The Centers for Medicare & Medicaid Services (CMS) issued a reminder Aug. 24 to health care providers, health plans, clearinghouses, and vendors about the approaching compliance dates for the transition to the Accredited Standards Committee X12 Technical Reports Type 3, Version 005010 (Version 5010) electronic health care transaction standards. Beginning January 2011, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) should be ready to test with their trading partners the functionality of the entities’ practice management and/or other related software featuring Version 5010 standards.

That date is right around the corner. Are you ready?

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Medical Coding Professionals meeting in Springfield, MA

SALT LAKE CITY — Aug. 16, 2010 —AAPC announced its 2010 Regional Conference being held at the Sheraton Springfield Monarch Place hotel in Springfield, Massachusetts on October 7–9.  This annual event draws hundreds of attendees including medical coders, office/practice managers and doctors to connect on the business side of health care.

“Attendees will enjoy in-depth training by world-class instructors and several keynote presentations by industry experts,” said Melanie Mestas, senior events manager.

Registration is now open for this two-day regional conference, which provides the same high quality coding education as AAPC’s larger national conference, but in a smaller setting. Participants will brush up on coding skills, learn about changing rules and regulations, network with fellow coders and other medical professionals. Read more »

AAPC is releasing its 10^th edition of its Medical Billing and Reimbursement online course. “This course is a great way to enhance your coding education by delving into specifics about the health insurance industry and different reimbursement methodologies for correct claim submissions,” said Shelly Cronin, CPC, CANPC, CGIC, CGSC, AAPC Business and Member Development.

The study program is aimed at providing the most up-to-date information relating to Medicare and third-party billing. This latest edition offers textbook, workbook, and audio lectures to add to your learning experience. More information is available at on the AAPC Medical Billing and Reimbursement Course webpage.

By Janice G. Jacobs, CPA, CPC, CCS, ROCC, and G. John Verhovshek, MA, CPC

The Centers for Medicare & Medicaid Services’ (CMS’) 2010 Outpatient Prospective Payment System (OPPS) Final Rule revised guidelines that define physician supervision of services performed in a hospital outpatient department, while leaving rules for services performed in free-standing centers/physician offices unchanged. The new guidelines, “Policies for Direct Supervision of Hospital and CAH Outpatient Therapeutic Services,” begin on page 264 of the final rule.

Resource Tip: View the 2010 OPPS Final Rule online at: http://edocket.access.gpo.gov/2009/pdf/E9-26499.pdf.

Midlevel Providers May Supervise Therapeutic Procedures

Under the 2010 OPPS Final Rule, CMS has broadened the rules for supervision of therapeutic procedures in the hospital outpatient setting to permit direct supervision by non-physician practitioners (NPPs), to include the following health care professionals:

• physician assistants (PAs)
• nurse practitioners (NPs)
• clinical nurse specialists (CNS)
• certified nurse-midwives (CNMs)
• licensed clinical social workers (LCSWs)

Eligible NPPs may supervise only those therapeutic services “that they may perform themselves under their state license and scope of practice and hospital-granted or CAH-granted privileges.” In other words, an NPP may supervise only those services he or she can perform personally under the applicable guidelines.

Therapeutic services falling under the new rules are those such as outpatient psychiatric group therapy, physical therapy (PT), speech therapy, and occupational therapy (OT).

For example, a LCSW may now supervise outpatient psychiatric group therapy sessions because he or she is qualified and trained to perform that service. That same LCSW may not prescribe medications or perform other services for which only the attending or other psychiatrist is qualified.

CMS guidelines define direct supervision to mean the supervising provider must be “immediately available to furnish assistance and direction throughout the performance of the procedure.” Specifically, “immediate availability” requires that:

The supervising provider must not be “performing another procedure or service that he or she could not interrupt.”

• The supervising provider must not be “so physically far away on the main campus from the location where hospital outpatient services are being furnished that he or she could not intervene right away.”
• • For therapeutic procedures performed on a hospital’s main campus, the supervising physician or practitioner must be present “on the same campus.” The supervisor may be located anywhere on the campus, including a physician’s office, an on-campus skilled nursing facility (SNF), or other nonhospital space.
  • For therapeutic procedures performed in an off-campus provider-based department (PBD), the supervising physician or practitioner must be present in the PBD during the procedure.
  • In addition to being able to provide the service/procedure under his or her state license, scope of practice, and hospital-granted or critical access hospital (CAH)-granted privileges, the supervising provider “must be prepared to step in and perform the service, not just respond to an emergency.”

A coding example of interactive group therapy provided by a LCSW would be CPT® code 90857 Interactive group psychotherapy billed on the CMS-1500 form under the LCSW’s own provider identification number (PIN).

Pay attention to payer requirements: Although these supervision guidelines apply specifically to Medicare patients/services, contractual ‘non-discrimination clauses’ with private payers may require hospitals (and participating physicians) to apply the same rules for all patients.

Diagnostic Services Specify Different Requirements

Supervision requirements for diagnostic services—such as computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography (PET), ultrasound, and X-rays—differ from those for therapeutic services, as described above. NPPs may not supervise diagnostic tests provided to hospital outpatients. The required supervision can be provided only by a physician (MD or DO).

CMS guidelines specify, “All hospital outpatient diagnostic services provided directly or under arrangement, whether provided in the hospital, in a PBD of a hospital, or at a nonhospital location, follow the physician supervision requirements for individual tests as listed in the [Medicare Physician Fee Schedule] MPFS Relative Value File.”

In the Relative Value File, in the “Physician Supervision of Diagnostic Procedures” column, CMS assigns a physician supervision indicator to each CPT®/HCPCS Level II code representing a diagnostic service.

Resource Tip: The Relative Value File is available online at: www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp?listpage=4.

The indicators and definitions are:

CMS defines “general,” “direct,” and “personal” supervision requirements in the Medicare Benefit Policy Manual, chapter 15, section 80:

General Supervision means the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure. Under general supervision, the training of the non-physician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician.

Direct Supervision (in the office setting) means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure (for example, the physician must not be performing another procedure that cannot be interrupted, and must not be so physically far away that he or she could not provide timely assistance). This does not require that the physician must be present in the room when the procedure is performed, however.

Personal Supervision means a physician must be in attendance in the room during the performance of the procedure.

For example: The MPFS relative value unit (RVU) file assigns the technical portion of CPT® 77014 Computed tomography guidance for placement of radiation therapy fields a “2” physician supervision indicator. This means the service requires direct physician supervision when performed in the hospital radiology department, in a hospital-owned imaging center that is defined as a PBD, or in a physician office under arrangements with the hospital (that is, an outside imaging facility bills the hospital for exams it performs on hospital patients).

SALT LAKE CITY — June, 6 2010 —AAPC announced its 2010-2011 Board of Directors for the AAPC Chapter Association (AAPCCA) at its National Conference in Jacksonville, Fla. AAPCCA is a voting board of 16 nationwide professional coders, current and former local chapter officers and leaders in their communities. The independent board provides policy, rules, regulations, direction, and advice to more than 450 AAPC local chapter leaders and members with the ultimate goal of improving the business side of medicine.

The following were elected as the 2010-2011 AAPCCA board officers:

Chair: Jill Young, CPC®, CEDC™, CIMC™

Vice Chair: Melissa Brown, CPC®, CPC-I®, CFPC™

Secretary: Freda Brinson, CPC®, CPC-H®

Treasurer: Charla Prillaman, CPC, CPMA, CPC-I, CEMC, CCC, CHCO

Meeting Coordinator: Angela Jordan, CPC®

AAPCCA and all AAPC local chapters are not-for-profit. In addition, two board members represent each of the eight regions across the country. Here’s how the regions are represented: New members are denoted with an asterisk (*)

Region 1—Northeast

*Susan Edwards, CPC

Newport, Northern Vt. Chapter

Cynthia Trapp, CPC®, CPC-I®

Burlington, Mass. Chapter

Region 2—Atlantic

*Claire Bartkewicz, CPC-H

Monmouth Ocean Chapter

Freda Brinson, CPC®, CPC-H®

Savannah, Ga. Chapter

Region 3—Mid Atlantic

*Charla Prillaman, CPC, CPMA, CPC-I, CEMC, CCC, CHCO

Charlotte, N.C. Chapter

*Judy A. Wilson, CPC, CPC-H, CPC-P, CPC-I, CANPC, CMBS-I, CMRS

Virginia Beach Chapter

Region 4—Southeast

*Lynn Ring, CPC, CPC-I, CCS, CCS-P

Winston, N.C., (Piedmont Professional Coders); Brandon, Fla. Chapters

Melissa Brown, CPC®, CPC-I®, CFPC™

Jacksonville River City, Fla. Chapter

Region 5—Southwest

*Brenda Edwards, CPC, CPMA, CPC-I, CEMC

Northeast Kansas (Topeka) Chapter

Wendy Grant, CPC®

Little Rock, Ark. Chapter

Region 6—Great Lakes

Jill Young, CPC®, CEDC™, CIMC™

Lansing, Mich. Chapter

*Diana Yates, CPC, CPC-H, CPC-I, CPEDC, CCS-P

St. Louis East, Mo. Chapter

Region 7—Mountains/Plains

*Lynn Keaton-Cockrell CPC, CPC-H, CPC-I, CEMC

Columbia, Tenn. Chapter

Angela Jordan, CPC®

Kansas City, Mo. Chapter

Region 8—West

Suzanne Fletcher-Petrich, CPC®, CPC-I®, CPC-P®

Tacoma, Wash. Chapter

Jeri Leong, CPC®, CPC-H®, CPC-I®

Honolulu, Hawaii Chapter

AAPC’s Director of Local Chapter Support, Marti Johnson, serves as the AAPC liaison on the AAPCCA Board of Directors.

More information about the AAPCCA is available on the AAPC’s Web site at http://www.aapc.com/aboutUs/local-chapter-board-of-directors.aspx.

Award recognizes example of hard work and professionalism

SALT LAKE CITY — June, 8 2010 — AAPC, (www.aapc.com), the nation’s largest medical coding training and credentialing association, has named AAPC member Nancy G. Higgins, CPC, CPC-I, CIRCC, CPMA, CEMC, of Monroe, N.C., as 2009 Coder of the Year. Lori Hendrix, CPC, CPC-H, CIRCC, CPC-I, of Georgia, was awarded the 2009 Networker of the Year. These prestigious awards recognize AAPC members who exemplify the higher standards of coding set by AAPC. The winners were selected based on nominations, volunteerism, coding expertise and networking skills. Read more »

The AAPC is opening a new audit services division that will provide full-service health care compliance and corporate integrity audits. The new audit division will service outpatient practices, health plans, health care attorneys, and government regulators, to determine key areas of risk and provide detailed recommendations to resolve them. AAPC will use member auditors to provide services in all specialties and are leveraged from the credentialed AAPC members nationwide.

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