PPR News :: Michigan Medical Billers Association Billing Expo

Michigan Medical Billers Association (MMBA) will be holding its Third Annual Billing Expo on Wednesday May 12th, 2010.  The expo will take place at the Genesys Conference and Banquet Center in Grand Blanc Michigan.

Professional Practice Resources is once again a proud sponsor of this event and will be available to discuss solutions to increase the profitability and efficiency of your practice.

Billing News :: Reimbursement change for mid-level practitioners

Beginning with June 1, 2010 dates of service, Aetna will pay mid-level practitioners at 85 percent of the contracted rates for covered professional services (consistent with CMS payment policy).

This policy applies to nurse practitioners, physician assistants, certified nurse midwives and registered nurses. As of June 1, you will need to list the mid-level practitioner’s name in the servicing provider field when you submit claims for services rendered by a mid-level practitioner.

This policy does not apply to:

• Certified registered nurse anesthetists, registered nurse first assistants or behavioral health practitioners
  
• Claims billed with an assistant surgery modifier
  
• Covered DME, orthotics, prosthetics, supplies, drugs, laboratory, radiology services and immunizations billed by a mid-level practitioner
  
• Medicare Private Fee-for-Service (non-network based)
  
• Providers contracted through a third party or vendor

Billing News :: Signature Requirements – New Medicare Guidelines

CMS recently published instructions to contractors on signature requirements. Those requirements are found in the Medicare Program Integrity Manual and are effective for claims with dates of service on or after March 1, 2010.

These guidelines apply not only to claims reviewed by the DME MAC but also to claims reviewed by the CERT contractor, Program Safeguard Contractor (PSC), and Recovery Audit Contractor (RAC).

For medical review purposes, Medicare requires that all orders and medical records that are used in the adjudication of claims be authenticated by the author. The method used must be a legible handwritten full signature, handwritten initials, or electronic signature. Stamped signatures are not acceptable.

Billing News :: Missing Evaluation and Management (E/M) Documentation

A basic requirement for the billing of covered Medicare Part B services is that documentation must support the medical necessity for the service. In addition, the Evaluation and Management (E/M) documentation must verify that the service was performed on the date billed, by the identified performing provider or incident to that provider, as listed on the date noted on the claim. When a service is not documented properly, the service may be denied.

The following are Examples of Missing Documentation identified by Medical Review:

• No provider signature - "Medicare requires a legible identity for services provided."
  
• No detailed statements of abnormal responses when documenting an abnormal body area/organ system for a Review of Systems or Examination. The 1995 and 1997 Evaluation and Management Documentation Guidelines require specific documentation. "A notation of abnormal without elaboration is insufficient."
  
• When referencing a section from a prior date of service that has a significant bearing on the current service, that prior date of service documentation should be submitted with the requested documentation. In many E/M services that CMS reviews, a provider will refer to a past medical/family/social history and state "unchanged"; but, without documentation for the date of service referenced, CMS does not know the extent of the history performed. For example, the provider states that the past medical history remains unchanged from the previous past history documentation, but is billing a comprehensive E/M CPT code. Without submitting the past history documentation with the encounter note, the specific PFSH patient information cannot be accurately determined. If a provider restates the information in the encounter note, the past history documentation does not need to be submitted. Please note that prior documentation referenced must have occurred within a reasonable time frame prior to the current service.
  
• No patient identification or dates of service included in the documentation submitted.
  
• The documentation must be complete and legible, per the guidelines.
  

Please remember: You are familiar with the patient; however, Centers for Medicare & Medicaid Services (CMS) must make determinations based solely on the documentation they receive. For example, only those elements present in the submitted documentation can be considered when we determine whether the level of E/M service billed is appropriate. Ultimately, the provider is responsible for submitting the appropriate documentation.

Download the CMS Evaluation and Management Services Guide (PDF)