Our Students feedback has led us to expand our CPC course, offering two Preview Classes before starting the Professional Medical Coding Curriculum which covers 21 chapters including CPT, ICD-9, HCPCS, Compliance and the Business of Medicine.

Students will feel  more prepared after taking the Preview Class with Mike Enos, providing an introduction to Anatomy and Terminology.  Mike's expertise is test taking and preparing students to understand how to succeed on an objective exam.  This preview class will also cover "Test Taking Skills". 

The AAPC tracks areas of weakness based on exam results.  The Evaluation and Management Codes are the most complex area of coding, and Nancy Enos  will cover an in-depth overview of this coding chapter in the second Preview Class..

These two Preview Classes are free of charge for registered students ($500 deposit paid).  Examinees who need a refresher before taking the exam again are welcome.  The $199 fee is discounted for former students of Nancy Enos Medical Coding.

Annual Wellness Visit Tips

The Annual Wellness Visit (AWV) is exactly what it says it is... a Wellness Visit. It is a wellness visit during which the beneficiary's medical history, risk factors, functional ability and routine measurements are all captured in order to provide a Personalized Prevention Plan which the beneficiary may choose to follow to maintain good health. The AWV is NOT the same as a yearly (annual) physical exam.

Both the first AWV and subsequent AWVs have a checklist of elements which must be provided, or provided and referred, before submitting a claim for the AWV. These checklists can be found for your use on a quick reference factsheet at the following link: www.cms.gov/MLNProducts/downloads/AWV_Chart_ICN905706.pdf

A Medicare beneficiary who is no longer within 12 months after the effective date of his/her first Medicare Part B coverage and who has not received either an Initial Preventive Physical Examination (IPPE) or an AWV within the last 12 months is eligible for an AWV. Medicare Part B will pay for one initial AWV and a subsequent AWV yearly thereafter. There is no coinsurance or copayment on the part of the beneficiary for the AWV.

An AWV can be performed by the following health professionals:

·         physician (doctor of medicine or osteopathy)

·         qualified non-physician practitioner such as a physician assistant, nurse practitioner, or clinical nurse specialist

·         health educator

·         registered Dietitian

·         nutrition professional

·         other licensed practitioner

·         team of such medical professionals working under the direct supervision of a physician

 You can help your patients prepare for the AWV by advising them that this is NOT a physical exam or "check-up", and encouraging them to come prepared with the following:

Medical records, including immunization records

Family health history

A full list of current medications and supplements

A full list of current providers and suppliers involved in their care

The following resources are helpful in understanding the AWV in greater detail:

 The Guide to Medicare Preventive Services - www.cms.gov/MLNProducts/downloads/mps_guide_web-061305.pdf

 Medicare Benefit Policy Manual - www.cms.gov/manuals/downloads/bp102c15.pdf

 Change Request 7079 - Annual Wellness Visit - www.cms.gov/transmittals/downloads/R2159CP.pdf

 Medicare Learning Network Preventive Services Educational Products Website - www.cms.gov/MLNProducts/35_PreventiveServices.asp

OIG 2012 Work Plan Summary of Physician billing errors under scrutiny

The 2012 OIG Work Plan has been published (http://oig.hhs.gov/reports-and-publications/archives/workplan/2012/Work-Plan-2012.pdf).  Practices should review the issues under review and ensure that these risk areas are included in their Compliance Program, continuing education and audit projects in order to detect and prevent fraud and correct any potential risks.  The following list is excerpted from the work plan:

Place of service

OIG will review physicians’ coding on Medicare Part B claims for services performed in ambulatory surgical centers and hospital outpatient departments to determine whether they properly coded the places of service. Federal regulations provide for different levels of payments to physicians depending on where services are performed. (42 CFR § 414.32.) Medicare pays a physician a higher amount when a service is performed in a nonfacility setting, such as a physician’s office, than it does when the service is performed in a hospital outpatient  department or, with certain exceptions, in an ambulatory surgical center.

Incident to

OIG will review physician billing for “incident-to” services to determine whether payment for such  services had a higher error rate than that for non-incident-to services. OIG will also assess CMS’s ability to monitor services billed as “incident-to.” Medicare Part B pays for certain services billed by physicians that are performed by nonphysicians incident to a physician office visit. A 2009 OIG review found that when Medicare allowed physicians’ billings for more than 24 hours of services in a day, half of the services were not performed by a physician. OIG also found that unqualified nonphysicians performed 21 percent of the services that physicians did not perform personally.

Incident-to services represent a  program vulnerability in that they do not appear in claims data and can be identified only by reviewing the medical record. They may also be vulnerable to overutilization and expose Medicare beneficiaries to care that does not meet professional standards of quality. Medicare’s Part B coverage of services and supplies that are performed incident to the professional services of a physician is in the Social Security Act, § 1861(s)(2)(A). Medicare requires providers to furnish such information as may be necessary to determine the amounts due to receive payment. (Social Security Act, § 1833(e).) (OEI; 00-00-00000; expected issue date: FY 2013; new start)

E/M trends in coding of claims

OIG will review evaluation and management (E/M) claims to identify trends in the coding of E/M services from 2000-2009. OIG will also identify providers that exhibited questionable billing for E/M services in 2009. Medicare paid $32 billion for E/M services in 2009, representing 19 percent of all Medicare Part B payments. Providers are responsible for ensuring that the codes they submit accurately reflect the services they provide. (CMS’s Medicare Claims Processing Manual, Pub. No. 100-04, ch. 12, § 30.6.1.) E/M codes represent the type, setting, and complexity of services provided and the patient status, such as new or established. (OEI; 04-10-00180; expected issue date: FY 2012; work in progress)

E/M during global period (Modifier 24)

OIG will review industry practices related to the number of E/M services provided by physicians and reimbursed as part of the global surgery fee to determine whether the practices have changed since the global surgery fee concept was developed in 1992. Under the global surgery fee concept, physicians bill a single fee for all of their services that are usually associated with a surgical procedure and related E/M services provided during the global surgery period. The criteria for global surgery policy are in CMS’s Medicare Claims Processing Manual, Pub. 100-04, ch. 12, § 40. (OAS; W-00-09-35207; various reviews; expected issue date: FY 2012; work in progress)

E/M improper documentation due to cloned notes, identical documentation

OIG will assess the extent to which CMS made potentially inappropriate payments for E/M services and the consistency of E/M medical review determinations. OIG will also review multiple E/M services for the same providers and beneficiaries to identify electronic health records (EHR) documentation practices associated with potentially improper payments. Medicare contractors have noted an increased frequency of medical records with identical documentation across services. Medicare requires providers to select the code for the service based upon the content of the service and have documentation to support the level of service reported. (CMS’s Medicare Claims Processing Manual, Pub. No. 100-04, ch. 12, § 30.6.1.) (OEI; 04-10-00181; 04-10-00182; expected issue date: FY 2013; work in progress)

Providers are responsible for auditing and monitoring their documentation and billing activity and should have an annual audit as a baseline.  For more information, contact Nancy Enos Medical Coding at www.nancyenoscoding.com

The next 12 week session for the AAPC's Professional Medical Coding Curriculum, and the CPC exam, will be held at 134 Thurber's Ave, Providence RI at the Care New England Administration Offices.  Classes will begin on January 10th and will meet on Tuesday and Thursday evenings From 5pm to 7:30pm through March, with the CPC exam being proctored on Saturday March 31st.  Sign up on this website  today, space is limited!!  Don't miss out on the opportunity to develop yourself professionally and take your career path to the next level.  Please comment or email Nancy with any questions you have.

The AAPC's Comprehensive, 12-week preparatory course for the CPC exam will be hosted by Care New England, and the dates are being scheduled now for the next session beginning in January 2012.

We are seeking your feedback on your preference for days and locations.  Do you prefer Warwick, or Providence? Do you prefer Saturdays, meeting once a week (8am to 1pm) , or evenings, meeting twice a week (5pm to 7:30pm)? Post your response and check the website for the schedule in the next few weeks.  

With ICD-10 coming in 2013, the demand for coders will increase.  The Patient Protection and Affordable Care Act, also known as Healthcare Reform, has increased the need for all medical providers to have a Compliance Plan in place as a condition of enrollment in Medicare and Medicaid.

Get ready for the opportunities these major changes will bring to the field of medical coding and compliance!  Plan on becoming a CPC and advancing in your career!

Is the Patient Centered Medical Home becoming more of a reality?  According to Modern Physician, The CMS will pay primary-care doctors to better coordinate care under a pilot program that would require other public and private insurers to make a similar investment. 
Primary-care doctors will receive an average of $20 per month for each Medicare fee-for-service enrollee to coordinate care in five to seven communities where most other insurers also agree to take part

The agency will pilot the effort under the Comprehensive Primary Care Initiative, federal health officials announced. Insurers must submit a letter of intent to participate by Nov. 15 (PDF) and formal applications by Jan. 17.

Care coordination payments or other support from public or private insurers “will be expected,” as part of the program, according to the solicitation. Insurers must also agree to shared savings; disclosure of cost and medical use data; and should be willing to coordinate quality and other measures.

Medical practices that participate in the program and meet quality measures will be eligible to keep a share of savings. Practices will apply next spring. Dr. Richard Baron, director of the seamless care models group at the CMS Innovation Center, said the initiative, which will begin next summer, is designed to provide primary-care doctors with funding and flexibility to manage chronically ill patients and coordinate care.


Read more: Care-coordination initiative announced - Healthcare business news and research | Modern Healthcare http://www.modernhealthcare.com/article/20110928/NEWS/309289975#ixzz1ZL8zMWSL
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 Written by: 
Nancy M Enos, FACMPE, CPMA, CPC-I, CEMC 
The benefits of Electronic Health Records – a coder’s perspective
Many physicians have been taught to fear a coding audit, and intentionally undercode in an effort to stay under the radar.  This leaves the physician two problems: lower reimbursement, and incorrectly coded claims.

The use of an electronic health record provides structured notes, eliminating the risk of omission of documentation required for higher level Evaluation and Management (E/M) Codes. For example, a new patient visit with a new problem, resulting in a moderate risk (two or more stable chronic illnesses, an undiagnosed new problem with an uncertain prognosis or an acute illness or complicated injury) should be reported as a 99204.  The American Medical Association (AMA) promotes “risk based coding”, where the Medical Decision Making matches the level of the code reported.  For many new patient visits, this means a level 99203 for low risk and 99304 for moderate risk.

How does a physician ensure that the History and Exam components meet the criteria for the level of medical decision making, and code correctly?  An Electronic Health Record is the answer.  The templates offered by an EHR guide the physician to capture the required information. The History of Present illness is the most important statement, as it sets the stage for justification of the extent of the exam.  The Review of Systems should also be supported by the chief complaint.  Past, Family and Social History are easily captured or confirmed in the EHR. 

The level of exam can be documented by the 1995 (general) or 1997 (specialty) guidelines. It is easier for pertinent negatives to be documented electronically.  Beware of overdocumenting using an “auto-negative” feature if all areas are not examined.

Calculating the type if decision making is often confusing. By providing a template field to capture assessments and diagnostic statements, orders and a plan, the “points” can be calculated and the type of medical decision making can be selected.

In addition to the coding values, the EHR also eliminates illegible handwriting which counts against a physician in an audit.  If it wasn’t documented, it wasn’t done.  If it cannot be read, then it was not documented.

Prepare for ICD-10 Implementation!  The time to learn about the transition from ICD-9 to ICD-10 is here. Practice administrators have multiple changes looming, including upgrades to 5010 transactions, Meaningful Use, and new relationships with hospital systems as accountable care organizations emerge.

Read the "Code of Conduct" article published in the July 2011 MGMA Connextion Magazine (page 13) to learn more about ICD-10 and what you can do to prepare, train, and succeed.

Office Staff members at Lawrence & Memorial Hospital in New London attended a luncheon and seminar on June 16th, 2011 entitled "Next Steps to ICD-10, the second seminar in a series designed by Donna Schneider at L&M and Nancy Enos, to prepare offices for the transition to ICD-10.    The seminar was co-sponsored by Optum CareTracker, Providence, RI.