CMS clarifies the proper use
of modifier 59 in coding

In certain cases, it may be necessary to indicate that a procedure or service is independent of other non-evaluation-and-management services performed on the same day. In these cases, the Centers for Medicare and Medicaid Services (CMS) says coders should use modifier 59.

According to CMS, "documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used."

Modifier 59 should not be used in relation to an evaluation and management service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.

New Meaningful Use Stage 2
attestation guide now available

The Centers for Medicare and Medicaid Services (CMS) has posted a new step-by-step guide to help eligible professionals (EPs) attest for Stage 2 of the EHR Meaningful Use Incentive Program. The guide walks users through the steps to attest for the program, including how to complete the core and menu measure questionnaires and receive confirmation of your submission. Included are screenshots of each step required for successful attestation. Note that while all providers begin their registration through the CMS Registration and Attestation System, Medicaid EPs must attest through their state Medicaid agency's website.

In late May, CMS and the National Coordinator for Health IT (ONC) jointly introduced a proposed rule that would allow certain eligible professionals (EPs) to use the 2011 edition of Meaningful Use certification criteria for Stage 1 or Stage 2 in 2014 due to lack of availability of the 2014 edition. If finalized, the rule would allow EPs to attest to the less rigorous 2013 definition of core and menu items and clinical quality measures, as well as formalize the extension of Stage 2 to 2016 and Stage 3 to 2017. Stay tuned.

Finally, don't forget that first-time participants in the Medicare and Medicaid Meaningful Use program should begin the 90-day reporting period or submit a hardship exception no later than July 1 to avoid payment penalties in 2015.

Plan to attend "Understanding the EHR Lexicon" event July 15

The Arapahoe-Douglas-Elbert Medical Society, Colorado Medical Society, and Denver Medical Society invite practice managers, physicians and Meaningful Use coordinators to attend a presentation by the Colorado Foundation for Medical Care (CFMC). The event, "Understanding the EHR Lexicon: PQRS, MU and VBPM" will be held 7:30 - 9 a.m. on Tuesday, July 15, 2014, at the COPIC building in Denver.

Stop paying to get paid:
Avoiding high virtual credit card fees

If your practice accepts virtual credit card (VCC) payments from health plans, you may be losing a significant amount of your contractual payments to high interchange fees.

To disburse claims payments, health plans have increasingly shifted from paper checks to electronic payment methods, including payer-issued VCCs. With this method, a health plan sends credit card payment information and instructions to physicians, who process the payments using standard credit card technology.

This method is beneficial to health plans, but costly for physicians. Health plans often receive cash-back incentives from credit card companies for VCC transactions. Meanwhile, VCC payments are subject to transaction and interchange fees, which can run as high as 5 percent per transaction for physician practices.

Click here to read more in AMA Wire about the three things you can do to avoid these fees and to access the AMA's VCC resource.

Medicare enrollment now required
for Part D prescribing

In late May, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for Medicare Advantage and Medicare Part D that includes provisions directly affecting physicians. Beginning June 1, 2015, in order to prescribe under Medicare Part D, physicians or eligible prescribers have to be enrolled in Medicare or, for those who have opted out of the program, have to have a valid affidavit on file with their Medicare contractor. Medicare Part D sponsors must deny pharmacy claims for providers who do not meet these criteria. Click here to read the rule.

CMS also finalized a proposal allowing the agency to revoke the Medicare enrollment of a physician or eligible professional who has a practice of prescribing Part D drugs that is abusive, fails to meet Medicare requirements or represents a threat to the health and safety of Medicare beneficiaries. MGMA reports that CMS only plans to exercise this new authority in very limited and exceptional circumstances. Action related to this new provision may begin as early as July 22, the effective date of the rule.

CMS finds high acceptance rate
for test ICD-10 claims

The Centers for Medicare and Medicaid Services (CMS) announced that the acceptance rate for test ICD-10 claims was 89 percent nationally during the testing week in March.

More than 127,000 claims with ICD-10 codes were submitted to the Medicare fee-for-service (FFS) claims systems and received electronic acknowledgements confirming that their claims were accepted. Approximately 2,600 participating providers, suppliers, billing companies and clearinghouses participated in the testing week, representing about 5 percent of all submitters.

CMS official Niall Brennan said HHS expects to issue an interim final rule soon that sets Oct. 1, 2015, as the compliance date for ICD-10 use.

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