Medicare Compliance & Reimbursement

Medicare Keeps Rolling During Government Shutdown

Your MACs will continue processing payments, enrollment, CMS says.

Whether you were worried that the government shutdowns would mean halted Medicare payments or you were thrilled at the thought that the OIG would be ceasing operations, you were incorrect in both cases. Although the government shutdown will affect scores of federal operations nationwide, Medicare payments won’t be impacted.

Although many government agencies are shuttered while Congress continues its back-and-forth over the Federal budget and the Affordable Care Act, Medicare claims will continue processing normally, CMS said in an Oct. 1 statement. “During the time that the partial government shutdown is in effect, Medicare Administrative Contractors will continue to perform all functions related to Medicare fee-for-service claims processing and payment,” the agency announced.

Therefore, you shouldn’t need to adjust or alter your claims submissions in any way during the governmental furlough.

Likewise, the OIG reminded practices on Oct. 2 that it will also continue working, noting, “During the Federal government shutdown, OIG will continue to send notices of updates to our website with information about our Medicare and Medicaid oversight and enforcement activities, which will continue under our mandatory funding.”

However, other HHS employees may not be reporting to work during the shutdown. HHS furloughed over half of its work force (52 percent), according to ABC News. For instance, in a summary of its shutdown plan, HHS notes that “CMS would be unable to continue discretionary funding for health care fraud and abuse strike force teams resulting in the cessation of their operations.”

This MAC Plans to Audit Level 5 Codes

If your physician’s go-to codes are 99205 and 99215, look for a lot more scrutiny of your claims going forward. At least that’s the word from Part B MAC NGS Medicare, which plans to start prospectively auditing these claims.

“The National Government Services Medical Review Department will be conducting service-specific prepayment reviews of CPT® codes 99205 and 99215 for claims submitted to Jurisdiction 6 Part B for the states of Illinois, Minnesota, and Wisconsin,” NGS Medicare said in an Oct. 1 announcement. “If one of your claims is selected for review, you will receive an Additional Documentation Request (ADR) letter,” the MAC continued. “You will have 30 days from the date of the ADR to submit the requested documentation.”

And for those of you confident that your history and physical always meet level five because you have a thorough electronic medical record (EMR), keep in mind that NGS will be looking beyond those two elements. “Please remember that the volume of documentation is not the determining factor for choosing the appropriate level of E&M service,” the MAC says. “The level of service provided and billed must be medically necessary in addition to meeting the individual requirements of the billed CPT® code.”

To read more on the audit, visit www.ngsmedicare.com.

New Edition of CPT® Debuts ‘Inter-professional Telephone/Internet’ E/M Codes

When Medicare stopped paying for consultations in 2010, you probably thought you’d never see another of these codes making its debut in a CPT® book — but that’s exactly what you’ll find when you crack open CPT® 2014.

Effective Jan. 1, CPT® will include four new codes that describe the work of two medical professionals who discuss a patient’s condition via phone or internet, as follows:

•  99446 … Inter-professional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review.
  
• 99447 … 11-20 minutes of medical consultative discussion and review.
  
• 99448 … 21-30 minutes of medical consultative discussion and review.
  
• 99449 … 31 minutes or more of medical consultative discussion and review.
  

As in the past, these new codes are consultative in nature, which means you’ll have to provide a written report back to the requesting physician to qualify for the code, as indicated by the phrase “including a verbal and written report.” It isn’t clear yet whether Medicare will include payment for these codes, since they are consultations.

Palmetto to Hospice: Get Supplier Number For Vaccination Billing

Hospices that don’t have a Part B billing number will have to do some extra paperwork to secure payment for vaccinations. In a transmittal released in May, the Centers for Medicare & Medicaid Services »

(CMS) makes it clear that vaccinations are a hospice’s responsibility.

“These services are only covered when provided to hospice beneficiaries by their hospice provider,” CMS says in CR 8908. “This Change Request (CR) updates Medicare systems to prevent non-hospice providers from providing vaccines to hospice beneficiaries.”

The edits enforcing this requirement will take effect next month. But how can hospices bill for the shots? That’s what one hospice agency asked Home Health & Hospice Medicare Administrative Contractor Palmetto GBA in a July 16 Ask the Contractor Teleconference.

“These vaccines should be billed to the local A/B Medicare Administrative Contractor (MAC) on the 1500 claim form and not on the UB-04 claim form,” Palmetto advises in its recently posted question-and-answer set from the ACT. “Payment is made using the same methodology as if they were a supplier.”

Do this: “Hospices that do not have a supplier number should contact their local A/B MAC to obtain one as these vaccinations would not be billable under their current hospice provider number,” Palmetto instructs.