Medical Business Journal - February 20112

Letter from the EditorDear Readers,

It is my pleasure to welcome you to the new format of the Medical Business

Journal (MBJ). The MBJ is distributed to over 50,000 professionals in the

community of educators and students dedicated to the business of medicine.

This is going to be an exciting year for the MBJ! Many innovative approaches to

meeting our commitment to the development, improvement, and advancement

of medical business through education and communication are on the horizon.

The healthcare delivery system has changed dramatically over the last few

years, and the future inevitably holds many more changes. In order to survive,

providers must depend upon dedicated professionals to run their practices

and facilities. In other words, they depend upon you! It is our mission to

provide information from highly qualified medical business professionals so

you can depend on us and the community. Likewise, it is our goal to become

a vehicle for you to advertise your practice and/or services to other medical

business professionals. For advertising options, please contact MMI at MBJ@

mmiclasses.com

In addition to providing you with the tools and references for success, I would

also like to encourage you to contact the MBJ with any suggestions you may

have that will continue to fulfill the needs of our professional community. Please

feel free to contact me directly at any time. Trust, I will be receptive to any ideas

you may have about strengthening our community! For information about

being published in the Medical Business Journal, please contact me freely as

well.

Thank you for reading.

Sincerely,

Jennifer Donovan, RMC, CPC, RMM

Managing Editor, Medical Business Journal

Medical Business Journal Issue 2, Volume 2, Februrary 2011

Managing Editor Jennifer Donovan, RMC, CPC, RMM

Assistant Editor Christopher Myers

Contributors Christopher Myers

Jennifer Donovan, RMC, CPC, RMM

Layout and Design Chris Rottmann

Production Clockwork Graphics

The Medical Business Journal is a monthly source of up to date information

on all issues affecting the healthcare industry. Its content ranges from medical

coding and billing to healthcare reform legislature and beyond. The MBJ is

not affiliated in any way with the Department of Health and Human Services,

Medicare, or the Centers for Medicare and Medicaid Services. This publication

is designed to provide accurate and authoritative information with regard

to the subject matter covered. It is sold with the understanding that the

publisher is not engaged in rendering legal, accounting or other professional

services, and is not a substitute for individualized expert assistance. The CPT

codes, descriptors, and modifiers are copyrighted by the American Medical

Association. The MBJ is sponsored by the Medical Management Institute. For

more information, please call MMI at: (866) 892-2765

3456891011

Medical Business Journal I S S U E 2 , V O L U M E 2 , F E B R U R A R Y 2 0 1 1

HEALTH CARE EMPLOYMENT RATEEHR INCENTIVE REGISTRATION OPEN

OUT WITH THE OLD IN WITH THE NEW 2010 - 2011

WAIVED COPAY AND DEDUCTIBLE FOR CERTAIN PRE-VENTATIVE SERVICES CHARTSURVEYS SHOWS INCREASED EHR ADOPTION

PERMANENT EHR CERTIFICATION PROGRAM IMPLEMENTED

SLEEP TO DREAM MONITOR SLEEP TO GET PAID

2011 CPT SLEEP CODES

CMS PROPOSES NEW QUALITY CARE INCENTIVESCLINICAL PROCESS OF CARE MEASURES

2011 CONVERSION FACTORPULMONARY REHABILITATIONEHR LEGACY CERTIFICATION PROGRAM UNDERWAY

www.mbjonline.com - Medical Business Journal 3

EHR Incentive Registration OpenFIRST PAYMENTS EXPECTED IN MAY

As of Jan. 3, registration for the Medicare Electronic Health Record (EHR) Incentive Program is open. Additionally, Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas have opened up their Medicaid EHR incentive programs. Eligible physicians and hospitals are encouraged to register as soon as they are ready so they can start seeing returns on their EHR investment.

Eligible professionals may apply to either the Medicare or the Medicaid programs, but not both. However, after payment for the first year is received they are able to switch one time. Eligible Hospitals may apply to both.

Attestation for the program begins in April, so if you register today you won’t have to immediately start recording EHR data.

A step-by-step walkthrough of the registration process is available at:

www.cms.gov/ehrincentiveprograms

The Medical Management Institute held a class on receiving EHR incentives Wednesday, Jan. 12. Our next one is scheduled for March 30, so be sure to register in order to learn how to earn maximum incentive payments.

Health Care Employment RateRELATIVELY STABLE IN A SHAKY ECONOMY

Healthcare was one of the few industries to expand its workforce in December, according the Bureau of Labor Statistics. Ambulatory services saw 21,000 new jobs, hospitals 8,000 and nursing, and residential care facilities 7,000.

An AAPC survey showed that unemployment rates of credentialed coders were also lower than the national average of 9.6 percent. Only 6.8 of coders with CPC and 5.6 of coders with CPC-I certification reported being unemployed within the past 12 months.

Additionally, the survey showed that the average salary of certified coders rose this past year to $45,404, from $44,740. CPC-I credentialed coders had the highest average salary, at $50,543.

© 2010 Auxilium Pharmaceuticals, Inc. 1210-009.a

Beginning January 1, 2011, use

J code J0775for XIAFLEX

• XIAFLEX Xperience™ Program provides support throughout the billing process

• Speak to a live reimbursement specialist at 1-877-XIAFLEX (1-877-942-3539) or visit XIAFLEX.com for more information

J Code Assigned to XIAFLEX®

Effective January 1, 2011

AAA-3098_MedBusinessJournal_M02.indd 1 12/14/10 12:07 PM

Medical Business Journal - February 20114

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NEED 12 CEUs?Surveys Shows Increased EHR Adoption81% OF HOSPITALS INTEND TO ACHIEVE MEANINGFUL USE

Partially due to incentive payments, the percentage of hospitals and office based physicians who intend to adopt electronic health record (EHR) capabilities has increased in the past year, according to a survey conducted by the American Hospital Association (AHA) and the National Ambulatory Medical Care Survey (NAMCS), conducted by the Centers for Disease Control (CDC) and Prevention’s National Center for Health Statistics (NCHS).

The surveys showed that about 65 percent of hospitals intend to enroll in stage 1 Meaningful Use (2011-2012).

The preliminary estimates show percentage of office based physicians currently using an EHR rose to 50.7 percent, from 48.3 in 2009. Also, the percentage of fully functional EHRs, currently in use, rose from 6.9 percent in 2009 to 10.1 percent in 2010.

Table of Preventative Services Codes, Co-Pays and Deductibles

Service Code Description CoPay DeductibleG0402 IPPE, first 12 mos Waived Waived

G0403Electrocardiogram, performed with IPPE Not waived Not waived

G0404

ECG, tracing only w/o interpretation and report; with IPPE Not waived Not waived

G0405ECG, interpretation and report only; with IPPE Not waived Not waived

Abdominal Aortic Aneurysm (AAA) G0389

Ultrasound, B-scan and/or real time with image Waived Waived

80061 Lipid panel Waived Waived82465 Cholesterol Waived Waived83718 Lipoprotein Waived Waived84478 Triglycerides Waived Waived82947 Glucose, quantitiave blood Waived Waived82950 Glucose, post glucose dose Waived Waived82951 Glucose, tolerance test Waived Waived

G0108 DSMT, individual per 30 mins Not waived Not waived

G0109 DSMT, group session, 30 mins Not waived Not waived

97802MNT, iniital assessment, ea. 15 mins Waived Waived

97803 MNT, re-assessment, 15 mins Waived Waived97804 MNT, group, 30 mins Waived Waived

G0270MNT, subsequent intervention, individual Waived Waived

G0271MNT, subsequent intervention, group Waived Waived

G0123Screen cervical or vaginal, thin layer Waived Waived

G0124 Screen c/v layer by MD Waived Waived

G0141Sreen c/v, automated system and MD Waived Waived

G0143 Screen c/v, thing layer, rescreen Waived WaivedG0144 Screen c/v thin layer, resreen Waived WaivedG0145 Screen c/v thin layer, rescreen Waived WaivedG0147 Screen c/v, automated system Waived Waived

G0148Screen c/v, automated system, rescreen Waived Waived

P3000Screen pap by tech with MD supervision Waived Waived

P3001 Screening pap smear by physician Waived WaivedQ0091 Obtaining screen pap smear Waived Waived

Screening pelvic exam G0101

Cervical or vaginal screen, pelvic/breast exam Waived Waived

77052Comp screen mammogram add-on Waived Waived

77057 Mammogram screening Waived WaivedG0202 Screening mammography, digital Waived WaivedG0130 Single energy X-ray study Waived Waived77078 CT bone density measure Waived Waived

Initial Preventative

Physical Examination

(IPPE)

Cardiovascular disease screen

Diabetes screening tests

Diabetes self-management

training services (DSMT

Medical nutrition therapy (MNT)

services

Screening pap test

Screening mammography

Bone mass measurement

Table of Preventative Services Codes, Co-Pays and Deductibles

Service Code Description CoPay DeductibleG0402 IPPE, first 12 mos Waived Waived

G0403Electrocardiogram, performed with IPPE Not waived Not waived

G0404

ECG, tracing only w/o interpretation and report; with IPPE Not waived Not waived

G0405ECG, interpretation and report only; with IPPE Not waived Not waived

Abdominal Aortic Aneurysm (AAA) G0389

Ultrasound, B-scan and/or real time with image Waived Waived

80061 Lipid panel Waived Waived82465 Cholesterol Waived Waived83718 Lipoprotein Waived Waived84478 Triglycerides Waived Waived82947 Glucose, quantitiave blood Waived Waived82950 Glucose, post glucose dose Waived Waived82951 Glucose, tolerance test Waived Waived

G0108 DSMT, individual per 30 mins Not waived Not waived

G0109 DSMT, group session, 30 mins Not waived Not waived

97802MNT, iniital assessment, ea. 15 mins Waived Waived

97803 MNT, re-assessment, 15 mins Waived Waived97804 MNT, group, 30 mins Waived Waived

G0270MNT, subsequent intervention, individual Waived Waived

G0271MNT, subsequent intervention, group Waived Waived

G0123Screen cervical or vaginal, thin layer Waived Waived

G0124 Screen c/v layer by MD Waived Waived

G0141Sreen c/v, automated system and MD Waived Waived

G0143 Screen c/v, thing layer, rescreen Waived WaivedG0144 Screen c/v thin layer, resreen Waived WaivedG0145 Screen c/v thin layer, rescreen Waived WaivedG0147 Screen c/v, automated system Waived Waived

G0148Screen c/v, automated system, rescreen Waived Waived

P3000Screen pap by tech with MD supervision Waived Waived

P3001 Screening pap smear by physician Waived WaivedQ0091 Obtaining screen pap smear Waived Waived

Screening pelvic exam G0101

Cervical or vaginal screen, pelvic/breast exam Waived Waived

77052Comp screen mammogram add-on Waived Waived

77057 Mammogram screening Waived WaivedG0202 Screening mammography, digital Waived WaivedG0130 Single energy X-ray study Waived Waived77078 CT bone density measure Waived Waived

Initial Preventative

Physical Examination

(IPPE)

Cardiovascular disease screen

Diabetes screening tests

Diabetes self-management

training services (DSMT

Medical nutrition therapy (MNT)

services

Screening pap test

Screening mammography

Bone mass measurement

WAIVED COPAY AND DEDUCTIBLE FOR CERTAIN PREVENTATIVE SERVICES CHART

www.mbjonline.com - Medical Business Journal 5

Permanent EHR Certification Program ImplementedONC NOW ACCEPTING APPLICATIONS

Replacing the temporary Electronic Health Record (EHR) certification program, the Office of the National Coordinator (ONC) has established a permanent certification program. The program is scheduled to create permanent certification bodies to replace the temporary ones by the beginning of 2012, according to the final rule.

These ONC-Authorized Certification Bodies (ONC-ACB) will have the option of certifying Complete EHRs, Modular EHRs, (potentially) other HIT products, or any combination thereof. They will have to renew their certification every three years.

ONC is taking a tiered approach to the structure of certification. First ONC will name an ONC- Approved Accreditor (ONC-AA) which will approve ONC-ACBs (ONC estimates six at a time). The ONC-AA will also have to renew its certification every three years. Once approved by the ONC-AA, ONC-ACBs can then submit an application to ONC.

EHR testing facilities must be separately certified by the National Voluntary Laboratory Accreditation Program (NVLAP), as administered by the National Institute of Standards and Technology (NIST). Organizations seeking ONC-ACB status may also perform testing if they acquire this separate certification, or they can test EHR products through a certified third party.

The ONC-ACBs will be required to submit to ONC a weekly update on any EHR product they have approved. These updates will translate into a “Certified HIT Products List (CHPL) that will be made publicly available on ONC’s website.”

The ONC-ACBs will have to attend mandatory ONC training programs. They will also be required to conduct internal surveillance on the EHRs they certify, which will be reviewed by ONC.

In the event that an ONC-ACB loses its certification due to violations, the EHRs it has certified will be inspected to see if they were certified in error. If that is the case, then the EHR will have to be completely recertified.

EHRs certified under the temporary certification program will be able to be recertified in a “gap-certification” process. In other words, only the updates in certification criteria will be required to be analyzed. Gap certification has been defined in the final rule to mean “…the certification of a previously certified Complete EHR or EHR Module to: (1) all applicable new and/or revised certification criteria adopted by the Secretary at subpart C of this part based on the test results of a NVLAP-accredited testing laboratory; and (2) all other applicable certification criteria adopted by the Secretary at subpart C of this part based on the test results used previously to certify the Complete EHR or EHR Module.”

EHR Modules presented in a bundle will be considered as a complete EHR if they can meet criterion as such. Each individual Module, in this case, will not have to meet all criterion (for example, security) if the entire bundle meets the definition of a complete EHR. For example, Modules A, B, C, and D are bundled together, but all their security software is located on C. In this case, the bundle can still be approved, even though A, B, and D would not meet the criterion for certified EHR Modules.

A pdf version of the full final rule, as well as other ONC resources, is available at:http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov_certification_program/2884

Medical Business Journal - February 20116

DELAYED MEDICARE CUTS We were threatened all year with these cuts and fought back, with Congress on our side, to cause several delays in 2010. These pay cuts are triggered by the Sustainable Growth Rate (SGR) and the results would force doctors to stop seeing Medicare patients or completely drop out of the Medicare program altogether. If this occurs, it could debilitate the entire system. The latest motion has been set to delay the pay cut through 2011. This delay will keep the 25% cut in Medicare Physician Reimbursement rate and give the physician community time to work with Congress on a permanent solution.

AFFORDABLE CARE ACTIn short, the ACA subsidizes health care cost for those who can’t afford it, penalizing those who refuse to purchase it and limit cases for insurance companies to deny coverage. On the provider side, this act boosts pay for primary care providers (PCP), encourages compensation based on quality care and bars co-pays for most preventative services. Lawsuits continue about individual mandate to buy health insurance and will likely end up before Supreme Court.

* Stay tuned for more on this in the March issue of MBJ.

PROSTATE CANCER SCREENINGThe advent of better tests can in some cases, save lives with early treatment. Tests can pick up benign diseases in addition to cancer, but can’t distinguish between aggressive and mild forms. Some cases of prostate specific antigen (PSA) have led to expensive and massive treatments in patients who may never experience symptoms. ACS encourages providers to spend the extra time to consult patients regardless of billing difficulties. To report screening of the second leading cause of cancer-related deaths in men (approx. 62% being 65 or older), use CPT 88305. For Medicare patients, report with G0102 and G0103

MAMMOGRAMSACS and the Society of Breast Imaging contradicted the 2009 recommendation from U.S. Preventative Services Task Force (USPSTF) calling an end to the routine mammogram for women under 50. More on coding for mammograms in next months issue

UPDATED PNEUMOCOCCAL VACCINE Updated Pneumococcal Vaccine guidelines state 23-valent vaccines in adult persons 19-64 with chronic or immunosuppressive medical conditions including asthma should get vaccinated. To report this, see CPT code 90732. To report the

pneumococal conjugate, 13 valent, see 90670 or the 7 valent, see 90669.

DSM-VA DSM-V draft was released in February 2010. It underwent a 2-month review and is estimated for release this year. The DSM is a publication used by the majority of mental health specialists in the US. Published by the American Psychiatric Association (authored by its members), it provides information from the rarest to most common mental health disorders as well as standardizes both diagnostic and treatment of such problems. The current version, DSM-IV was released in 1994 and reflects studies up until 1992. DSM-IV-TR, was published in 2000. The work on the DSM-V is in the process of being completely re-written to reflect the clinical and scientific advances made over the last 17 years.

MEDICARE PART D AND THE DONUT HOLEThe Donut Hole is the gap in coverage that beneficiaries may find themselves in after they reach their deductible and before catastrophic coverage kicks in. The Donut Hole was $3,610 in 2010 and is expected to reach $6,000 by 2020. Beneficiaries who reach the doughnut hole are give $250 plus up to 50% off their prescriptions to help alleviate the burden until their coverage reachs “catastrophic” status.

2010 FDA RECALLS & WARNINGSThe following is a list of drugs the

FDA recalled and the reasons for the decision.

Propoxyphene, (aka. Darvon, Darvocet) by Xanodyne Pharma and generic manufacturers were instructed by the FDA to remove the product from the market due to potentially serious or fatal hearth rhythm abnormalities established with patient use. This drug was formally reported with G0430.

Calcium boosts heart attack risk. Calcium without Vitamin D may increase heart attacks by 30%. Suggested for osteoporosis it showed relatively small benefits. Recommendations to eat calcium rich foods as opposed to supplements are the best alternative.

Quinine, prescribed for leg cramps, may result in serious to life threatening hematologic adverse effects. The FDA warned manufacturers and distributors of the associated risk of myopathy including Rhabdomylosis, opioid tramadol which is linked to increased suicide risk, bisphosphonates used to treat osteoporosis possibilities include risk of atypical femur fracture; rosiglitazone remained available under stringent restricted access despite adverse cardiovascular effects and triglycine linked to include death in patients with certain severe infection.

Obesity drug Sibutramine was removed from the market in October. The drug was related to an increase in stroke and myocardial infarction risk. Over 100,000 people in the US were prescribed

this drug.

A look at where

took us...

www.mbjonline.com - Medical Business Journal 7

2011 THE YEAR OF INCENTIVES & PENALTIES

2011 brings many opportunities to earn bonuses to help offset the cost of transforming your practice’s information technology systems to, reduce care costs and improve outcomes. There is, of course, the EHR bonus of up to $18,000 [depending on your Medicare charges] when you attest to meaningful use of a certified EHR system. Registration for this program began on January 3rd and attestation begins this April. You must attest for 90 days to earn the bonus. There is opportunity to earn more money in the following 4 years when your practice continues to utilize the system.

Conversely, there are penalties that play a big factor in your future reimbursements as well. Failure to e-prescribe in 2011 could reduce your Medicare reimbursement in future years. Eligible professionals (EPs) are to report G8553 at least 10 times by June to avoid Medicare payment reduction by 1% in 2012 and 1.5% in 2013. Those who do not implement an EHR by 2015 will be penalized in the same manner.

Remember, EPs cannot participate in these two particular two programs simultaneously. If you are already in the e-prescribe program, you must wait until it is over before

your participation in the EHR program begins.

KEY BILLING AND PAYMENT CHANGES FOR 2011: THE ANNUAL WELLNESS VISITProviders can start the AWV services detailed in the 2011 MPFS by meeting the requirements to report and earn up to $172 per patient. To report the first AWV service, use G0438 for subsequent, G0439.

DEDUCTIBLEThe Part B deductible increased by 4.5% over the 2010 deductible of $155. In 2011, Medicare Part B beneficiaries are responsible for $162.

PRIMARY CARE BONUSThis bonus is worth 10% of an EPs Medicare charges. Eligibility requires providers have at least 60% of your Medicare allowable charges to come from office visits. Bonuses for this program are paid quarterly. Eligibility is determined by CMS based on your 2009 claims.

GENERAL SURGERY BONUSCMS is also offering 10% quarterly bonus payments to general surgeons practicing in health professional shortage areas (HPSA).

WAIVED COPAY AND DEDUCTIBLE FOR CERTAIN PREVENTATIVE SERVICESCopays and deductibles are no longer collectible for specific preventative services. See chart on page 4.

MULTIPLE PROCEDURE PAYMENTS REDUCTION (MPPR) ON THERAPY SERVICESCMS states a reduction of 25% for therapy services provided in institutional settings. These payments will reduce the practice expense component for multiple outpatient therapy services by 20%.

SELF-REFERRAL LISTProviders must now give patients a list of five alternative suppliers (within a 25-mile radius) for advanced imaging services when you offer to provide an advanced imaging service in your office.

COUNSELING AND TOBACCO CESSATIONOne or two G-codes can be reported when you provide tobacco cessation counseling to a patient who doesn’t suffer from a tobacco-related disease. Remember, the codes are G0436 for 3 to 10 minutes of counseling; and G0437 for more than 10 minutes. CMS instructs the use of ICD-9 code 305.1 (tobacco use disorder) and V15.82 (history of tobacco use) when reporting this service.

TIMELY CLAIMSAs of March 2010, Medicare requires claims to be submitted within 12 months of the date-of-

service, effective January 1, 2010.

NEW Q-CODES FOR FLU SHOTSCPT 90658 (flu vaccine, 3 years and up) is no longer billable to Medicare as of January 1, 2011. When providing the following shots, use the coinciding codes:Q2035 AfluriaQ2036 FlulvalQ2037 Fluvirin Q2038 Fluzone or Q2039 not otherwise specified flu vaccine.

CPT codes 90465-90468 have also been deleted for the vaccine administration. They have been replaced with 90460 and 90461 to allow separate reporting of multiple vaccine/toxoid components for pediatric patients (18 and under).

EXPANSION OF TELEHEALTHG0420 and G0421 are not reportable with a telehealth system, for individual and group diabetes self-management training. Use 96153 and 96154 for health and behavior assessment and intervention and 99231-99233 for subsequent hospital service, which may only be billed every three days by the patient’s admitting provider (AI).

PAYMENT FOR CERTIFIED NURSE MIDWIVES Services provided by these CNM will be paid at 100% of the fee schedule rate (same as physicians). Previously, midwives were paid 65% only.

... and where we go from here in

Medical Business Journal - February 20118

MONITOR SLEEP TO GET PAIDFrom 2011 and beyond, sleep codes may see some restlessness. Four major forces became effective January 1, 2011. Each new code (presumably) includes the recording of heart rate and oxygen saturation and respiratory analysis, by airflow or peripheral arterial tone. CPT codes 95808, 95807, 95810 and 95811 were all cut 20-25%. Cuts were also seen across the board for interpretation only codes (those reported with modifier 26). CMS rebased the practice expense (PE) data, which resulted in the PE component to increase the malpractice component. In many cases, the PE increase will offset the loss of physician work. The PE increase is temporary for the next 4 years as CMS transitions to a new system for collecting and reimbursing the PE codes that will likely impact the CPT system. The PE component for sleep codes saw a reduction of 7-20% where the largest PE values saw the greatest reduction. So in short, you will see TC codes go up, and 26 codes go down (see chart).

WHAT ABOUT THE CHANGES IN PHYSICIAN WORK?

Lets start with a brief background. CPT code 95810 was created in 1994 and 95811 in 1998. First, created to reflect the intensity and time required to conduct as polysomnograph, equipment, staff time and supplies for service were evaluated in 2002. CMS is required to review RVUs of procedures based on the Resource Based Relative Value Scale (RBRVS - used by Medicare and other insurance companies). Since, many advances have taken place, polysomnographs can now be conducted with less provider time, less sleep, and less lab technician time, PE costs were lowered. CMS was aware and after, established reimbursement for unattended studies in home and initiated steps to review and adjust reimbursement for facility-based polys. These cuts are said to be painful and accurate as they reflect the time and cost it currently associates with providing these specific procedures.

On the bright side, the addition of unattended home sleep studies (95800-95801) were introduced from their former position as Category III codes 0203T and 0203T. Revisions were also introduced for 95806. Specifically, the reduction in facility-based polys services may be offset by the expected growth of unattended sleep studies. Facility-based studies still play a role in the diagnosis of atypical and challenging patients suspected with sleep related disorders.

SLEEP TO DREAM

www.mbjonline.com - Medical Business Journal 9

2011 CPT Sleep Codes

CPT Code Desriptor2010

Payment2011

PayemntMonetary Differnce

95800 Sleep study unattended NA pending NA95800-TC Sleep study unattended NA pending NA95800-26 Sleep study unattended NA pending NA95801 Sleep study unattended w/ anal NA pending NA95801-TC Sleep study unattended w/ anal NA pending NA95801-26 Sleep study unattended w/ anal NA pending NA95803 Actigraphy testing $120.57 $176.25 $55.6895803-TC Actigraphy testing $70.43 $125.74 $55.3195803-26 Actigraphy testing $50.15 $50.52 $0.3795805 Mulitple sleep latency test $395.65 $446.90 $51.2595805-TC Multiple sleep latency test $302.73 $379.79 $77.0695805-26 Mulitple sleep latency test $92.92 $67.11 ($25.81)

95806Sleep Study unattened & resp effort $204.28 $198.38 ($5.90)

95806-TCSleep Study unattened & resp effort $122.05 $130.16 $8.11

95806-26Sleep Study unattened & resp effort $82.23 $68.21 ($14.02)

95807 Sleep study attended $479.35 $511.80 $32.4595807-TC Sleep study attended $397.86 $443.21 $45.3595807-26 Sleep study attended $81.49 $68.58 ($12.91)95808 Polysomn 1-3 channels $668.87 $707.59 $38.7295808-TC Polysomn 1-3 channels $537.98 $609.88 $71.9095808-26 Polysomn 1-3 channels $130.90 $97.71 ($33.19)95810 Polysomnograph 4 or more $769.17 $756.26 ($12.91)95810-TC Polysomnograph 4 or more $596.60 $619.83 $23.2395810-26 Polysomnograph 4 or more $172.57 $136.43 ($36.14)95811 Polysomnograph w/cpap $848.08 $816.00 ($32.08)95811-TC Polysomnograph w/cpap $662.97 $673.67 $10.7095811-26 Polysomnograph w/cpap $185.10 $142.33 ($42.77)

* Note all payment rates consider 2010 Medicare conversion factor as $36.8729 and are all national payments without reflection of geographic differences

2011 CPT SLEEP CODES 2011 CPT Sleep Codes

CPT Code Desriptor2010

Payment2011

PayemntMonetary Differnce

95800 Sleep study unattended NA pending NA95800-TC Sleep study unattended NA pending NA95800-26 Sleep study unattended NA pending NA95801 Sleep study unattended w/ anal NA pending NA95801-TC Sleep study unattended w/ anal NA pending NA95801-26 Sleep study unattended w/ anal NA pending NA95803 Actigraphy testing $120.57 $176.25 $55.6895803-TC Actigraphy testing $70.43 $125.74 $55.3195803-26 Actigraphy testing $50.15 $50.52 $0.3795805 Mulitple sleep latency test $395.65 $446.90 $51.2595805-TC Multiple sleep latency test $302.73 $379.79 $77.0695805-26 Mulitple sleep latency test $92.92 $67.11 ($25.81)

95806Sleep Study unattened & resp effort $204.28 $198.38 ($5.90)

95806-TCSleep Study unattened & resp effort $122.05 $130.16 $8.11

95806-26Sleep Study unattened & resp effort $82.23 $68.21 ($14.02)

95807 Sleep study attended $479.35 $511.80 $32.4595807-TC Sleep study attended $397.86 $443.21 $45.3595807-26 Sleep study attended $81.49 $68.58 ($12.91)95808 Polysomn 1-3 channels $668.87 $707.59 $38.7295808-TC Polysomn 1-3 channels $537.98 $609.88 $71.9095808-26 Polysomn 1-3 channels $130.90 $97.71 ($33.19)95810 Polysomnograph 4 or more $769.17 $756.26 ($12.91)95810-TC Polysomnograph 4 or more $596.60 $619.83 $23.2395810-26 Polysomnograph 4 or more $172.57 $136.43 ($36.14)95811 Polysomnograph w/cpap $848.08 $816.00 ($32.08)95811-TC Polysomnograph w/cpap $662.97 $673.67 $10.7095811-26 Polysomnograph w/cpap $185.10 $142.33 ($42.77)

* Note all payment rates consider 2010 Medicare conversion factor as $36.8729 and are all national payments without reflection of geographic differences

Medical Business Journal - February 201110

CMS Proposes New Quality Care IncentivesINPATIENT VALUE-BASED PURCHASING PROGRAM FOR FY 2013

A new hospital inpatient quality care incentive program has been proposed by the Centers for Medicare and Medicaid Services (CMS). The program would expand on the Hospital Inpatient Quality Reporting (IQR) Program which provides incentives for hospitals that report quality measures. The new program will take this a step further by rewarding hospitals for achieving quality benchmarks in addition to just reporting them.

The new program will affect acute-care hospitals paid under the Medicare Inpatient Prospective Payment System (IPPS) for inpatient services furnished to Medicare beneficiaries. It is set to take effect for fiscal year (FY) 2013 and was authorized by the Affordable Care Act (ACA).

Under the new program, CMS would determine a hospitals’ base performance levels during an observation period and use that to measure quality improvements. The incentive payments could apply to discharges occurring as soon as Oct. 1, 2012.

Below is a table of the proposed measures, provided by CMS:

CLINICAL PROCESS OF CARE MEASURES Measure ID Measure Description

ACUTE MYOCARDIAL INFARCTION AMI-2 Aspirin Prescribed at Discharge AMI-7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival AMI-8a Primary PCI Received Within 90 Minutes of Hospital Arrival

HEART FAILURE HF-1 Discharge Instructions HF-2 Evaluation of LVS Function HF-3 ACEI or ARB for LVSD

PNEUMONIA PN-2 Pneumococcal Vaccination PN-3b Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patient PN-7 Influenza Vaccination

HEALTHCARE-ASSOCIATED INFECTIONS SCIP-Inf-1 Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients SCIP-Inf-3 Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose

SURGICAL CARE IMPROVEMENT

SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period

SCIP-VTE-1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered

SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery

www.mbjonline.com - Medical Business Journal 11

Medical reimbursement for pulmonary rehab increased for both hospital outpatient and physician settings. Hospital outpatient 2011 payment is now roughly $60 per session, which is an increase of approximately 24% over 2010. The physician-based rehabilitation increased also by 38% to just over $33 per session and is reported with G0424. Payments above may fluctuate due to Medicare’s conversion factor of $36.8729 for 2010/2011 depending on geographic area.

2011 Conversion FactorCONGRESS ACTED TO POSTPONE BIG DROP

Set for $25.5217 for 2011, Congress acted to raise this figure and maintain the 2010 conversion factor of $36.8729. This will likely fall to $33.9764. How does this happen? CMS made several budget neutral RVU adjustments to the fee schedule. Changes to RVU and other fee schedule fixes can cause the conversion factor to fluctuate.

Pulmonary RehabilitationHOSPITAL OUTPATIENT & PHYSICIAN SETTING SEES INCREASE

EHR Legacy Certification Program UnderwayCCHIT OPENS EACH PROGRAM

Beth Israel Deaconess Medical Center (BIDMC), Boston, is the first hospital to have its self-developed electronic health record (EHR) technology Office of the National Coordinator for Health Information Technology (ONC) certified as a complete EHR for meaningful use on Jan. 24. This comes as part of the pilot program launched by Certification Commission for Health Information Technology (CCHIT).

The program, titled EHR Alternative Certification for Hospitals (EACH™), aims to give hospitals the option to certify both legacy EHR technology, which they already have in place, and self-developed or customized EHRs. The ONC-Authorized Temporary Certification Body (ATCB) certification label allows for hospitals to receive incentive funds by assuring that their technology has the capability to achieve meaningful use.

In addition to certification, the EACH program offers self-paced, online learning courses, inventory and self-assessment tools, and hands-on support provided by CCHIT staff. CCHIT also plans to launch a similar program for physicians in the upcoming months.

For more information about CCHIT and the EACH program, visit their website at: http://each.cchit.org/web/each/home/

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