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Archive for December, 2009

Thoughts For The Blue Moon

Posted by Paul Spencer, CPC, CPC-H in Community Involvement, Fi-Med Services, Hot Topics, Paul Spencer CPC CPC-H

Today’s a special day on the astronomical calendar. Every 32 months or so, two full moons occur in the same calendar month. We had a full moon back on December 2, and a look to the skies this evening will find that we have another full moon ringing in the New Year to the celebrating world below. In honor of this rare occurrence, I thought I’d take a step away from professional subject matter and bring forth some observations of a more personal nature.

Back in 1977, I was 11 years old, growing up in the suburbs of Philadelphia. I was required to take a book out of the elementary school library. I was always looking for material that interested only me. While this made the graded results of my schooling rather shocking in their downward path, I dare say that my desire for exploration and inquisition has served me better intellectually than many of my peers from so long ago. Looking through the books, I chose one called 2010: Living In The Future by Geoffrey Hoyle.

As a fan of the future, I marvelled at what I saw within the pages. My bed wouldn’t be on a squeaky metal bed frame, but would pop up from the floor with the push of a button. My children wouldn’t be going to a brick and mortar school. They would be going to school via “videophone” (this is what we called web cams in 1977 while we waited for our Ford Pintos to explode due to rear impact). You could leave your car at home and strap on a jet pack, as the cartoon-illustrated skies would be darkened by free-hanging people with fuel-filled propulsion engines strapped to their backs. I’m leaving out moon colonies and environmentally-controlled domed cities, but I think you get the general thrust of this book.   

I don’t know how I can say this without sounding critical of the over 7 billion people currently inhabiting the Earth, but the calendar leaves me no alternative.

Tomorrow is 2010, and we have failed our own future.

This is not some run-of-the-mill failure, such as a misspelling or a briefly untied shoe. This is an international, multi-societal, cross-generational, self-inflicted catastrophe equivalent to laying on one’s back on train tracks as the 5:15 high speed commuter line is within view.

In my civilian life, I am an acolyte of the great scientist and renaissance man R. Buckminster Fuller, who spent more than half of the 20th century attempting to explain to the world at large both layman and academic that the Earth indeed had the resources (both sustainable and non-sustainable) for everyone on the planet to comfortably coexist. To that end, he designed tools for responsible care and habitation of the planet, not only in the realm of housing, but across the width and breadth of design sciences.

I’ve spent a great deal of my post-adolescent life hoping that the powers that be would invest heavily in a future closer to what Fuller imagined, and have been continuously frustrated as vital resources have been heavily tilted to obsolete models of existense. Whether it is the removal of mountaintops in West Virginia for coal or watching a drunken captain of an Alaskan supertanker run aground and spill oil over hundreds of miles of coastline, hanging on brazenly to the past doesn’t appear to be improving anyone’s life in a measurable fashion.

More disturbingly, there appears to be a truth fatigue gripping the world. Turn on any TV news program or surf the darker reaches of the internet for any length of time and a basic set of facts is being reputed by someone who has apparently crawled out from under a rather large, moss-covered rock somewhere who has either an ideological or monetary interest in bringing forth a contrary viewpoint, no matter how ridiculous. As this type of person is slowly given more time to spout nonsense to a broader audience, truths that have sometimes taken scholars and scientists centuries to be realized disappear in waves of reddened faces and screeds in capital letters, replaced with dogma, superstition and an utter lack of intellectual rigor. And admit it, when was the last time you saw a rocket lifting off from Cape Canaveral, and felt any sense of anticipation or excitement?

In looking back, the only thing from that children’s book that came true was the idea of using computers to order food remotely and having it delivered to your house. Currently, this is only in effect for restaurants and pizza parlors and not supermarkets, as was fully envisioned. Thanks to this “innovation”, someone else’s plan for the future has helped to make me, according to my sister-in-law’s Wii Fit Pro, “obese”. I guess if you’re weighed down by calories, it’s somewhat hard to find the energy to fight for a future that benefits more than your perpetually-full digestive tract. My same-old squeaky metal bed frame (push button not included) is a little louder nowadays.

Going back to Buckminster Fuller, he once wrote the following as he contemplated his own actions in the world and how he could be of most benefit to the planet and its inhabitants at large:

I am not a noun, a thing. I seem to be a verb; an evolutionary process, an integral function of the universe”.

We’re now knee-deep in the 21st century. Many people in power across the globe have a great deal invested in making sure your internal drive to be anything more than a noun remains dormant. As we go forth into 2010, it is my hope that mankind’s inate curiosity about its universal place leads to a litany of much-needed, long-dormant questions, followed in short order by a storm of ideas aimed at improving current existence and ensuring future survival. Until my next posting of this nature (August 31st, 2012, according to my astrological calendar), I challenge you to do the right thing, both for yourself and the world at large. Be a verb!

Paul Spencer CPC, CPC-H

Introduction to 2010 HCPCS Code Set

Posted by Paul Spencer, CPC, CPC-H in Fi-Med Services, Hot Topics, Paul Spencer CPC CPC-H

Sometimes, honesty is the best policy. With regard to this week’s blog posting, I was woefully unprepared. Any number of reasons for this are available, from the sudden lack of relevant government transmittals and general industry silence ahead of the holidays, to the fact that I still have gifts to buy and have maybe 10 hours of useful daylight left in order to do it.

So, with 9 days before the new year, I present a slapdash overview of relevant changes to the HCPCS code set for 2010. I’m going to attempt as best I can to restrict my updates to codes that I myself have seen our client base utilize on a regular basis, or new codes that represent a service that is widely provided in the world at large. This will keep this posting from slipping precipitously into the Gorge of Too Much Information:

A6200-A6202 – These codes are currently used for composite dressing pads without adhesive borders. These codes are disappearing on January 1, 2010. There are no codes to replace these codes, based on the fact that these codes have been covered based on individual carrier discretion for some time (read: not often or at all).

G0151-G0155 – This represents a new set of codes for 2010 for different types of therapy services provided to patients in either the home health or hospice settings. These services are billed in 15-minutes increments.

G0420 – This is a new code for individual chronic kidney disease education. This code is billed on an hourly basis. Once the actual dollars and cents fee schedule is released for 2010 by Medicare, this code can be accurately assessed for usefulness.

J7322 – The code for Synvisc is changing for 2010. J7322 is being replaced by J 7325. The reason for this has to do with there now being more than one type of Synvisc now available. Code J7325 now covers more than one Synvisc derivative.

Elastic Orthoses – Several HCPCS L codes are being deleted from the HCPCS code set. Since April 1st, 2009, the codes to be deleted have been found by CMS to not meet the definition of a brace and coverage has been denied. The deletion of these codes is a natural progression from that determination. 

The majority of the balance of changes to the 2010 HCPCS code set are an expansion of the existing Physician Quality Reporting Initiative (PQRI) codes. If you are currently utilizing PQRI, a quick review of these codes may be worth a look.

Thus concludes this somewhat informative and not the least bit inspired blog post.  As you conclude you holiday seasons, do your best to show a little kindness. You’d be surprised how far it goes, and how much it will be appreciated. As Randy Newman says, “It’s a jungle out there”.

Introducing the -AI Modifier

Posted by Paul Spencer, CPC, CPC-H in Fi-Med Services, Hot Topics, Industry Updates, Paul Spencer CPC CPC-H

A.I.

Up until this week, those two letters stood for a number of different things. Being from Philadelphia, A. I. stood for Allen Iverson for a period of time to any basketball fan (I hear he’s back, but I’m a hockey fan, so let’s move on). In the scientific world, A.I. stands for artificial intelligence. In the case of my one brother, A.I. most often stands for alleged intelligence. Maybe the reader knows a few that I left off this short list.

Beginning on January 1, 2010, the letters “AI” represent a new modifier which stands for “Primary physician of record”.

With the impending elimination of inpatient consultation codes to choose from, physicians once designated as “consultants” will now be utilizing CPT codes 99221-99223 for their first encounter with the patient in the hospital setting in the same way that the admitting physician does currently. With this change comes a need to differentiate between the admitting physician coordinating care and other physicians participating in the care of the patient. Medicare has decided that the best way to do this is for the admitting physician to include a modifier on the charge for the initial encounter. The modifier they have created for this purpose is -AI.

The -AI modifier will be used only by the admitting physician, and only on their initial encounter with the patient in the inpatient setting. In addition, this modifier is to be used for the admitting/primary physician of record for patients admitted to nursing facilities.

According to CMS in Transmittal 1875 announcing the new modifier, if the -AI modifier is mistakenly included by the primary physician on subsequent facility services, the provider will not be penalized with a denial. In spite of this, it is not recommended that the modifier be used in this fashion.

Hunger Task Force Food Drive

Posted by Rosa Rodriguez in Community Involvement, Fi-Med News

Those of you who have been with us for a while know that we love our community! In the past, Fi-Med Management, Inc. has participated in programs to help the less fortunate by buying presents for children who otherwise might not have had any for the holidays. This year, Fi-Med’s Special Events Committee has decided to host a food drive for the Hunger Task Force.

Here at Fi-Med, we are very competitive and so we have decided to take advantage of our competitive nature by splitting up the entire office into two teams to see which team can collect the most food items. We will be collecting food until January 25th.

Even though times are tough for all of us, let’s take a moment to consider all the other families that are struggling to put food on their tables and try to find ways that we can help. Below is a list of important facts that concern the Milwaukee area:

Food Facts

  • Each year Hunger Task Force distributes more than 6 million pounds of food to Milwaukee’s hungry.
  • Each month Hunger Task Force-affiliated food pantries serve 37,500 people, and soup kitchens and homeless shelters dish up more than 58,000 hot meals.
  • Milwaukee suffers from the seventh-worst poverty in the nation, with a poverty rate of 24.4 %. More than 34% of Milwaukee’s children are living in poverty, the ninth worst in the nation.
  • Nearly 40% of families who visit food pantries live on less than $800.00 per month. Many families, even food stamp recipients, are unable to sufficiently feed their families.
  • Hunger Task Force advocates for well-run government programs that help people feed themselves and their families, including Food Stamps (FoodShare), School Breakfast and Lunch; Women, Infants and Children (WIC); the Fueling Young Minds Summer Meals Program and the Child and Adult Care Food Program.

 

In their own words

I lost my job. All I get is FoodShare and it’s not enough. I came here because I ran out of food.”-Visitor, Salvation Army West Food Pantry

“I have three children. I’m a single parent trying to hold down a job and go to school.”-Visitor, House of Peace Community Center Food Pantry

“All around, there just isn’t enough food.”-Visitor, St. Benedict’s Community Meal Program

Preferred Food Items

  • Fruit and Juice: canned pears, apricots, pineapple and peaches
  • Breakfast Items: Dry cereal, oatmeal, grits, and pancake mixes
  • Protein: Canned meat, poultry, fish, peanut butter, beans, nuts and high-protein main dishes such as chili and stews
  • Vegeatbles: Canned corn, green beans, carrots and peas
  • Baby Items: Powdered or concentrated infant formula (Nestle Good Start), food and diapers
  • Dinner Items: Pastas, rice (plain or mixes), potato mixes, macaroni and cheese dinners
  • Lunch Items: Canned or dry soups (vegetable, beef or chicken) and canned pasta items

 

Please join us as we all work together to really make a difference this holiday season by starting your own food drive!

The Real Gift of Giving

Posted by Karla Brown in Community Involvement

As we approach the upcoming Christmas season, everyone seems to be in the “spirit of giving”. Giving toys to our kids, cologne to our significant others, sweaters to our siblings, etc…In this time when so many have so little to give, it seems people are finding a way. The malls are packed and the streets are crowded as ever on the weekends with holiday shoppers. My husband also notices this and says, “I thought we were in a recession!” I look over at him and smile, thinking the same thing.

Like some, however, I am feeling this recession thing but I figured I had at least 2 cents to shell out and give some of my ideas for giving this year that won’t cost a thing except a good heart and a little time…

  • Give a thought to our troops overseas  who aren’t coming home for the holidays.
  • Give blood if you can. It could help someone get home for the holidays.
  • Give a hand to your neighbor with something they may not be able to handle alone.
  • Give words of encouragement to someone you know who may have lost their job or home this year.
  • Give thanks because you still have a job and home this year.

 

I spoke to a young lady from Georgia on the phone last week who was calling to give her Tricare Military Insurance information to bill a claim for her 1 yr. old son. When I asked her who the primary insurance carrier was, she stated her husband, Jeffrey. She went on to tell me he was recently killed in Afghanistan. My heart instantly felt heavy. Before I hung up with her I gave her my blessings and I could hear the sincerity in her voice when she said thank you. My heart instantly felt lighter. I know my kind words and the things listed above are free to give and recession proof. Happy Holidays!

E-Prescribe Reporting Easier for 2010

Posted by Paul Spencer, CPC, CPC-H in Fi-Med Services, Hot Topics, Industry Updates, Paul Spencer CPC CPC-H

We are surrounded by cliches in our culture. We hear them virtually every day in our society from one source or another. From my point view, one topic that always plummets into cliche is the topic of change. I’m now past the halfway point in my life, and it’s safe to say that the next person who approaches to me with a happy, revelatory look on their face and says “The only constant is change” as if they have just discovered the Ark of the Covenant has a 50/50 chance of forcibly eating the chair I’m currently sitting in.

Having said that, I’d like to reveal what I feel are two great changes with regard to the reporting of the utilization of electronic prescriptions to Medicare and the reimbursement for this reporting under the current e-prescribe bonus program.

Beginning on January 1, 2010, if a medical provider electronically prescribes at least one medication electronically, this will be reported with the new e-prescribe HCPCS code of G8553. The prior reporting codes of G8443, G8445 & G8446 will be deleted. This change will eliminate any confusion concerning what code to choose. If you e-prescribe one or more medications, G8553 will be reported. If no prescriptions are electronically prescribed, nothing is reported.

In addition, the qualifying for the incentive bonus payment is about to get easier. Currently, in order to qualify for the e-prescribe bonus, a provider must have a 50% rate of electronic prescribing for all prescriptions generated from his or her practice. For 2010, the physician will only need to electronically prescribe 25 times a year in order to qualify.

There are a few things to take into account as we approach these changes. The reporting code must always be reported with a unique face-to-face patient encounter in order to count towards the 25-visit minimum. Also, the definition of electronic prescribing does NOT include faxes.  

In conclusion, if you want an illustration of negative change, as a resident of Milwaukee, I need only look at where the temperatures stood on Thanksgiving and compare them to today. The temperature has dipped into the low teens, and I’ve spent the bulk of the time trying to stay warm at my desk as I type this by playing the more raucous portions of my mp3 player’s catalog. Who knew that Husker Du’s Zen Arcade had a legitimate business purpose? Sometimes, it is of huge advantage to avoid cliche.

Reports Are Falling From The Sky

Posted by Paul Spencer, CPC, CPC-H in Fi-Med Services, Hot Topics, Industry Updates, Paul Spencer CPC CPC-H

Here in Milwaukee, we had our first snowfall of the season overnight. While it wasn’t enough to keep me at home today, it was just enough to make the process of getting from here to there just slightly more time-consuming. For someone like me, who operates in this world of ours thinking that a great deal of the world functions specifically to be in my way, it was a typical morning.

As the calendar turned to December earlier this week, I am also reminded that snowflakes are not the only thing  falling from the sky. With the approach of a new calendar year, a number of news releases, reports, pending legislation, industry updates and warning shots are coming from the federal government. Some of these began implementation at the beginning of the fiscal year on October 1, but it helps to review the regulatory landscape on a regular basis. With that in mind, here’s a portion of what we know:

  • The OIG Work Plan - While some of the usual suspects appeared once again on the OIG work plan for fiscal year 2010. there were a few new and not-so-new things that jumped out at me. OIG is again looking at the unbundling of laboratory tests. One of the most surprising bits of news this year was the large fine levied against Quest Diagnostics for violating bundling rules, mainly because this company, under its previous incarnation as Smithkline Beecham Clinical Labs, faced a 9-figure fine for similar violations back in 1996. The OIG has now officially decided to revisit this topic. Other targets of the OIG in the coming year will be E/M services performed in the global period of a surgery, a review of the current payment system for ambulatory surgery centers, practice expense for radiologists, the effects of payments for services referred by excluded providers, and a multi-layered review of claims related to durable medical equipment.
  • The OIG Semiannual Report – In addition to this year’s Work Plan, the OIG just released their semiannual report, which reports a total of almost $21 billion in program savings and recoveries. For fiscal year 2009, the OIG recovered just short of $4.5 billion through investigations and audits. The savings portion of $16.5 billion came through recommendations for putting agency funds to better use which were finally implemented long after they were suggested during the last administration.
  • The 2010 Conversion Factor - Quietly over the Thanksgiving holiday, the projected conversion factor for 2010 was lowered from 28.4061, which represents a 21.2% cut from 2009, to 28.3895, bringing the total cut from 2009 to 2010 to just short of 21.3%. In past years, there has been last-minute legislation passed that eliminated projected cuts to the conversion factor. This year, the urgency to address this issue has disappeared in a wave of uncivil, unproductive and distracting arguments about the future of health care in the United States. With the New Year 4 weeks away as of today, it may be in the best interests of all Medicare Part B providers  to make financial preparations for the coming year that assume a 21.3% reduction in Medicare reimbursement. If this cut is rescinded on the cusp of January, those that have planned ahead will be that much better off.
  • Medicare Fee-For-Service (FFS) Error Rate – CMS reported that the error rate for claims payments under Medicare FFS plans more than doubled from 3.6% in 2008 to 7.8% in 2009. This was a result of increased scrutiny of claims for these plans. This FFS error rate works out to $24.1 billion dollars in improper payments.

 

With the rancor currently displayed in the Legislative Branch of the government, coupled with the attention-deprived caterwauling that defines the 24-hour cable news environment, it will not be the occasional regional snowfall making December a treacherous time for our industry. Much like the Buick-driving senior citizen in a hat, these and other reports will make the best attempt at getting in the way of a pleasant holiday season. As always, look for an opening, give it some gas and do your best to leave it in the dust, but be aware that you’ll more than likely see them again.