auxiliary services performed by personnel not supervised by a clinic physician, such services are not “incident to” a physician’s service. 

Auxiliary personnel means any individual acting under the supervision of a physician, regardless of whether the individual is an employee, leased employee or independent contractor of the physician, or of the legal entity that employs or contracts with the physician. 

Find additional information under the Medicare Benefit Policy Manual 100-2, Chapter 15, beginning at section 60.

EKG and documentation
Because of a language change in the 2008 CPT Coding Manual, it is no longer appropriate to just sign the rhythm strip with “agree” or “read and agree with interpretation.”

Language in the CPT manual pertains to electrocardiograms as well as rhythm strips. National Government Ser-vices provided the ISMA the following important clarification concerning EKG and interpretation reports.

“Electrocardiograms and Interpretation reports (computer generated reports): It is not adequate simply to sign a computer-generated report. It is expected the physician would read, measure, interpret, prepare a report of, and sign the reading of the EKG. The physician may do this ON the computer generated report and place in the chart, or it may be done separate from the computer generated report; but the expectation is that the physician’s interpretation and the computer’s interpretation are separately identifiable even if the conclusions are the same.  This would apply to any EKG/recording code that includes a physician report/physician reporting component.”

Therapy cap exceptions
The therapy cap exception process has been extended until June 30, 2008.

Medicare secondary claims
Medicare secondary claims must be sent electronically, unless a physician is eligible to file on paper with a signed waiver exception. 

NPI crosswalk
If your claims are not crosswalking, check to determine if all correct information is properly placed in each field on the claim. If claims are still not going through, you may contact EDI at (877) 273-4334.

Vaccine administration in 2008
Note that guidance for administration of Part D drugs can be found in MLN Matters article SE0723. It states that effective Jan. 1, 2008, physicians can no longer bill Medicare Part B for the administration of Medicare Part D-covered vaccines using special G code G0377. See MLN Matters SE0727 (Click on 2007).

Interactive Voice Response (IVR)
Many National Government Services (NGS) post office boxes have been consolidated. The changes effective Dec. 26, 2007, can be found on the NGS Web site. Click on Adminastar Federal and you will see a link titled Post Office Box Consolidated Crosswalk. Click on this link for the new information.

NGS has developed an IVR application to assist you in answering a number of questions through a speech-enabled interface that responds to your voice. You can obtain patient eligibility and claim information, check other details, and access some general information.  This began on Feb.1, 2008.

If you call the Customer Care number with an issue that should be addressed through the IVR, you will be referred back to the IVR line. The IVR is programmed to allow for touch-tone entry in the event a user is unable to successfully speak to the IVR. Complete information is on the NGS Web site.

Please note the toll-free telephone numbers for IVR effective Feb. 1, 2008:

• (866) 250-5665 Indiana
• (866) 290-4036 Kentucky

Here are new toll-free numbers for Customer Care Inquiries effective Feb. 1, 2008:

• (866) 276-8129 Indiana]
• (866) 276-9558 Kentucky

A brochure on the NGS Web site provides this information.

Prepayment reviews
Psychiatric Diagnostic Interview Examination CPT codes 90801 and 90802 are subject to prepayment review because NGS has identified potential errors.

Prolonged service codes 99354 through 99357 are subject to prepayment review because of a high error rate identified by NGS and CERT.

Back to Basics - Advance Beneficiary Notice
Proposed rules were made to change the ABN but the information has not been finalized. Physicians will be notified of any change. In the meantime,

• Use only approved forms
• Follow directions per CMS
• Remember to use proper Modifier GA, GY or GZ

Box 33 details
Bill Woodruff from EDS stressed the importance of correctly completing box 33 on the claim form. This field should include the billing service location address (not a PO Box) and ZIP Code+4 on all claims.

This “billing service location” is defined by the Indiana Health Coverage Programs (IHCP) as the physical address where the service was rendered, NOT the address where billing occurs or where payments are mailed.

Make certain your claims have this information in box 33 or they eventually will be denied. The edit is currently an informational edit only; therefore, claims are continuing to process for payment. However, on May 23, 2008, Medicaid will start denying your claims if they do not have the proper information in box 33.

Please refer to EDS Bulletin BT200703 for more information on this important deadline.

Update on refund project
Laura Johnson, provider administration manager for MDwise, updated attendees on a refund project, the work of Hoosier Alliance. Johnson informed the group that MDwise had received other insurance information from EDS and was subsequently requiring physicians to refund the payment to MDwise and then file with the primary carrier for payment.

Johnson also notified the group that MDwise has learned that the electronic file with this information obtained from EDS was not accurate. MDwise recently advised the ISMA that this refund project has been stopped.

MDwise will now seek reimbursement from the third party instead of the physician. All physicians involved will receive a letter explaining the refund project and why it has been halted. According to Johnson, no refunds were ever recouped.

Claims for family planning
Sherri Miles, manager of Provider Services for MDwise, responded to concerns about filing claims for family planning services. MDwise requires claims for family planning services be sent to only one of their delivery systems and claims for non-planning services be sent to another delivery system.

The concern is that physicians cannot maintain two claims addresses for one payer. Miles acknowledged the concern and assured the group that MDwise intends to move those claims to the correct delivery system internally.

If this is not occurring, please notify Miles in Provider Services. 

Enrollment applications timeline
An attendee expressed concern that provider enrollment applications are pending approval for an abnormal amount of time. Bill Woodruff explained that EDS is aware of the problem and has taken action to process new provider enrollment applications in a timely manner.

Woodruff also advised that claims should be held until the application has been approved. He assured the group that retroactive payment is approved for claims that were held. The managed care organizations (MCOs) agreed that each of them would recognize that those claims would be held until approval and -- once sent – would make retroactive payment.

Other updates
Chris Kern, MDwise representative for the Care Select program, and Kelvin Orr, Advantage representative for the Care Select program, were available for updates and questions. Both announced that Care Select will be implemented statewide on March 1. Both care management organizations (CMO) are working to build a statewide network.

The representatives reminded attendees that claims should still be submitted to EDS for patients within the Care Select program; however, prior authorizations should be requested from the individual CMO. 

Medicaid reimburses for after hours
The ISMA staff reminds you of the following Medicaid billing code pertaining to evening, weekend and holiday hours.

“Procedure code 99051 - Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service, providers may bill a maximum of one unit per patient per day. Evening hours are defined as routinely scheduled after 5 p.m. in the prevailing time zone. Providers may only bill for the following holidays, which represent days when physician offices are generally closed for the day: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day. When billing for 99051, please document in the medical chart the time, date, or holiday, as applicable. All other billing requirements will remain unchanged.”

Please see Banner Page BR200805 for additional information.