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3 rd Party References Providing… NOA, Medicare, Medicaid, and other resources to help you understand 3 rd party requirements and file 3 rd party claimsNOA,

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Presentation on theme: "3 rd Party References Providing… NOA, Medicare, Medicaid, and other resources to help you understand 3 rd party requirements and file 3 rd party claimsNOA,"— Presentation transcript:

1 3 rd Party References Providing… NOA, Medicare, Medicaid, and other resources to help you understand 3 rd party requirements and file 3 rd party claimsNOA, Medicare, Medicaid, and other resources to help you understand 3 rd party requirements and file 3 rd party claims

2 Disclaimers This information was prepared by the 3rd Party Consultant to the Nebraska Optometric Association, Ed Schneider OD. To the best of his knowledge, it was current and accurate at the time it was prepared. It is not guaranteed to be error or omission free. It was prepared as general information to assist doctors and staff, and is not intended to grant rights or impose obligations.

3 Disclaimer The ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services. The Nebraska Optometric Association, and its presenters, agents, consultants and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free or omission-free, and will bear no responsibility or liability for the results or consequences of the information contained herein.

4 4 Coding References CPT (Current Procedure Terminology) CPT (Current Procedure Terminology) – Service Codes Ophthalmology Ophthalmology Evaluation & Mgmt Evaluation & Mgmt – Surgical Procedure Codes Removal of FB Removal of FB Epilation of Lashes Epilation of Lashes

5 5 Coding References Available from Available from – AOA – Combines multiple references – Delivery later than some – AMA – https://catalog.ama-assn.org/Catalog/;jsessionid=Q3YRMMKGBTFOLLA0MRPVX5Q?_requestid= https://catalog.ama-assn.org/Catalog/;jsessionid=Q3YRMMKGBTFOLLA0MRPVX5Q?_requestid= – Amazon.com UPDATE YEARLY – effective January 1stUPDATE YEARLY – effective January 1st

6 6 Coding References ICD-9-CM ICD-9-CM International Classification of Diseases International Classification of Diseases – Refractive Diagnosis Codes – Disease Diagnosis Codes – Injury Diagnosis Codes

7 7 Coding References Available from Available from – AOA – Combines multiple references – Delivery later than some – AMA – https://catalog.ama-assn.org/Catalog/;jsessionid=Q3YRMMKGBTFOLLA0MRPVX5Q?_requestid= https://catalog.ama-assn.org/Catalog/;jsessionid=Q3YRMMKGBTFOLLA0MRPVX5Q?_requestid= – Amazon.com UPDATE YEARLY – effective October 1 st of previous yearUPDATE YEARLY – effective October 1 st of previous year (the 2013 issue is effective October 1 st, 2012.) (the 2013 issue is effective October 1 st, 2012.)

8 8 Coding References 1997 Documentation Guidelines for Evaluation & Management Services 1997 Documentation Guidelines for Evaluation & Management Services – Explains how to code and document the codes – Includes information on single organ systems (such as eyes)

9 9 CMS: Medicare Learning Network You can download it from: You can download it from: MLN/MLNProducts/downloads/MLN_Suite_of_Products_and_Resources_for_Instructors.pdf

10 Medicare Education NEW: How to Use the National Correct Coding Initiative (NCCI) Tools at NEW: How to Use the National Correct Coding Initiative (NCCI) Tools at https://www.cms.gov/MLNProducts/downloads/How-To-Use-NCCI-Tools.pdf https://www.cms.gov/MLNProducts/downloads/How-To-Use-NCCI-Tools.pdf https://www.cms.gov/MLNProducts/downloads/How-To-Use-NCCI-Tools.pdf ---explains explains--- National Correct Coding Initiative National Correct Coding Initiative NCCI Program to reduce incorrect coding based on NCCI Program to reduce incorrect coding based on –Mutually exclusive codes (92083 & 92081) –Anatomic considerations (cataract extraction & enucleation). Medically Unlikely Edits (MUEs) Medically Unlikely Edits (MUEs) –Program to reduce errors due to clerical entries and incorrect coding based on frequency of procedures on same day.

11 11 NE Medicare B References Our Medicare B Administrative Carrier is Our Medicare B Administrative Carrier is Wisconsin Physician Services [WPS] Wisconsin Physician Services [WPS]

12 12 NE Medicare B References Medicare B Medicare B – Local Coverage Determinations (LCDs) – Standardizes what Medicare considers “Reasonable and Necessary”Standardizes what Medicare considers “Reasonable and Necessary” Lists very specific coding requirements for those services & procedures that have a history or potential of abuse Lists very specific coding requirements for those services & procedures that have a history or potential of abuse

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14 14 NE Medicare B References WPS Medicare Communiqué Quarterly Newsletter WPS Medicare Communiqué Quarterly Newsletter Changes in CMS policy Changes in CMS policy Updates in coding requirements Updates in coding requirements Updates on documentation needed Updates on documentation needed FAQs FAQs Changes in contact information Changes in contact information Changing in billing requirements Changing in billing requirements All Provider are legally responsible for reading and abiding by this document. https://corp-ws.wpsic.com/apps/commercial/unauth/medicareListservUserWelcomeLoadAction.do

15 15 NE Medicare DME References Medicare Durable Medical Equipment is for Medicare Durable Medical Equipment is for Cataract post-op glasses and CLs Our DME Carrier is Noridian Administrative Services, LLC Our DME Carrier is Noridian Administrative Services, LLC https://www.noridianmedicare.com/dme/index.html

16 16 NE Medicare DME References DME Supplier Manual DME Supplier Manual What Documentation is required What Documentation is required – Written order – Proof of Delivery – ABN – Supplier Standards Claims Submission Claims Submission V-codes V-codes Pricing Pricing https://www.noridianmedicare.com/dme/news/manual/index.html%3f

17 17 NE Medicare DME References DME Quarterly Newsletter Happenings - All Provider are legally responsible for reading and abiding by this document. DME Carrier newsletter DME Carrier newsletter Changes in CMS policy Changes in CMS policy Updates in coding requirements Updates in coding requirements Updates on documentation needed Updates on documentation needed FAQs FAQs Changes in contact information Changes in contact information Changes in Billing Requirements Changes in Billing Requirements Listserv URL https://naslists.noridian.com/list/subscribe.html?mContainer=2&mOwner=G303 92x2n39372t36 https://naslists.noridian.com/list/subscribe.html?mContainer=2&mOwner=G303 92x2n39372t36 https://naslists.noridian.com/list/subscribe.html?mContainer=2&mOwner=G303 92x2n39372t36

18 18 https://www.noridianmedicare.com/dme/coverage/lcd.html NE Medicare DME References

19 19 Noridian LCD on Refractive Lenses LCD Source: https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_lcds/refractive_lenses.htm https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_lcds/refractive_lenses.htm NE Medicare DME References

20 20 Noridian Policy on Refractive Lenses Policy Article Source: https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_articles/refractive_lenses.htm https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_articles/refractive_lenses.htm NE Medicare DME References

21 21 NE Medicaid References Medicaid Provider Manual Medicaid Provider Manual Includes Visual Care Services Includes Visual Care Services Covered and Non-Covered Services Covered and Non-Covered Services Examination Examination Lenses Lenses Frames Frames Contact Lenses Contact Lenses Billing Requirements Billing Requirements

22 22 NE Medicaid References Medicaid Provider Manual – Vision Care Medicaid Provider Manual – Vision Care Visual Care Services regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-24.pdf Visual Care Services regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-24.pdf regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-24.pdf regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-24.pdf  Payment Rules regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-03.pdf regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-03.pdf regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-03.pdf  Fee Schedule  Billing Instructions  Bulletins (bottom of page)

23 23 NOA References NOA 3 rd Party Newsletters NOA 3 rd Party Newsletters Changes in Carrier Policy Changes in Carrier Policy LMRP Updates & Reminders LMRP Updates & Reminders Unique Coding in Nebraska Unique Coding in Nebraska Changes on the Horizon Changes on the Horizon HIPAA Updates HIPAA Updates Q & A Page Q & A Page

24 24 NOA References

25 25 NOA References

26 26 Monthly Newsletter Mass NOA References

27 27 NOA References NOA 3 rd Party Web Page NOA 3 rd Party Web Page   Index page with over 1000 links  Past Newsletter Articles by title  CMS, Medicare, Medicaid, BCBS, AOA, & other web sites  Archived newsletters by date published  HIPAA page, including HIPAA manual  New Licensee page  Previous 3 rd Party Presentations

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31 31 NOA References

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33 33 NOA 3 rd Party Consultation Contact Methods Contact Methods – – Fax (contact Ed first) Cover page: Contains PHI-for Dr. Schneider’s eyes only Cover page: Contains PHI-for Dr. Schneider’s eyes only 24 hour turn-around time 24 hour turn-around time


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