Benign skin lesion removal
An updated policy for removal of benign skin lesions was placed on the National Government Services (NGS) Web site July 1, 2009. Find this policy here.

Note that the two paragraphs on page 3 of the old supplemental instructions were removed. Those were:

“If a benign skin lesion excision was performed, report the applicable CPT code, even if final pathology demonstrates a malignant or carcinoma in situ diagnosis for the lesion removed. The final pathology does not change the CPT code of the procedure performed.”

“To report removal of lesions of uncertain morphology, prior to identification of the specimen, report ICD-9-CM code 239.2 (neoplasms of unspecified nature, bone, soft tissue, and skin), since proper coding required the highest level of diagnosis known at the time the procedure was performed.”

Medicare administrative contractor
There is no update for the Indiana Medicare administrative contractor (MAC), Jurisdiction 8. Jurisdiction 7 was awarded July 10, 2009, to TrailBlazer Health Enterprises, LLC.

Medicare e-prescribing
Lindy Lady, Provider Outreach and Education, moderated the NGS teleconference on e-prescribing at the Medicare Coalition meeting July 17. Here is a synopsis. 

What is the e-prescribing program?
The e-prescribing program provides incentives for eligible professionals who are “successful e-prescribers” as follows: 

You must submit claims no later than two months after the close of the reporting period.

Also, to receive the incentive in 2009, you must be an eligible professional whose estimated allowed Medicare Part B charges for the e-prescribing measure codes are at least 10 percent of your total Medicare Part B allowed charges.

What is a “successful e-prescriber”?
For 2009, you must report the quality measure (125) in at least 50 percent of applicable cases during the reporting year. Report these through your Medicare Part B claims.

How do I report the E-Prescribing Incentive Program measure?
To get the incentive in 2009, you have to report on the e-prescribing quality measure. With applicable cases, you can report using two steps. 

STEP 1 –
Bill on one of the following denominator codes:

Even if you’re not sure if the Medicare service you’re billing with these denominator codes will exceed 10 percent of your Medicare revenues, you should have started to report the e-prescribing codes in November 2008.

STEP 2 – Report one of the three G-codes listed below on more than 50 percent of applicable cases for the numerator. Each of the three codes (even the one for not generating prescriptions) counts toward the e-prescribing incentive. One of the G codes must be reported on the same claim as the denominator billing code.

* The Drug Enforcement Agency (DEA) currently prohibits e-prescribing for controlled substances. The DEA has issued a proposed rule to allow e-prescribing for controlled substances under certain conditions. Even if the DEA allows e-prescribing for controlled substances, G-code G8446 allows you to report on the e-prescribing measure for controlled substances without using an e-prescribing system to do so.

For more details visit:

• www.cms.hhs.gov/ERXincentive
• www.ama-assn.org/ama/pub/ erx/
  medicare-erx-incentive.shtml
• www.ehealthinitiative.org/eRx/

EDS
Notification of Pregnancy (NOP) form
A recognized provider is eligible for a $60 reimbursement for one NOP per pregnancy, completed and successfully submitted to EDS. NOP is Web-based; submit the form through Web interChange. Refer to bulletin BT200914 dated May 21, 2009, and BT200921, dated July 2, 2009, for more information.

Presumptive Eligibility for Pregnant Women
Presumptive Eligibility for Pregnant Women, a process that began July 1, provides coverage to women while the Hoosier Healthwise application is under review by the Division of Family Resources. Refer to bulletin BT200910 dated May 21, 2009, and BT200920 dated July 02, 2009, for information.

Phase-out of paper
Effective Sept. 1, 2009, EDS will no longer print and mail:

• Paper Remittance Advices
• Banner pages
• Bulletins
• Newsletters
• Claim Correction Forms (CCFs)

• Pressure ulcer stages III and IV
• Falls and trauma
• Surgical site infections after bariatric surgery for obesity, certain orthopaedic procedures and bypass surgery (mediastinitis)
• Vascular-catheter urinary tract infection
• Administration of incompatible blood
• Air embolism
• Foreign object unintentionally retained after surgery

Effective Oct. 1, 2009, hospitals will be required to begin reporting on discharges whether the diagnoses for these selected conditions were present on admission.

National Provider Identifier (NPI)
Stage Three, completing full implementation of NPI, will change the current logic in the system to eliminate use of Legacy Provider Identifiers (LPIs) for typical health care providers. Several technical processes involving paper claims as well as financial and electronic data interchange (EDI) will be updated to fully implement Stage Three. Implementation is anticipated by approximately September 2009.

Education and outreach
Third-quarter workshops are set for August and September 2009. Topics include Open Enrollment, Care Select, EPSDT and PE/NOP. Also, each of the managed care organizations (MCOs) will be represented.

Register for the workshops online.

The annual 2009 Provider Seminar will be held Oct. 20-22, 2009. There is no cost for the seminar. Sessions are offered at various times during the three-day event. EDS provider field consultants and representatives from ADVANTAGE Health Solutions, insurers for the Healthy Indiana Plan (HIP), provider associations, other EDS departments and MCO representatives will be present. The location is:

Indianapolis Marriott East
7202 E. 21st Street
Indianapolis, IN 46219.
Updating provider profiles
Providers may make updates to their provider profile using Web interChange. The Web user must have permission from Provider Maintenance to perform updates. Web interChange allows administrators to grant permission to the parent group in their Web interChange set up. Administrators should review the Group Report to determine how their users are set up and what permissions have been granted.

Find the March 2009 IHCP Provider newsletter here. It contains instructions for viewing the Group Report, adding Provider Maintenance permissions and placing users into appropriate groups.

For questions about Web interChange or help moving users, please view the Group Administration Help text on Web interChange Help or contact the EDS EDI Solutions Help Desk at 1-877-877-5182 or (317) 488-5160.

MDwise
New Address for MDwise
Effective Aug. 1, 2009, mail all Healthy Indiana Plan (HIP) claims – medical and behavioral – to: 

MDwise (HIP)
P.O. Box 33049
Indianapolis, IN 46203
Payer ID
MDwise has learned Comprehensive Behavioral Care, Inc. (CompCare) is not paying claims under its Hoosier Healthwise and HIP contracts with MDwise. CompCare’s failure to fulfill its obligations to pay claims is a serious concern, and MDwise has taken steps to address the situation. 

MDwise has filed a lawsuit against CompCare to require CompCare to fulfill its claims payment obligations. Although the contractual obligation to pay claims lies with CompCare, MDwise understands that litigation may not bring immediate results.

Therefore, MDwise developed an alternative claims payment process to pay claims as quickly as possible. For questions, call MDwise Customer Service. Ask for Jacquie Marsalis from MDwise’s Provider Relations Department.

MDwise Hoosier Healthwise Customer Service: 1-800-356-1204 or 317-630-2831 MDwise Healthy Indiana Plan (HIP) Customer Service: 1-877-822-7196 or 317-822-7196.

August message from MHS
Before presstime in mid-August, Managed Health Services (MHS) Provider Relations advised the ISMA that a problem was occurring with the translation of EDI claims for anesthesia. The MHS system is was unable to identify time units – resulting in payment for base units only. A system fix was being worked out.

Please resubmit claims via paper until a proper fix can be put in place. 

Clarification of hysterectomy codes
Effective July 1, 2009, prior authorization (PA) requirements were reactivated for the following hysterectomy Current Procedural Terminology (CPT®1) codes:

• 58200 – Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(ies)
• 58285 – Vaginal hysterectomy, radical
• 59525 – Subtotal or total hysterectomy after cesarean delivery.

ISMA President David J. Welsh, M.D., expressed concern when this reactivation was brought to his attention because 59525 is an “add on” code for a procedure typically performed only in emergency situations, for example, to halt post-operative bleeding and save a mother’s life. In those emergency cases, physicians cannot wait for pre-authorization.

Medicaid advised the ISMA that when an emergency occurs, the Family and Social Services Administration (FSSA) allows PA for those services to be obtained after the fact. The physician should call and provide information about the emergency procedure to get approval.

For any emergency service that requires PA, providers have up to 48 hours to call or send in a request indicating the service was an emergency.