10-09 - Nebraska Optometric Association
Contents
1. officials recently indicated they might push eye care EHR certification forward to mid 2010 In addition the commission on Sept 8 launched a new dual track certification program under which its estab lished CCHIT certifications will be offered along with new ARRA specific certifications designed to more quickly provide health care practitioners with EHRs that will meet the requirements for the federal incen tives The ARRA certifications will be used mostly for records that do not fall into one of the commission s established EHR classifications The AOA Advocacy Group is urging the commission to include eye care when it announces additional CCHIT certifications in June 2010 However even if it does not eye care EHRs could probably be approved using the ARRA criteria the AOA Advocacy Group staff says Either way certified eye care EHRs could be on the market in the coming months the AOA Ad vocacy Group notes The AOA does not recommend specific EHR programs but will offer updated guidance for association mem bers on how to choose an EHR product see the AOA Web site Health Information Technology page at www aoa org HIT xml Page 5 Security enhancements to the NPPES Web site include secret questions and password updates EHRS and CCHIT Page 6 NOA 3rd Party Newsletter Use C SNAP to Check Claim Status amp Patient Eligibility From WPS Discover the ease of check assist providers C SNAP offe2. October 2009 NOA 3rd Party Newsletter SURETY BOND UPDATE SINCE LAST ISSUE OF THE AOA NEWS Nebraska Optometric Association Volume 9 Issue 10 NEW Change in OD Requirements for DME Surety Bonds The National Supplier Clearinghouse NSC has published a question and answer page regard ing surety bonds Question No 46 below ad dresses optometry and ophthalmology and requires a surety bond if an OD fills an outside Medicare Rx Q How does an optometrist or ophthal mologist who dispenses eyeglasses qualify for the physician exemption A An optometrist or ophthalmologist who dispenses eyeglasses can qualify for the physician exemption if the glasses are fur nished only to his her own patients as part of his her own service For purposes of this exemption a patient is someone who for instance receives an eye exam or other diagnostic test from the physician prior to receiving the glasses The term patient does not include however a person who walks into the physician s office with a pre scription for glasses that was issued by an other physician and simply receives the glasses without any sort of examination or test being furnished The same general principle applies to an enrolled optical center owned by an optome trist or ophthalmologist The center can only qualify for the physician exemption only if 1 the shop and the physician s practice are under within the same TIN taxpayer iden
3. P 4 FROM THE AOA CCHIT CERTIFICATION FOR OD EHRS At the urging of the AOA and ophthalmology groups com mission officials recently indicated they might push eye care EHR certification forward to mid 2010 P 5 USING C SNAP TO CHECK CLAIM STATUS amp PATIENT ELIGIBILITY C SNAP offers registered users with a FREE Web portal to conveniently access claim status and patient eligibility in formation 24 hours a day P 6 TECHNICAL COMPONENT TC PAID BILATERALLY IF A SSCANS DONE OU THE SAME DAY If you do A scan 76519 TC on both eyes the same day it doesn t make any difference if you bill with the 50 modifier RTLT modifier or on separate lines they still will only pay as a bilateral procedure one amount for both eyes for the technical component P 7
4. ator at 1 800 465 3203 or email the request to the NPI Enumerator at Customerservice NPlEnumerator com Not sure if you have already obtained an NPI or cannot remember your NPI you can visit the NPI Registry at https nppes cms hhs gov NPPES NElRegistryHome do to search for the information The NPI Regis try enables you to search for a provider s NPPES information which includes the NPI All information displayed in the NPI Registry is done so in accordance with the NPPES Data Dissemination Notice Information in the NPI Registry is updated daily You may run simple queries to retrieve this read only data For example users may search for a pro vider by the NPI or Legal Name Legal Busi ness Name There is no charge to use the NPI Registry Visit CMS dedicated NPI Web page at http www cms hhs gov NationalProvidentStand for additional NPI education and information From the AOA CCHIT Certification for OD EHRs From the AOA News EHRs must be certified by the Certification Commis sion for Health Information Technology CCHIT in order to be used with the government s planned Na tional Health Information Network NHIN which is slated to become operational in 2014 Over the past two years the commission has set certification stan dards for several types of EHRs However the com mission has not been planning on certifying any eye care EHRs before 2011 At the urging of the AOA and ophthalmology groups commission
5. deadline Source http www aoa org x13414 xml then the practice will need to get a surety Thus as Dr Quack understands it at bond and accreditation For example 4 lf an optometry practice supplies any DMEPOS items to Medicare beneficiar ies other than post cataract eyeglasses Updated Medicaid Reimbursement stances A complete description of the service and additional documentation if applicable is required for review RNE Relative Value Rate Not Estab lished Paid at reasonable charge based on the service and circumstances Continued from page 1 longer required 3 PAYMENT IS THE LOWER OF THE FEE SCHEDULE ALLOWABLE OR THE PRO VIDER S SUBMITTED CHARGE The pro vider s submitted charge must reflect their charge to the general public 4 SPECIAL PRICING Some procedure codes will have actual dol lar amounts listed The dollar amount listed is the fee schedule allowable No further calcu lations are required BR By Report Paid at reasonable charge based on the service and circum IC Invoice Cost Paid at invoice cost An invoice must be submitted with the claim Some of these services may also have an associated maximum allowable and will be reimbursed at the lower of in voice cost or maximum allowable htto Awww dhhs ne gov med 471 000 524 09 pdf Changes to the Visual Care Section of Medicaid has been announced Page 4 You will
6. e Laugh amp The Whole World Laughs With You e You Can t Teach An Old Dog New Math Cry and You Have To Blow Your Nose e If You Lie Down With The Dogs You ll Stink e None Are So Blind As Helen Keller e Two s Company Three s The Musketeers In The Morning e Children Should Be Seen And Not Spanked e Love All Trust Me Or Grounded e The Pen Is Mightier Than The Pigs e lf At First You Don t Succeed Get New Batter e An Idle Mind Is The Best Way To Relax les e Where There s Smoke There is Pollution e You Get Out Of Something What You See Pictured On The Box e When The Blind Leadeth The Blind Get Out Of The way e Happy The Bride Who Gets lots of Presents e A Penny Saved Is Not Much Volume 9 Issue 10 TC Paid Bilaterally if A Scans done OU the Same Day Dear Dr Quack have a question about A scans We have always billed for each eye as 76519TC RT or LT on the day it was performed stating the date surgery would be performed and have always gotten paid We always do both eye s A scans the same day so they are done Just within the last couple of weeks to a month we are getting them denied have called and talked to Medicare and they are now telling me that we cannot do both A scans the same day told them if we know both surgery dates and they are within a very close distance of each other we have always done that rather than patient having to come back
7. find the an nual HPSA bonus payment file and other important HPSA information on the CMS Website When a LCD is retired the provider no longer has a source upon which to depend when coding and billing for those services NOA 3rd Party Newsletter 2010 Annual Update for the Health Professional Shortage Area HPSA Bonus Payments Source http www wpsmedicare com jomacpartb publications communique current files 0909comm pdf The Medicare Prescription Drug Improve ment and Modernization Act of 2003 MMA Section 413 b mandated that the auto mated HPSA bonus payment files be up dated annually CMS will create a new auto mated HPSA bonus payment file for claims with dates of service on or after January 1 2010 through December 31 2010 and post it to the Website in early December of 2009 You will find the annual HPSA bonus pay ment file and other important HPSA informa tion on the CMS Website at http www cms hhs gov hpsapsaphysicianbonuses You should also review the CMS Website to determine whether a HPSA bonus will auto matically be paid for services provided in your ZIP code area or whether a modifier must be submitted You can determine if you are eligible for the automated payment by going to http www cms hhs gov HPSAPSAPhysicianBonuses Downloads instructions pdt on the CMS Website and following the in structions on the page WPS Retires Some Local Coverage Determinations The Wisconsin P
8. he recent letter sug gested However at press time this ex emption does not apply if you are filling out side Medicare post op prescriptions Complicating Factors Optometrists might want to check their Medicare DMEPOS enrollment form 855S and their practice or business model for po tential issues Optometrists who have atypi cal business arrangements may want to carefully review their practice to determine whether the bond requirement might apply to them 1 As long as the supplier is a practicing optometrist or a group of optometrists in which the ODs are the owners and are billing for the glasses themselves or through the company the business ar rangement should be exempt with the exception of outside RXs However if the business is owned by a company such as Pearle Vision and the business not the individual optometrist is en rolled as the supplier then the business might need to have a surety bond and or accreditation 2 An optometry practice that employs Continued on page 3 Page 3 Volume 9 Issue 10 DME Surety Bond not necessary in some cases Continued from page 2 supplying diabetic test strips or wheel opticians is exempt as long as the opti cians do not have their own DMEPOS billing numbers The surety bond ex emption does not extend to opticians who are enrolled as Medicare suppli ers If an enrolled optician is employed by an optometry practice then the entire practice mig
9. ht need a surety bond 3 An optometry practice that did not check optometrist or physician on the 855S supplier enrollment form may need to respond to the recent Palmetto letter and certainly should respond to any sub sequent notification demanding a re sponse within 30 days In these cases the practice should respond as instructed in the letter and inform the NSC whether chairs To summarize for members If you checked any box on the 855S sup plier enrollment form in addition to optometrist or physician then you probably received the recent letter be cause of the other supplier type that was checked You can ignore this notice from Palmetto unless you fill outside RXs If you did not check optometrist or ohysician on the 855S supplier enroll ment form then you probably received the recent letter because of the other supplier type s that was checked in stead You might want to notify Palmetto about your practice arrangement and Based on informa tion available at press time if you fill outside RXs for Medicare Post op patients you must obtain a 50 000 Surety Bond be fore October 2 2009 the business is an optometry practice whether exemption applies to you that is exempt from the surety bond and or accreditation requirement If you receive any other notice from CMS or the NSC demanding a response within 30 days then you should answer that letter before the
10. hysician Services J5 MAC September Communiqu announced that the following Local Coverage Determinations LCDs are being retired effective 09 1 2009 LCD ID Number Title e L26666 Extended Ophthalmoscopy e L26712 Fundus Photography e L26673 YAG Capsulotomy Source http www wpsmedicare com j5macpartb publications communique current _files 0909comm pdf Quack Note LCDs are carrier developed coverage policies containing coding and utili zation guidelines as well as descriptive pas sages They are developed for various rea sons some of which are 1 To define the appropriate use of new technologies 2 To address services with an abuse his tory or potential 3 High volume high dollar services When a LCD is retired the provider no longer has a source upon which to depend when coding and billing for those services but ostensibly s he is no longer limited by those LCD guidelines WPS LCDs can be found at http www wpsmedicare com jumacpartb policy PC ACE PRO 32 Software Upgrades Again If you are currently using the PC Ace Pro32 billing software you can now download the latest upgrade online You can download this information from the WPS EDI Website http www wpsic com edi pcaceprooZ shtml Now available on line are e The upgrade to the latest version of PC Ace version 2 14 e Instructions related to the up grade e User guides manuals If you are not using the version listed ab
11. irectly to the code you wish to view 2 The dollar amount listed is the fee sched ule allowable Further calculations are no Continued on page 3 Page 2 NOA 3rd Party Newsletter eee DME Surety Bond not necessary in some cases The likelihood of PamettoGBA NSC modifying their current stance at the request of the AOA is unknown Based on current NSC requirements if you fill Medicare post op RXs written by a provider outside of your office you will need a surety bond by October 2nd Other situations requiring ODs to obtain bonds also exist Continued from page 1 tion The AOA is in contact with CMS regarding this requirement and hopefully will have additional information regarding surety bonds sometime in the near future The like lihood of PamettoGBA NSC modifying their current stance is unknown Time is growing short since the deadline for the PalmettoGBA NSC surety bond requirement is October 2nd If your office does fill outside RXs for Medicare post op prescriptions and wishes to continue to do so you might want to research the possibil ity of obtaining a surety bond Dr Quack knows nothing about surety bonds However when checking the BBB web site regarding surety bonds in Ne braska a number of sources were listed including their BBB rating If you do not per sonally have a resource for a surety bond and you are stumped as to how to proceed you might find
12. ln NE 68512 NOAonline org The NOA Third Party Newsletter is published monthly by the Nebraska Optometric Association with the assistance of Ed Schneider O D Third Party Consultant To reach Ed aka Dr Quack gt Email BEST SchneiderEd msn com HIPAA Compliant gt Ed s mobile phone is 402 310 2367 Voicemail available gt Fax number is 402 464 1214 Call Ed before faxing Better Vision for Nebraskans Prsrt Std U S Postage PAID Lincoln NE Permit No 676 NEW CHANGE IN OD REQUIREMENTS FOR DME SURETY BONDS Requirements have changed very recently There are cases where ODs appear to need surety bonds by Octo ber 2 2009 Details are explained P 1 3 MEDICAID CHANGES TO VISUAL CARE SERVICES FEE SCHEDULE Medicaid recently announced updates to Visual Care Ser vices Fee Schedule retroactive to July 1 2009 P 1 2010 UPDATE FOR HPSA BONUS PAYMENTS You will find the annual HPSA bonus payment file and other important HPSA information on the CMS Website P 4 WPS RETIRES SOME OPHTHALMOLOGY OPTOMETRY LOCAL COVERAGE DETERMINATIONS The Wisconsin Physician Services announced some Lo cal Coverage Determinations are being retired effective 09 1 2009 including Extended Ophthalmoscopy Fundus Photography YAG Capsulotomy P 4 PC ACE PRO 32 SOFTWARE UPGRADES AGAIN If you are currently using the PC Ace Pro32 billing soft ware you can now download the latest upgrade online
13. ove it is very important that you up date your software immediately Source http www wpsmedicare com j5macpartb publications communique current _files 0909comm pdf Volume 9 Issue 10 Enhancements Updates to NPPES Security enhancements to the NPPES Web site include secret questions and password updates NPPES Web users will be required to select five secret questions and answers Upon im plementation of this enhancement and upon successful login NPPES Web users will be prompted to select five secret questions and provide answers to those questions These five secret questions and answers will be saved and used for verification in order to allow NPPES Web users to reset their own passwords NPPES Web users will be prevented from changing their passwords more than once within 24 hours from the last password up date Upon implementation of this enhance ment NPPES Web users will be required to wait 24 hours before attempting to change their passwords once they have already suc cessfully reset their passwords Electronic File Interchange EFI In addition the EFI User Manual and Techni cal Companion Guide have been revised The upcoming changes will not impact the EFI XML Schema Additional Information Health care providers can apply for an NPI online at https nppes cms hhs gov Health care providers needing assistance with applying for an NPI or updating their data in NPPES records may contact the NPI Enumer
14. r the column bil Surg the number for 76519TC is a 2 which means it is already being paid on a bilateral basis fee paid includes both eyes The 76519 26 component however has a 3 which means it is paid fully for both eyes So what they told you over the phone is correct If you bill both TC services on the same day you will be paid bilaterally The professional component modifier 26 is paid per eye however Dear Dr Quack return email But we are only being reimbursed 37 21 for both eyes Will it help if I bill on separate lines or use a RTLT modifier or a 50 modifier Dr Quack s Quote I m afraid you are going to have to accept the 37 21 total for both eyes if you do A scan 76519 TC on both eyes the same day It doesn t make any difference if you bill on separate lines they still will only pay one amount for both eyes for the technical compo nent You could save some ink by billing one line without the RT and LT modifier Or if you want them to be completely aware that you did both eyes you could bill one line using 76519 50TC But it won t make any difference all you are going to get is the 37 21 if you do both eyes on the same day I m afraid Sorry P I Dr Quentin Quack If you do A scan 76519 TC on both eyes the same day Medicare will reimburse as a bilateral procedure one amount for both eyes IQA Nebraska Optometric Association 1633 Normandy Court Suite A Linco
15. rs regis ing claim status and patient eligibility on tered users with a FREE Web portal to WPS Medicare offers a line using the CMS Secure Net Access conveniently access claim status and FREE Web based applica Portal C SNAP patient eligibility information 24 hours a tion that allows Medicare Are you aware that WPS Medicare offers day a FREE Web based application that al providers to check claim status and patient eligibil ity securely over the Inter OWS Medicare providers to check claim To learn more about C SNAP go to the net status and patient eligibility securely over WPS website found at the Internet The Centers for Medicare amp Medicaid Services CMS and WPS Medicare are committed to offering self service tools to http www wpsmedicare com jumacpartb seltservice claims elig tools csnap Dr Quentin Quack s Quacked Humor Old Adages as Completed by To access the new NOA 3rd Party web Grade School Children page directly Go to http nebraska aoa org e Better To Be Safe Than Punch A 5th Grader Click on DOCTORS gray horizontal bar e Strike While The Bug Is Close Click on THIRD PARTY INDEX gray bar e Never Under Estimate The Power Of Ter left side of screen mites Enter your User Name AOA member e You Can Lead A Horse To Water But How and Password DOB MMDDYY when requested e Don t Bite The Hand That Looks Dirty e No News Is Impossible eee rene COOR AEA MSIE
16. the BBB web site helpful This is how featherbrained Dr Quack pro ceeded e Go to http nebraska bbb org Business Search e Click on Check out a business or Char ity e Under type of business chose Bonds Surety or Fidelity e Under Location enter your zip code Dr Quack used Lincoln Nebraska Re sults are given within 500 miles e Click on BBB Accreditation to learn specifics on each business listed and to see how the BBB rates the company The following earlier surety bond infor mation may also pertain to your office The following information was parsed from an earlier articles on the AOA website posted prior to the PamettoGBA informa tion found in the previous paragraphs Dr Quack has interspersed his bracketed com ments to update the following information The AOA has learned that many optome trists can ignore the PalmettoGBA letter to obtain surety bonds but should not ignore any future communication from the National Supplier Clearinghouse Palmetto or CMS that requires a response within 30 days The Centers for Medicare amp Medicaid Ser vices CMS re confirmed to AOA that prac ticing optometrists are exempt from the surety bond requirement as long as they do not fill outside Medicare post op prescrip tions Palmetto as the NSC will be sending a list serve reminder to all suppliers within a week reiterating that optometrists are currently exempt despite what t
17. tifi cation number and business structure e g part of the same corporation and 2 the glasses are furnished only to the optome trist ophthalmologist s own patients as part of his her own service The term patient again would not include a person who en ters the optical center with a prescription for glasses that was issued by another physi cian and simply receives the glasses without any sort of examination or test being per formed by the optical center SOUrCE http www palmettogba com palmetto providers nsf DocsCat National 20Supplier 020 Clearinghouse Supplier 02 0Enrallment FAQs Sure ty 2 0Bond 620 Requirements B020 746 ADDSS0AA88520 7oAGD0SCA5AR Therefore an OD would need to obtain a surety bond if s he wishes to fill an out side Rx for a Medicare post op correc Continued on page 2 Medicaid Changes to Visual Care Services Fee Schedule Medicaid recently announced updates to Visual Care Services Fee Schedule retroac tive to July 1 2009 The fee schedule found in section 471 000 524 can be found on the Internet at http www dhhs ne gov reg appx 471 000 524 pdf The applicable Visual Care Provider Hand books have also been updated The pro vider handbooks for vision can be found at http www dhhs ne gov med phvis htm How to Determine the Fee Allowable 1 Locate the procedure code Procedure codes are listed numerically The online PDF format has a search feature which will bring you d
18. to have second eye A scan done They said the TC portion of the A Scan has to be billed on two separate dates but that the 26 por tion can both be billed on same date What can you tell me about this Are they forcing us to either do only one eye each time or are they forcing us to have to make up an other date to bill the second A Scan on Like said we have never over the past several years had a problem with this and now all the sudden we are get ting the second eye denied saying the frequency of the service is not correct Thanks for your help Ed Your input always much appreciated Dr Quack s Quote As Dr Quack sees it if you have been paid in the past for the A scan of each eye separately on the same day for CPT code 76509TC technical compo nent think you have been paid in error Let me explain my reasoning The Medicare Physician Fee Schedule Database or MPFSDB for codes 76510 thru 75519 explains which codes can be paid per eye and which will be paid bilaterally one fee for both eyes You can read about the MPFSDB in a previous Quack article lo cated on pages 2 and at http nebraska aoa org prebuilt NOA 2009 03 203RD 020PARTY2020NEWLSETTER pdf The code in the column that is labeled bil surg on the MPFSDB explains how Medicare pays The meanings of those codes can be found in a article found at http nebraska aoa org prebuilt NOA MPFSDB pdf Looking at the MPFSDB one will note that unde
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