08/07/2018

ASK MSHO

August 2018, Frequently Asked Questions

Question:   Everyone is talking about the changes Medicare might be making to the office visit codes and my physician wants me to provide an update on this. Can you give me a reference?

Answer: The possible Evaluation and Management (E & M) changes are within the CMS Proposed Physician Fee Schedule Final Rule for 2019.  This Proposed Rule is very long so I recommend that you review the ASCO Summary that includes a section on the “Changes in Evaluation and Management Code Payment” from the oncology perspective.  CLICK HERE to review this summary.

Question:  I just wanted to reach out and ask you if our Nurse Practitioners are seeing patients before they start a new chemo drug at a separate appointment, what code can we charge the insurance company for the education.

I was reviewing the 99212-99215, but this requires that we do a ROS for the patient, and if they are not having vitals obtained or going over the ROS, then what could we bill the Education code under.

Answer: I would recommend that you review the CMS Guidance from the Benefits Manual, Medicare Claims Processing Manual,Chapter 12 - Physicians/Nonphysician Practitioners

I have attached the link CLICK HERE

REVIEW - Section 30.6.1 - especially as it pertains to billing on time.....  BE SURE TO READ THE EXAMPLE IN SUB-SECTION C!

C. Selection of Level of Evaluation and Management Service Based On Duration of Coordination of Care and/or Counseling

Advise physicians that when counseling and/or coordination of care dominates (more than 50 percent) the face - to - face physician/patient encounter or the floor time (in the case of inpatient services), time is the key or controlling factor in selecting the level of service. In general, to bill an E/M code, the physician must complete at least 2 out of 3 criteria applicable to the type/level of service provided. However, the physician may document time spent with the patient in conjunction with the medical decision - making involved and a description of the coordination of care or counseling provided. Documentation must be in sufficient detail to support the claim.

EXAMPLE: A cancer patient has had all preliminary studies completed and a medical decision to implement chemotherapy. At an office visit the physician discusses the treatment options and subsequent lifestyle effects of treatment the patient may encounter or is experiencing. The physician need not complete a history and physical examination in order to select the level of service. The time spent in counseling/coordination of care and medical decision - making will determine the level of service billed. 

Question: I need to clarify about whether we can bill our visit as a new patient or an established.  Our physicians argue with us and say THEY did not see them and therefore it is a new patient visit.  

Answer: Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient. This information is found in:

Medicare Claims Processing Manual, Chapter 12 – Physicians/Nonphysician Practitioners section 30.6.7: CLICK HERE

Medicare has published an excellent document on Evaluation and Management Services that includes information on billing of New Patient Services (see page 4).  I recommend you print this and give it to your physician to review.  CLICK HERE

I also HIGHLY recommend reviewing the article published by AAPC in March of this year!  CLICK HERE

Question:  Do you know if anyone provides free transportation to and from the office for chemotherapy treatments?

Answer from Debra Averill, CPC, Oncology Financial Navigator , St. Joseph Mercy Oakland:  Medicaid patients have free Medical transportation, must give a 24 hour notice:

Transportation for Straight Medicaid patients residing is Oakland, Wayne and Macomb Counties call 866-569-1902 (Logisticare) to arrange transportation. Allow 2 days prior notice.

Transportation for United Health Care, Molina, Meridian HMO Medicaid patients contact 877-892-3995. Allow 2 days notice to arrange transportation.

American Cancer Society Road to Recovery program

Transportation                                     1-800-227-2345

-        Need time of apt

-        Date of apt

-        Duration of time of apt

Additional organizations that charge:

Smart Connector over 65 $1.00 each way, under 65  $3.00 each way, 4 to 5 day notice.  866-962-5515

Best Taxi – Michigan Green Cars – no flat rate, $2.90 per mile  877-476-8294.

Bright Transportation – first $18.00 includes 15 miles, $1.00 per mile after that.  313-758-9893.

MyRide2.com (recommended by Area Aging 1B)  855-697-4332.