The Centers for Medicare & Medicaid Services (CMS) - HIPAA Version 5010 Updates

New from the Medicare Learning Network (MLN): The Centers for Medicare & Medicaid Services (CMS) has released two new HIPAA Version 5010 fact sheets, as well as two companion checklists, to assist providers in transitioning to 5010.

Version 5010 is the new version of the X12 standards for HIPAA transactions; version D.0 is the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions; and version 3.0 is a new NCPDP standard for Medicaid pharmacy subrogation.

The implementation of HIPAA Version 5010 presents substantial changes in the content of the data that providers submit with their claims, as well as the data available to them in response to their electronic inquiries for eligibility or claims status. These new educational materials inform providers of these changes and how they need to plan for their implementation. This information is designed for Medicare Fee-For-Service providers; however, it may be of interest to all health care providers. Go to the CMS 5010 website at http://www.cms.hhs.gov/Versions5010andD0/ and click on “Educational Resources” to view these new educational products.

"Wellmont taps veteran Burgin for interim CEO post"

According to a press release from Wellmont Health Systems, a retired healthcare executive will provide interim leadership as Wellmont continues its national search for their next chief executive.

Bob Burgin, a retired healthcare executive who served for more than two decades as president and CEO of Mission Hospitals in Asheville, N.C., has assumed the responsibilities of interim CEO. Burgin has been as a member of the Wellmont board of directors since July 2009.

Outgoing President and CEO Mike Snow, will leave the system later this month to become chief operating officer of Amedisys Inc.

“Bob’s exemplary record at Mission speaks for itself, and he has demonstrated a keen understanding of the opportunities and challenges facing our hospitals during his tenure on the Wellmont board,” said Roger K. Mowen Jr., board chairman. “His experience as a Wellmont board member enables him to hit the ground running, which is a tremendous benefit to our organization and the patients we serve.

“Bob is an experienced leader who will provide strong, steady leadership for our health system during this time of transition.”

With Burgin’s selection as interim CEO, Mowen said, the Wellmont board of directors will now turn its attention to a national search for a permanent president and CEO. The board will work with an executive search firm to identify and select a top candidate, a process expected to be complete within six months.

Click here to read the full Johnson City Press article from February 2, 2010.

Above quoted from http://timesnews.net/article.php?id=9020259

Revised Medicare Physician Fee Schedule Fact Sheet

The Medicare Physician Fee Schedule Fact Sheet (February 2010) has been revised to include information about the two month zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) effective only for dates of service January 1, 2010 through February 28, 2010. This fact sheet, which also provides information about MPFS payment rates and the MPFS payment rates formula, is available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at: http://www.cms.hhs.gov/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf

Medicare Learning Network

Did You Resolve To Learn Something New This Year?
New Information Is Just A Click Away.

The Medicare Learning Network (MLN) web-based training courses are a perfect way to make good on that resolution. You can choose from a variety of courses that cover Medicare Program policy topics, ranging from general overviews to specific billing and coding information, as well as important education on new CMS initiatives.

You won’t have to miss a moment in the office because you can access any course 24 hours a day, 7 days a week—and it’s easy to complete the courses at your own pace. Each course is a compact learning opportunity; you gain a significant amount of information in just a short period of time. Stay on track with our Learning Management System. The System charts your completed courses and evaluations, and even remembers the chapters you have completed if you are not able to finish in one sitting.
Here is another benefit: many of our courses offer continuing education credits to help you meet academic requirements to obtain or maintain your license or certification.

And, remember—like all Medicare Learning Network products—our web-based training courses are free of charge.

Resolve to visit the MLN Products page today. Find out more information and click on Web-Based Training to get started!

HITECH/HIPAA Information Page

On February 17, 2009 the American Recovery and Reinvestment Act (ARRA) (a/k/a the Stimulus Bill) was signed into law. A subset of ARRA is the Health Information Technology for Economic and Clinical Health Act (HITECH Act). The HITECH Act authorizes a $36 billion investment in Health Information Technology (HIT) and Health Information Exchanges (HIE) to improve quality, care coordination and to lower costs.

• The HITECH Act is divided into four parts:


• Subtitle A: Promotion of HIT


• Subtitle B: Testing of HIT


• Subtitle C: Grants and Loan Funding


• Subtitle D: Privacy

New Privacy and Security rules went into effect on September 23, 2009. However, HHS will not enforce the new rules until February 22, 2010. But some states are beginning to enforce the new rules effective immediately.

Below are four of the major changes to the privacy rules:


1. Creates new obligations for Covered Entities and their Business Associates and modifies individual rights under the Privacy Rule.


2. Creates new civil money penalties and enforcement mechanisms.


3. Applies HIPAA Security & Privacy Rule standards to Business Associates as matter of law.


4. Requires "notification" after a breach of "unsecured PHI" is discovered by Covered Entity or Business Associate.

The following link will take you to the HITECH/HIPAA Information/Resource page on the Highlands Wellmont Health Network (HWHN) website. In order to have consistent and updated resources we opted to place all information relative to HIPAA/HITECH Act on one site rather than duplicate this information at both the HPI and HWHN websites.

Click Here

CMS News from the Medicare Learning Network

The revised Understanding the Remittance Advice (RA) for Professional Providers Web-Based Training (WBT), has been made available by the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN). Available for Continuing Education credit, this course provides instructions to help fee-for-service Medicare providers and their billing staffs interpret the RA received from Medicare and reconcile it against submitted claims. It additionally provides guidance on how to read Electronic Remittance Advices (ERAs) and Standard Paper Remittance Advices (SPRs), as well as information for balancing an RA. This course also presents an overview of software that Medicare provides free to providers in order to view ERAs. This training can be accessed by visiting http://www.cms.hhs.gov/MLNgeninfo/ and scrolling to the “Related Links Inside CMS” page section. Within these links, select Web Based Training (WBT) Modules and then Understanding the Remittance Advice for Professional Providers from the list of training courses provided.

CMS eliminates consultation codes – FAQs, and guidance available

In the final 2010 physician fee schedule, the Centers for Medicare & Medicaid Services (CMS) eliminated the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation G-codes) on a budget-neutral basis. Instead, CMS increased the work relative value units (RVUs) for new and established office visits, as well as initial hospital and initial nursing facility visits.

Recently, CMS released Transmittal 1875 and MLN Matters 6740 which provides guidance to practices on how to bill for services for Medicare Part B patients now that consultation codes have been eliminated. CMS announced that the modifier to distinguish the admitting physician from other physicians who may furnish care is “-AI.” The admitting physician should append the “-AI” modifier along with initial visit codes to their claims while other physicians who perform initial evaluations should only bill the appropriate evaluation and management (E/M) code. CMS instructs providers to select the appropriate E/M codes based on the content of services provided and not the level of documentation.

According to agency, documentation should merely support the level of services provided. CMS advises practices to take time and/or controlling factors into consideration when determining the level of service provided. In this transmittal, CMS also clarifies billing procedures for:

• Observation services;


• Inpatient hospital care;


• Emergency departments; and


• Nursing facility services

(From MGMA Washington Connexion 12/17/09)