James Pyles, Esq. Powers, Pyles, Sutter and Verville will analyze the effect of the Supreme Court ACA decision on home care medicine and home care. The webinar is presented by the American Academy of Home Care Physicians. Proceeds will go to fund the Academy's (C)(4)Home Care Medicine Action Fund efforts to support expansion of Independence at Home*

 

Date: July 3, 3pm-4pm EST

  

Price:  Non AAHCP Members - $95 per registrant
             AAHCP Members - free

  

AAHCP members register here. 

  

Non AAHCP members register here. 

  

*Mr. Pyles, a well-known national home care expert has also led the legislative efforts to create, and in the future expand, the Independence At Home Demonstration. He is donating his time for this fund-raising event.

Dear All,

 

Earlier this month, and in the last eNewsletter,  I let you know that the RUC has decided to value two important new sets of codes for home care medicine (and other specialties)-care transitions and transitional care. IT IS ESSENTIAL THAT HOME CARE MEDICINE BE REPRESENTED WITH ENOUGH SURVEYS TO BE CONSIDERED STRONG DATA. Otherwise, we will not be heard in the final valuation recommended to the RUC and CMS.

 

Therefore, if you are a US provider (MD, DO, NP, PA), please make the time-and encourage others in your group-to complete the survey. MD, NP, and PAs are eligible. The notice has gone out from the AGS to your email.(See below) You need to follow the links to the survey which is completed on line through a Survey Monkey link.

 

If you have any questions, you are welcome to contact Gary Swartz at gary.swartz@aahcp.org, as well as the AGS contact people outlined in the transmittal.

 

Constance F. Row
Executive Director

 

 

The American Geriatrics Society (AGS) needs your assistance in completing surveys on the level of work associated with care coordination and transitions of care management services. The surveys will be used to recommend Medicare reimbursements for these procedures. This project is part of the AMA/Specialty Society's Relative Value Scale Update Committee (RUC) process.  The Centers for Medicare and Medicaid Services rely on the RUC's recommendations as a basis for setting payment levels for physician services.  We need your input to ensure that we have strong data.  If we do not have enough completed surveys, neither the RUC nor Medicare will accept our recommendations.   
 
We greatly appreciate you taking 30 minutes to complete this work on behalf of your specialty society and colleagues within the next 2 weeks.
 
If you have any questions about this survey process, please contact:

• Susie Sherman, Senior Coordinator of Public Affairs and Advocacy at ssherman@americangeriatrics.org or 212.308.1414 

• Alanna Goldstein, Assistant Director, Public Affairs and Advocacy
   agoldstein@americangeriatrics.org or 212.308.1414

 

Follow this link to the surveys:

• Care Coordination Services
• Transitions of Care Management

 

Or copy and paste the URL below into your internet browser:

• https://www.surveymonkey.com/s/CCCCServices2012
• https://www.surveymonkey.com/s/TCMServices2012

 

As you may know, nearly all reimbursement for physician work is based on relative work values that have been based upon surveys conducted on behalf of the American Medical Association. The American Geriatrics Society has participated in all of those surveys that pertain to geriatric and family medicine.
 
You, as a US non-commercial member of the physician/physician assistant/nurse practitioner community, have been selected to participate in an AMA RUC survey for the valuation of two families of CPT Codes. There are two URL links above, that will take you to different procedure code family surveys. We ask you to complete both of these surveys, Care Coordination Codes AND Transitions of Care Management only if you perform these services. You may come back to this e-mail and the links as long as the survey is open.

 

Thank you for your time!   

 

 

Member Ted Rosenberg, MD, MSc sent along his wonderful new article in this month's Journal of the American Geriatrics Society. Titled "Acute Hospital Use, Nursing Home Placement, and Mortality in a Frail Community-Dwelling Cohort Managed with Primary Integrated Interdisciplinary Elder Care at Home," the article describes his program in the Department of Family Medicine, University of British Columia, and Island Medical Program, University of Victoria, Victoria, British Columbia, Canada and its effects on 248 frail elderly adults. Results were terrific: a 39.7% reduction in hospital admissions, 37.6% reduction in hospital days, and 20% reductions in ED contacts after entering the practice. Only 16% were admitted to nursing homes.  The link to the article is here.  

While the Academy successfully intervened to end a recent Medicare pre-payment review, practices may experience 20 or so different types of federal, state and private payer audits. These can include payers retrospectively demanding partial or whole recoupment of previously paid claims. The AMA developed an audit webinar series to help practices with such audits.

 

The first in this series, "Private payer audits: What you need to know," reviews the various types of private payer audits; how physicians can minimize their risk of being audited; what physicians should do if they are audited; and, what actions physicians can take if the audit results in recovery payments. The presenter, Dennis Mihale MD, MBA, is a Partner and Chief Medical Officer with Sunera, a health care auditing firm that focuses on medical records, technology audit, and HIPAA compliance. The webinar has also been archived for physicians and their practice staff.

 

Click here for further information. 

CMS released a new educational article on Phase 2 of the Medicare ordering/referring requirements. You may be receiving emphasis on these requirements from your DME and HHAs relationships.

 

The requirements include that the ordering, referring or certifying  provider must have an enrollment record in Medicare, be of a specialty that is eligible to order/certify in Medicare and that the physician's legal name and national provider identifier must be listed on the claim.

 

CMS, while in phase 1, is issuing warnings for claims that fail to meet the requirements. These claims will be denied in Phase 2. While CMS has not yet announced when Phase 2 will begin, they will give 60 days notice before it goes into effect.

 

Practices should look for the following informational messages on the remittance advice for provider and supplier Part B claims:

• N264: Missing/incomplete/invalid ordering physician provider name
• N265: Missing/incomplete/invalid ordering physician primary identifier

Practices with DMEPOS supplier relationships

• N544: Alert: Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected, this will not be paid in the future.

The "three-day payment window" went into effect July 1. This will impact practices that are wholly owned or operated by a hospital.  Under the expanded rule, physician services that are performed in the three days before an inpatient admission, are related to that admission and are performed in an entity that is wholly owned or operated by a hospital will be paid at the lower facility rate. Such physician services will need to be billed by the practice or other entity with a "PD" modifier. 

 

Academy members rendering service in such practices will want to be aware of this change. And CMS just released 43 Frequently Asked Questions about the rule to respond to operational questions about the application of the rule.  

 

CMS will not make the determination whether a practice is wholly owned or operated. This is left to the hospital and the practice. CMS encourages practices determining themselves not to be wholly owned and operated to document their determination. At the same time the AMA and the MGMA have requested a delay in implementation to next year due to the complexity of this issue and the necessary adjustments to billing and other processes. 

Beginning July 1, independent laboratories will no longer have claims accepted for the technical component (TC) of physician pathology services furnished to hospital inpatients or outpatients. This change in policy has been delayed several times, both by CMS and by Congress the most recent delay expired June 30.

 

We are bringing this policy change to your attention as there could be scenarios where you have an independent lab or are aware of labs and you have seen and ordered labs on a beneficiary during a day of hospital admission or outpatient service.

 

CMS refers to two previously released MLN Matters articles (MM5943 and MM5347) for background and policy information regarding payment to pathologists and independent laboratories for the TC of physician pathology services furnished to such  hospital patients.

  

Advertise with us 

Many of you have been approached by or wish to approach hospitals to offer the support of your housecalls program to their effort to reduce readmissions. You have asked us for a basic briefing document you could take with you, something that would explain how house calls can help, and give some concrete examples of benefits.

 

An interested group met at the Annual Meeting to give the background needed and to describe their programs.Click here for a Policy Brief giving the argument and their examples. Consider this an Annual Meeting gift that we hope will keep on giving! And many thanks to those who participated!

The Academy is pleased to announce an updated and expanded Medical Management of the Home Care Patient (MMHCP) is Now Available. This important publication for care of your patients and operating a home care medicine practice is updated with the most current and relevant material.  This book is applicable to the practice and patients of all Academy members including physicians, nurse practitioners and physician assistants. Leaders of your Academy in conjunction with the AMA authored the MMHCP. Order you copy here.

 

This 4th edition, like the field of home care medicine, has grown across many aspects of care, organization and regulation and covers the changing landscape from care of special populations, relationships with community based long term care supportive services through skilled nursing and therapy services to the latest in acute hospital in the home programs.

 

Specific topics include:

• The basis for care of the home care medicine patient.
• Care transitions and the importance of care transitions in reducing hospital readmissions.
• Legal, compliance and ethical issues that arise or are present in practice of home care medicine.
• The Veterans Administration's Home Based Primary Care Program.
• Special home care medicine populations from neonatal through hospice and end of life care.
• A caregiver self-assessment tool.
• A comprehensive glossary.
• Listing of national, state and local resources.
• Case studies, tables, figures and easy-to-read text.
• A continuing medical education component for physicians interested in obtaining AMA PRA Category 1 Credits™

The MMHCP is a care delivery complement to the expanded Field Guide to Home Care Medicine  and both beginning and growing practices will want to have both references.