NEWS...

Brought to you by: Katherine Becker,  JD, LLM, CHC, CHPC, CPC, Associate Consultant

Chronic Care Management
Frequently Asked Questions Addressed

CMS released new guidance and frequently asked questions for billing Chronic Care Management in 2017. It is important that practices billing for this service review the requirements to make sure that they are billing appropriately. This is particularly important for practices that may have chosen to hire a third party vendor to assist with these services. The frequently asked questions specifically addresses this concept and details which work must be performed by the billing provider. The CCM codes require the billing provider to be doing the medical decision making as well as providing ongoing reassessment, oversight, management and collaboration. Any work provided by external staff (e.g. case management company) must meet all of the “incident to” criteria and there must also  be clinical integration between the care team members. 

CMS has created a web page specifically to help physicians educate their patients and implement Chronic Care Management (go.cms.gov/ccm). On this page you will find a provider “toolkit” and resources for your Medicare patients, including posters and educational pieces. The Medicare program has recognized the positive impact CCM can have on your patients and your practice and continues to expand the resources available to you!

CCM FAQ - Click here

MLN Matters Article - Click here

HIPAA Violations – Make Sure You Report in a Timely Manner

The Office of Civil Rights (OCR) announced a settlement agreement with Presence Health, a large health care network based on the untimely reporting of a breach of unsecured protected health information (PHI). This is the first HIPAA settlement based on untimely reporting. Presence Health discovered a breach of PHI affecting 836 individuals on October 22, 2013 but failed to notify OCR, the patients impacted as well as media outlets. All of which is required when a breach affects more than 500 individuals. This is an important reminder to practices to make sure that they have policies and procedures in place to address breaches in a timely manner. It is also important to remember that state laws may also impact the amount of time a practice has to respond to a breach. For example, the Florida Information Protection Act has a more restrictive timeline of 30 days. Any such state regulations should also be considered during the development of policies, and a component of any effective privacy program.

Educational Opportunities...

Compliance for 2017: Current Trends (Complimentary Webinar)

This webinar will discuss the current enforcement landscape in the healthcare industry and how healthcare providers must ensure their compliance programs are not only properly tailored for the practice, but more importantly, how the practice is conducting necessary audits to ensure compliance. Brian E. Dickerson will discuss recent billing audit trends, healthcare billing and fraud enforcement and the recent false claims settlements and criminal convictions.   Jean Acevedo will then discuss how a practice can utilize current enforcement trends to ensure its compliance program is sufficient, how to conduct the necessary audits to warn the practice of any compliance concerns and how to best modify the compliance program to protect the practice.

Speakers: Jean Acevedo, LHRM, CPC, CHC, CENTC, AAPC Fellow & Brian E. Dickerson, Esq.

March 30, 2017 - 12:00 - 1:00 p.m. (EDT)

Acevedo Consulting Incorporated and FisherBroyles, LLP

Registration

HIPAA 2017: What You Need to Know Now (Lecture - Fort Lauderdale, FL)

Participants will:

• Learn about recent enforcement actions and what to be on the lookout for in their own practice.  
• Hear tales from the trenches about where we see practices succeeding with HIPAA as well as their mistakes you can learn from
• Learn which policies you may be overlooking in your own practice

Speaker: Katherine Becker, JD, LLM, CHC, CHPC, CPC

April 19, 2017 - 11:30 - 1:03 p.m. (EDT)

Broward County Medical Association

More Information to Follow

Non-Face-to-Face Prolonged Services (Webinar)

Is your organization aware of this new revenue opportunity? If not, you should be as this is a chance to be paid for time and/or tasks that were previously bundled into the payment of an Evaluation and Management (E&M) visit. As of January 1, 2017, Medicare will now allow payment for prolonged services without face-to-face contact with the patient. Tasks such as extensive medical record review, review of diagnostic test results or other ongoing care management work may now be considered a component of Non-Face-to-Face Prolonged Service codes 99358 and 99359.

As with any allowable service, there are coding guidelines and payer conditions of coverage that need to be adhered to. Spend your lunch hour with us as we:

• Define codes 99358 and 99359;

• Review payer coverage nuances;

• Discuss documentation recommendations for best practice with a review of documentation examples;

• Provide recommendations for implementation and monitoring.

Speaker: Joanna Bennett, CPC, CHC

April 20, 2017 - 12:00 - 1:00 p.m. (EDT)

Acevedo Consulting Incorporated

Registration

5 E Rule of Incident-to (Lecture - Coconut Creek, FL)

As the use of non-physician practitioners (NPP) and scribes increase, so does the complexity of how these individuals can practice and/or bill for their services. During this session we will discuss essential billing concepts such as Incident-to and Shared Services while also discussing scope of practice and the use of scribes.

During this session you will learn about:

• The impact of state laws and regulations on NPP services.

• Medicare’s “Incident-to” provision: How are these services documented, billed and reimbursed?

• The “Shared Visit” concept: When is this concept used? And what must be documented to appropriately bill for these services?

• How some Managed Care payers view the use of NPPs.

• How to appropriately document the use of scribes.

Speaker: Joanna Bennett, CPC, CHC

April 27, 2017 - 12:00 - 1:30 p.m. (EDT)

Palm Beach County Medical Society & West Boca Medical Center

Registration

For more upcoming educational events, please click here

Please forward this publication to others who may also be interested in this information.

Acevedo Consulting Incorporated