Stress is a common theme for health care professionals and it’s not going anywhere anytime soon. AAPC member Lois Mazza, CPC recently wrote an article for Just Coding on stress for the everyday medical coder.
“Stress can be hard to define as what stresses one person may not bother another person at all,” she wrote. “Everyone has different levels of tolerance. Nor is stress inherently a problem. It is the effects of stress that cause the problems. Those who study stress and its effects believe stress can cause a myriad of troubles, both physical and emotional.”
Read the full article here.
July 31st, 2012
Today is the day remittance for 5010 begins. You will find improvements over the old 4010 system of remittance advice.
Version 5010 introduces some significant improvements over ASC X12 version 4010. For example, in version 5010, the Health Policy Segment will report the National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). In addition, the 835 will have a website where the specific LCD or NCD code is explained. You will have access to the code as well as the code description. The 5010 version of the 835 also will contain technical contact information not currently in version 4010. Version 5010 contains new segments such as coverage expiration date and claim received date, which will help providers access important information without manual intervention.
Let your Medicare contractor know you want to receive the version 5010 835.
For more information on ASCX12 version 5010 and NCPDP version D.0, please visit CMS’ Versions 5010 and D.0 website.
July 30th, 2012
The Centers for Medicare & Medicaid Services (CMS) has opened a National Coverage Analysis (NCA) for the Ocular Photodynamic Therapy (OPT) National Coverage Determination (NCD 80.3.1) after receiving a formal written request from the American Academy of Ophthalmology on May 25.
OPT is a treatment for age-related macular degeneration (AMD), a common eye disease among the elderly. AMD is the leading cause of blindness in adults over the age of 50. OPT involves the infusion of an intravenous (IV) photosensitizing drug called verteporfin followed by exposure to a laser. The laser activates verteporfin, which selectively targets and treats the pathologic ocular tissue. Verteporfin therapy is neither a cure nor a preventative for AMD; it is meant to slow progression of the disease.
The American Academy of Ophthalmology notes that the current coverage decision for OPT is from 2004, prior to the emergence of targeted anti-VEGF intravitreal treatments, and that these newer therapies have largely supplanted OPT as initial management of AMD, and that OPT is largely relegated to patients in whom the newer therapies have failed. The American Academy of Ophthalmology believe that the current NCD requirement for follow-up fluorescein angiography with OPT is not supportable for these end-stage patients.
CMS is interested in receiving evidence speaking to the need for fluorescein angiography with OPT in patients for whom targeted anti-VEGF intravitreal therapy has failed. The initial 30-day public comment period begins July 24, 2012.
July 26th, 2012
The Centers for Medicare & Medicaid Services (CMS) recently notified contractors of 11 new tests approved by the U.S. Food and Drug Administration (FDA) as waived tests under Clinical Laboratory Improvement Amendments of 1988 (CLIA).
Effective Oct. 1, 2012, appropriately certified facilities may be reimbursed for the following 11 new waived tests:
| CPT® Code |
Effective Date |
Description |
| G0434QW |
March 14, 2012 |
Wondfo Oxycodone Urine Test {Dip card format} |
| G0434QW |
March 14, 2012 |
Wondfo Oxycodone Urine Test {Cup format} |
| 87880QW |
March 23, 2012 |
McKesson Strep A Test – Dipstick |
| 87880QW |
March 23, 2012 |
McKesson Strep A Test – Twist |
| 86318QW |
April 3, 2012 |
McKesson H. pylori Test (Whole Blood) |
| 87804QW |
April 20, 2012 |
Sofia Analyzer and Influenza A+B FIA (for user with nasal swabs and nasopharyngeal swabs) |
| 85610QW |
May 8, 2012 |
AlereINRatio®2 PT/INR Home Monitoring System {Prescription Home Use} |
| 83986QW |
May 8, 2012 |
Dale Medical Products, Inc. RightLevel pH |
| 83986QW |
May 8, 2012 |
Dale Medical Products, Inc. RightSpot pH |
| G0434QW |
May 22, 2012 |
Chemtron Biotech, Inc. Chemtrue Single/Multi-Panel Drug Screen Cassette Tests |
| G0434QW |
May 22, 2012 |
Chemtron Biotech, Inc. Chemtrue Single/Multi-Panel Drug |
Note the effective date for each test. Contractors will not search their files to retroactively pay claims, but facilities may bring such claims to the attention of their contractor.
See CMS transmittal 2496 for the complete list of waived tests.
Providers and suppliers of health care services and supplies to Medicare Parts A and B beneficiaries will pay contractors more in interest for unrecouped overpayments and delinquent unrecouped underpayments in the fourth quarter of 2012. (more…)